New Born-profile and Chara

7/28/2019 New Born-profile and Chara

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INTRODUCTION

The birth of an infant is one of the most awe-inspiring and emotional events

that can occur in ones life time. The individuality of each baby requires the nurse to be

knowledgeable about the averages and the range of normality of newborn infants. Newborn

period encompasses the first four weeks of extra uterine life. Assessment of the newborn, as soonas possible after birth and subsequent assessment in the post natal period are vital responsibility

of the nurses as a new individual is being evaluated for the first time.

DEFINITION OF NEW BORN

A healthy infant born at term (between 38-42 weeks) should have an average

birth weight for the country (usually exceeds 2500g), cries immediately following birth,

establishes independent rhythmic respiration and quickly adapts to the changed environment.

Most essential assessment is the first cry. Good cry helps in establishment of

satisfactory breathing. Another significant assessment of the neonate is Apgar Scoring as

described by Dr Virginia Apgar. Five objective criteria are evaluated in one minute and five

minute. The criteria are respiration, heart rate/minute, muscle tone, reflex irritability and skin

color.

APGAR SCORING

CRITERIA 0 1 2

Respiration Absent Slow, irregular Good, crying

Heat rate Absent Slow(below 100) More than 100

Muscle tone Flaccid Some flexion ofextremities

Active bodymovements

Reflex response No response Grimace cry

Skin color Blue, pale Body pink,

extremities blue

Completely pink

Total score = 10

No depression : 7-10 Mild depression : 4-6

Severe depression :0-3

PHYSICAL FEATURES OF NEW BORN

The newborn must be examined thoroughly within 24 hours of birth.


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Posture:

Arms flexed and fists clenched. Legs flexed at knees and hips.

Infants behavior is carefully noted by asking certain questions to self such as

Is the newborn awakened easily by a loud noise? Is the baby comforted by rocking, sucking or cuddling? Do there seem to be periods of deep and light sleep? When awake does the infant seem satisfied after a feeding? What stimuli elicit response from the infant? When disturbed how much does the infant protest?

Anthropometric Measurement

Length: 48-53 cm (from top of head to heel). Because of the usual flexed position of the infant, it

is important to extend the leg completely when measuring total body length.

Weight: most newborn weigh 2700 -4000g, the average weight being about 3,400g.

10% loss of birth weight occurs by 4th

to 5th

day and is regained by 7th

to 10th

day. The loss is due

to loss of water through skin, lungs, urine and bowel when very little food is taken. The bigger

the baby, the more the weight loss. Weight gain is at the rate of 25-30g/day.

Head circumference: For a full term infant average head circumference is between 33-35 cm.

(occiputo-frontal). Head circumference may be somewhat less immediately after birth because of

the molding process that occurs during vaginal delivery. Usually by the second or third day, the

skull is normal in size and contour.

Head circumference is also be compared with crown-to-rump length, or sitting height.

Crown-to-rump measurements are usually 31-35 cm and are approximately equal to head

circumference. Head circumference has been shown to be equal to or up to 1 cm more than

crown-to-rump length in 62%n of the infants examined and determined to be normocephalic.

Chest circumference: 31-33 cm (measure at nipple line).

Abdominal circumference: same as chest circumference. Abdominal circumference is measured

just above the level of the umbilicus, since the umbilical cord is still attached. Measuring theabdominal circumference below the umbilical region is unsuitable because bladder status may

affect the reading.

Vital signs:

Temperature: 36.5-37.2 degree centigrade. Temperature is stabilized by 8-10 hours of age.


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Pulse: Apical pulse: heart rate is taken apically with a stethoscope. Visible pulse in left mid

clavicular line, fifth intercostals space. Pulse vary according to the periods of reactivity and the

newborns behaviors, but are usually in the range of 120-140 beats per minute. Both are counted

for a full 60 seconds to detect irregularities in rate or rhythm. Peripheral pulses and femoral

pulses are equal and strong.

Respiration: 30-60 breaths /minute.

BP: Blood pressure is most easily and accurately assessed using oscillometry (Dinamap). The

average oscillometric systolic/diastolic pressure is 65/41 at 1-3 days of age. Compare blood

pressure in the upper and lower extremities, which should be equal.

Skin:

The skin has an important role in temperature regulation, protection from infection

reflecting the well being of the baby, and in facilitating communication. The texture of the

newborns skin is velvety smooth and puffy.Sebaceous glands are inactive. The infants poor

melanin production renders him vulnerable to infection. At birth skin is covered with vernix

caseosa and lanugo.

