Newborn features

1. CHARACTERSTICS OF
NEWBORN….
BY:-
Richa Mishra
M.Sc.(Nursing) 1st year

2. Introduction..
• Newborn or neonate (from Latin, neonatus, newborn) refers
to an infant in the first 28 days after birth.
• Healthy newborn infant born at term, cries immediately
after birth and establish satisfactory rhythmic pulmonary
respiration.

3. Cont….
General Appearance:-
• The skin is a dark red to purple color (at birth)
• The color changes to red (at first breath).
• This redness normally starts to fade in the first day.
• A baby's hands and feet may stay bluish in color for several days.
Measurments:-
• Length – 50 cm (20 inches, at birth)
• Weight – 2.8 to 3.5 kg.
• Head circumference – 33 – 35 cm.
• Chest circumference – 30 - 33 cm.

4. Vital Sign..
Temperature:-
• Route- Preferably through axillary routes
• Frequency-Once daily for healthy babies and every 2 hours
for sick small babies.
• Normal body temperature for a healthy baby is between (36
to 38 degrees Celsius) - American Academy of Pediatrics
(AAP).

5. Hypothermia..
Introduction- Less than 36.5C. The prevention of
hypothermia is one of the very major step in newborn.
• Types of hypothermia are:-
• COLD STRESS( 36.5 to 37.5C)
• MODERATE HYPOTHERMIA (32 to 35.9 C)
• SEVERE HYPOTHERMIA( LESS THAN 32C)

6. Cont….
• Steps of prevention of Hypothermia are:-
• Ambient room temperature of labor room
• Dried immediately, and skin-to-skin contacts with mother is
essential
• KMC(in LBW baby).
• Warm Transportation.
• Mother and baby should be kept at same bed (Rooming-in)
• Bathing and weighing should be postponed specially in
preterm babies.
• Frequent breastfeeding is critical to provide energy to keep
the baby warm.
• Trainning / awarness of healthcare providers is also a
necessary step which is to be done by the institute.

7. Pulse..
• Because the newborn has very low immuity, and prone to infection, it is very
important for all the nurse to maintain strict hand hygiene. And maintain
adequate warmth between both the palm before touching baby.
• “ When checking an apical pulse in newborn, approach the child in a soothing,
calm and quit manner.”
• The child can be held on caregiver’s lap for security for the full minute that the
pulse is counted”.
• Reference values for pulse oximeter saturations (SpO2) in term and preterm
infants show that during normal breathing 95% of infants maintain SpO2 at or
above 93-97%, depending on age.”
• “The stethoscope is placed between child’s left nipple and sternum.”
• “A radial pulse my be taken on an older child.

8. Cont…
• “ A pulse which is unusual in quality, rate, rhythm should be counted for
one whole minute”.
• Cardiac monitors are used to detect changes in cardiac functioning
• The pulse rate is normally irregular, due to immaturity of the cardiac
regulatory center in the medulla.
• The normal pulse ranges for an infant is 120 to 150 beats per minute
(bpm).
• The rate may raise when infant is crying and drop when infant is sleeping.
• The apical pulse is considered the most accurate.

9. Respiration..
• Respiration in the neonate are irregular in
depth, rate and rhythm.
• It varies from 35 to 50 per minute.
• Normally, respiration are gentle, quiet, rapid,
and shallow.

10. Blood Pressure..
• In infants the flush and Doppler* methods of
blood pressure measurement are usually
used.
• Normal blood pressure at birth is determined
by the birth weight of the baby.
• A newborn has a normal blood pressure of
about 70 over 42 mm of Hg.

11. Newborn Head...
• Infants head is one fourth of his total body length.
• Normal head circumference is 33–35 cm (13”- 14”).
• FONTANELS (SOFT SPOTS) – The fontanels are
openings at the points of union of the skull bones.
There are normally several fontanels on a newborn's
skull, mainly at the top, back, and sides of the head.

