Characteristic of newborn and reflexes

CHARACTERISTICS OF
NEWBORN
AND
REFLEXES
Mrs. D. Melba Sahaya Sweety
M.Sc Nursing
Pediatric Speciality
GIMSAR

INTRODUCTION
• The neonatal period is the first 4 weeks of a child's life. It
is a time when changes are very rapid. Many critical events
can occur in this period:
•Feeding patterns are established.
•Bonding between parents and infant begin.
•The risk for infections that may become more serious are
higher.
•Many birth or congenital defects are first noted.

• A baby from birth to 28 days of age is
called newborn. A healthy infant born
at term (between 38-42 weeks) should
have an average birth weight for the
country (usually exceed 2500 gm.),
crises immediately following birth,
establishes independent rhythmic
respiration and quickly adapts to
changed environment.
DEFINITION

PHYSIOLOGY AND
CHARACTERISTICS
OF NEWBORN.
Vital signs:
• Temperature : 97.7 degree Fahrenheit or 36.4 to 37.2
degree Celsius.
• Pulses: normal- 120-160 beats per min.
• Respiration: normal- 40-60breats /min.
• Blood pressure :normal range 60-70/31-45mmHg. BP is
directly related to gestational age and birth weight of the
infant.

PHYSIOLOGY AND
CHARACTERISTICS
OF NEWBORN.
Anthropometric measurements
Height – 45- 55 cm
Weight – 2.5 – 3.5 kg
Head circumference – 33- 35 cm
Chest circumference - 31- 33 cm
Posture The newborn assumes the attitude of its
intrauterine life , i.e. extremities flexed and fists clenched.

SKIN CHANGES
At birth, the skin of a normal
infant is purplish-red in color,
then within minutes, the skin
pinks up. Blueness of the hands
and feet is frequently seen
during the early hours of life.
CHARACTERISTICS
OF NEWBORN SKIN.

BROWN FAT Infants who are chilledcanproduce body heat
through stimulating the metabolismof brownfat, a special
adipose tissue in newborns, locatedbetweenthe scapulae,
aroundthe neck, in the axillae, behindthe sternum, aroundthe
kidneys, and surrounding some of the major arteries. It is
importantto keepthe neonate warmto avoid excess energy
expenditure. Brownfat is the infant’slast defense mechanism
against hypothermia Immature brownadipocytes can be seen
as early as 29 weeks' gestation. But it matures at 35th week.
CHARACTERISTICS
OF NEWBORN SKIN.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Acrocyanosis
Acrocyanosis is a condition that causes
the hands and feet to turn blue. The
main cause of this is the constriction of
the tiny arteries at the ends of the arms
and legs. In newborns, it is common in
the first few hours.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Vernix Caseosa
Vernix caseosa is a white, creamy,
naturally occurring biofilm covering the skin
of the fetus during the last trimester of
pregnancy. Vernix coating on the neonatal
skin protects the newborn skin and facilitates
extra-uterine adaptation of skin in the first
postnatal week if not washed away after birth.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Lanugo
Lanugo is the hair that covers the
body of some newborns. This downy,
unpigmented hair is the first type of
hair that grows from hair follicles.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Jaundice
Nearly 50% of babies become jaundiced two to four days after
birth. The skin and whites of the eyes appear yellow. This
yellow hue comes from a pigment called bilirubin which is
released from the normal breakdown of red blood cells. The
liver removes this substance and excretes it into the
gastrointestinal tract. Because the liver of a newborn is
immature, the bilirubin builds up faster than the liver can
eliminate it. In the majority of cases, however, this jaundice is
temporary and harmless.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Desquamation
Babies lose their outer layer of skin after they
are born. You'll see flaking. Especially
around the ankles, feet, hands and
extremities. Remember, they've been living
inside a fluid environment for the past 9
months. Avoid using a lot of baby lotion. Just
let it flake off.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Erythema Toxicum
Many babies develop a blotchy red
rash called erythema toxicum (also
called “flea bites”) which fade by
the time the baby is several weeks
old

