neonatal stage.pptx

neonatal stage

1. CHARACTERISTICS OF NEWBORN & REFLEXES

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 38-4 weeks) should have an average birth weight for the country (usually exceed 2500 gm .), cries immediately following birth, establishes independent rhythmic respiration and quickly adapts to changed environment . DEFINIT I ON

4. PHYSIOLOGY AND C H A R A C TERISTICS 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- 40-60breat h /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 C H A R A C TERISTICS 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 . C H A R A C TERISTICS OF NEWBORN SKIN.

7. C H A R A C TERISTICS 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.

8. C H A R A C TERISTICS 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

9. C H A R A C TERISTICS 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.

10. C H A R A C TERISTICS OF NEWBORN SKIN. SKIN CHANGES Jaundice -The skin and whites of the eyes appear yellow. yellow color comes from a pigment called Bilirubin which is released from the normal breakdown of RBC. The liver removes Bilirubin and excretes into the Gastrointestinal tract the Bilirubin builds up faster due to high RBC breakdown and since, the liver is immature, it cannot eliminate fully Bilirubin gets accumulated in the baby’s body which is the cause for causing Jaundice

11. C H A R A C TERISTICS 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 caused due to the change in environment since the baby had been living inside a fluid environment in the mother’s womb for the past 9 months

12. C H A R A C TERISTICS OF NEWBORN SKIN. SKIN CHANGES Erythema Toxicum develop a pat chy red rash called erythema toxicum (also called “flea bites ”) which fade by the time the baby is several weeks old Caused due to the accumulation of eosinophils in dermal lesions

13. C H A R A C TERISTICS OF NEWBORN SKIN. SKIN CHANGES Stork bites red areas around their foreheads, eyelids, and noses or on the backs of their necks more visible when the baby cries and disappear by itself during the first year Caused when blood vessels dilate under the skin during fetal development and hence, the blood flow increases to that area

14. C H A R A C TERISTICS OF NEWBORN SKIN. SKIN CHANGES Milia look like " white heads usually appear on the nose or chin usually disappear by themselves in the first weeks of life Occurs when the sweat glands get blocked since they are not fully developed

15. C H A R A C TERISTICS OF NEWBORN SKIN. SKIN CHANGES Mongolian Spot refers to a macular blue-gray pigmentation usually on the sacral area of healthy infants usually present at birth or appears within the first weeks of life Occurs when the pigment cells make melanin under the skin’s surface during embryonic development typically disappears spontaneously within 4 years but can also persist for life

16. C H A R A C TERISTICS OF NEWBORN SKIN. SKIN CHANGES Petechiae small, blue-red dots on the infant's body caused by breakage of tiny capillaries seen on the face as a result of pressure exerted on the head during birth

17. CHARACTERISTICS OF NEWBORN HEAD Fontane l l es Neonate is born with six fontanelles (soft membraneous gaps) Anterior Fontanel- on the top of the head , diamond shaped Posterior Fontanel –on the back of the head, triangular shaped Mastoid Fontanel –total two -one on left side and other on the right side of the head Sphenoid Fontanel- total two- one on left side and other on the right side of the head FUNCTIONS: Bones are not joined together firmly at birth which allows the head to change shape to help it pass through the birth canal. allows the brain and skull to grow during the infant’s first year .The fibrous connective tissue(suture) found at the joining of the bone in the skull gradually gain minerals and hardens, firmly joining the skull bines together Closure : Posterior Fontanelle:2-3 months Anterior Fontanelle : 12-18 months Sphenoid Fontanelle : 6 months Mastoid Fontanelle : 6-18 months

18. 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 (elongated shape) rather than round shape. Newborn head molding is a common occurrence that usually disappears after a few days .

19. CHARACTERISTICS OF NEWBORN HEAD Caput Succedaneum swelling of the scalp in a newborn caused 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

20. CHARACTERISTICS OF NEWBORN HEAD. Cephalohematoma Accumulation of blood under the scalp During the birthing process, shearing forces on the skull and scalp result in the separation of the periosteum from the underlying skull resulting in the subsequent rupture of blood vessels Note: The periosteum is a dense, fibrous connective tissue sheath that covers the bones

21. CHARACTERISTICS OF NEWBORN HEAD. Craniosynostosis occurs when one or more of the sutures closes early before the baby’s brain is fully formed As the brain grows, the skull will take an unusual shape.

22. CHARACTERISTICS OF NEWBORN EYES Eye Lid Edema Newborn tend to have their eyes tightly closed Pressure on face during childbirth can make newborn's eyelids temporarily puffy or swollen

23. CHARACTERISTICS OF NEWBORN EYES. Lacrimal A pparatus The lacrimal A pparatus (glands) is small and nonfunctioning at birth and tears are not usually produced with crying until one to three months of age .

24. CHARACTERI S TICS OF NEWBORN G A S T R O INT E S T I N AL SYSTEM MOUTH The infant's lips should be pink and the tongue smooth and symmetrical. The tongue should not extend or protrude b e t w een t h e li p s N o s a l i v a t ion f o r t h e f i r s t 3 m o n t hs .   babies (unlike adults) do have lipase in their mouths to initiate fat digestion

25. NEW BORN BREAST Breasts Both male and female newborns may have some swelling under the nipples. This is a result of maternal hormones and will disappear over a few weeks. Occasionally, some milky discharge may occur. This is normal. Simply wipe any discharge away.

