2. Onset of respiration At the birth the baby is
transferred from the warm contentment of the uterine
environment to the outside world where the role of
independent existence is assumed.
3. 1. With cutting of the cord, remove oxygen supply
2. Asphyxia occurs fall in pao2 and rise in
paco2
3. CO2 and O2 and pH = ACIDOSIS
4. Acidotic state-- stimulates the respiratory center
in the medulla and the chemoreceptors in carotid
artery to initiate breathing
4. As the chest passes
through the birth canal
the lungs are compressed
Subsequent recoil of the chest wall produces passive
inspiration of air into the lungs
7. 1. Pressure
in RA decreases
3. Ductus Arteriosus
begins to constrict
2. Blood flows
to the lungs
4. Pressure in the
LA increases RT
Flow of blood from
the lungs
5. Increase
pressure
in the LA forces
the foramen ovale
to close
9. Methods of heat loss
Evaporation – wet surface exposed to air
Conduction – direct contact with cool objects
Convection- surrounding cool air - drafts
Radiation – transfer of heat to cooler objects not in
direct contact with infant
12. Red blood cell and haemoglobin
Cord blood of term newborn may have Hb of 14to24g/dl.
The hematocrit ranges from 44%to 64%. The RBC is 4.8 to
7.1 mm3.the initial blood values are affected by the
clamping of cord
Leucocytes
Leukocytosis
Platelet
The platelet count ranges from 150,000 to 300,000/mm3.
The level of factor 2,7,9,10 found in the liver are less during
the first few days of life because newborn cannot synthesis
vitK
13. GFR of newborn is is approximately 30% to 50% of
adult
Immunological adaptations
14.
15. General characteristics Appearance
The skin
Physiology
Respiratory system
Cardiovascular system and blood
Temperature regulation
Renal system
Gastrointestinal system
Reproductive system: genitalia and breasts
Skeletomuscular system
16. Special senses Vision
Hearing
Smell and taste
Touch
Sleeping and waking
Crying
18. TIMING
Immediate evaluation.
Detailed examination before discharge.
Frequent evaluation for neonatal problem.
19. Room must be warm and comfortable.
Preferably under radiant warmer.
Good source of light.
Aseptic teqnique of examiner.
Flat surface with convenient height.
Completely undressed child.
21. The physical maturity part of the examination should
be done in the first two hours of birth
The neuromuscular maturity examination should be
completed with 24 hours after delivery
Derived to look at various stages in an infants
gestational maturity and observe how physical
characteristics change with gestational age
Neonates who are more physically mature normally
have higher scores than premature infants
Points are awarded in each area -2 for extreme
prematurity to 5 for postmature infants
22. used with newborn as young as 20 weeks’ gestation.
The tool has physical and neuromuscular sections
it includes -1 to -2 score that reflect signs of extremely
premature (such as fused eyelids, imperceptible breast
tissue ;sticky ,friable, transparent skin; no lanugo; and
square-window [flexion of wrist] angle greater than 90
degrees)
23.
24.
25. Posture & Tone
Square Window
Arm Recoil
Popliteal Angle
Scarf Sign
Heel to Ear
26. • Posture & Tone
• Before 30 weeks-
hypotonic, little or no
flexion seen
• 30-38 weeks-varying
degrees of flexed
extremities
• 38-42 weeks-may appear
hypertonic
27. Square Window-wrist
flexibility and/or resistance
to extensor stretching
resulting in angle or flexion
at wrist
Flex hand down to wrist-
measure the angle between
the forearm & palm
Before 26 weeks-wrist can’t
be flexed more than 90
degree
Before 30 weeks-wrist can
be flexed no more than 90
degree
36-38 weeks-wrist can be
flexed no more than
28. Neuromuscular Maturity
Arm Recoil-measures the angle of recoil following a
brief extension of the upper extremity
For 5 seconds flex the arms while infant is in the supine
position, pulling the hands fully extend the arms to the
side, then release-measure the degree of arm flexion &
strength (recoil)
Before 28 weeks-no recoil
28-32 weeks-slight recoil
32-36 weeks-recoil does not pass 90 degrees
36-40 weeks-recoils to 90 degrees
After 40 weeks-rapid full recoil
29. Popliteal Angle-assesses
maturation of passive
flexor tone about the knee
joint by testing resistance
to extension of the leg
The angle decreases with
advancing gestational age
Before 26 weeks-angle 180
degrees
26-28 weeks-angle 160 degrees
28-32 weeks-angle 140 degrees
32-36 weeks angle 120 degrees
30. Scarf Sign-tests the passive
tone of the flexors about the
shoulder girdle
Increased resistance to this
maneuver with advancing
gestational age
Before 28 weeks-elbow passes torso
28-34 weeks-elbow passes opposite
nipple line
34-36 weeks-elbow can be pulled
past midline, no resistance
36-40 weeks-elbow to midline with
some resistance
After 40 weeks-doesn’t reach
midline
31. Heel to Ear-measures
passive flexor tone about
the pelvic girdle by
testing passive flexion or
resistance to extension of
the posterior hip flexor
muscles
Breech infants will score
lower than normal
Before 34 weeks-no
resistance
40 weeks-great resistance
may be difficult to
perform
32.