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Stork bites or Telangiectatic nevi
Many new babies have red areas around
their foreheads, eyelids, and noses or on
the backs of their necks. They are called
"stork bites." They will be more visible
when the baby cries and disappear by
itself during the first year.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Milia
• These look like "white heads" or
pimples. They usually appear on the
nose or chin. They usually disappear
by themselves in the first weeks of life.
Do not squeeze or put cream or lotion
on them.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Mongolian Spot
Mongolian spot refers to a macular
blue-gray pigmentation usually on the
sacral area of healthy infants. Mongolian
spot is usually present at birth or appears
within the first weeks of life. Mongolian
spot typically disappears spontaneously
within 4 years but can persist for life.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Harlequin Colour Change
Harlequin colour change appears transiently
in approximately 10% of healthy newborns. This
distinctive phenomenon presents as a well-
demarcated colour change, with one half of the
body displaying erythema and the other half
pallor. Usually occurring between two and five
days of age, harlequin colour change has been
seen as late as three weeks of age.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Cutis Marmorata
Cutis marmorata is a transient skin
disorder in which the skin has a bluish
red marbling pattern when exposed to
cold temperatures. When the skin is
warmed the condition disappears.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Petechiae
These are small, blue-red dots on
the infant's body caused by breakage
of tiny capillaries. They may be seen
on the face as a result of pressure
exerted on the head during birth. True
petechiae does not blanch on pressure.

CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Hemangioma
A Hemangioma or strawberry mark is a
type of birthmark that is characterized by a dark
or bright red raised, rough surface. They do not
develop for several days. They may regress
spontaneously or may even increase in size.
Surgical removal is not recommended. There is a
"wait-and-see" attitude advocated before surgical
removal

CHARACTERISTICS OF NEWBORN HEAD.
Fontanels
An infant is born with two major soft spots on the top of the
head called fontanels. This allows the skull to be moulded during
birth. The smaller spot at the back usually closes by age 2 to 3
months. The larger spot toward the front often closes around age
18 months. The anterior fontanel is a diamond shape and
measured anywhere from barely palpable to 4-5 cm at its widest
point.The posterior fontanel is easily located by following the
sagittal suture towards the occiput. It is triangular in shape,
usually measuring between 0.5 and 1 cm at its widest point.The
fontanels should be feel flat, firm and well demarcated against
the bony edges of the skull.
It's normally slightly depressed and pulsates. Soft spots are
covered by a thick fibrous layer and are safe to gently touch.

Molding
During a head first birth, pressure on the head caused by
the tight birth canal may 'mold' the head into an oblong
rather than round shape. Newborn head molding is a
common occurrence that usually disappears after a few
days.

Caput Succedaneum
Caput succedaneum is swelling of the scalp in a newborn.
It is most often brought on by pressure from the uterus or
vaginal wall during a head-first (vertex) delivery. Vacuum
extraction or Forceps done during a difficult birth can also
increase the chances of a caput succedaneum. It will clear
up on its own within a few days

Cephalohematoma
Newborn cephalohematoma is a buildup of ruptured blood vessels in
the periosteum, which is the tissue that covers the skull.
In a hematoma, blood pools outside the blood vessels and is visible on
the baby’s scalp. The pooled blood puts pressure on brain tissue, which
may lead to fatal complications or lifelong disability if not immediately
diagnosed and treated.

Craniosynostosis
Craniosynostosis is a birth defect in which the bones in a
baby's skull join together too early. This happens before
the baby's brain is fully formed. As the baby's brain grows,
the skull can become more misshapen.

CHARACTERISTICS OF NEWBORN EYES.
Eye Lid Edema
Newborn tend to have
their eyes tightly closed,
it is the best to begin the
examination of eye by
observing the lid for
edema, which is normaly
present after 2 days of
delivery.

Lacrimal
Apparatus
The lacrimal
apparatus is small and
nonfunctioning at birth
and tears are not usually
produced with crying
until one to three
months of age.

Subconjunctival
Hemorrhage
Subconjunctival hemorrhages in
newborns because pressure forces blood
pressure to abruptly rise, pushing
blood vessels to the breaking point. It
is occurs when blood leaks under the
covering of the eyeball due to the
trauma of delivery. This will resolve
within 6 weeks

Strabismus or
nystagmus
The infant's eyes may
not track properly and
may cross (strabismus)
or twitch (nystagmus).
This will cause concern
if it extends beyond six
months.

CHARACTERISTICS
OF NEWBORN
RESPIRATORY SYSTEM
Fetal lung development Filled with fluid Surfactant synthesis: begins at 24-28w, peak at
35w Establishment of breathing after birth - opening of the alveoli by mechanical
,chemical ,thermal, sensory stimuli Characteristics of Newborn respirations are irregular
in depth, rate, and rhythm and vary from 30 to 60 beats per minute.
Respirations are affected by the infant's activity (that is, crying). Normally, respirations
are gentle, quiet, rapid, and shallow. They are most easily observed by watching abdominal
movement because the infant's respirations are accomplished mainly by the diaphragm
and abdominal muscles ,No sound should be audible on inspiration or expiration
Abnormal findings: retractions, grunting, nasal flaring, more 15 sec apnea; abnormal
rate

CHARACTERISTICS
OF NEWBORN
CIRCULATORY SYSTEM
Umbilical arteries and vein contract and close.
Ductus arteriosus functionaly close within 10 – 96 hrs after birth and
anatomically close at 2 – 3 wks after birth and converted in to Ligamentum
arteriosum.
Ductus venosus functionaly close within several minutes after birth and
anatomically close at 3 – 7 days after birth and converted in to Ligamentum
venosum.
When the pressure in the left atrium exceeds than that of right atrium Formen
Ovale closes within several minutes after birth and anatomically close one year
after birth and converted in to Fossa Ovalis.

