newborn

NewbornNewborn

TermsTerms

AcrocyanosisAcrocyanosis Appropriate for gestational age Appropriate for gestational age Caput succedaneumCaput succedaneum CephalhematomaCephalhematoma CircumcisionCircumcision Cold stressCold stress ConductionConduction

TermsTerms

ConvectionConvection CryptorchidismCryptorchidism Down’s syndromeDown’s syndrome EpispadiasEpispadias Epstein’s pearlsEpstein’s pearls Erythema toxicum neonatorumErythema toxicum neonatorum EvaportationEvaportation

TermsTerms

ForemilkForemilk GynecomastiaGynecomastia HindmilkHindmilk Hallux varusHallux varus HydroceleHydrocele HyperbilirubinemiaHyperbilirubinemia HypospadiusHypospadius KernicterusKernicterus

TermsTerms

LanugoLanugo Large for gestational ageLarge for gestational age MeconiumMeconium MiliaMilia MoldingMolding Mongolian spotsMongolian spots MyelomeningoceleMyelomeningocele Nevus flammeusNevus flammeus

TermsTerms

RadiationRadiation TheromoregulationTheromoregulation PsuedomenstrationPsuedomenstration

AcrocyanosisAcrocyanosis

Although some Although some newborn infants are newborn infants are uniformly pink in uniformly pink in color, many have color, many have some degree of some degree of "acrocyanosis." This "acrocyanosis." This means that the central means that the central portion (chest) is pink, portion (chest) is pink, but the extremities, but the extremities, particularly the hands particularly the hands and feet, are blue or and feet, are blue or purple.purple.

Acrocyanosis is Acrocyanosis is normal for a newborn normal for a newborn during the first few during the first few hours, disappearing hours, disappearing over the next day. It is over the next day. It is due to relatively due to relatively sluggish circulation of sluggish circulation of blood through the blood through the peripheral structures, peripheral structures, related to immaturity related to immaturity or inexperience of the or inexperience of the newborn blood flow newborn blood flow regulatory systems.regulatory systems.

Appropriate for Gestational AgeAppropriate for Gestational Age

Assigning size is a Assigning size is a way to measure way to measure and monitor the and monitor the growth of the growth of the infant throughout infant throughout the pregnancy as the pregnancy as well as at the time well as at the time of birth.of birth.

The measurement is The measurement is calculated based on calculated based on the estimated the estimated gestational age (how gestational age (how many weeks the many weeks the mother was pregnant) mother was pregnant) in comparison to what in comparison to what is considered normal is considered normal height, weight, head height, weight, head size, and size, and developmental level developmental level for a child of the same for a child of the same gestational age and gestational age and gender.gender.

Appropriate for Gestational AgeAppropriate for Gestational Age

Graphs are available Graphs are available showing the upper showing the upper and lower normal and lower normal limits for different limits for different gestational ages gestational ages from the mid-20s from the mid-20s through 42 weeks through 42 weeks of gestation. See of gestation. See pg 1561, Figure 54-pg 1561, Figure 54-2020

An appropriate for An appropriate for gestational age gestational age full-term infant is full-term infant is heavier than 2500 heavier than 2500 grams (about 5.5 grams (about 5.5 lbs.) and lighter lbs.) and lighter than about 4000 than about 4000 grams (about 8.75 grams (about 8.75 lbs.).lbs.).

Caput SuccedaneumCaput Succedaneum

Caput succedaneum is Caput succedaneum is swelling of the scalp in swelling of the scalp in a newborn. It is most a newborn. It is most often brought on by often brought on by pressure from the pressure from the uterus or vaginal wall uterus or vaginal wall during a head-first during a head-first (vertex) delivery.(vertex) delivery.

SymptomsSymptoms Soft, puffy swelling of part Soft, puffy swelling of part

of the scalp in a newborn of the scalp in a newborn infant infant

Swelling may or may not Swelling may or may not have some degree of have some degree of discoloration or bruising discoloration or bruising

Swelling may extend over Swelling may extend over the midline of the scalp the midline of the scalp

Most often seen on the Most often seen on the portion of the head which portion of the head which presented first presented first

May be associated with May be associated with increased molding of the increased molding of the headhead

Caput SuccedaneumCaput Succedaneum TreatmentTreatmentNo treatment is No treatment is

necessary, and it usually necessary, and it usually heals spontaneously within a heals spontaneously within a few days.few days.

CausesCausesA caput A caput succedaneum is more likely succedaneum is more likely to form during a prolonged to form during a prolonged or difficult delivery. This is or difficult delivery. This is especially true after the especially true after the membranes have ruptured, membranes have ruptured, because the amniotic sac is because the amniotic sac is no longer providing a no longer providing a protective cushion for the protective cushion for the baby's head. Vacuum baby's head. Vacuum extraction can also increase extraction can also increase the chances of a caput the chances of a caput succedaneum.succedaneum.

A caput succedaneum is A caput succedaneum is sometimes identified by sometimes identified by prenatal ultrasound even prenatal ultrasound even before labor or delivery before labor or delivery begins. It has been found as begins. It has been found as early as 31 weeks of early as 31 weeks of pregnancy. More often than pregnancy. More often than not, this is associated with not, this is associated with either premature rupture of either premature rupture of the membranes or too little the membranes or too little amniotic fluid amniotic fluid (oligohydramnios). All other (oligohydramnios). All other things being equal, the things being equal, the longer the membranes are longer the membranes are intact, the less likely it is intact, the less likely it is that a caput will form. Pg that a caput will form. Pg 15541554

CephalhematomaCephalhematoma

swelling caused by swelling caused by subcutaneous subcutaneous bleeding and bleeding and accumulation of blood. accumulation of blood. It may begin to form in It may begin to form in the scalp of a fetus the scalp of a fetus during labor and during labor and enlarge slowly in the enlarge slowly in the first few days after first few days after birth. It is usually a birth. It is usually a result of trauma, often result of trauma, often caused by forceps. caused by forceps.

