Baby at Risk (NBU) Notes
Baby at Risk (NBU) Notes
Nose
Check for any deformities e.g. well formed septum
Bleeding from the nose
Check for nasal flaring which is a sign of respiratory
distress
Check for blocked nostrils
Mouth
Bleeding from the mouth
Check for tongue tie
Abnormalities e.g. cleft palate or cleft lip
Frothing of the mouth
Ears
Bleeding from the ears
Leakage of CSF through the ears (otorrhoea)
Shape of the lobes to rule out malformations
Extra lobe of the ears
Neck
Check out for abnormalities e.g. congenital goiter
Check for meningocele
Chest
Shape of the chest for symmetry
Chest movement during respiration
Take apex beat (at level of 5th ICS, LMCL).
Check breast for swelling and discharge
Abdomen
Check for skin colour and presence of rashes
Check whether the cord is well ligated
Bleeding from the umbilical cord
Abdominal abnormalities e.g. hernia
Genitalia
For males check for the testis to rule out undescended
testis
Female check for vaginal discharge, labia should be well
formed; check size of a clitoris
Hip joint
Rule out congenital hip dislocation
Limbs
Check if arms and hands are moving freely
Rule out dislocation, fractures and Erb’s paralysis
Check for equality of the arms and to rule out
abnormalities
Fingers for webbed and extra digits
Legs for equality, abnormalities and movement
Rule out talipes and club foot
Back
Abnormalities of the back e.g. spina bifida,
myelomeningocele
Check for skin colour and septic spots
Anus
While taking rectal temperature, check for imperforate
anus
Bruises on the skin or rashes
Check for the following reflexes:
Sucking reflexes – full term infant sucks the small finger
Moro reflex – tested by gently lifting the baby up by its
fingers from a flat surface and suddenly releasing it. It
will respond by spreading its hands then move them
together as though hugging.
Rooting reflex – the baby turns in search of the nipple
Grasping reflex – it will grasp your finger if you put it in
its palm.
Stepping reflex – when held on a flat surface in standing
position, it makes stepping movement.
NORMAL NEONATE
This refers to a baby born at term or as near term
as possible after 37 weeks of gestation and has no
complications.
Upon birth the infant has to undergo
physiological changes in order to adapt to life
outside the uterus to have independent existence.
PHYSIOLOGICAL CHANGES AT BIRTH
1. Respiration occurs due to:
Low oxygen and high carbon- dioxide stimulates
respiratory center and respiration begins
Compression of the chest wall during second stage
creates a vacuum and aid respiration
External stimuli e.g. handling the baby, cold extra
uterine environment makes the baby gasp and respiration
starts
Baby is encouraged to cry initially by flicking the sole of
the foot for it allows complete aeration of the lungs
Presence of surfactant factor aids expansion of the lungs
(Lecithin : Sphingomyelin = 2 :1 and is an indicator of
lung maturity detectable on amniocentesis)
The normal respiration rate at birth is 40-50/min
Irregular breathing may be due to the following
factors:
i. Prematurity (inadequate surfactant factor)
ii. Depression of the respiratory centre by drugs e.g.
pethidine or strong uterine contractions
iii. Excessive carbon dioxide (hyperpnoea)
iv. Lack of oxygen (hypoxia)
2. Circulatory system
Extra-uterine circulation is established and the baby is
able to divert deoxygenated blood to the lung for de-
oxygenation. This accounts for the pink colour of an
infant.
In utero the Hb is high 18-20g/dl and high RBC to
transport sufficient oxygen to the foetus. After birth the
Hb drops to 14g/dl and some of the RBC are broken
down by the liver cells to bilirubin and may lead to
physiological jaundice.
Normal heart rate in utero is 120 -160 beats/minute but
upon birth it drops to 100 -120 beats /min
3. Temperature regulation
Temperature in utero is 38oC but the baby’s rectal
temperature is 37oC. The temperature drops due to
evaporation, conduction, convection and radiation.
RESUSCITATION
OF A NEW BORN
(DRUGS AND THE CPR PROCESS)