neonatal stage

1. CHARACTERISTICS OF
NEWBORN & REFLEXES

2. 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.

3. • A baby from birth to 28 days of age is
called newborn. Ahealthy infant born
at term (between 38-40 weeks) should
have an average birth weight for the
country (usually exceed 2500 gm.),
cries immediately following birth,
establishes independent rhythmic
respiration and quickly adapts to
changed environment.
DEFINITION

4. 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- 40-60breath /min.
• Blood pressure :normal range 60-70/31-45mmHg. BP is
directly related to gestational age and birth weight of the
infant.

5. 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.

6. SKIN CHANGES
At birth, the skin of a normal
infant is purplish-red in color,
then within minutes, the skin
pinks up.
CHARACTERISTICS
OF NEWBORN SKIN.

7. 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.

8. 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

9. 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.

10. CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Jaundice
-The skin and whites of the eyes appear yellow.
-yellow color comes from a pigment called Bilirubin which is
released from the normal breakdown of RBC.
-The liver removes Bilirubin and excretes into the
Gastrointestinal tract
-the Bilirubin builds up faster due to high RBC breakdown and
since, the liver is immature, it cannot eliminate fully
-Bilirubin gets accumulated in the baby’s body which is the
cause for causing Jaundice

11. 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
• caused due to the change in environment since
the baby had been living inside a fluid
environment in the mother’s womb for the past 9
months

12. CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Erythema Toxicum
• develop a patchy red rash called erythema
toxicum (also called “flea bites”) which fade
by the time the baby is several weeks old
•Caused due to the accumulation of
eosinophils in dermal lesions

13. CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Stork bites
• red areas around their foreheads, eyelids,
and noses or on the backs of their necks
•more visible when the baby cries and
disappear by itself during the first year
•Caused when blood vessels dilate under the
skin during fetal development and hence, the
blood flow increases to that area

14. CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Milia
• look like "white heads
• usually appear on the nose or chin
• usually disappear by themselves in the first
weeks of life
• Occurs when the sweat glands get blocked
since they are not fully developed

15. CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Mongolian Spot
• refers to a macular blue-gray pigmentation usually on
the sacral area of healthy infants
• usually present at birth or appears within the first weeks
of life
•Occurs when the pigment cells make melanin under the
skin’s surface during embryonic development
•typically disappears spontaneously within 4 years but can
also persist for life

16. CHARACTERISTICS
OF NEWBORN
SKIN.
SKIN CHANGES
Petechiae
• small, blue-red dots on the infant's body caused
by breakage of tiny capillaries
• seen on the face as a result of pressure exerted
on the head during birth

17. CHARACTERISTICS OF NEWBORN HEAD
Fontanelles
Neonateisbornwithsix fontanelles (soft membraneous gaps)
•Anterior Fontanel-onthetop ofthe head, diamondshaped
•PosteriorFontanel–onthebackof thehead, triangularshaped
•MastoidFontanel–totaltwo -oneonleftsideandotherontherightsideofthehead
•SphenoidFontanel- totaltwo-oneonleftsideandotherontherightsideofthehead
FUNCTIONS:
•Bonesarenotjoinedtogetherfirmlyatbirthwhichallowstheheadtochangeshapetohelpitpassthroughthebirthcanal.
• allowsthebrainandskulltogrowduringtheinfant’sfirstyear.Thefibrousconnectivetissue(suture)
foundatthejoiningoftheboneintheskullgraduallygainmineralsandhardens,firmlyjoiningtheskull
binestogether
Closure:
1. PosteriorFontanelle:2-3months
2. AnteriorFontanelle:12-18months
3. SphenoidFontanelle:6months
4. MastoidFontanelle:6-18months

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

20. CHARACTERISTICS OF NEWBORN HEAD
Caput Succedaneum
• swelling of the scalp in a newborn
•caused 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

22. CHARACTERISTICS OF NEWBORN HEAD.
Cephalohematoma
•Accumulation of blood under the scalp
•During the birthing process, shearing forces on the skull and scalp result
in the separation of the periosteum from the underlying skull resulting in
the subsequent rupture of blood vessels
Note: The periosteum is a dense, fibrous connective tissue sheath that
covers the bones

23. CHARACTERISTICS OF NEWBORN HEAD.
Craniosynostosis
-occurs when one or more of the sutures closes early
before the baby’s brain is fully formed
-As the brain grows, the skull will take an unusual
shape.

24. CHARACTERISTICS OF NEWBORN EYES
Eye Lid Edema
•Newborn tend to have their eyes tightly closed
•Pressure on face during childbirth can make newborn's
eyelids temporarily puffy or swollen

25. CHARACTERISTICS OF NEWBORN EYES.
Lacrimal Apparatus
•The lacrimal Apparatus(glands) is
small and nonfunctioning at birth
and tears are not usually produced
with crying until one to three
months of age.

26. CHARACTERISTICS
OF NEWBORN
GASTROINTESTINAL SYSTEM
 MOUTH
• Theinfant's lips shouldbepinkandthe tonguesmooth
andsymmetrical.Thetongueshouldnotextendor
protrude betweenthelips
• Nosalivationforthefirst 3 months.
• babies (unlike adults) do have lipase in their
mouths to initiate fat digestion

27. NEW BORN BREAST
Breasts Both male and female newborns may
have some swelling under the nipples. This is a
result of maternal hormones and will disappear
over a few weeks. Occasionally, some milky
discharge may occur. This is normal. Simply
wipe any discharge away.

