DAVAO DOCTORS HOSPITAL

THE NEWBORN INFANT

Xylia Sahara E. Tocao

Medical Clerk

OVERVIEW

PERINATAL PERIOD
from 28th week of gestation through the 7th day after birth

Nelson Textbook of Pediatrics , 19th Edition

OVERVIEW
NEONATAL PERIOD -1st 28 days after birth

Birth to < 24 hours

Very early Early

Birth to <7 days

7 days to < 28 days

Nelson Textbook of Pediatrics , 19th Edition

Late

INFANCY
Ist year after birth

Nelson Textbook of Pediatrics , 19th Edition

HISTORY IN NEONATAL PEDIATRICS

Demographic & Social data Past medical illnesses Previous maternal reproductive problems Events in the pregnancy Description of the labor & delivery
Nelson Textbook of Pediatrics , 19th Edition

PHYSICAL EXAMINATION

As soon as possible after

delivery Within 24 hours of birth Within 24 hours of discharge

GENERAL APPEARANCE

Physical activity Active & Passive tone

Posture
Edema

SKIN

SKULL

CRANIOSYNOSTOSIS

FACE

-should be noted with regard to dysmorphic features

EYES
PUPILLARY REFLEX- (+) after 28-30 weeks of

gestation
LEUKOCORIA

EARS
PREAURICULAR SKIN TAGS NOSE

MOUTH
EPSTEIN PEARLS

NECK
CONGENITAL TORTICOLLIS

CHEST LUNGS
Term Infants: 30-60 breaths/min Preterm: higher

HEART
<96 % 24 hours O2 saturation after birth

cut off for suspicion of serious congenital heart disease.

ABDOMEN Liver palpable , 2cm below the rib margin Gas should normally be present in the rectum on roentgenogram by 24 hours of age

ABDOMEN
Abdominal distention -obstruction/ perforation
Scaphoid abdomen -diaphragmatic hernia

ABDOMEN
OMPHALOCELE

GENITALS
Imperforate hymen Neonates:void by 12 hours Premature & Term infants : void within 24 hours

ANUS
Passage of meconium 1st 12 hours after birth

Term & Preterm infants : within 48 hours

Imperforate anus not always visible

EXTREMITIES
examined for :

polydactyly syndactyly abnormal dermatoglyphic patterns ( simian crease)

NEUROLOGIC EXAMINATION
severe positional deformation and contractureS

Manifestation of neuromuscular Disease: Breech presentation Polyhydramnios Failure to breathe at birth pulmonary hypoplasia clubfoot

ROUTINE DELIVERY ROOM & INITIAL CARE

Low risk infants

Healthy infants: given directly to mothers

APGAR SCORE

MAINTENANCE OF BODY HEAT

Generation of heat :body weight

Heat loss: surface area

Usual delivery room ( 20-25 OC )

-infants skin temperature falls approximately 0.3 oC / min - deep body temperature decreases approximately 0.1 oC / min -cumulative loss of 2-3 oC in deep body temperature

4 MECHANISMS OF HEAT LOSS

convection conduction heat radiation evaporation

ANTISEPTIC SKIN & CORD CARE

to decrease colonization with S. aureus ,umbilical

cord should me treated with bactericidal or antimicrobial agents such as triple dye / bacitracin

OTHER MEASURES
Eyes: 1 % silver nitrate/0.5 % erythromycin

(gonococcal ophthalmic neonatorum)

Vit. K : 1 mg of water soluble Vit. K (phytonadione)

(hemorrhagic disease)
Hepatitis B immunization Universal hearing screening

NURSERY CARE

Non high risk- mothers room Nursery temperature : 22-26 oC Early discharge : <48 hours Very early discharge: <24 hours

NURSERIES & BREAST FEEDING

Hospital practices that encourage successful

breastfeeding:
Antepartum education & encouragement

Immediate postpartum mother-infant contact

Rooming-in arrangements Inclusion of father in prenatal breastfeeding

education Support from experienced women

DRUGS & BREAST FEEDING

Maternal sedatives
Maternal drugs :

>weak acids >containing large molecules