33.
34.
35.
36.
37. Crown to ramp length.
10% weight loss.
Mid upper arm
82. Blood volume soon after birth is about 80 mL/kg body
weight , if immediate cord clamping is carried out .
RBC -6-8 million /cumm, Hb%-18-20g% WBC- 10,000-
17000/cumm, platelets -3,50,000 /cumm, Nucleated
red cells 500/ cumm , sedimation rate is elevated.
Clotting power is poor due to deficient vit K .
reticulocyte count 3%-7%
83. The Neonatal Behavioral Assessment Scale (NBAS),
developed by Brazehon (1973).
The scale consists of six major categories—
habituation, orientation, motor maturity, variation,
self-quieting abilities, and social behavior.
These categories are explained in. Brazelton's scale
measures 27 specific behavioral items that fall into one
of the six major categories Each item is scored on a
scale of one to nine, based on the newborn's best
rather than average performance.
84. Habituation—How soon the neonate diminishes responses to specific
repealed stimuli. Items tested are response to light, rattle, bell, and
pinprick.
Orientation—How often and when the newborn attends to auditory
and visual stimuli. Items include inanimate and animate visual and
auditory stimuli.
Motor Maturity—Demonstrated by how well the newborn coordinates
and controls motor activities as tested by items such as alertness,
general tonus, and pull-to-sit.
Variation—Indicated by how often the newborn exhibits alertness,
state changes, color changes, activity, and peaks of excitement.
Self-quieting abilities—How often, how soon, and how effectively the
neonate can use his or her own resources to quiet and console himself
or herself when upset or distressed. Behaviors tested include hand-to-
mouth facility.
Social behaviors—Measured by how often and how much tlit*
newborn smiles and cuddles.
86. Classification of High-Risk Newborns
Classification According to Size
Low-birth-weight (LBW) infant
Very low–birth-weight (VLBW) infant
Extremely low–birth-weight (ELBW)
Appropriate-for-gestational-age (AGA) infant
Small-for-date (SFD) or small-for-gestational-age (SGA)
Intrauterine growth restriction (IUGR)
Large-for-gestational-age (LGA)
Classification According to Gestational Age
Preterm (premature)
Full-term infant
Postterm (postmature)
Late-preterm infant
87. Live birth—Birth in which the neonate manifests any
heartbeat, breathes, or displays voluntary movement,
regardless of gestational age
Fetal death—Death of the fetus after 20 weeks of gestation
and before delivery, with absence of any signs of life after
birth
Neonatal death—Death that occurs in the first 27 days of
life; early neonatal death occurs in the first week of life; late
neonatal death occurs at 7 to 27 days
Perinatal mortality—Describes the total number of fetal
and early neonatal deaths per 1000 live births
Postnatal death
88. PRENATAL FACTORS
Maternal characteristics;
Age
Reproductive history;
Parity>-3 previous abortions,
Substance abuse; Drugs, alcohol, smoking
Enviormental hazards
Exposure to known teratogens
Medical problems
Anemia
Complications of present pregnancy
89. Intrapartum factors
Complications of labor and delivery; labor longer than
24 hours in primigravida
Labor longer than 12 hours in multigravida
Second stage longer than1 hour
Rupture of membrane longer than 24 hour
Immediate problems of newborn
Malformation or significant anomaly . birth injury,
asphyxia APGAR <6at 5 minute
Neonatal factor
Characteristics of newborn , clinical problems
90.
91.
92.
93.
94.
95.
96.
97.
98. Parenting is a process of role attainment and role
transition that begins during pregnancy. The
transition ends when the parent develops a sense of
comfort and confidence in performing the parental
role.
99. SKILL AND KNOWLEDGE COMPONENT
AFFECTIVE COMPONENT
