The document describes various classifications and immediate changes that occur in newborns. It classifies newborns based on size, mortality, and gestational age. It discusses the physiological and environmental changes newborns experience at birth including respiratory, circulatory, neurological, and other body system changes. The fetal circulation system is also described. The document provides details on assessing a newborn including a head to toe examination process.

1. IMMEDIATE CHANGES
NORMAL NEWBORN

2. Classification according to Size
1. Low birth weight infant (LBW) – less than 2500g, regardless of
gestational age.
2. Moderately low birth weight infant (MLBW)- 1501g-2500g.
3. Very low birth weight infant (VLBW)- less than 1500g.
4. Extreme low birth weight infant (ELBW)- less than 1000g.

3. CLASSIFICATION ACCORDING TO MORTALITY
1. Fetal death- death of fetus after 20 weeks of gestation and before
delivery, with absence of any signs of life after birth.
2. Neonate death – Death occurs in the first 27 days of life.
3. Perinatal mortality – Describe the total number of fetal and early
neonatal deaths per 1000 live.
4. Postnatal death – death of neonates occurs between 28 days – 1 years.

4. Classification according to gestational age
1. Premature infant – an infant born before completion of 37 weeks
of gestation regardless of birth weight.
2. Full term infant- Born between the beginning of 38 weeks and
completion of 42 weeks of gestation, regardless of birth weight.
3. Post term infant- an infant born after 42 weeks of gestational age,
regardless of bith weight.

5. IMMEDIATE CHANGES IN NEW BORN
• During the process of birth , the baby has to face many physiological
and environmental changes which produced stress in newborn.
• The neonates needs to adjust to extra-uterine life to maintain normal
physiological activity.

6. RESPIRATORY CHANGES
 After the birth, changes occurs in blood gases and blood pH.
 ↑CO2 and ↓pH in blood.
 This chemical changes excites the respiratory centre.
 When baby passes though reproductive tract during labor, the chest
of the fetus is compressed which removed fluid accumulated in lungs.
 To replace the fluid lost air enters the lungs and respiration is
facilitated.

8. At birth, major changes take place.
• After umbilical cord is clamped.
 The baby no longer receives oxygen and nutrients from the
mother.
With the first breaths of air the lungs start to expand.
The ductus arteriosus and the foramen ovale both close.
Continue normal circulation.

9. Contd..
• During pregnancy, the fetal circulatory system works differently than
after birth.
• The fetus is connected by the umbilical cord to the placenta. This is
the organ that develops and implants in the mother's uterus during
pregnancy.
• Through the blood vessels in the umbilical cord, the fetus gets
all needed nutrition and oxygen. The fetus gets life support from the
mother through the placenta.
• Waste products and carbon dioxide from the fetus are sent back
through the umbilical cord and placenta to the mother's circulation to
be removed.

11. FETAL CIRCULATION

13. SHUNTS
• The fetal circulatory system uses 3 shunts.
• These are small passages that direct blood that needs to be oxygenated.
• The purpose of these shunts is to bypass the lungs and liver.
• That's because these organs will not work fully until after birth.
• The shunt that bypasses the lungs is called the foramen ovale. This shunt
moves blood from the right atrium of the heart to the left atrium.
• The Ductus arteriosus moves blood from the pulmonary artery to the
aorta.
• the Ductus venosus shunts a portion of umbilical vein blood flow directly
to the inferior vena cava.

17. NEUROLOGIC CHANGES
• At birth, the nervous system is sufficiently develop to sustain
extrauterine life.
• Most neurologic functions are primitive reflexes.

18. DIGESTIVE SYSTEM
• The neonate is born with rooting, sucking, swallowing reflexes which
helps in taking feed.
• Increased amount of saliva in first 2 months.
• Cardiac sphincter of stomach is immature.
• stomach capacity is 90 ml and emptying time is short so they require
small frequent feeds.
• Liver is immature. Store less glycogen, ↑ chance of hypoglycaemia.
• Neonates first stool is meconium, sticky and greenish black colour,
should pass within 36 hours of birth.

19. RENAL SYSTEM
• The ability of the immature kidneys to concentrate urine is less.
• Bladder capacity is about 15 ml.
• So neonates void about 15-20 times a day.
• May not be able to mange fluid volume in case of fluid overload or
fluid deficiency.
• Majorities of the babies pass urine within 12 hours of birth.

20. INTEGUMENTARY SYSTEM
• Skin is very fine and delicate.
• Sebacious gland are very active in neonates.
• Mostly located in faces, scalp and genetalia and produce greasy and
cheasy material called ‘VERNIX CASEOSA’ that covers the skin.
• Rubs off on its own within few days of birth.