Large Large cephalhematomas cephalhematomas may become may become infected, require infected, require surgical drainage, surgical drainage, and take several and take several months to resolve. months to resolve. Also called Also called cephalhaematoma.cephalhaematoma.

Caput Succedaneum vs Caput Succedaneum vs CephalhematomaCephalhematoma

Important! Know how to recognize the difference between the two.

CircumcisionCircumcision

Breathing Breathing

Four FactorsFour Factors• PhysicalPhysical

• ThermalThermal

• ChemicalChemical

• SensorySensory

Immediate NeedsImmediate Needs

AirwayAirway Newborns are usually nose Newborns are usually nose

breathers-if nose is stuffy-will open breathers-if nose is stuffy-will open mouth to breathemouth to breathe

Suctioning usually done by bulb Suctioning usually done by bulb syringe at birthsyringe at birth

Airway must be kept clear Airway must be kept clear

NeedsNeeds

BreathingBreathing Pressure factors, chilling, noise light, Pressure factors, chilling, noise light,

environmental stimuli encourage environmental stimuli encourage initial newborn breathinitial newborn breath

Breathing movements began in Breathing movements began in uterus at about 11 weeksuterus at about 11 weeks

BreathingBreathing

At term 20 ml of fluid/kg in lungsAt term 20 ml of fluid/kg in lungs Air is substituted for the fluid with Air is substituted for the fluid with

the first breath the first breath Fluid moves into chest wall as trunk Fluid moves into chest wall as trunk

emerges at birthemerges at birth As more air enters the lungs, more As more air enters the lungs, more

fluid moves interstitialfluid moves interstitial

BreathingBreathing

Fluid is absorbed during the first day Fluid is absorbed during the first day after birthafter birth

May hear wet sounds in the lungMay hear wet sounds in the lung After birth or soon after birthAfter birth or soon after birth Wet sounds are more prominent on Wet sounds are more prominent on

c-section infantsc-section infants

Chemical factorsChemical factors

Arterial oxygen decreases--Arterial oxygen decreases-- Carbon dioxide increases---Carbon dioxide increases--- Respiratory center is stimulated-----Respiratory center is stimulated----- Infant takes first breath Infant takes first breath Usually within 1 minute of birthUsually within 1 minute of birth

Thermal factorsThermal factors

Change in temperature from uterus Change in temperature from uterus to environment is 20 degrees to environment is 20 degrees

Cool environment is a stimulus to Cool environment is a stimulus to breathe breathe

Sensory factors Sensory factors

Auditory, visual, touch stimuli are Auditory, visual, touch stimuli are increased when bornincreased when born

All the stimuli are new and increase All the stimuli are new and increase the stimuli to breathethe stimuli to breathe

Circulation changesCirculation changes

Pulmonary blood vesselsPulmonary blood vessels Begin with the first breathBegin with the first breath Lungs inflate and reduces pulmonary Lungs inflate and reduces pulmonary

vasculature resistance vasculature resistance Reduces pulmonary artery pressureReduces pulmonary artery pressure Dilation occurs and allows blood to Dilation occurs and allows blood to

flow for O2 in the lungsflow for O2 in the lungs

CirculationCirculation

Pressure in the right atriumPressure in the right atrium Decreases-- allowing increased Decreases-- allowing increased

pulmonary return to the left side of pulmonary return to the left side of the heartthe heart

Increased pressure in the left atrium Increased pressure in the left atrium promotes closure of the foramen promotes closure of the foramen ovaleovale


Ductus arteriosusDuctus arteriosus Blood is shunted from the pulmonary Blood is shunted from the pulmonary

artery to the descending aorta before artery to the descending aorta before birthbirth

Closes soon after birth and Closes soon after birth and permanently closed within 3-4 permanently closed within 3-4 months of lifemonths of life


Foramen ovaleForamen ovale Before birth the opening allows blood Before birth the opening allows blood

to flow directly to left atriumto flow directly to left atrium Functionally closes at birth and Functionally closes at birth and

permanently closes in a few monthspermanently closes in a few months


Ductus venosusDuctus venosus Connection of umbilical vein and Connection of umbilical vein and

inferior vena is present before birthinferior vena is present before birthat birth the umbilical at birth the umbilical

cord is cut…cord is cut… With blood loss from the umbilical With blood loss from the umbilical

vein, the connection closes and vein, the connection closes and becomes ligamentum arteriosumbecomes ligamentum arteriosum

WarmthWarmth

Thermoregulation must begin at Thermoregulation must begin at birth-balance of heat loss and heat birth-balance of heat loss and heat productionproduction

When cold, the infant needs to raise When cold, the infant needs to raise the metabolism to increase the heatthe metabolism to increase the heat

Infants do not shiver when coldInfants do not shiver when cold Infant will break down brown fat on Infant will break down brown fat on

body to increase metabolismbody to increase metabolism

WarmthWarmth

Brown at is on back of neck, between Brown at is on back of neck, between scapula, around kidneys and around scapula, around kidneys and around adrenalsadrenals

Brown fat is deposited at 26-30 Brown fat is deposited at 26-30 weeksweeks

Increased metaboism requires more Increased metaboism requires more oxygenoxygen

Infant may present with hypoxiaInfant may present with hypoxia

Heat retentionHeat retention

Infant normaly lays in fetal or flexed Infant normaly lays in fetal or flexed position to maintain heatposition to maintain heat

Vasoconstriction allows head Vasoconstriction allows head retentionretention

Heat lossHeat loss

Newborn heat moves from internal to Newborn heat moves from internal to periphery to external environmentperiphery to external environment

