CHARACTERISTICS OF NEWBORN

In medical contexts, newborn or neonate (from Latin, neonatus, newborn) refers to an infant in the first 28 days after birth. Healthy newborn infant born at term, cries immediately after birth and establish satisfactory rhythmic pulmonary respiration.

POSTURE:The newborn assumes the same posture after birth as in utero.

MEASUREMENTS: Length 50 cm (20 inches). Weight 2.8 to 3.5 kg. Head circumference 33 35 cm. Chest circumference 30 - 33 cm.

VITAL SIGNS OF THE NEWBORN INFANTS

TEMPERATURE Infants temperature at birth is slightly higher than the mothers. The temperature drops immediately after birth in response to the extra uterine environment due to Skin is very thin and does not contain much subcutaneous fat. The infants heat regulating mechanism has not fully developed.

The temperature rises normal within about 8 hours. Normal body temperature for a healthy baby is between 97 and 100.4 degrees Fahrenheit (36 to 38 degrees Celsius) - American Academy of Pediatrics (AAP). PULSE

 The pulse rate is normally irregular, due to immaturity of the cardiac regulatory center in the medulla. The normal pulse ranges for an infant is 120 to 150 beats per minute (bpm). The rate may raise when infant is crying and drop when infant is sleeping. The apical pulse is considered the most accurate. RESPIRATION Respirations in the neonate are irregular in depth, rate and rhythm. It varies from 35 to 50 per minute. Normally, respirations are gentle, quiet, rapid, and shallow. BLOOD PRESSURE In infants the flush and Doppler* methods of blood pressure measurement are usually used. Normal blood pressure at birth is determined by the birth weight of the baby. A newborn has a normal blood pressure of about 70 over 42 mm of Hg.

CHARACTERISTICS OF NEWBORN INFANTS HEAD

Infants head is one fourth of his total body length. Normal head circumference is 3335 cm (13- 14). FONTANELS (SOFT SPOTS) The fontanels are openings at the points of union of the skull bones. There are normally several fontanels on a newborn's skull, mainly at the top, back, and sides of the head. 1. Anterior fontanel (bregma) The anterior fontanel is diamond shaped and is located at juncture of two parietal and two frontal bones. It is 2 to 3 cm in width and 3 to 4 cm in length. It usually closes between 12 to 18 months. The posterior fontanel is triangular and located between the occipital and parietal bones.
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2. Posterior fontanel (lamda)

It is much smaller than the anterior fontanel. It usually closes between 1 to 2 months.

Figure 1 Sutures of skull

Figure 2 Fontanels

 MOLDING Molding is the temporary reshaping of the fetal head as it passes through the birth canal during childbirth. During the molding process the over lapping of skull bones occurred and it reduces the diameter of the skull temporarily. This elongated look usually disappears a few hours after birth.

Figure 3 Molding

Figure 4 Molding

 CAPUT SUCCEDANEUM Causes Mechanical trauma of the initial portion of scalp pushing through a narrowed cervix Prolonged or difficult delivery Vacuum extraction A caput succedaneum is an edema of the scalp at the neonates presenting part of the head. It often appears over the vertex of the newborns head as a result of pressure against the mothers cervix during labor. The edema in caput succedaneum crosses the suture lines. It may involve wide areas of the head or it may just be a size of a large egg.

Management Needs no treatment. The edema is gradually absorbed and disappears about the third day of life.

Figure 5 Caput succedaneum and Cephalhematoma

 CEPHALHEMATOMA Causes Rupture of a periostal capillary due to the pressure of birth Instrumental delivery. It is an accumulation of blood between the periosteum and a flat skull bone. The collection of blood does not cross a suture line. A Cephalhematoma may not be evident during the first few days of life because of the presence of a large caput succedaneum. Aspiration of this sanguineous collection should not be done because of danger of infection. The condition usually clears within few weeks.

Management Observation and support of the affected part. Transfusion and phototherapy may be necessary if blood accumulation is significant. DIFFERENCE BETWEEN A CAPUT SUCCEDANEUM AND CEPHALHEMATOMA INDICATORS Location CAPUT SUCCEDANEUM CEPHALHEMATOMA

Presenting part of the head Periosteum of skull bone and bone

Extent of Involvement Period of Absorption Treatment

Both hemispheres; CROSSES Individual bone; DOES NOT the suture lines 3 to 4 days None CROSS the suture lines Few weeks to months Support

CHARACTERISTICS OF NEWBORN INFANTS SKIN

A baby's skin colour often changes with environment and health. In fact, right after a baby is born the colour if his skin may appear dark red or purple, but as the infant breathes his colour brightens to a red. This redness should fade during the first 24 hours, but the baby's feet and hands may continue to have a bluish hint for several days. Good elasticity, or turgor, is evidence that an infant is in good condition. 1. LANUGO Lanugo is the downy hair on the body of the fetus and newborn baby. It is the first hair to be produced by the fetal hair follicles, usually appearing on the fetus at about five months of gestation. It is very fine, soft, and usually unpigmented. It is normally shed before birth around seven or eight months of gestation. It is sometimes present at birth. It will disappear within a few days or weeks of its own accord.