12. Cont....
1.Anterior fontanel (bregma) –
• The anterior fontanel is diamond shaped and is located at juncture of two
parietal and two frontal bones.
• The anterior fontanelle is the largest of the six fontanelles, and it resembles
a diamond-shape ranging in size from 0.6 cm to 3.6 cm with a mean of 2.1 cm.
• It is 2 to 3 cm in width and 3 to 4 cm in length.
• It usually closes between 12 to 18 months.
2.Posterior fontanel (lamda) –
• The posterior fontanel is triangular and located between the occipital and
parietal bon It is much smaller than the anterior fontanel.
• The posterior fontanel is triangular and lies at the apex of the occipital bone.
• At birth, the average size of the posterior fontanel is 0.5 cm in white infants
and 0.7 cm in black infants
• It usually closes between 1 to 2 months.

13. cont....
MOLDING –
• Molding is the temporary reshaping of the fetal head
as it passes through the birth canal during childbirth.
• During the molding process the over lapping of skull
bones occurred and it reduces the diameter of the
skull temporarily.
• This elongated look usually disappears a few hours
after birth.

14. Caput succedanum..
• A caput succedaneum is an edema of the scalp at the neonate’s
presenting part of the head.
• It often appears over the vertex of the newborn’s head as a result
of pressure against the mother’s cervix during labor.
• The edema in caput succedaneum crosses the suture lines.
• It may involve wide areas of the head or it may just be a size of a
large egg.
Causes
• Mechanical trauma of the initial portion of scalp pushing through a
narrowed cervix
• Prolonged or difficult delivery
• Vacuum extraction

15. cont....
CEPHALHEMATOMA –
• It is an accumulation of blood between the periosteum and a flat skull bone.
• The collection of blood does not cross a suture line.
• A Cephalhematoma may not be evident during the first few days of life
because of the presence of a large caput succedaneum.
• Aspiration of this sanguineous collection should not be done because of
danger of infection.
• The condition usually clears within few weeks.
Causes-
• Rupture of a periostal capillary due to the pressure of birth
• Instrumental delivery.

16. Difference between caput
succedaneum & cephalohematoma
INDICATOR CAPUT
SUCCEDANEUM CEPHALOHEM
ATOMA
Incidence Common Less Common
Location Presenting part of
the head
Periosteum of
skull bone
Extent of
Involvement
Both Hemispheres Individual bone
Period of
Absorption
3 to 4 days Few weeks to
months
Time of
Presentation
Maximum at birth Increase size
for 12-24 hours
& then stable.
Characteristi
cs features
Diffuse, Crosses
suture line.
Has distinct
margin, do not
crosses suture
line.
Associations None Linear skull

17. Eyes, Ears, & Nose...
EYES
• The eyes are blue or gray at birth, changing to the permanent
colour in 3 to 6 months.
• Eye movements are not coordinated.
• The eye lids may be edematous for about 2 days after birth.
• Chemical conjunctivitis may follow instillation of silver nitrate
drops into the eyes soon after birth to prevent ophthalmia
neonatorum.
• The lacrimal apparatus is small and non functioning at birth, but
lacrimal fluid is present in the eyes to some degree from birth.

18. cont...
It has two functions:
• to cleanse the eyes.
• to prevent drying of the conjunctiva.
• The cornea should be transparent and clear
and the iris of the eye should be round.
• Assess for PERLA ( Pupils equally reactive to
light and accommodation.)

19. Ear & Nose...
EARS
• The infant ears tend to be folded and creased.
• A line drawn through the inner and outer canthi of the
eye should come to the top notch of the ear.
• The infant usually responds to sound at birth.
• Low set ears may be an indication of mental retardation,
renal anomalies, or craniofacial malformation.
NOSE
• At birth, the nose and mouth are often filled with mucus.

20. Mouth & Throat..
• Cleft lip and palate are birth defects that affect the upper lip and
the roof of the mouth.
• Precocious dentition or supernumerary teeth may be observed in
the lower incisor area or elsewhere on the gums.
• Epstein pearls are temporary accumulations of epithelial cells.
• Oral Thrush is a fungal infection of mouth. It is caused by an
overgrowth of candida albicans
NECK
• The neck appears short in comparison with the size of the baby and
is creased.