Excess heat loss is cold stressExcess heat loss is cold stress Infant becomes cold and begins to Infant becomes cold and begins to

break down brown fat …break down brown fat … To increase metabolismTo increase metabolism Increased metabolism requires more Increased metabolism requires more

oxygen…hypoxia can develop oxygen…hypoxia can develop

Heat lossHeat loss

Prolonged cold stress reduces Prolonged cold stress reduces surfactant production which surfactant production which increases lung resistance and increases lung resistance and respiratory distressrespiratory distress

When glucose stores depleted; When glucose stores depleted; Hypoglycema develops… from brown Hypoglycema develops… from brown fat breakdown, fatty acids are fat breakdown, fatty acids are released=metabolic acidosis released=metabolic acidosis

Heat lossHeat loss

Excess fatty acid release causes less Excess fatty acid release causes less bilirubin to be transported to the liver bilirubin to be transported to the liver and jaundice may developand jaundice may develop

Heat loss methodsHeat loss methods

Conduction: direct contact with a Conduction: direct contact with a cool objectcool object• Hands, stethoscopeHands, stethoscope

Convection: movements of airConvection: movements of air• Air conditioning, open doorAir conditioning, open door

Evaporation: water is changed into Evaporation: water is changed into vapor vapor • Drying of wet infantDrying of wet infant

Heat loss methodsHeat loss methods

RadiationRadiation• cooler objects near sides of crib walls of cooler objects near sides of crib walls of

isoletteisolette

• Reduced by keeping cribs away from Reduced by keeping cribs away from draftsdrafts

APGARAPGAR22 11 00

Heart rateHeart rate(Pulse)(Pulse)

over 100over 100 Below 100Below 100 absentabsent

Inspiratory Inspiratory efforteffort(Rate and effort)(Rate and effort)

good crygood cry SlowSlow absentabsent

Muscle toneMuscle tone(Activity)(Activity)

activeactive Some flexionSome flexion flaccidflaccid

ColorColor(Appearance)(Appearance)

Completely pinkCompletely pink body pink body pink extremities blue extremities blue

pale blue-graypale blue-gray

Reflex Reflex irritabilityirritability(Grimace)(Grimace)

vigorous cry, vigorous cry, pulls away, pulls away, sneezessneezes

Grimace Grimace w/stimulationw/stimulation

NoneNone

Newborn TestNewborn Test The newborn is commonly The newborn is commonly

assessed with the APGAR assessed with the APGAR score, a quick test score, a quick test performed at 1 and 5 performed at 1 and 5 minutes after birth to minutes after birth to determine the physical determine the physical condition of the newborn. condition of the newborn. The five categories The five categories assessed are heart rate, assessed are heart rate, respiratory effort, muscle respiratory effort, muscle tone, reflex irritability, and tone, reflex irritability, and color. Each of these color. Each of these categories is scored 0, 1, categories is scored 0, 1, or 2, depending on the or 2, depending on the observed condition of the observed condition of the newborn. newborn.

ResucitationResucitation

Usually suctioned with bulb syringe Usually suctioned with bulb syringe after birthafter birth

May need wall suction/ suction trap May need wall suction/ suction trap for excess mucusfor excess mucus

May need oxygenMay need oxygen RN or Physican will apply O2, suction RN or Physican will apply O2, suction

as neededas needed

Thermal environment Thermal environment

Infant temperature should be 97-99 fInfant temperature should be 97-99 f Warmth is importantWarmth is important Infant is placed under warmer after Infant is placed under warmer after

birth and in isolette in the nursery birth and in isolette in the nursery until infant can maintain own heatuntil infant can maintain own heat

Identification/ bondingIdentification/ bonding

Identification: identification bands on Identification: identification bands on one leg, one hand, foot prints (bold one leg, one hand, foot prints (bold numbers on the band) numbers on the band)

May breastfeed in delivery roomMay breastfeed in delivery room Parents may hold infantParents may hold infant Infant is usually very awake during Infant is usually very awake during

the first hour after birththe first hour after birth

Prophylactic careProphylactic care

Vitamin k: given in delivery room in Vitamin k: given in delivery room in left vastus lateralis IMleft vastus lateralis IM

Infant does not make vitamin K until Infant does not make vitamin K until food is present in intestine food is present in intestine

Usually about 8 days of age vitamin Usually about 8 days of age vitamin K is producedK is produced

Prophylactic careProphylactic care

Erythromycin ointment: placed in Erythromycin ointment: placed in both eyes in delivery room to both eyes in delivery room to prevent inflammation/ eye problems prevent inflammation/ eye problems from gonorrhea or chlamydiafrom gonorrhea or chlamydia

Umbilical cordUmbilical cord

Cord is checked for 3 vessels Cord is checked for 3 vessels Cord is clamped until cord is dryCord is clamped until cord is dry Cord is usually short and cleaned Cord is usually short and cleaned

with alcoholwith alcohol Cord clamp is removed when the Cord clamp is removed when the

cord is drycord is dry

Umbilical cordUmbilical cord

Cord may be kept long for Rh Cord may be kept long for Rh negative mother and Rh positive negative mother and Rh positive infant cord may be kept damp with infant cord may be kept damp with normal saline dressingsnormal saline dressings

Some hospitals clean the cord with Some hospitals clean the cord with triple dye-purple colortriple dye-purple color

Physical characteristicsPhysical characteristics

Weight: 2500-4000g 5 lb 8 oz-8lb Weight: 2500-4000g 5 lb 8 oz-8lb and 13 ozand 13 oz

Neonates loose 10% of birth weight Neonates loose 10% of birth weight and will gain weight back by 10-14 and will gain weight back by 10-14 days of lifedays of life

Average infant : 7 lbs 8 ounces and Average infant : 7 lbs 8 ounces and 20 inches long20 inches long

