Characteristics of a Healthy Newborn

Detailed newborn characteristics

1. CHARACTERISTICS OF HEALTHY NEWBORN PREPARED BY: RITTIKA DAS NEOGI, 1 ST YEAR M.Sc. NURSING

2. DEFINITION: Born at term (between 38 to 42 weeks) Avg. birth weight of above 2.5 kg Cries immediately after birth Establishes independent respiration Adapts to the extra-uterine environment No congenital anomalies

3. TERMINOLOGIES: NEONATAL PERIOD The period from birth to 28 days of life NEWBORN OR NEONATE the infant in this neonatal period

4. OBJECTIVES OF NEWBORN EXAMINATION For early detection of problems & initiation of prompt management 2. To collect information about the newborn. 3. To inform parents about current health status of the newborn. 4. To ensure health of the newborn in future.

5. SET-UP FOR NEWBORN EXAMINATION: Warm comfortable room, temp : 25 to 30° C, draught free. Baby completely undressed and rested on warm flat surface. Height of surface should be convenient for the examiner. A good source of light. Examiner’s hand should be clean and warm. Absence of unnecessary personnel to avoid infection.

6. PHYSICAL CHARACTERISTICS OF HEALTHY NEWBORN

7. WEIGHT Varies between 2.5 to 3.9 kgs, average is 2.9 kgs.

8. LENGTH: Average crown heel length is 50 cm (avg 48-53 cm)

9. HEAD CIRCUMFERENCE: Avg 35 cm, varies 33-37 cm. Bi-parietal dia is 9.5 cm.

10. CHEST CIRCUMFERENCE: Approximately 3 cm less than Head circumference at birth. Avg is 32 cm.

11. GENERAL APPEARANCE Body ratio is 1.8:1 Midpoint at the umbilicus The trunk is larger & extremities shorter Abdomen is prominent Head large with short neck posture is partial flexion as in utero

12. VITAL SIGNS a. Temperature: 36.5 – 37.5° C b. Respiration: 30 – 60 breaths/ min c. Pulse: 140 ± 20 beats / min d. Blood Pressure: Systolic: 60-80 mm of Hg. Diastolic: 25-40 mm of Hg. Average: 60-40 mm of Hg.

13. SKIN Skin is pinkish Covered with Vernix Caseosa Covered with Lanugo.

14. SKIN Mongolian spot Erythema Toxicum

15. HEAD FONTANELLES: Anterior & posterior fontanelles are palpable. It must be checked for Bulging, depressed, large or small.

16. CAPUT SUCCEDENUM It is the swelling due to stagnation of fluid in layers of scalp. Formed due to compression on descending head by vulval ring. It reduces spontaneousl y within 24 hrs. of birth.

17. CEPHALHEMATOMA It happens due to sub-periosteal hemorrhage resulting from traumatic delivery.

18. MOULDING It is the alteration of shape of the fore-coming head while passing through birth canal during labour.

19. HAIRS It is silky and black in appearance and each fiber is easily understandable.

20. NECK Neck must be checked for mobility, fracture clavicle, rigidity, hyperextension, sternomastoid hematoma, webbing, etc .

21. FACE Face is symmetrical, without frontal bossing, facial paralysis, swelling or abnormal twitching.

22. MOUTH Mouth is checked for thrush, natal teeth, cleft lip or palate, micro or macroglossia, tongue tie.

23. EAR The ear cartilage is firm, fully curved & shows good elastic recoil. Low set ears, discharge, audiometry are checked for.

24. EYES Eyes remain mostly covered with eyelids & closed as the newborn is asleep almost for 20 hours a day. Pupils are reactive to light.

25. EYES Eyes are checked for edema, conjunctivitis, discharge, sub-conjunctival hemorrhage, yellowish discoloration of sclera, hypertelorism.

26. CHEST Chest is checked for abnormal shape & size, asymmetry, rate & rhythm of respiration, retraction, abnormal respiratory and heart sounds.