21. cont...
CHEST
• Bell shaped and at birth is approximately the same
circumference as the abdomen and about 1 inch less than the
head circumference.
• The thorax of the newborn is almost circular.
• The infant does not use thoracic cage in breathing, but uses the
diaphragm and abdominal muscles.
• The breasts may be swollen because of hormonal activity
originating from the mother, and pale milky fluid (witch’s milk)
can be expressed.

22. Esophagus,Stomach& Intestine..
• The cardiac sphincter is not well developed as the
pyloric sphincter.
• Stomach content immediately emptied into
duodenum.
• Meconium, the first fetal material, is a sticky,
odorless material, greenish black to brownish green
which passes from 8 to 24 hours after birth.

23. Abdomen...
• Shape- Rounded & slightly protuberant
• Peristalsis- Can be seen on thin neonates, not on
well nourished.
• Umbilical cord, gelatinuous bluish white, gelatinous
structure at birth. It normally contains two umbilical
arteries and one vein.
• Abdominal girth in LBW group was 24.47cm in boys,
and 24.92cm in girls.

24. Cont....
• The liver usually can be felt about 2 to 3 cm below
the right costal margin.
• The tip of the spleen may be palpable by about 1
week after birth in the left upper quadrant.

25. Anogenital Area..
• The newborn infant should pass meconium within
the first 24 -48 hours after birth through a patent
rectum.
• A newborn should pass urine within 12 hours of
birth.

26. Cont...
Males:-
• The testes usually descended into the scrotum by the
8th month of intrauterine life.
Females:-
• The female genitalia may be slightly swollen from the
action of maternal hormones.
• The labia minora and clitoris appear large.

27. System wise features...
• Integumentry System:-
After Birth- Skin may appear dark red or purple, but as
the infant breathes his colour change to red.
Good elasticity, or turgor is evidence.
Lanugo-
• Downy hair on the body of the fetus and newborn
baby.
• Usually disappear after 8th month of gestation.
• Fine, soft body hair.

28. Cont....
Venix Caseosa
• It is also known as’ vernix’, is the waxy or cheese like-
yellowish white substance found coating the skin of
newborn human babies It consists of secretions from the
sebaceous gland and epithelial cell.
Functions
• Facilitating passage through the birth canal
• Conserve heat
• Antibacterial effect.
• Protecting the infant from infection.

29. Cont...
Milia-
• Tiny white spots, sometimes appears on the roof of
the mouth known as Epstein pearl.
Stroke Bite/ Navus simplex/ Salmon patches-
• Common Birth Mark
• Pink and Flat
• May be found on the forehead, eyelids, nose, upper
lip, or back of the neck.

30. Cont...
• Typical Growth Pattern of Hemangiomas
Age of Child Hemangiomas
Birth Often not present or noticeable
1-2months Becomes noticeable
1-6months Grows most rapidly
12-18months Begins to shrink (involute)

31. cont...
Mongolian Spot-
• Flat, blue, or blue-gray skin markings near the
buttocks that commonly appear at birth or shortly
thereafter.
• Non-cancerous skin markings.
• spots are usually 2 - 8 centimeters wide.
Petechie –
• These are small, blue-red dots on the infants body
caused by the breakage of tiny capillaries.

32. Hematological system...
• RBC- 4 to 6.6 millions of cells/mm3 and a high
hemoglobin level (Hb – 14.5 to 22.5 gm/dl) at birth.
• Physiological jaundice may be seen in approximately
55 to 70% of all neonates.
• The blood volume of the newborn infant is about 10
to 12% of body weight.

33. Renal System...
• The bladder contains urine at birth and may empty
immediately or after several hours.
• The urine is dilute because of the immaturity of
kidneys.
• Loss of large amount of water may result in
temporary hemoconcentration.

