Characteristic of newborn and reflexes

Characteristic of newborn and reflexes

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

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. 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

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- 40-60breats /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. Blueness of the hands and feet is frequently seen during the early hours of life. CHARACTERISTICS OF NEWBORN SKIN.

7. BROWN FAT Infants who are chilled can produce body heat through stimulating the metabolism of brown fat, a special adipose tissue in newborns, located between the scapulae, around the neck, in the axillae , behind the sternum, around the kidneys, and surrounding some of the major arteries. It is important to keep the neonate warm to avoid excess energy expenditure. Brown fat is the infant’s last defense mechanism against hypothermia Immature brown  adipocytes can be seen as early as 29 weeks' gestation. But it matures at 35th week. CHARACTERISTICS OF NEWBORN SKIN.

8. 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.

9. 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.

10. 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.

11. 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 .

12. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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 . 

18. 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.

19. 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.

20. 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

21. 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 .

22. 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 rather than round shape. Newborn head  molding  is a common occurrence that usually disappears after a few days .

23. CHARACTERISTICS OF NEWBORN HEAD. 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

24. CHARACTERISTICS OF NEWBORN HEAD. 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.

25. CHARACTERISTICS OF NEWBORN HEAD. 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.

26. 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.

27. CHARACTERISTICS OF NEWBORN EYES. 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.

28. CHARACTERISTICS OF NEWBORN EYES. 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

29. CHARACTERISTICS OF NEWBORN EYES. 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.

30. 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

31. 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 .

32. 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.

33. CHARACTERISTICS OF NEWBORN GASTROINTESTINAL SYSTEM 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.

34. CHARACTERISTICS OF NEWBORN GASTROINTESTINAL SYSTEM 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

35. 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 .

36. 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

37. 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.

38. NEWBORN REFLEXES

39. 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

40. 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

41. 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

42. 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

43. NEWBORN REFLEXES   Pupillary Reflex:-   Pupil contracts when bright light shines, it persists throughout life.   Sneeze reflex :- Nasal passage respond spontaneously to irritation or obstruction, persists throughout life.

44. 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.

45. 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

46. 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.

47. 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

48. 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.

49. 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 .

50. 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

51. NEWBORN REFLEXES   Moro Reflex :- There are many ways to elicit Moro reflex. However, the most common method used is the “ drop method ” wherein the  nurse  lifts the baby completely off the bed while supporting the head and the neck, and then the nurse lowers the baby rapidly till there is only 4-8 inches between the baby and the bed. It is important to note that while doing this, the baby is kept in supine position. Complete Moro reflex involves bilateral abduction of arms, extension of forearms, and fanning of fingers with index fingger and thumb forming a C shape. Disappear at 3 – 4 month

52. 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

53. 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

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

55. 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 .

56. 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.

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