Figure 6 Lanugo

2. VERNIX CASEOSA Vernix caseosa, also known as Vernix, is the waxy or cheese-like yellowish white substance found coating the skin of newborn human babies. It consists of secretions from the sebaceous gland and epithelial cells.
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It appears primarily in full term infants, while premature and post mature births generally lack any.

Functions Moisturizing the infant's skin, and facilitating passage through the birth canal. It serves to conserve heat and protect the delicate newborn skin from environmental stress. Vernix is also thought to have an antibacterial effect. Chemical role of Vernix in protecting the infant from infection.

Figure 7 Vernix caseosa

3. MILIA Tiny white spots very often appear on a newborn's face and gums during the first week. The spots are called milia (say "MIL-ee-uh"). Sometimes they also appear on the roof of the mouth (palate), where they are called Epstein pearls.
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Milia occur when dead skin becomes trapped in small pockets at the surface of the skin or mouth. Milia are common in newborn infants. Milia go away by themselves in a few weeks and aren't harmful.

Figure 8 Milia

4. STROKE BITES A stork bite is a common type of birthmark seen in a newborn. It is most often temporary. The medical term for a stork bite is nevus simplex. A stork bite is also called a salmon patch. A stork bite usually looks pink and flat. A baby may be born with a stork bite, or the birthmark may appear in the first months of life. Stork bites may be found on the forehead, eyelids, nose, upper lip, or back of the neck.
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A stork bite is due to a stretching (dilation) of certain blood vessels. It may become darker when the child cries or the temperature changes. It may fade when you push on it. No treatment is needed.

Figure 9 Stroke bite

5. HEMANGIOMA - Hemangiomas are simply a collection of extra blood vessels in the skin. They may have different appearances depending on the depth of the increased numbers of blood vessels.

Strawberry Hemangioma is an abnormal collection of blood vessels in the skin characterized by a bright red color and well-defined border.

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A Deep or Cavernous Hemangioma is a large, collection of blood vessels beneath the skin surface characterized by a soft, bluish, or skin colored mass.

A Combined Hemangioma is a combination of a deep and superficial (strawberry) hemangioma.

TYPICAL GROWTH PATTERN OF HEMANGIOMAS Age of Child Birth 1-2 months 1-6 months 12-18 months Hemangiomas often not present or noticeable becomes noticeable grows most rapidly begins to shrink (involute)

Figure 10 Hemangioma

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6. MONGOLIAN SPOTS (CONGENITAL DERMAL MELANOCYTOSIS OR DERMAL MELANOCYTOSIS) Mongolian spots are flat, blue, or blue-gray skin markings near the buttocks that commonly appear at birth or shortly thereafter. Mongolian spots are noncancerous skin markings and are not associated with disease. The markings may cover a large area of the back. Symptoms include: a) Blue or blue-gray spots on the back, buttocks, base of spine, shoulders, and other body areas b) Flat area with irregular shape and unclear edges c) Normal skin texture d) The spots are usually 2 - 8 centimeters wide

Figure 11 Mangolian spot

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7. PETECHIAE These are small, blue-red dots on the infants body caused by the breakage of tiny capillaries. They may be seen on the face as a result of pressure exerted on the head during birth. True petechia does not blanch on pressure.

Figure 12 Petechiae

8. ERYTHEMA TOXICUM Erythema toxicum is a common, noncancerous skin condition seen in newborns. Its cause is unknown. The main symptom is a rash of small, yellow-to-white colored papules surrounded by red skin. There may be a few or several papules. They usually appear on the face and middle of the body, but may also be seen on the upper arms and thighs. Erythema toxicum may appear in 50 percent or more of all normal newborn infants. It usually appears in term infants between the ages of 3 days and 2 weeks.

