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Characteristics of Newborn
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.
MEASUREMENTS: Length 50 cm (20 inches). Weight 2.8 to 3.5 kg. Head circumference 33 35 cm. Chest circumference 30 - 33 cm.
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.
It is much smaller than the anterior fontanel. It usually closes between 1 to 2 months.
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.
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
Both hemispheres; CROSSES Individual bone; DOES NOT the suture lines 3 to 4 days None CROSS the suture lines Few weeks to months Support
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.
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.
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.
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
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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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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.
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The stools of the breast fed infant are yellow and pasty; between 2 and 4 passed a day.
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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.
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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.
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Figure 21 Syndactyl
Figure 22 Polydactyl
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.
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.
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.
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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.
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.
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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).
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.
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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
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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