21. ENDOCRINE SYSTEM
• The endocrine glands are almost formed but their functions are
immature.

22. MUSCULOSKELETAL SYSTEM
• The muscles increases in size and develop after birth.
• Bones of neonates are cartilaginous and undergo ossification
gradually.
• The skull bones are soft and well fused.

23. BLOOD
• Blood volume is 80ml/kg body weight.
• RBCs 6-8 millions / mm

24. NEW BORN ASSESSMENT

25. Immediate new born assessment
1. APGAR scoring
2. Birth weight.
3. Umbilical cord is examine for the presence of 2 arteries and 1 vein.
4. Orifice counting and checking their patency.
• Mouth is checked for cleft palate and lip.
• Ears and nose.
• Anus is checked for imperforation and malformation.
• Urethra is checked hypospadiasis or epispadiasis.
• Any visible lesions on back or fronts.

26. General examination
1. Posture – In full term babies, generalized flexion is seen. The neck and
extremities are flexed. Preterm babies may lie in frog like position.
2. Activity – normal neonates are alert and active. The baby may be
irritable or drowsy if having any neurological problem.
3. Cry – cries when hungry or wet. Weak cry is seen in preterm or LBW.
4. Color – the entire body and extremities are pink. If the baby is having
respiratory distress, extremities may blue.
5. Vital signs- temp 35.5C -37.5C, HR 120-140/min, Resp- 40-60/min.

27. ANTHROPOMETRIC ASSESSMENT
• Weight.
• Length.
• Head circumference.
• Chest circumference.

28. HEAD TO TOE EXAMINATION
1. Skin:
The neonate's skin is soft, smooth and puffy. At birth it covered with
the substance called vernix caseosa.
Vernix has insulating and bacteriostatic power.
The color of should be observed for presence of pallor, jaundice or
cyanosis.
Check skin turgor for dehydration.

29. Head
• New born's skull bones are not completely
fused. They are joined together by sutures
and fontanelle.
• The anterior fontanelle which is bound by
frontal and parietal bones is diamond
shaped. It is 2.5cm x 4cm.
• The posterior fontanelle, bounded by
occipital and parietal bones is trianglular
shaped.

30. • Widely spaced sutures and bulging fontanelle suggest increased intra
cranial pressure as seen in hydrocephalus and meningitis.
• Depressed fontanelle may indicate dehydration.
• Skull should also be examined for cephalohematoma and caput
succedaneum.

31. • Face: Examine the newborn's face for any asymmetry or
malformation.
• Eyes: Examine eyes for position and symmetry. The distance between
inner canthus of both eyes should be 2cm.
• Notify any abnormal eye discharge, hemorrhage or inflammation.
• Ears: In a term infant, the ear cartilage is well formed. Malformed or
low set cars are seen Down's syndrome.
Startle reflex on hearing loud noise indicates audibility

33. • Nose: The neonates are nasal breathers.
• Examine nose for its shape and nasal bridge.
• Nasal flaring indicates respiratory distress.
• Mouth: The mouth and throat can be examined when the neonate is
crying or yawning.
• Observe for cleft lip and cleft palate.
• White plaques adhering to oral mucosa and tongue indicate infection
by candida albicans.

34. • Neck: The neck is palpated for any lymphadenopathy or any abnormal
masses.
• Chest: The chest of newborn is barrel shaped. The breast may be engorged
and having witch's milk due to stimulation by maternal hormones.
• Abdomen: The abdomen on palpation should feel soft. There should be no
palpable mass.
• Look for presence of umbilical or inguinal hernia.
• The umbilical cord should be inspected for presence of two arteries and
one vein.
• Auscultate abdomen for presence of bowel sounds.

35. • Feet and Hands: Look for creases in feet and hands.
• A transverse palmar crease suggests down's syndrome.
• Observe the number of digits and any webbing between the digits
(known as syndactyly).
• Examine the range of motion also.

36. Genitalia:
• In full term female neonates, the labia majora cover the labia minora
and clitoris is visible only on separating labia.
• The urethral opening is situated behind clitoris.
• Vaginal bloody discharge (pseudomenstruation) may be noticed due
to abrupt withdrawal of maternal hormones.
• In full term male neonates the scrotum is large, pendulous, darkly
pigmented and testes are descended.
• The penis should be inspected for location of urethral opening.

37. Back and Spine:
Inspect the spine for any mass, opening, any tuft of hair or protruding
sac.

38. Referance
• Essentials of pediatric nursing, Rimple sharma second edition Jaypee
publisher.
• Pal Panchali, “ Textbook of pediatric nursing ,” 1st edition ;2016 ,Paras
medical publishers ,p.p-198-204.
• Dutta D.C, “ Textbook of obstetrics ;7th edition new central book
agency (P) ltd,p.p-483-487.