26. GENITALS Both male and female infants may develop swollen and red genitals during their passage through the birth canal Genital Areas Vaginal Discharge : It is common for baby girls to have a thick creamy or bloody vaginal discharge for the first two to three weeks of life. This is the result of maternal hormones and is not a reason for concern.

27. NEWBORN REFLE X ES

28. NEWBORN REFLEXES R o o t i ng r e fle x : - When th e che e k 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 Su c king r e f l ex : - When touching or stroking the lips, the mouth opens and sucking movements begin.It begins to diminish at 6 months

29. NEWBORN REFLEXES Moro Reflex :- There are many ways to elicit Moro reflex. However, the most common method used is the “ drop m et h od ” w h e re i n th e n u r s e lif t s th e b a b y co m p l e t e l y o f f th e 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

30. 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.

31. NEWBORN REFLEXES Crawling Reflex When the infant is placed on the stomach and pressure (such as hand) is applied to the sole of the foot, the infant will attempt to push against the hand and move the arms and legs in crawling like motion Dissapearance : Few weeks to months after birth

32. NEWBORN REFLEXES E x t rution R e f lex : - When substance placed on be expelled out. It disappear at about age 4 month B l i n k i ng r e flex o r C o r neal R e f l ex : - anterior portion of the tongue, it’ll Protection of eye by rapid eye lid closure when the eyes are exposed to bright light. It does not disappear

33. NEWBORN REFLEXES D o l l ’s Ey e R e f l ex : - As head is mov e d 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

34. NEWBORN REFLEXES G l ab e l lar R e f lex : - Tapping briskly on eyes to close tightly Y a w n r e f lex : - Infant has spontaneous response to glabella(bridge of nose) cause decreased oxygen by increasing amount of inspired air, persists throughout life.

35. NEWBORN REFLEXES C o u gh R e f l e x : - Irri t ation of mucous membranes of larynx causes coughing, persists throughout the life; Usually present after 1st day of birth. B ab i n ski r e flex : - When the bottom of the foot is stroked from the heel upward along the outward part of the foot, the big toe bends back and the other toes spread out . Disappear after one year of age

36. NEWBORN REFLEXES P a l m ar G r asp : - When the objects are place in the palm of newborn, it grasps the object. Diminishes by 3 month of age 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

37. NEWBORN REFLEXES Step r e fl e x : - When holding the infant upright with legs and feet touching a surface, the infant will move the legs like steps or walking Disappearance: -About 3-4 months of age

38. NEWBORN REFLEXES S t a r tle R e f l ex : - St a rt l e reflex i s 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

39. PERCEPTUAL SKILLS IN NEONATES  Perceptual skills include vision, hearing, smell, taste, and touch VISION within the first month, their eye movement begins to strengthen. They can distinguish light from dark at birth. Prefer stripes and curved lines At birth lens, nerves and muscles of the eye are just developing Newborns can’t see small objects that are far away Prefer and identify mother’s face

40. Newborns initially look around the edge of image to develop a unified whole, Newborns prefer to look at patterned figures rather than plain figure. As they grow older they focus on more complex patterns

41. Very fuzzy image 1 month 2 month s 3 months 4 month s

42. HEARING Perception develops in utero and is fully operative at birth. auditory perception appears to be influenced by prenatal experiences with sounds. For example, newborns prefer listening to their own mother’s voice over the voice of another woman. At birth Can hear better than they can see Can be startled by loud noises Can turn toward soft sounds Can discriminate among sounds that differ in loudness, duration, direction, and frequency/pitch

43. Touch Perception The sense of touch develop before birth Newborns are sensitive to warm and cold- can understand well the difference when placed on their cheeks A touch on lip –Suckling movement Sensitive to painful stimuli like needle pricks Taste Perception Sensory receptors-taste buds on the tongue Newborns can distinguish sweet, bitter, and sour tastes and show preference for sweet Sensitivity to taste present even before birth

44. Smell Sensory receptors of smell are present in the nasal passage Response positively to pleasant smell(Vanilla, Strawberry) and negatively towards unpleasant smell(Rotten eggs, Fish smell) Just after birth infants when placed down between mother’s breast –they spontaneously latch on to nipple and starts sucking within an hour

45. NEEDS OF NEWBORN L o v e a n d a ff ecti o n H u m a n c o n t a c t a n d S e n s o ry s t i mula t i o n Su c k ing a n d B r east f ee d ing 2 - 3 h o u r s M a i ntain b o d y t e m p erature H y g i e n ic n ee d s P r e ve n ti o n o f i n j ur y /as p ira t i on P r e ve n ti o n o f i n f ec t i o n a n d i n j u ry P r o v isi o n o f o p t i ma l nu t r iti o n W a t ch f o r d a n g er s i g n s o f n e w b o rn li k e h y p o t hermia, h y p og l ycemi a , j a u nd i ce, a p n e a , e t c .