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Figure 13 Erythema toxicum

CHARACTERISTICS OF NEWBORN INFANTS EYES, EARS AND NOSE

1. EYES The eyes are blue or gray at birth, changing to the permanent colour in 3 to 6 months. Eye movements are not coordinated. The eye lids may be edematous for about 2 days after birth. Chemical conjunctivitis may follow instillation of silver nitrate drops into the eyes soon after birth to prevent ophthalmia neonatorum. The lacrimal apparatus is small and non functioning at birth, but lacrimal fluid is present in the eyes to some degree from birth. It has two functions: to cleanse the eyes. to prevent drying of the conjunctiva.

The cornea should be transparent and clear and the iris of the eye should be round. 2. EARS The infant ears tend to be folded and creased. A line drawn through the inner and outer canthi of the eye should come to the top notch of the ear. The infant usually responds to sound at birth.

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 Low set ears may be an indication of mental retardation, renal anomalies, or craniofacial malformation. 3. NOSE At birth, the nose and mouth are often filled with mucus.

CHARACTERISTICS OF NEWBORN INFANTS MOUTH AND THROAT

Cleft lip and palate are birth defects that affect the upper lip and the roof of the mouth. Precocious dentition or supernumerary teeth may be observed in the lower incisor area or elsewhere on the gums. Epstein pearls are temporary accumulations of epithelial cells. Oral Thrush is a fungal infection of mouth. It is caused by an overgrowth of Candida Albicans.

Figure 14 Oral thrush

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Figure 15 Cleft lip and palate

Figure 16 Epstein pearls

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CHARACTERISTICS OF NEWBORN INFANTS NECK

The neck appears short in comparison with the size of the baby and is creased.

CHARACTERISTICS OF NEWBORN INFANTS CHEST

The chest is bell shaped and at birth is approximately the same circumference as the abdomen and about 1 inch less than the head circumference. The thorax of the newborn is almost circular. The infant does not use thoracic cage in breathing, but uses the diaphragm and abdominal muscles. The breasts may be swollen because of hormonal activity originating from the mother, and pale milky fluid (witchs milk) can be expressed.

CHARACTERISTICS OF NEWBORN INFANTS HEMATOLOGIC SYSTEM

The blood volume of the newborn infant is about 10 to 12% of body weight. The blood contains relatively high number of red blood cells (RBC- 4 to 6.6 millions of cells/mm3) and a high hemoglobin level (Hb 14.5 to 22.5 gm/dl) at birth. Most of the newborn babies have reduced levels of vitamin K in their blood, resulting in prolonged in prothrombine clotting times. Physiological jaundice may be seen in approximately 55 to 70% of all neonates on the second to fourth day of life when the level of bilirubin increases from the normal level.

CHARACTERISTICS OF NEWBORN INFANTS OESOPHAGUS, STOMACH AND INTESTINE

The cardiac sphincter is not well developed as the pyloric sphincter. The stomach contents are emptied immediately into the duodenum. Digestion is slowed by food high in protein or fat. Meconium, the first fetal material, is a sticky, odorless material, greenish black to brownish green, which is passed from 8 to 24 hrs after birth.
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 The stools of the breast fed infant are yellow and pasty; between 2 and 4 passed a day.

Figure 17 Anatomy of stomach

CHARACTERISTICS OF NEWBORN INFANTS ABDOMEN

The normal neonates abdomen appears rounded and slightly protuberant. Peristaltic waves may be observed on the abdominal surface of thin neonates but cannot be seen in infants who are well nourished. The umbilical cord, the connection between the fetus and placenta, is bluish white, gelatinous structure at birth. It normally contains two umbilical arteries and one vein encased in Whartons jelly. During the first day of life, the cord begins to dry and shrink. It changes in colour from a dull yellow-brown to black. It sloughs off by 6 to 10 days after birth. The liver usually can be felt about 2 to 3 cm below the right costal margin.

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 The tip of the spleen may be palpable by about 1 week after birth in the left upper quadrant. Before the intestines fill with air, the experienced nurse may be able to palpate the kidneys.

Figure 18 Umbilical cord

CHARACTERISTICS OF NEWBORN INFANTS ANOGENITAL AREA

The newborn infant should pass meconium within the first 24 hrs after birth through a patent rectum. IN MALES The size of the male newborn genitalia, penis, and scrotum varies. The prepuce or foreskin, of the penis may adhere to the glans. The urethral opening should be at the tip of the penis. The scrotum of the many male neonates is oedematous.

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The testes usually descended into the scrotum by the 8th month of intrauterine life.