HeightHeight

45-55 cm or range 19-21 inches 45-55 cm or range 19-21 inches Head averages 13-14 inches and Head averages 13-14 inches and

chest 12-13 incheschest 12-13 inches Resp rate 30-60/minResp rate 30-60/min Heart rate 120-160/minHeart rate 120-160/min Axillary temp 97.6--98.6 fAxillary temp 97.6--98.6 f (Hospitals 97-99f)(Hospitals 97-99f)

SkinSkin

Generally pinkGenerally pink Acrocyanosis of hands and feetAcrocyanosis of hands and feet Lanugo on shoulders or foreheadLanugo on shoulders or forehead Vernix caseosa-in creasesVernix caseosa-in creases Physiologic jaundice after 24 hoursPhysiologic jaundice after 24 hours Pathologic jaundice before 24 hoursPathologic jaundice before 24 hours

HeadHead

Circumference 13-14 inchesCircumference 13-14 inches MoldingMolding Anterior fontanel-junction of saggital and Anterior fontanel-junction of saggital and

coronal sutures coronal sutures Diamond shaped 5 cm in sizeDiamond shaped 5 cm in size Closes by 18 monthsCloses by 18 months Posterior fontanel-at junction of Posterior fontanel-at junction of

lambdoidal and saggital sutures-closes by lambdoidal and saggital sutures-closes by 2 months—may not be palpable2 months—may not be palpable

EyesEyes

Sclera: white and clear Sclera: white and clear Pupils: react to lightPupils: react to light Do not accommodateDo not accommodate Strabismus (cross eyed): common for 3-4 Strabismus (cross eyed): common for 3-4

monthsmonths

Dolls eyes: for 10 days commonDolls eyes: for 10 days common Color: slate blue, grey, brownColor: slate blue, grey, brown Color established in 3 monthsColor established in 3 months

EarsEars

Ears: symmetrical in shape and sizeEars: symmetrical in shape and size Top of ear aligns with inner and outer Top of ear aligns with inner and outer

canthi of eyescanthi of eyes Hearing test should be done for all Hearing test should be done for all

infantsinfants Loud noise will create the startle Loud noise will create the startle

reflexreflex

Ear AlignmentEar Alignment

Top of ear aligns Top of ear aligns with inner and with inner and outer canthi of outer canthi of eyeseyes

Neck/ ChestNeck/ Chest

Neck is Neck is symmetrical symmetrical without webbing without webbing neck short, thick, neck short, thick, several folds, several folds, flexible flexible

Allows free Allows free movement of the movement of the head from side to head from side to sideside

Chest: Chest: circumference 12-circumference 12-13 inches 13 inches measured at the measured at the nipple line nipple line symmetricalsymmetrical

AbdomenAbdomen

Symmetrical/roundSymmetrical/round Moves with breathingMoves with breathing Bowel sounds audibleBowel sounds audible Umbilical cord clamped-whitish blue Umbilical cord clamped-whitish blue

color, 3 vesselscolor, 3 vessels Cord dries and falls of about 2 weeks Cord dries and falls of about 2 weeks

after birthafter birth

MeconiumMeconium

Meconium passed Meconium passed within 24 hourswithin 24 hours

GenitaliaGenitalia

Mature for gestational ageMature for gestational age Check for descent of testiclesCheck for descent of testicles Scrotum covered with rugaeScrotum covered with rugae Voiding should occur within 24 hoursVoiding should occur within 24 hours Rust stained urine (uric acid crystals) Rust stained urine (uric acid crystals)

may occur may occur Vernix in folds Vernix in folds

BackBack

Spine should be straight and easily Spine should be straight and easily flexedflexed

No limitation of movement or No limitation of movement or abnormality of spinal columnabnormality of spinal column

No bumps or tufts of hair seenNo bumps or tufts of hair seen

ExtremitiesExtremities

Check: the number of toes and fingersCheck: the number of toes and fingers Absence of digitsAbsence of digits Excess digitsExcess digits Syndactly-webbing of fingersSyndactly-webbing of fingers SymmetricalSymmetrical Range of motionRange of motion Creases on anterior 2/3 of sole of foot Creases on anterior 2/3 of sole of foot

Variations of newbornVariations of newborn

Vernix caseosaVernix caseosa

yellowish white yellowish white cream substance cream substance on bodyon body

Jaundice after 24 Jaundice after 24 hours-yellow color hours-yellow color on chest, face, on chest, face, sclerasclera


bluish color of bluish color of hands/ feethands/ feet

EcchymosisEcchymosis

bruisingbruising PetechiaePetechiae

small spots of small spots of bruisingbruising


Blue discoloration Blue discoloration of hands and feet of hands and feet after birth and for after birth and for about 24 hours but about 24 hours but can last as long as can last as long as 7-10 days7-10 days

VariationsVariations

Milia:Milia: Tiny white Tiny white papules (plugged papules (plugged sebaceous glands) sebaceous glands) located over nose, located over nose, cheek, and chin. cheek, and chin.


Newborn rash/ Newborn rash/ erythema erythema toxicum toxicum neonatorum:neonatorum:

hivelike rash hivelike rash that disappears that disappears without without treatmenttreatment


Talangietactic Talangietactic nevi/ stork bites:nevi/ stork bites:

Flat pink or red Flat pink or red marks on eyelids, marks on eyelids, nose, necknose, neck

Dilated capillaries Dilated capillaries and will disappear and will disappear at 1-2 years of ageat 1-2 years of age


Mongolian spots:Mongolian spots: pigmentation of pigmentation of

lumbar dorsal/ lumbar dorsal/ buttocks areabuttocks area

Look like black and Look like black and blue spotsblue spots

Seen in dark Seen in dark skinned personsskinned persons

Will dissapear in Will dissapear in timetime


Nevus flammeus:Nevus flammeus: Port wine colored Port wine colored

reddish/purple reddish/purple discoloration on discoloration on face or neckface or neck

May be lightened May be lightened or treated by laseror treated by laser

VariationsVariations Nevus Nevus

vascularis/ vascularis/ strawberry strawberry birthmark=enlabirthmark=enlarged superficial rged superficial blood vessels blood vessels often on head , often on head , face, neck, face, neck, arms, may arms, may disappear by disappear by school ageschool age


Molding:Molding: will disappear in a will disappear in a

day or two after day or two after deliverydelivery

Caput SuccedaneumCaput Succedaneum

Swelling of the soft Swelling of the soft tissue of the scalp tissue of the scalp caused by pressure caused by pressure of the fetal head on of the fetal head on a cervix that is not a cervix that is not fully dilated. fully dilated. Swelling crosses Swelling crosses suture line and suture line and decreases rapidly decreases rapidly in a few days after in a few days after birth. birth.