34. Skeltal System...
• Bones are soft.
• Skeleton is flexible
• Back is normally straight and flat when the baby is
lying prone.
• Lumbar and sacral curves develop later, when the
infant sits up and begins to stand.
• Common Anomilies can be found-Club foot,
syndactyl (a union of the fingers or toes), and
polydactyl (supernumerary digits).

35. Muscular System...
• The movements of the neonates are random
and uncoordinated.

36. Nervous System..
• The nervous system is strikingly immature
when compared with that of the child or
adult.

37. Respiratory System..
Once the baby takes the first breath, a number of
changes occur in the infant's lungs and circulatory system:
• Increased oxygen in the lungs causes a decrease in
blood flow resistance to the lungs.
• Blood flow resistance of the baby's blood vessels also
increases.
• Fluid drains or is absorbed from the respiratory system.
• The lungs inflate and begin working on their own,
moving oxygen into the bloodstream and removing
carbon dioxide by breathing out (exhalation).

38. Circulatory System
• At birth umbilical cord is clamped
• The baby no longer receives oxygen and
nutrients from the mother.
• With the first breaths of life, the lungs begin
to expand. As the lungs expand, the alveoli in
the lungs are cleared of fluid

39. Cont....
• An increase in the baby's blood pressure and a
significant reduction in the pulmonary
pressures reduces the need for the ductus
arteriosus to shunt blood.
• These changes promote the closure of the
shunt and increases pressure in the left atrium
of the heart, which decrease the pressure in
the right atrium.

40. cont...
• The shift in pressure stimulates the foramen
ovale to close.
• The closure of the ductus arteriosus and
foramen ovale completes the transition of
fetal circulation to newborn circulation.

41. Genito-Urinary System..
• Renal function undergoes rapid maturation during
the first weeks post birth in both term and preterm
infants.
• In the initial days of life, the weight of newborn
looses 10% due to immature renal function and then
starts gaining 25-30gm/day.
• Significant risks for all infants include over-hydration,
dehydration, and electrolyte imbalances.

42. G.I. System..
• During the immediate postnatal period, the gastrointestinal
(GI) tract undergoes profound growth, morphological changes
and functional maturation.
• The oesophagus shows an accelerated cell proliferation in the
epithelium.
• The stomach shows a rapid tissue growth and a marked
increase in acid secretion capacity.

43. cont...
• The stomach shows a rapid tissue growth and a marked
increase in acid secretion capacity.
• The intestine shows increased tissue growth and marked
epithelial modifications; the latter include the loss of the
ability by the epithelial cells of the small intestine to absorb
macro molecules, and the loss of the ability by the epithelial
cells of the large intestine to synthesize digestive enzymes and
to absorb amino acids and glucose.

44. Reflexes...
Reflexes Characteristics Time to Disappear
Rooting
Head turns towards the
stimulation, mainly
to find
3-4 months when awake & 7-8
months when sleep.
Sucking Sucking movements to take in
food
Begins to diminish at 6 month.
Swallowing Food, reaching the posterior
mouth is swallowed
Does not disappear.
Gagging Immediate return of
undigested food
Does not disappear.
Sneezing & Coughing Clearing upper and lower air
passage .
Does not disappear.

45. cont...
Extrusion( tongue- thrust
reflex)
Baby pushes solid food out of
their mouth
using their tongue.
Disappear at 4- 6 momth after
birth
Blinking
Protection of eyes by rapid
eyelid closure.
Does not disappear
Doll’s Eyes Normally eyes do not move. When fixation develops.
Palmer Reflex
Grasping of object by closing
fingers around
it.
Disappear in 6 weeks to 3
months.
Dancing Reflex
Rapid alternating flexion &
extension of leg
in stepping.
Disappear within 3 to 4
weeks.

