newborn final 1

8/8/2019 Newborn Final 1

1/76

NEWBORN


2/76

EARLY NEWBORNASSESSMENT


3/76

VITAL SIGNS

RESPIRATION : 30-60 cpm

HEART RATE : 120-160 bpm

TEMPERATURE : 36.5-37.40C

BP : 65-95 sys /30-60 dias

80/46mmHg at birth

100/50mmHg at 10th day


4/76

THE FETAL SKULL

Fetal Bones and Fontannelles


5/76


6/76

Anterior fontanelle

Diamond shape, found at the junctionof the two parietal bones and the two

fused frontal bones

2-3cm in width; 3-4cm in lengthCloses at 12 to 18 months

Posterior fontanelle

-triangular in shape, found at thejunction of parietal bones and the

occipital bones, 1cm

-Closes at 2 months


7/76

FETAL HEAD MOLDING

MOLDING change in the shape of the fetal headthat allow it to pass through the birth canal, the headwill be restored to its normal shape within few daysafter birth.


8/76

CAPUT SUCCEDANEUM

CAPUT SUCCEDANEUM (edema of the scalp) oftenappears over the vertex on the fetal head as a result ofthe pressure from the birth canal; normally resolves at

about the third day of life.


9/76


10/76

CEPHALHEMATOMA

CEPHALHEMATOMA bleeding that occurs between theperiosteum of the skull (rupture of the periostealcapillary); normally appears 24 to 48 hours after birthand resolves slowly after several weeks


11/76

CephalhematomaCephalhematoma

collection of blood under thecollection of blood under the

periosteumperiosteum of a cranial boneof a cranial bone

appearing 1appearing 1--2 d; does not cross2 d; does not cross

suture line; disappears in weekssuture line; disappears in weeks

to monthsto months


12/76

CRANIOTABES Localized softening of the cranial bones. the bone is so soft that the pressure of an

examining finger can indent it

It corrects itself without treatment after a few

months It is probably caused by the pressure of the

fetal skull against the mothers pelvic bone inutero.

It is more common in 1st born infants than ininfant born later, because of the lower positionof the fetal head in the pelvis during the last 2weeks of pregnancy in Primiparous women.


13/76


14/76


15/76

EARS

Top of ear should align with the inner

and outer canthus of the eye.

If ears are set lower, there could be akidney malformation or chromosomal

defect (Trisomy 18 and 13)

Sense of Hearing highly developed inNewborn


16/76

MOUTHShould open evenly when crying. If not,

suspect Cranial Nerve VII Paralysis (BellsPalsy).

Palate should be intact;breaks on the lip = cleft palate; cleft lipEpstein Pearls small round glistening

cysts seen on palate and gums, due to extraload of maternal calciumIf with tooth (NATAL TOOTH=not covered

with gum membrane) should be extracted to

prevent aspirationOral thrush white gray patches usually on

the tongue and sides of cheeks due to Candidaalbicans acquired during the passage of thebaby through the birth canal of his mother


17/76

Cleft lip


18/76

Cleft Palate (Posterior)


19/76

THE FETAL NECK

NECK of the newborn is short and often chubby; thenewborn should be able to raise the head briefly andturn it to both sides


20/76

CHES

T

Usually smaller than the head

Symmetrically expands (retractionindicates respiratory distress)

Breasts may be engorged (due tomaternal hormones) There could bepassage of thin, watery fluid knownas WITCHS MILK.


21/76

AbdomenNormally dome shaped; If scaphoid orsunken appearance, suspect missingabdominal contents or a DIAPHRAGMATICHERNIA (bowel sounds heard in the chest).

Bowel sounds should be present within 1hour after birth.


22/76

THE UMBILICAL CORD

THE UMBILICAL CORD should contain AVA


23/76

THE EXTREMITIES

EXTREMITIES should actively move equally; shouldsharply remain in flexed attitude and resist extensionduring examination


24/76

EXTREMITIES

Should be symmetric and ofequal length

Fingers and toes in equal count.