CephalhematomaCephalhematoma

Subperiosteal Subperiosteal extravasation of blood due extravasation of blood due rupture of vessels. Swelling rupture of vessels. Swelling increases in size on second increases in size on second and third day after and third day after delivery. Often associated delivery. Often associated with delivery by forceps. with delivery by forceps. Swelling does not cross Swelling does not cross suture line and may take suture line and may take several weeks after birth. several weeks after birth. Jaundice may occur as Jaundice may occur as blood cells are broken blood cells are broken down as the swelling down as the swelling resolves. resolves.

FaceFace

Face movements symmetricalFace movements symmetrical Epstein’s pearls on hard palateEpstein’s pearls on hard palate Precocious teeth-if loose removePrecocious teeth-if loose remove Nystagmus dissapears in 3-4 monthsNystagmus dissapears in 3-4 months Usually does not produce tearsUsually does not produce tears Check for candidia infectionCheck for candidia infection

EyesEyes

Eyelids edematous to ointmentEyelids edematous to ointment Strabismus common Strabismus common Can see 8-10 inches from faceCan see 8-10 inches from face Ears pinna located with outer Ears pinna located with outer

canthus of eyecanthus of eye Low set ears= may indicate Low set ears= may indicate

chromosome disorderchromosome disorder

ChestChest

Engorged breasts Engorged breasts may be present may be present due to estrogen due to estrogen nipples excrete nipples excrete whitish fluid-whitish fluid-

Witches milk- Witches milk- from day three to from day three to two weeks after two weeks after birthbirth

Will stop without Will stop without treatmenttreatment

AbdomenAbdomen

Check: umbilical cord,bowel sounds, Check: umbilical cord,bowel sounds, bowel movementbowel movement

Patent anusPatent anus Elimination: psuedomentration to Elimination: psuedomentration to

estrogen withdrawal during first estrogen withdrawal during first week blood tinged mucus from week blood tinged mucus from vagina will stop without treatmentvagina will stop without treatment

StoolStool

First stool is black-green and thick First stool is black-green and thick called meconiumcalled meconium

Transitional stool is greenish brown Transitional stool is greenish brown to yellowish brown and thinnerto yellowish brown and thinner

Milk stool= about day 4 with yellow Milk stool= about day 4 with yellow to golden stool breastfed infants to golden stool breastfed infants have a looser stool than formula fed have a looser stool than formula fed infants infants

StoolStool

Green watery stool is diarrhea and is Green watery stool is diarrhea and is serious in the newbornserious in the newborn

This is not a normal stoolThis is not a normal stool Notify physician immediatelyNotify physician immediately Infant can dehydrate quicklyInfant can dehydrate quickly Monitor for: hydrocele, Monitor for: hydrocele,

cryptochidism, phimosis (foreskin), cryptochidism, phimosis (foreskin), epispadias (urethra displacement), epispadias (urethra displacement), hypospadius (urethra displacement)hypospadius (urethra displacement)

CryptorchidismCryptorchidism In normal fetal In normal fetal

development, during the development, during the last months of birth, the last months of birth, the testicles develop in the testicles develop in the abdomen and descend into abdomen and descend into the scrotum in the male the scrotum in the male fetus. Sometimes at birth, fetus. Sometimes at birth, one or both testicles may one or both testicles may fail to descend into the fail to descend into the scrotum. If the testicle has scrotum. If the testicle has not descended within the not descended within the first year of the baby's life, first year of the baby's life, surgery may be surgery may be recommended to return recommended to return the testicle to its proper the testicle to its proper position in the scrotum. position in the scrotum.

HydroceleHydrocele A hydrocele is a collection of A hydrocele is a collection of

fluid inside the area of the fluid inside the area of the scrotum, surrounding the scrotum, surrounding the testicle. Hydroceles are testicle. Hydroceles are common in newborn infants common in newborn infants and normally resolve after a and normally resolve after a few months after birth. The few months after birth. The main symptom is a painless, main symptom is a painless, swollen testicle, on one or swollen testicle, on one or both sides, which feels like a both sides, which feels like a water-filled balloon. water-filled balloon. Hydroceles are usually not Hydroceles are usually not dangerous, and they are dangerous, and they are usually only treated when usually only treated when they cause discomfort or they cause discomfort or embarrassment, or they get embarrassment, or they get so large that they threaten so large that they threaten the blood supply of the the blood supply of the testicle. testicle.