46. cont....
Moro’s Reflexes
Generalized muscular activity.
Symmetric abduction and
extension of arms & legs with
fanning of fingers. The thumb &
index fingers from ‘C’ shaped in
both hand. The extremities then
flex and adduct. The baby
may cry.
Stop upto 2 months disappears
by 3-4 months
Babinski’s Reflex
When the sole of the foot is
firmly stroked, the big toe
bends back towards the top of
the foot and the other toes fan
out.
Normal upto age of 2 years.
Tonic – neck reflexes
When a baby’s head is turned to
one side, the arm on that side
stretches out and the opposite
arm bends up at the elbow.
Disappear at 5- 7 months.

47. Special Sense..
TOUCH –
• The sense of touch is the most highly developed of
the special senses and is most acute on the lips,
tongue, and ears and fore head.
VISION –
• Child’s vision development begins before birth.
• Newborns focus on black and white objects at a
distance of 9 to 12 inc.

48. cont...
HEARING –
• Hearing occurs after the first cry.
• The infant normally make some response to sound.
TASTE –
• A newborn has the ability to discriminate taste, because taste buds
are developed and functioning even before birth.
• Sweet fluids are accepted, where as acid, sour, or bitter ones are
resisted.
SMELL –
• The sense of smell is present in newborns as soon as the nose is
clear of mucus and amniotic fluid.

49. Difference between full term and preterm..
CHARACTERSTICS PRE-TERM FULL-TERM
Primitive reflexes Weak Strong
Skin texture and Opacity
Shiny oily plethoric, Plenty of
lanugo, edema with visible
veins & venules on abdomen.
Pink, Scanty lanugo and only
large veins are
seen. Good elasticity or turgor.
Hair Texture & distribution
on scalp
Wooly, Fuzzy and very fine. Silky, black coarse and individual
strands.
Breast nodules & nipple
formation.
Breast tissue less than 5 mm
on one or both sides.
More than 10 mm diameter
breast tissue and nipples raised
above skin level.

50. cont...
.
Ear Cartilage Pinna feel soft with no
cartilage and no recoil.
Pinna is firm with definite
cartilage and instant recoil.
Planter Creases
Faint red marks over
anterior part of sole or
may be absent.
Entire sole covered with deep
creases.
Genitalias- Male
Srotum small with no or
few rugae & light
pigmentation.Testis
usually not descend or in
inguinal canal.
At least one testes descend in
scrotum.Prominent rugae &
deep pigmentation.
Genitalias- Females
Labia majora widely
separated with prominent
labia
minora.Clitoris is
prominent.
Labia Majora completely
covers the labia minora and
clitoris.Not prominence
Clitoris is seen.
Heel to Ear Manoeuvre
Heal is easily brought to
ear meeting with no
resistance.
Heal Cannot brought to the
ear easily feeling resstance.

51. Conclusion...
The newborn is having very varied characterstics
within them. There are various changes takes
place during their phase of growth and
development. Many biological, physical, Bio-
chemical, Physiological changes continuously
happens untill maturity, sometimes they are
normal and sometimes abnormal.

52. Refrences...
• GHAI,O.P, ESSENTIAL PEDIATRICS, EDITION 9TH ;CBS PUBLISHERS AND DISTRIBUTORS PVT. LTD
NEW-DELHI,2019; PP-143-144
• HATFIELD T. NANCY, BROADRIBB’S TNTRODUCTORY PEDDIATRIC NURSING; 7TH EDITION
LIPPINCOTT WILLIAMS AND WILKINS; PP- 50
• DATTA PARUL, PEDIATRICS NURSING EDITION 4TH ; JAPEE PUBLISHERS NEW-DELHI, 2018 PP-65
• Medline Plus, Cranial Sutures, https://medlineplus.gov/ency/article/002320.htm
• Babycentre, Soft Spots, http://www.babycentre.co.uk/x552709/what-are-the-soft-spots-on-my-
newborns-head
• American Family Physician, The Abnormal
Fontanelle, http://www.aafp.org/afp/2003/0615/p2547.html
• WWW.SLIDESHARE.COM
• WWW.WIKIPEDIA.ORG

53. ...
THANK YOU