Supernumery = POLYDACTYLY;

fused or webbed = SYNDACTYLY

Simean line single palmar

crease = DOWNS SYNDROME


25/76

HANDS AND FEET

FINGERS AND FEET are examined for extra digits andwebbing


26/76

SYNDACTYLY,POLYDACTYLY


27/76

SYNDACTYLY

PO

LYD

ACTYLY

POLYDACTYLY &


28/76

SENSESSight all newborns can see at birth although

they cannot see objects past the visual midline(not until 6-8 weeks).The visual field is 9-12inches;focus best on black and white objects.HearingHearing as soon as amniotic fluid has been

absorbed, the newborn can already hearTasteTaste as soon as secretions have beensuctioned, newborns can already taste becausetaste buds are developed and functioning even

before birth.SmellSmell as soon as the nose has been cleared ofmucus and fluid, newborns can smellTouchTouch the most developed of all the senses;also react on painful stimuli


29/76

CARDIOVASCULAR SYSTEM

As the lung inflate for the 1st time,pressure decreases in the chest generally,and in the pulmonary artery specifically

The decrease in pressure in thepulmonary artery plays a role in promotingthe closure of the ductus arteriosus.

As pressure in the left side of the heartfrom increased blood volume, theForamen Ovale closes because of thepressure against the lip of the structure.


30/76

Pulse using apicalpulse =

PMI: Point ofMaximum Impulse(located at

MCL 5th ICS or below the left nipple line)This is done using a stethoscope.Radial pulse is normally not prominent. If it is, it

may be a sign of congenital heart anomaly(i.e.,PDA).Femoral or brachial pulses if absent,indicates,coarctation of the aorta and hip

dislocation.

PulseisIRREGULAR, RAPID

>160-180 beats/min. at birth

120-140 (stable)


31/76


32/76

Increased pressure on the left side of the

newborns heart results in:

Closure of the foramen ovale (fossaovale)

Change of the ductus arteriosus into amere ligament (ligamentum arteriosum)Ductus venosus becomes ligamentum

venosum

Since no more blood goes through theumbilical vein and arteries, these bloodvessels atrophy and degenerate


33/76

GI SYSTEM

Newborns stomach holds about 60-90 ml

Has limited ability to digest fat and starch

because the pancreatic enzymes, lipase

and amylase, are deficient for the 1st fewmonths of life.

Because milk, the infants main diet for

the 1st

year is low in Vit. K, the intestinalsynthesis is necessary for blood

coagulation.


34/76

Initial Feedinggiven 1-6 hours after

birth 1 oz ofsterile water to begiven to

find out ifnewborncanswallow withoutaspirating. Glucose water has been found

to beirritating to thelungs if aspirated.

Purposes of breastfeeding:

Primarily to promote bonding

Facilitates uterinecontraction

through sucking because of releaseof oxytocin byneurohypophysis

Facilitates release ofcolostrums

(contains antibodies-IgA).


35/76

TYPES OF STOOLS PASSED BY NB

Meconiuma sticky,tarlike, blackish-green,odorless material formed from mucus, vernix,

lanugo, hormones and carbohydrates thataccumulated during intrauterinelife;take note of

time when meconium first passed(should bewithin 24 hours)Transitionalpassed from 2nd to 3rd day of

life,become green and loose stool.

Milk stoolBreast fed infant stool loose light yellow incolor with sweet odor; 3-4x/dayBottle fed infant stool formed, bright yellow

with a typical odor; usually passed 2-3x /day


36/76

URINARY SYSTEMThe average newborn voids within 24 hrs

after birthNewborns who do not void within this time

should be examined for the possibility ofureteral stenosis or absent kidneys or

ureterA single voiding in a newborn is only about

15 mlThe dailyurinary output for the 1st1-2

days is about 30-60 ml total. after a week a total of 300ml/dayThe 1st voiding may be pink or dusky

because of uric acidcrystals that were

formed in the bladder in utero


37/76

CONGENITAL MALFORMATIONS

OF THE URINARY TRACT

Epispadias -

urethral openingon the dorsal

surface of the

penis

Surgical correction


38/76

HYPOSPADIA

Male urethralopening on the

ventral surface ofpenis, or femaleurethral opening invagina

Surgicalreconstruction


39/76

HYPOSPADIA


40/76

FemaleG

enitalia May have swollen labia andmay pass a slightly bloody vaginaldischarge known as

PSEUDOMENSTRUATION (due to

maternal hormones)Male Genitalia Scrotum may be edematousdue to maternal hormones.Foreskin should be retracted to test for

PHIMOSIS (tight foreskin)

Testes should be present: if undescended thecondition is called CRYPTORCHIDISM.

The GENITALS


41/76

Conditions for CRYPTORCHIDISM:

Agenesis absence of an organ

Ectopic testes testes cannot enter the

scrotum because the opening of the scrotalsac is closed.

Undescended testes- Vas deferens or

artery is too short to allow the testes todescend.