ExtremitiesExtremities

Spine straightSpine straight Extremities symetrical and move Extremities symetrical and move

freelyfreely Polydactyly=extra digitsPolydactyly=extra digits Syndactly=webbing of hands or feetSyndactly=webbing of hands or feet Hip dysplasia-one leg longerHip dysplasia-one leg longer Down’s syndrome-one crease across Down’s syndrome-one crease across

handhand

Syndactly/PolydactylySyndactly/Polydactyly

Hip dysplasiaHip dysplasia

One leg longer One leg longer than otherthan other

Asymmetrical skin Asymmetrical skin foldsfolds

Downs Syndrome Downs Syndrome Simian Line Simian Line

ReflexesReflexes

Rooting: touch face or corner of Rooting: touch face or corner of infant mouth and infant turns toward infant mouth and infant turns toward touchtouch

Sucking: usually strong at birthSucking: usually strong at birth Blink/ yawn/ gag: at birthBlink/ yawn/ gag: at birth Cough/ swallow: at birthCough/ swallow: at birth Hiccup/sneeze: at birthHiccup/sneeze: at birth

ReflexesReflexes

Extrusion: tip of tongue touched or Extrusion: tip of tongue touched or depressed infant will force tongue depressed infant will force tongue outwardoutward• Disappears at 4 monthsDisappears at 4 months

Grasp/palmar: infants fingers tighten Grasp/palmar: infants fingers tighten on finger when a finger is placed in on finger when a finger is placed in the infants palmthe infants palm• Present for 4 monthsPresent for 4 months

ReflexesReflexes

Plantar: toes curl downward when fingers Plantar: toes curl downward when fingers are placed at the base of the toesare placed at the base of the toes• Disappears at 8 monthsDisappears at 8 months

Tonic neck reflex (Fencing position) : when Tonic neck reflex (Fencing position) : when infants head is turned to one side, the arm infants head is turned to one side, the arm and leg on that side will extend while the and leg on that side will extend while the opposite arm and leg will flex opposite arm and leg will flex • disappears in 3-4 monthsdisappears in 3-4 months

ReflexesReflexes

Startle (Moro reflex):Startle (Moro reflex): sudden jarring causes extension and sudden jarring causes extension and

abduction of extremities index finger and abduction of extremities index finger and thumb form a cthumb form a c• Disappears in 3-4 monthsDisappears in 3-4 months

Trunk incurvation(gallant): Infant prone Trunk incurvation(gallant): Infant prone run finger down back 1 ½ -2 inches from run finger down back 1 ½ -2 inches from spine on one side and the other. Trunk is spine on one side and the other. Trunk is flexed and pelvis moved toward the flexed and pelvis moved toward the stimulated sidestimulated side• Disappears 1 monthDisappears 1 month

RelfexesRelfexes

Dancing or stepping reflex: when Dancing or stepping reflex: when held, sole of foot touches hard held, sole of foot touches hard surface there will be flexion and surface there will be flexion and extension of leg as if walking extension of leg as if walking • Disappears 3-4 weeksDisappears 3-4 weeks

ReflexesReflexes

Babinski: sole of foot is stroked from Babinski: sole of foot is stroked from heel to toe , the toes will fan out with heel to toe , the toes will fan out with dorsiflexion of the big toedorsiflexion of the big toe• Disappears in 12-18 monthsDisappears in 12-18 months

Normal periods of reactivityNormal periods of reactivity

First period of reactivity-first 30 First period of reactivity-first 30 minutes after birthminutes after birth

Infant is alert good time fore Infant is alert good time fore breastfeedingbreastfeeding

Spontaneous startle reflex, crying, Spontaneous startle reflex, crying, tremorstremors

Sleep will last 2-4 hours Sleep will last 2-4 hours

Second period of reactivitySecond period of reactivity

Can range in time from 10 minutes to Can range in time from 10 minutes to several hoursseveral hours

Have increased muscle tone, often Have increased muscle tone, often mucus production mucus production

May spit up May spit up Brazelton behavioral states: quiet Brazelton behavioral states: quiet

sleep=eyes closedsleep=eyes closed Active sleep=stretch,face changesActive sleep=stretch,face changes

Sleep statesSleep states

Drowsy state=eyes open Drowsy state=eyes open Quiet alert=focus on environmentQuiet alert=focus on environment Active alert=fussyActive alert=fussy Crying state=crying, jerking Crying state=crying, jerking

movements movements

Gestational assessmentGestational assessment

External physical characteristicsExternal physical characteristics Resting posture=newborn is flexedResting posture=newborn is flexed Skin=preterm has transparent skin Skin=preterm has transparent skin

newborn may have cracking of skin newborn may have cracking of skin at ankles and feetat ankles and feet

Lanugo=abundant at 28-30 weeksLanugo=abundant at 28-30 weeks


Lanugo: full termLanugo: full term Slight on shoulders, ears, side of Slight on shoulders, ears, side of

forehead forehead Plantar creases= develop at 32 Plantar creases= develop at 32

weeks and cover 2/3 of sole by 37 weeks and cover 2/3 of sole by 37 weeks , cover entire sole at 40 weeksweeks , cover entire sole at 40 weeks


Breast size= 1 cm at termBreast size= 1 cm at term

Eye/ear=32 weeks minimal ear Eye/ear=32 weeks minimal ear cartilege cartilege

Full term= cartilage springs back Full term= cartilage springs back when foldedwhen folded

Neuromuscular maturityNeuromuscular maturity

Square window=bend wrist so palm Square window=bend wrist so palm is flat against the armis flat against the arm

Scarf sign= arm is drawn across Scarf sign= arm is drawn across body toward opposite shoulder until body toward opposite shoulder until resistance is feltresistance is felt

Birth classificationsBirth classifications

Small for gestational age= infant is Small for gestational age= infant is below 10below 10thth percentile for gestational percentile for gestational age age

Appropriate for gestational Appropriate for gestational age=infant is between 10age=infant is between 10thth and 90 and 90thth percentile for gestational agepercentile for gestational age

LGA / sleep positionLGA / sleep position

Large for gestational ageLarge for gestational age Infant is above the 90Infant is above the 90thth percentile for percentile for

gestational age gestational age

Sleep position= infant on back to Sleep position= infant on back to prevent sudden infant death prevent sudden infant death syndromesyndrome

