This document provides information about a normal newborn, including circulatory changes at birth, lung changes, carbohydrate metabolism, temperature regulation, and essential newborn care. It discusses assessment of gestational age, physical examination of the newborn, and neonatal immunization in Singapore. The key points are circulatory adaptation to extrauterine life, lung fluid reabsorption, temperature regulation, glucose level changes, screening for malformations, danger signs, and the neonatal immunization schedule in Singapore.

1. Normal Newborn
Dr Varsha Atul Shah
Consultant
Dept. of Neonatal& Dev Medicine
Singapore General Hospital

2. Newborn Adaptation At Birth
o Circulatory changes (gas exchange from placenta to the lungs)
g Reabsorption of fetal lung fluid
f Closure of patent ductus arteriosus
t Stabilization of cardiac rhythm
Establishment of regular breathing
Temperature regulation
l Changes in carbohydrate metabolism

3. Circulatory changes
g Reduction of pulmonary vascular resistance, increased PBF by
10 folds
m Increase in left atrial pressure
Closes foramen ovale
v Increase systemic vascular resistance
c Rt to lt flow at PDA diminishes, closes PDA
PS: failure to achieve reduce PVR cause PPHN

4. Fetal Circulation

6. Circulation in the
normal newborn

8. Lung changes
Lung fluid absorption (failure cause TTNB, Transient
Tachypnea of Newborn)
b RR rises to 60/min
i Transient grunting, mild retraction, ala nasi flare may
be seen

9. Carbohydrate Metabolism
a Cessation of maternal glucose supply
e Decline in glucose level by 2 hrs
s 20-30% CHO comes from milk
Gluconeogenesis from AA, glycerol, lactate

10. Temperature regulation
l Low ambient temp, evaporation, radiation, convection,
conduction loss of heat –Hypothermia
o Achieve Neutral thermal environment
t Drying, swaddling, skin-skin contact, radiant warmer, leave
vernix, wrapping, early feeding

11. Immediate care after birth
Prevent hypothermia
Eye, skin, cord care
Give injection vitamin K
Breastfeed within ½ hour of birth
Search for malformations

12. Increased risk of malformation
Single umbilical artery
Simian crease
Dysmorphic features
Asymmetric cry due to absence of Depressor
Angularis Oris Muscle
Excessive drooling of saliva

13. Quick screening for malformations
Screen from top to bottom and in midline
Orifice examination
– Anal opening
– Oesophagus patency*
– Choanal atresia
– * SGA baby, polyhydramnios, excessive drooling,
• single umbilical artery

14. Essential postnatal care
Nurse in thermal comfort
(warm to touch, pink soles)
Check umbilicus, skin, eyes
Good sucking at breast
Screen for danger signals
Advice on immunization

15. Care of umbilical stump
Inspect 2 to 4 hours after ligation for bleeding
Do not apply anything, keep cord
clean and dry
Inspect for discharge or infection till healing
occurs

16. Care of the skin
Dry using soft prewarmed clean cloth
Bathing soon after birth is not
recommended
Do not make vigorous attempts to
remove vernix caseosa
Inspect for superficial infections

17. Care of the eyes
Clean at birth and subsequently daily
For sticky eyes use normal saline or appropriate
medication
u Nasolacrimal duct blockage, Massaging helps

18. Danger signs
Lethargy r Bleeding
Hypothermia r Yellow palms/ sole
Respiratory distress l Excessive wt loss
r Cyanosis s Vomiting
r Convulsions s Diarrhoea
r Abd distension

19. Infant Classification
-by Gestational Age
ATerm : 37-41+6/7 weeks
Preterm: <37 weeks
k Post-term: 42 or more weeks

20. Infant Classification
-by birthweight
a Macrosomia: 4000 gm or more
Normal birthweight: 2500-3999 gm
h Low birthweight: <2500 gm
Very low birthweight: <1500 gm
i Extremely low birthweight: <1000 gm

21. Term infant
A well term infant loses up to 10% of birth weight in
the first week of life;
f Birth weight is regained by 10-14 day and thereafter
gains 30g/day.
r His caloric intake/requirement is 100-120 kcal/kg/day
k with 2-5 g/kg/day of protein for cellular growth.