27. Breast tissue is palpable & over 5mm in diameter. Development of nipple & breast tissue is checked for gestational age assessment. Enlargement of breast tissue & & white discharge from nipple may be caused by effects of maternal estrogen.

28. ABDOMEN Abdomen is smooth & rounded, auscultation of abdomen reveals bowel sounds in quadrants of abdomen

29. Abdomen must be observed for distension, abdominal mass, enlargement of organs.

30. UMBILICUS: Cord stump looks white, shiny & feels damp. As the stump dries and heals, it turns black or brown.

31. UMBILICUS: Observed for signs of infection, discharge, redness around insertion, greenish yellow coloured cord, single umbilical artery, omphalocele.

32. BACK Spine is shaped as ‘C’ as the newborn sleeps in fetal position, tucking knees beneath the chest in good flexion.

33. Back is checked for abnormal spinal curvature, tufts of hair or skin, disruption in continuation.

34. GENITALIA (MALE) Full term baby will have both testes in scrotal sac, scrotum is pigmented, wrinkled with rugae.

35. Penis is examined for Hypospadias, Epispadias, phimosis.

36. GENITALIA (FEMALE) Labia majora will cover the labia minora.

37. Check for clitoral enlargement, fused labia & clitoris, blood stained vaginal discharge etc.

38. BUTTOCKS: Assessed for abnormal mass, anal fissure, imperforation, etc.

39. EXTRIMITIES Limbs are examined for fractures, paralysis, range of motions, missing digits, polydactyl, syndactyl, talipes

40. PHYSIOLOGICAL CHARACTERISTICS Cries immediately after birth & establishes spontaneous respiration. Neonates breath with nose & mouth. Respiration is periodic, shallow, irregular, thoraco-abdominal. Heart rate may be irregular & increased during crying. Breastfeeding done within one hour of birth preferably. Newborn spends 80% of time in sleeping.

41. PHYSIOLOGICAL CHARACTERISTICS Energy requirement increases from 55kcal/kg/day to 120 kcal/kg /day within a week. Protein & carbohydrate are easily digested. Imperfect control over cardiac sphincter causes regurgitation & vomiting. Neonates loses 7-8% of body weight by first week of life & regains in 10th day. Baby passes urine within 24 hours of birth and 7-8 times a day. Meconium is passed within 48 hours and 3-4 times a day and till 3-4 days.

42. PHYSIOLOGICAL CHARACTERISTICS Blood volume: 80 ml/ kg of body weight. RBC: 6-8 million/cu mm. WBC: 10,000-17,000/ cu mm. Platelets: 35,000/ cu mm. HB %: 18 gm % Increased ESR RBC are easily destructible. Deficit of Vitamin K causes poor blood clotting. Blood sugar & calcium level is low. IgG level is high. IgM is absent. T lymphocyte functions are reduced.

43. PHYSIOLOGICAL CHARACTERISTICS Immature neurological development causes poor temperature regulation, poor muscular control & uncoordinated movements. Limited hepatic functions lead to decreased ability to conjugate bilirubin level, regulate blood glucose levels & produce coagulation factors.

44. NEWBORN REFLEXS

45. ROOTING REFLEX

46. SUCKING REFLEX

47. SWALLOING REFLEX

48. SNEEZING REFLEX

49. GAGGING REFLEX

50. EXTRUSION REFLEX If a Substance is placed in the anterior aspect of tongue, the substance is pushed out by tongue. Extrusion of substance to prevent swallowing. Disappears in about 4 months.

51. DOLL’S EYE REFLEX Turn the newborn’s head slowly to the right or left side. Normally eyes do not move. When fixation develops.

52. PALMAR AND PLANTER GRASP

53. MORO REFLEX

54. BABINSKI REFLEX

55. TONIC NECK REFLEX

56. DANCING STEPS REFLEX

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