Infant bathInfant bath

In hospital: usually one hour after In hospital: usually one hour after birth or when infant can maintain birth or when infant can maintain temperaturetemperature

Washed with hypoallergenic soap Washed with hypoallergenic soap Cord cleaned with alcoholCord cleaned with alcohol Diaper foldes under cordDiaper foldes under cord


At home At home Sponge bathSponge bath Room temperature 75 degrees free Room temperature 75 degrees free

of draftsof drafts Water 100 degrees Water 100 degrees Clean each eye= inner canthus to Clean each eye= inner canthus to

outer canthus with separate area of outer canthus with separate area of wash clothwash cloth

Use water for faceUse water for face


Infant not to have tub bath until cord Infant not to have tub bath until cord falls offfalls off

Clean front to back on perineal areaClean front to back on perineal area Never leave infant alone during bath Never leave infant alone during bath Do not use q tips to clean earsDo not use q tips to clean ears Dry well wrap in blanketDry well wrap in blanket

CircumcisionCircumcision

For: easy cleaning, religious reasons, For: easy cleaning, religious reasons, prevent surgery later, reduce urinary prevent surgery later, reduce urinary tract infectionstract infections

Against: painful, infection, adhesions, Against: painful, infection, adhesions, hemorrhagehemorrhage

Parent= signed consent required Parent= signed consent required infant on circumcision board some infant on circumcision board some physicians use lidocaine for nerve physicians use lidocaine for nerve blockblock

CircumcisionCircumcision Hospitals may use: 20% sucrose solution Hospitals may use: 20% sucrose solution

for infant for infant Sucking or pacifierSucking or pacifier Methods: gomco clamp or plastibellMethods: gomco clamp or plastibell Petroleum gauze used and changed with Petroleum gauze used and changed with

diaper changediaper change Assess for voiding and for bleeding may Assess for voiding and for bleeding may

use a&d ointment or petroleum jelly for use a&d ointment or petroleum jelly for moisture after proceduremoisture after procedure

Circumcision - series: Procedure

CircumcisionCircumcision Circumsicion of a newborn Circumsicion of a newborn

boy is usually done before boy is usually done before he leaves the hospital. A he leaves the hospital. A numbing medication (local numbing medication (local anesthesia such as anesthesia such as Xylocaine) is injected into Xylocaine) is injected into the penis to reduce pain. the penis to reduce pain. Ring-type clamps are Ring-type clamps are placed around the foreskin, placed around the foreskin, tightened like a tourniquet tightened like a tourniquet to reduce bleeding, and to reduce bleeding, and the foreskin is removed the foreskin is removed below the clamp. below the clamp. Sometimes a plastic clamp Sometimes a plastic clamp is used (Plastibell). The is used (Plastibell). The Plastibell will fall off in 5 to Plastibell will fall off in 5 to 8 days, after the surgical 8 days, after the surgical site has healed. site has healed.

AftercareAftercare For both newborns and older For both newborns and older

children, circumcision is children, circumcision is considered a very safe considered a very safe procedure with complete procedure with complete healing expected. Healing healing expected. Healing time for newborns usually time for newborns usually takes about 1 week. Apply takes about 1 week. Apply petroleum jelly after diaper petroleum jelly after diaper changes to protect the changes to protect the healing incision. Some initial healing incision. Some initial swelling and yellow crust swelling and yellow crust formation around the incision formation around the incision is normal. Healing time for is normal. Healing time for older children and older children and adolescents may take up to 3 adolescents may take up to 3 weeks. In most instances, the weeks. In most instances, the child will be discharged from child will be discharged from the hospital on the day of the the hospital on the day of the surgery. surgery.

Breastfeeding positionsBreastfeeding positions

Cradle=infant across mothers lapCradle=infant across mothers lap Foot ball hold=infant under mothers Foot ball hold=infant under mothers

armarm Lying down=mother lying on her sideLying down=mother lying on her side Infant is on the side facing motherInfant is on the side facing mother

Breast feedingBreast feeding

Benefits:Benefits: Correct temperature, inexpensive, Correct temperature, inexpensive,

immunoglobins, better jaw and tooth immunoglobins, better jaw and tooth alignment,alignment,

Bonding, no allergies, antibodies, Bonding, no allergies, antibodies, hormones reduce uterushormones reduce uterus

Breast milkBreast milk

Colostrum=produced for 2-4 daysColostrum=produced for 2-4 days Transitional milk or foremilk is Transitional milk or foremilk is

thinner and is more watery- more thinner and is more watery- more calories than colostrumcalories than colostrum

Hindmilk or mature milk present in Hindmilk or mature milk present in about 2 weeks has lactose, protein, about 2 weeks has lactose, protein, minerals and vitaminsminerals and vitamins

FormulaFormula

Thicker and richer Thicker and richer Feed q 3-4 hours Feed q 3-4 hours Vitamin d may be supplementedVitamin d may be supplemented Soy milk may be used for allergiesSoy milk may be used for allergies Burp freqentlyBurp freqently Do not heat formula or food in the Do not heat formula or food in the

microwavemicrowave

HyperbilirubinemiaHyperbilirubinemia

Physiologic or pathologic jaundice Physiologic or pathologic jaundice Management: increase feeding Management: increase feeding Feed q3h, bilirubin lights if needed-Feed q3h, bilirubin lights if needed-

eye patches on when under the lighteye patches on when under the light Bilirubin levels daily monitor Bilirubin levels daily monitor

temperature q2htemperature q2h If severe=exchange blood If severe=exchange blood

transfusiontransfusion

Respiratory distressRespiratory distress

Preterm infant or deficient surfactantPreterm infant or deficient surfactant Isolette with o2,cpap, o2 sat Isolette with o2,cpap, o2 sat

continuously, monitor heart rate, continuously, monitor heart rate, resp rate, vs, retractions, resp rate, vs, retractions,