22. Infant Classification
-by Gestational Sizes
S Appropriate for gestational age
g Large for gestational age
i Small for gestational age
i classify based on maturity
and intrauterine growth
PS:Energy stores in the fetus builds up mostly
during the 3rd trimester of the pregnancy.

23. Gestational Age Assessment
A Maternal dates
S Early Ultrasound dating
Dates of first recorded fetal activity
e Dates of first recorded fetal heart sounds
e Dubowitz or Ballard scores

24. Decreasing lanugo hair over the back is a
sign of increasing gestational age.

25. Dubowitz L, Dubowitz V:
Gestational Age of the Newborn

26. Physical Examination
of the Newborn
t Purpose
- detect malformations or deformations
- determine manifestations of various neonatal
diseases
- evaluate the effects of labour and delivery
on newborn

27. Physical Examination
t General appearance
- cyanosis, nasal flaring, intercostal retractions, grunting, meconium staining
of skin, perfusion, level of spontaneous activity, tone, cry
Vital signs
- HR (120-160 beats/min), RR (30-60 breaths/min), To, b/p, Wt, length and
OFC In term healthy infants, the core temperature will fall after birth by about
0.8-2 degrees Celsius.
l Gestational age assessment

28. Physical Examination
t Skin
- harlequin color change, hair tufts, mongolian spots, naevus
flammus, malia malenocytic naevus, haemangiomas, pustular
melanosis, erythema toxicum
e Skull
- cranial synostosis, fontanels, craniotabes, caput
succedaneum, subgaleal hemorrhage

29. Milia

30. Erythema Toxicum

31. Epstein Pearls

32. Mongolian Spots

33. Capillary Haemangioma

34. Physical Examination
t Face
- facial asymmetry, preauricular tags/pits/sinus,low setears,
hypertelorism, cleft lip/palate, red reflex, white reflex
l Neck and chest
- sinuses, cystic hygromas, sternomastoid tumour, webbed neck, thick
nuchal folds, clavicular fracture,chest wall asymmetry, breast tissue
formation, supernumerary nipples

38. Physical Examination
t Lung examination
- RR, breath sounds, shift of cardiac impulse, bowel sounds
n Heart
- normal heart sounds, murmurs, peripheral pulses, b/p
o Abdomen
- distension, masses, umbilical hernia, omphalocoele, omphalitis,
gastroschisis

42. Umbilical Cord

43. Physical Examination
t Genitalia examination
- testicular descend, scrotal pigmentation, vaginal discharge, mucosal tags,
imperforate hymen, clitoral enlargement
n Extremities
- symmetry, polydactyl, syndactyl, simian creases, absent fingers, clubfoot,
fracture
d Spine
- sacral tufts, scoliosis, lipoma, meningomyelocele

44. Milky white or blood-streaked vaginal
discharge is the result of maternal
hormone withdrawal.

45. Physical Examination
t Hip assessment
- Barlow test, Ortolani manoeuver to determine whether femoral head
can be displaced from acetabulum and replaced respectively
Neurologic assessment
- tone, alterness, primitive reflexes (Moro’s, palmar grasp, rooting
reflex), deep tendon reflexes, spontaneous motor activity, cranial nerves

46. Neonatal Immunization In
Singapore

47. Immunization
Age Vaccine Optional
0-7 days BCG, Hep B
1 month 2nd Hep B
3 months OPV,DPT, Hib/Pneumococ/Rota
4 months OPV,DPT, Hib/Pneumococcal
5 months OPV, DPT, Hib/Pneumococ/Rota
6 Months Hep B
15 months MMR Chicken Pox/flu
18 months OPV, DPT Hib/Pneumococcal
School entry(4-5 yrs) OPV, DT

48. Visit site for Formative assessments
MCQ :
http://www.geraldtan.com/school/5-
paedsneonate.html
http://www.geraldtan.com/school/