CHARACTERISTICS
OF NEWBORN
GASTROINTESTINAL SYSTEM
 MOUTH.
Epstein pearls are whitish-yellow cysts. These form on
the gums and roof of the mouth in a newborn baby. A
common site for them is at the junction of the hard and soft
palates
The infant's lips should be pink and the tongue smooth and
symmetrical. The tongue should not extend or protrude
between the lips
No salivation for the first 3 months.

CHARACTERISTICS
OF NEWBORN
STOMACH
•The capacity of the infant's stomach is about one to two ounces (30 to 60 ml) at
birth, but increases rapidly. Milk passes through the infant's stomach almost
immediately.
•Low amylase, lipase and bile acids cause difficulty in fat digestion
•Cardiac sphincter is immature (leads to regurgitation)
INTESTINES
Irregularity in peristaltic motility slows stomach emptying. Peristaltic increases
in the lower ileum, which results in one to six stools a day. The first stools after birth and
for three to four days afterwards are called meconium. Meconium is stringy, tenacious,
and black and has a tarry texture.

CHARACTERISTICS
OF NEWBORN
Hepatic Function
Decrease ability to conjugate bilirubin will lead
to jaundice it Occurs in approximately 60% of
full-term infants and in up to 80% of preterm
infants (becomes visible when the total serum
bilirubin level is greater than 5 mg to 7 mg/dL)
Physiologic jaundice may start 1-2 days after
birth, peak at 5-7 days, & decline after days.
Elevated blood levels of unconjugated
bilirubin can be toxic and result in kernicterus

CHARACTERISTICS
OF NEWBORN
ENDOCRINE SYSTEM
Witch's milk or neonatal milk is milk secreted from
the breasts of some newborn human infants of either sex.
Neonatal milk secretion is considered a normal physiological
occurrence and no treatment or testing is necessary. The most
common cause of neonatal galactorrhea is what's known as
transplacental maternal hormone. In less medical terms, the milky
discharge can occur when your baby is in the placenta and high
levels of maternal estrogen pass into their bloodstream. It is
common and most often goes away within 2 weeks. The breast
should not be squeezed; it only increases the chances of infection
and injuries to the tender tissue.

CHARACTERISTICS
OF NEWBORN
ENDOCRINE SYSTEM
Pseudomensturation
Vaginal discharge and/or bleeding may
occur in female infants. This discharge is
white mucoid in color. Bleeding may occur
as a result of withdrawal from maternal
hormones at the time of birth. There are
usually only a few blood spots seen on the
diapers. The entire process terminates in
one to two days

CHARACTERISTICS
OF NEWBORN
RENAL SYSTEM
At birth the kidney’s function 30 % - 50% of the adult’s capacity
and cannot concentrate urine.
Term newborns are unable to adequately concentrate urine
(reabsorb water back into the blood). This alteration may lead to an
inappropriate loss of substances such as amino acids and glucose.
Neonate usually voids immediately after birth or within few hours,
but it may take up to 24 hours. Anuria should be reported.
Increase uric acid will stain in the diaper.
GFR rapidly increases during the first 4 months, but reaches
adult’s function after 2 years.

NEWBORN REFLEXES
• Rooting reflex:- When the cheek or
corner of the mouth is stroked, the infant’s
head should turn towards the stimulus and
the mouth should open.It disappear at
about age 3-4 months but may persist for
up to 12 months
Sucking reflex:-
When touching or stroking
the lips, the mouth opens and
sucking movements begin.It
begins to diminish at 6
months

NEWBORN REFLEXES
• Swallowing reflex:- The
passage of food from the posterior
aspect of mouth to the stomach.It
does not disappear
Gagging reflex:-
When the posterior pharynx is
stimulated with food, there is
an immediate return of
undigested food. It does not
disappear

NEWBORN REFLEXES
• Extrution Reflex:-
When substance placed on
anterior portion of the tongue, it’ll
be expelled out. It disappear at
about age 4 month
Blinking reflex or
Corneal Reflex :-
Protection of eye by rapid eye lid
closure when the eyes are exposed
to bright light. It does not
disappear

NEWBORN REFLEXES
• Doll’s Eye Reflex:-
As head is movd slowly to right to
left eye lag behind and donot
immediately adjust to new position
of head. It disapear at the age of 3
month

NEWBORN REFLEXES
• Pupillary Reflex:-
Pupilcontractswhenbrightlight
shines,itpersiststhroughoutlife.
Sneeze reflex :-
Nasal passage respond
spontaneously to irritation or
obstruction, persists throughout
life.