Expiratory grunt, flaring of nares, Expiratory grunt, flaring of nares, cyanosiscyanosis

Iv fluid or tpn, artificial surfactantIv fluid or tpn, artificial surfactant

HydrocephalusHydrocephalus

Excess cerebral spinal fluid in the Excess cerebral spinal fluid in the ventriclesventricles

Monitor: fontanells for buldging, vital Monitor: fontanells for buldging, vital signs, head circumference daily, signs, head circumference daily, change position q2h, careful handlingchange position q2h, careful handling

Spina bifidaSpina bifida

Etiology: failure of the spinal column Etiology: failure of the spinal column to closeto close

Category: spina bifida cysticaCategory: spina bifida cystica Meningocele=external sac containing Meningocele=external sac containing

meninges and spinal fluid =protrudes meninges and spinal fluid =protrudes through defect in vertebral column through defect in vertebral column

Visible at birthVisible at birth


Myelomeningocele=often in Myelomeningocele=often in lumbosacral area lumbosacral area

Covered with fragile thin membraneCovered with fragile thin membrane Sac contains cerebral spinal fluid, Sac contains cerebral spinal fluid,

meninges, nervesmeninges, nerves Associated with motor and sensory Associated with motor and sensory

deficits below lesion of the corddeficits below lesion of the cord


Mylomeningocele=associated with Mylomeningocele=associated with downward displacement and downward displacement and improper development of part of the improper development of part of the brain, hydrocephalis which may not brain, hydrocephalis which may not be present at birthbe present at birth

Prefer delivery by c-section to Prefer delivery by c-section to prevent rupture of the sacprevent rupture of the sac


Management; Surgical repairManagement; Surgical repair Prevent infection- from leaking csf Prevent infection- from leaking csf

from the sac, side lying or prone from the sac, side lying or prone position, crede method to empty position, crede method to empty bladder, measure head bladder, measure head circumference, neuro assessment, circumference, neuro assessment, monitor sensation, movement, keep monitor sensation, movement, keep clean and dryclean and dry

Down syndromeDown syndrome

Trisomy of # 21 chromosomeTrisomy of # 21 chromosome Flat occiput, small: ears, nose and Flat occiput, small: ears, nose and

mouth, protruding tongue, broad mouth, protruding tongue, broad short hands with stubby fingers, short hands with stubby fingers, simian palmar crease,simian palmar crease,

Broad, stubby feet with wide space Broad, stubby feet with wide space between big toe and second toe, between big toe and second toe, mental retardationmental retardation

Talipes equinovarusTalipes equinovarus

Club foot: foot and ankle are twisted Club foot: foot and ankle are twisted out of normal positionout of normal position

Foot seems c shaped ; pointing Foot seems c shaped ; pointing downward and inwarddownward and inward

Management: splint, cast, special Management: splint, cast, special shoes shoes

Treatment begins soon after birthTreatment begins soon after birth

Infant of a diabetic motherInfant of a diabetic mother

Neonatal conditions: Neonatal conditions: Macrosomia, hypoglycemia, Macrosomia, hypoglycemia,

polyhydramnios, pre term birth, fetal polyhydramnios, pre term birth, fetal lung immaturitylung immaturity

Birth trauma polycythemiaBirth trauma polycythemia Hyperbilirubinemia Hyperbilirubinemia

Infant of hiv positive motherInfant of hiv positive mother

Clean skin with soap and water Clean skin with soap and water before injections givenbefore injections given

Zidovudine given for 6 weeks Zidovudine given for 6 weeks following deliveryfollowing delivery

If infant is positive=treatment with If infant is positive=treatment with combination of antiretroviral combination of antiretroviral medicationsmedications

Typically asymptomatic at birthTypically asymptomatic at birth

Hiv positive infantsHiv positive infants

May be low birthweightMay be low birthweight May develop opportunistic infections May develop opportunistic infections

within the first two years within the first two years Some children who are positive show Some children who are positive show

no symptoms for 8-10 yearsno symptoms for 8-10 years

Substance abuseSubstance abuse

Alcohol=fas=short eyelid opening, Alcohol=fas=short eyelid opening, flat midface, flat upper lip groove, flat midface, flat upper lip groove, thin upper lip, microcephaly, thin upper lip, microcephaly, hyperactivity, developmental delayshyperactivity, developmental delays

Cocaine=prematurity, poor feeding, Cocaine=prematurity, poor feeding, difficult to console, developmental difficult to console, developmental delays, prune belly, skull defectsdelays, prune belly, skull defects

Substance abuseSubstance abuse

Heroin=low birth weight, poor Heroin=low birth weight, poor feeding, vomiting, shrill cry, crying feeding, vomiting, shrill cry, crying incessantly, convulsions,tachypnea, incessantly, convulsions,tachypnea, tremors, sweatingtremors, sweating

Tobacco=low birth weight, Tobacco=low birth weight, bronchitis, pneumonia, bronchitis, pneumonia, developmental delaysdevelopmental delays

Infant screening testsInfant screening tests

Pku=phenylketonuriaPku=phenylketonuria Maple sugar disease=problems using Maple sugar disease=problems using

fats,proteinfats,protein HypothyroidHypothyroid GalactosemiaGalactosemia Medium chain acyl-coa Medium chain acyl-coa

dehyrogenase deficiency=unable to dehyrogenase deficiency=unable to convert fat into energyconvert fat into energy

Newborn testsNewborn tests

Homocystinuria=problems breaking Homocystinuria=problems breaking down proteindown protein

Congenital adrenal hyperplasia=Congenital adrenal hyperplasia= Adrenals do not make enough Adrenals do not make enough

cortisolcortisol

newborn

Documents

gestational agegraphs

estimated gestational

newborn infant swelling

gestational ageassigning

causesa caput succedaneum

different gestational

newborn infants

head size