28. GENITALS
• Both male and female infants may develop swollen
and red genitals during their passage through the
birth canal
• Genital Areas Vaginal Discharge: It is common for baby girls
to have a thick creamy or bloody vaginal discharge for the
first two to three weeks of life. This is the result of maternal
hormones and is not a reason for concern.

29. NEWBORN
REFLEXES

30. NEWBORN REFLEXES
• Rootingreflex:-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
Suckingreflex:-
When touching or stroking
the lips, the mouth opens and
sucking movements begin.It
begins to diminish at 6
months

31. NEWBORN REFLEXES
MoroReflex:-There are many ways to elicit Moro
reflex. However, the most common method used is the “drop
method” whereinthe nurse lifts the baby completelyoff the bed
while supporting the head and the neck, and then the nurse
lowers the babyrapidlytillthere is only4-8 inches betweenthe
baby andthe bed.It is importantto notethat whiledoingthis, the
baby is kept in supine position. Complete Moro reflex involves
bilateralabductionof arms, extension of forearms, andfanningof
fingers withindexfingger andthumbforminga C shape.
Disappearat 3 – 4 month

32. NEWBORN REFLEXES
TonicneckReflex:-Turninga newborn’shead 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
becauseof the positionof the newborn.This appears8weeksor 2 month
and disappearat 3 – 4 month or 6 – 9 month.

33. NEWBORN REFLEXES
Crawling Reflex
•When the infant is placed on the stomach and
pressure (such as hand) is applied to the sole of the
foot, the infant will attempt to push against the
hand and move the arms and legs in crawling like
motion
Dissapearance:
Few weeks to months after birth

34. NEWBORN REFLEXES
• Extrution Reflex:-
When substance placed on
be expelled out. It disappear at
about age 4 month
Blinkingreflexor
CornealReflex:-
anterior portion of the tongue, it’ll Protectionof eye by rapid eye lid
closurewhen theeyes are exposed
to bright light. It does not
disappear

35. NEWBORN REFLEXES
• Doll’sEyeReflex:-
As head is moved slowly to right to
left , eye lag behind and donot
immediatelyadjustto newposition
of head . It disapear at the age of 3
month

36. NEWBORN REFLEXES
• GlabellarReflex:-
Tapping brisklyon
eyes to close tightly
Yawnreflex:-
Infant has spontaneous response to
glabella(bridge of nose) cause decreased oxygen by increasing
amount of inspired air, persists
throughout life.

37. NEWBORN REFLEXES
• CoughReflex:-
• Irritation of mucous membranes of
larynx causes coughing, persists
throughout the life; Usually present
after 1st day of birth.
Babinskireflex:-
When the bottom of the foot is stroked
from the heel upward along the outward
part of the foot, the big toe bends back
and the other toes spread out.
Disappearafter one year of age

38. NEWBORN REFLEXES
Palmar Grasp:-
When the objects are place in the
palm of newborn, it grasps the
object. Diminishes by 3 month of
age
Plantar Grasp:-
When objectstouch thesoul of the
foot at the base of the toes,toes
graspsaroundvery small
object.Diminishs by 8 months of
age

39. NEWBORN REFLEXES
Stepreflex:-
When holding the infant upright with legs and feet
touching a surface, the infant will move the legs like
steps or walking
Disappearance:
-About 3-4 months of age

40. 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

41. PERCEPTUAL SKILLS IN NEONATES
Perceptual skills include vision, hearing, smell, taste, and touch
VISION
• within the first month, their eye movement begins to
strengthen.
• They can distinguish light from dark at birth.
• Prefer stripes and curved lines
• At birth lens, nerves and muscles of the eye are just
developing
• Newborns can’t see small objects that are far away
• Prefer and identify mother’s face

42. Newborns initially look around the edge of
image to develop a unified whole,
Newborns prefer to look at patterned figures rather
than plain figure. As they grow older they focus on
more complex patterns

43. Very fuzzy
image
1 month
2months 3 months 4 months

44. HEARING Perception
• develops in utero and is fully operative at birth. auditory
perception appears to be influenced by prenatal experiences
with sounds. For example, newborns prefer listening to their
own mother’s voice over the voice of another woman.
• At birth
– Can hear better than they can see
– Can be startled by loud noises
– Can turn toward soft sounds
Can discriminate among sounds that differ in loudness, duration, direction, and
frequency/pitch

45. Touch Perception
• The sense of touch develop before birth
• Newborns are sensitive to warm and cold- can understand well
the difference when placed on their cheeks
• A touch on lip –Suckling movement
• Sensitive to painful stimuli like needle pricks
Taste Perception
• Sensory receptors-taste buds on the tongue
• Newborns can distinguish sweet, bitter, and sour
tastes and show preference for sweet
• Sensitivity to taste present even before birth

47. Smell
• Sensory receptors of smell are present in the nasal
passage
• Response positively to pleasant smell(Vanilla, Strawberry)
and negatively towards unpleasant smell(Rotten eggs, Fish
smell)
• Just after birth infants when placed down between mother’s
breast –they spontaneously latch on to nipple and starts
sucking within an hour

48. NEEDS OF NEWBORN
• Loveandaffection
•Humancontact and Sensorystimulation
•Suckingand Breast feeding2-3 hours
•Maintainbody temperature
• Hygienicneeds
• Preventionof injury/aspiration
• Preventionof infectionandinjury
•Provisionof optimalnutrition
•Watchfordangersignsof newbornlike
hypothermia,hypoglycemia, jaundice,apnea, etc.