NEWBORN REFLEXES
• Glabellar Reflex:-
Tapping briskly on
glabella(bridge of nose) cause
eyes to close tightly
Yawn reflex :-
Infant has spontaneous response to
decreased oxygen by increasing
amount of inspired air, persists
throughout life.

NEWBORN REFLEXES
• Cough Reflex:- Irritation
of mucous membranes of larynx or
tracheonchial tree causes coughing,
persists throughout the life; Usually
present after 1st day of birth.
Babinski reflex :-
Stroking outer soul of food upward
from heel and across ball of foot to
hyperextend and hallux to dorsiflex.
Disappear after one year of age

NEWBORN REFLEXES
Tonic neck Reflex :-Turning a newborn’s head to one side
will cause the extremities to on that side extends while the opposite
extremities contracts or flexes. This is also called boxer of fencing reflex
because of the position of the newborn. This appears8 weeks or 2 month
and disappear at 3 – 4 month or 6 – 9 month.

NEWBORN REFLEXES
• Perez Reflex :- While
baby is prone on firm surface and
thumb is passed along spine,
defecation and urination may
occur; disappears by 4 - 6
months.
Palmar Grasp :-
When the objects are place in the
palm of newborn, it grasps the
object. Diminishes by 3 month of
age

NEWBORN REFLEXES
Plantar Grasp :-
When objects touch the soul of the
foot at the base of the toes,toes
grasps around very small
object.Diminishs by 8 months of
age
Galant or Trunk
incurvation Reflex :-
While baby is prone on firm surface
and thumb is passed along
spine,causes hip to move toward
stimulated side disappears by 4 - 6
months.

NEWBORN REFLEXES
Dancing or Stepping Reflex :-
Hold newborn in a vertical position with the feet
touching a flat firm surface, there will be a rapid
alternating flexion and extention of the legs and
disappear at 3 – 4 weeks.

NEWBORN REFLEXES
Placing reflex:- When baby is
held upright under arms and dorsal side of
foot, it briskly places against hard objects
such as table, leg lifts as if foot is stepping on
the table, the age of disappearance varies

NEWBORN REFLEXES
Moro Reflex :- There are manyways to elicit Moro
reflex.However, the most commonmethodused is the “drop
method”whereinthe nurse lifts the babycompletelyoff the bed
while supportingthe headand the neck, and thenthe nurse
lowers thebabyrapidlytill there is only4-8 inches betweenthe
babyand the bed. It is important to note that while doingthis, the
babyis kept in supine position. CompleteMoro reflex involves
bilateral abduction of arms, extension of forearms, and fanning of
fingers withindexfingger and thumbforminga C shape.
Disappearat 3 – 4 month

NEWBORN REFLEXES
Startle Reflex :- Startle reflex is different from
Moro reflex in the sense that it lacks full extension and
hand opening and can be elicited spontaneously by
sudden noise or movement. Disappear at 4 month

NEWBORN REFLEXES
Crawl Reflex :-
Whenplaced on abdomen,
infants makes crawling
movements with arms and
legs disappear at 6 weeks
Ankle clonus Reflex :-
Briskly dorsi flexing foot while supporting
knee in partially flexed position results in 1-2
oscillating movements, eventually no beats
should be felt. Disappear at the age of 2
month

NEWBORN REFLEXES
Parachute Reflex :- When we suddenly lowers th
neonate froma short distance in ventral suspension it is
followedby extension of arms, hands and fingers same like a
parachute it’s beginning age is 7 – 9 months it won’t
disappear .

NEWBORN REFLEXES
Landau Reflex :- When the infant is suspended
in prone position with the examiner’s hand under the
abdomen, he responds by extension of head , trunk and
hips. On flexing the head , trunk and hip also shows
flexion it’s beginning age is 6 – 8months and disappear
at the age 12 – 24 month .

NEEDS OF NEWBORN
• Love and affection
•Human contact and Sensory stimulation
•Sucking and Breast feeding 2-3 hours
•Maintain body temperature
• Hygienic needs
• Prevention of injury/aspiration
• Prevention of infection and injury
•Provision of optimal nutrition
•Watch for danger signs of newborn like
hypothermia, hypoglycemia, jaundice, apnea, etc.

Characteristic of newborn and reflexes

Characteristic of newborn and reflexes

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Characteristic of newborn and reflexes