IN FEMALES The female genitalia may be slightly swollen from the action of maternal hormones. The labia minora and clitoris appear large. Large amounts of Vernix caseosa may be evident. Pseudo-menstruation - The vagina exudes a mucous discharge that occasionally may be blood tinged. This is caused by hormones transmitted from mother to newborn daughter.

CHARACTERISTICS OF NEWBORN INFANTS URINE

The bladder contains urine at birth and may empty immediately or after several hours. The urine is dilute because of the immaturity of kidneys. Loss of large amount of water may result in temporary hemoconcentration.

CHARACTERISTICS OF NEWBORN INFANTS SKELETAL STRUCTURE

The bones of the newborn are soft because they are composed of chiefly of cartilage. The skeleton is flexible and the joints are elastic to ensure a safe passage through the birth canal. The back is normally straight and flat when the baby is lying prone. The lumbar and sacral curves develop later, when the infant sits up and begins to stand. The legs are small, short, or bowed or curved outward with the feet turned inward. Some common anomalies of the neonate can be noted in the extremities, e.g., club foot, syndactyl (a union of the fingers or toes), and polydactyl (supernumerary digits).

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Figure 19 Curves in vertebral column

Figure 20 Club foot

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Figure 21 Syndactyl

Figure 22 Polydactyl

CHARACTERISTICS OF NEWBORN INFANTS MUSCULAR DEVELOPMENT

The movements of the neonates are random and uncoordinated.

CHARACTERISTICS OF NEWBORN INFANTS NERVOUS SYSTEM The nervous system is strikingly immature when compared with that of the child or
adult.

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 REFLEXES
1. ROOTING Touching or stroking the cheek near the corner of the mouth. Head turns in the direction of stimulation so that the neonate can find food. When the breast touches the cheeks, the neonate turns toward the nipple.

Figure 23 Rooting reflex

2. SUCKING Touching the lips with the nipple of the breast or bottle or other object, sucking movements that enable the newborn to take in food.

Figure 24 Sucking reflex

3. SWALLOWING Accompanies the sucking reflex. Food reaching the posterior of the mouth is swallowed. 4. GAGGING When more is taken into the mouth than can be successfully swallowed. And immediate return of undigested food.
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5. SNEEZING & COUGHING Foreign substance entering the upper or lower airways, clearing of the upper air passages by sneezing, the lower air passages by coughing. 6. EXTRUSION Substance placed on anterior position of tongue, extrusion of the substance to prevent swallowing.

Figure 25 Extrusion

7. BLINKING Exposure of eyes to bright light from a flash light or otoscope or sudden movement of object toward eye. Protection of the eye by rapid eye lid closure. 8. DOLLS EYE Turn the newborns head slowly to the right or left side, normally eyes do not move.

Figure 26 Doll's eye

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9. PALMAR GRASP Object placed in the newborns palm, grasping of object by closing fingers around it. 10. PLANTAR GRASP Touching the sole of the foot at the base of the toes, toes grasp around very small object.

Figure 27 Palmar grasp & Plantar grasp

11. DANCING (STEP IN PLACE) Hold neonate in vertical position with the feet touching a flat, firm surface. Rapid alternating flexion and extension of the legs as in stepping.

Figure 28 Dancing reflex

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12. BABINSKI Stroking the lateral aspects of the sole of the foot with a relatively sharp object from the heel up toward the little toe and across the foot to the big toe. Fans of the toes (positive Babinski sign).

Figure 29 Babinski reflex

13. TONIC NECK (FENCING POSITION) Turning the head quickly to one side while infant is supine, arm and leg on the side the head is turned toward extend and arm and leg on the opposite side flex. Both hands may make fists.

Figure 30 Tonic neck reflex

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14. MORO (STARTLE) Startling the infant with a loud voice or apparent loss of support due to a change in equilibrium

Figure 31 Startle reflex

CHARACTERISTICS OF NEWBORN INFANTS SPECIAL SENSES

TOUCH The sense of touch is the most highly developed of the special senses and is most acute on the lips, tongue, and ears and fore head. VISION Childs vision development begins before birth. Newborns focus on black and white objects at a distance of 9 to 12 inch. Hearing occurs after the first cry. The infant normally make some response to sound.

HEARING

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 TASTE A newborn has the ability to discriminate taste, because taste buds are developed and functioning even before birth. Sweet fluids are accepted, where as acid, sour, or bitter ones are resisted. The sense of smell is present in newborns as soon as the nose is clear of mucus and amniotic fluid. The only evidence of smell is that many newborn infants appear to smell breast milk and search for the nipple. SMELL

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