42/76

MEASUREMENTS

HEAD CIRCUMFERENCE : 33-35cm

CHEST and ABDOMEN : 31-33cm

LENGTH : 47-54cm

WEIG

HT : 2500-4000 grams


43/76


44/76

VERNIX CASEOSA

White, cream-cheese-like substance that

serves as a skin lubricant, usually

noticeable on a newborn skin, prominently

seen in the skin folds, at birth in a term

neonate.


45/76

VERNIX CASEOSA

The cheesy-white substance found on the newbornsskin


46/76

LANUGO

Is the fine downy, hair that covers a newborns

shoulder, back and upper arms

Found also in the forehead and ears.

The newborn of 37-39 wks has more lanugo

than the 40th wks old infant.

Post-mature infants have rarely have lanugo

By age of 2 wks. It has disappear.


47/76

LANUGO

The fine hair of the newborn


48/76

DESQUAMATION

Within 24 hrs. of birth, the skin of most

newborns has become extremely dry

The dryness is particularly evident on thepalms of the hands and soles of the feet.

this is normal and needs no treatment.


49/76


50/76


51/76

FORCEPS MARK

There may be a circular or linear contusion

matching the rim of the blade of the forcep

on the infants cheek.

The mark disappears in 1-2 days along

with the edema that accompanies it.


52/76


53/76

HARLEQUIN SIGN

HARLEQUIN SIGN clown suit-like appearance of thenewborn


54/76

HARLEQUINSIGN

- BECAUSEOF IMMATURITYOFCIRCULATION, ANINFANT WHOHAS

BEEN LYINGONHISSIDE WILL APPEAR

REDONTHEDEPENDENTSIDE & PALE

ONTHEUPPER SIDE.


55/76

MOTTLING

MOTTLING map-like appearance on the skin of thenewborn


56/76

CUTISMARMORATA

- TRANSITORYMOTTLINGONNBSSKIN WHENITISEXPOSEDTOCOLD.


57/76


58/76

MILIA

Newborn sebaceous gland is immature. Atleast one pin-point white papule (a plugged

orunopened sebaceous gland) can befound in the cheek or across the bridge ofthe nose of every newborn.

Disappears by 2-4 wks of age as the

sebaceous glands mature and drain. Parents should be instructed to avoid

scratching or squeezing the papules toprevent secondary infection.


59/76

MILIA

MILIA pimple like spots that may be found on theface of the newborn


60/76

MONGOLIAN SPOTS

bluish gray or dark nonelevated pigmentation

area over the lower back and buttocks present at

birth, primarily nonwhite, disappear at SCHOOL

AGE


61/76

MONGOLIAN SPOT


62/76


63/76

NEWBORN REFLEXES


64/76

NEUROMUSCULAR SYSTEM

Reflexes

Blink Reflex- to protect the eye fromany object coming near it by rapid eyelidclosure

Tonic Neck Reflex- the arm and the leg

on the side toward which the head turnsextend, and the opposite arm and leg

contract


65/76

RootingReflex turnstoward anyobject touching/strokingcheek/mouth,opens mouth,and sucksrhythmicallywhen finger/nipple isinserted intomouth (usuallydisappears by 6wks.)


66/76

Sucking Reflex-

when newborns

lips are touched,

the baby makes

a sucking motion.It diminishes at

about 6 months

of age


67/76

Swallowing Reflex- food that reaches theposterior portion of the tongue is automatically

swallowed.

Placing Reflex- similar to step-in-place Reflex,except it is elicited by touching the anterior

surface of a newborns leg against the edge of a

bassinet or table A newborn will make a few quick lifting motions as if to

step onto the table


68/76

PLACING REFLEX


69/76

Palmar grasp

pressure on palm

elicits grasp

(disappears atabout 6 weeks to

3 months of age)


70/76

Moro orStartleReflex

elicited by suddendisturbance in theinfants immediateenvironment, bodywill stiffen, arms intense extensionfollowed by embracegesture with thumband index finger ac formation(disappears by 4th-5th months)


71/76

MORO OR STARTLE REFLEX


72/76

EXTRUSION REFLEX

a newborn will extrudeany substance that is

placed in the anterior

portion of the tongue.

Protective reflex prevents

the swallowing of inedible

substance

Disappears at 4 mos.


73/76

Step (walk)-in-

place reflex when held upright

with one foot

touching a flatsurface, withalternating step(fades 3 months of

age)

Babinski Reflex stroking the sole of the foot from heel


74/76

Babinski Reflex stroking the sole of the foot from heelupward like an inverted J across ball of foot will cause all

toes to fan (positive Babinski sign)

(remains positive until 3 months of age)


75/76


76/76

THE END

newborn final 1

Documents