Vernix Caseosa: Grayish white, cheesy, odorless substance which covers the newborns skin. It

is the mixture of sebum and desquamating cells. It is more in creases and folds.

Lanugo: It is a slight, downy distribution of fine hair over the body. It is most evident on the

shoulders, back, extremities, and forehead. It begins to appear on the fetus by about 16th

week of

gestation and to disappear after the 32nd

week.

Skin color-

Skin color depends on racial and familial background and varies greatly among newborns.

Normally pink in color. Acrocyanosis may be normal immediately following birth. It may be due

to cold stress.

Cutis Marmorata: A transitory mottling of the skin, sometimes due to exposure of the skin to

cold.

Common variations or minor abnormalities of skin

Neonatal jaundice after first 24 hours.

Extensive bruising: May be due to difficult or traumatic delivery.

Milia (milk spot): it is due to sebaceous glands. Seen on the nose, forehead and cheeks. When

milia is in the deeper layer, it appears as red. So it is called milia rubra.

Miliaria or sudamina: distended sweat glands that appear as minute vesicles, especially on face.


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Mongolian spots: are bluish, often large, commonly seen on the back, buttocks or thighs. It

occurs due to melanin containing spindle shaped melanocytes in dermis. They disappear by 4

years of age.

Erythema Toxicum: Papular lesions with an erythematous base. Commonly seen after 48 hours

of birth. This rash resolves spontaneously. Common in trunk and face, occur anywhere except inpalms and soles.

Harlequin Color Change: A rare discrepancy in color between the two longitudinal halves of the

body when the neonate is placed on the side for several minutes. The dependent portion of the

body becomes pink, while the upper halves remain pale.

Salmon patches (stork bites/ nevus simplex/ telangiectatic nevi): flat, deep pink localized areas

usually seen in back of neck, upper eyelid, forehead and root of the nose, which spontaneously

disappear within one month.

Major abnormalities

Pallor- occurs due to anemia, birth asphyxia or shock.

Central cyanosis: It is caused by low oxygen saturation. It may be due to congenital heart or lung

disease. Peripheral cyanosis: may be due to drugs (nitrites or nitrates).

Jaundice: Progressive jaundice, especially in first 24 hours. Bilirubin level more than 5 mg/dl.

Plethora: commonly seen in infants with polycythemia. A term applied to the beefy red

coloration of a newborn. The "boiled lobster" hue of the infant's skin is caused by an unusually

high proportion of erythrocytes per volume of blood. The term formerly was used to describe anyred-faced person.

Hemorrhage, poor skin turgor, rashes, pustules or blisters.

Nevus flammeus: port-wine stain.

Head:

Making up 1/4th

of body length. General observation of the contour of the head is

important, because molding occurs in almost all vaginal deliveries. The usual, more oval contour

of the head is apparent by 1-2 days after birth. The change in shape occurs because the bones ofthe cranium are not fused, allowing for the overlapping of the edges of these bones to

accommodate to the size of the birth canal during delivery. Head is covered with fine, silky hair.

Cranium is large and face relatively small. Six bones- the frontal, occipital, two parietals and two

temporal-makes up the cranium. Skull is formed of 8 bony plates, each one connected to another

by bands of connective tissue called suture lines. At the junction of the sutures are wider spaces

of unossified membranous tissue called fontanels. These are palpated to determine whether they


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are open or closed. The 2 most prominent fontanels in infants are the anterior fontanel and the

posterior fontanel.

Sutures feel like cracks between the skull bones. Fused cranial sutures are called

craniosynostosis.

Craniotabes: softening of skull bones. That is pung-pong feel when pressure is exerted by a

fingertip near suture lines.

Fontanels feel like wider soft spots at the junction of the sutures. These are palpated by using the

tip of the index finger and running it along the ends of the bones. The fontanels should feel flat,

firm. Frequently pulsations are felt at the anterior fontanel.

Anterior fontanel: It is formed by joining of the 4 sutures in the mid plane. The sutures are

anteriorly frontal, posteriorly sagital and on either side, coronal. It is diamond shaped. It is 2-3cm

in width and 3-4 cm in length. It becomes ossified 18 months after birth.

Posterior fontanels: Formed by junction of 3 suture lines such as sagital suture anteriorly and

lambdoid suture on either side. It is triangular in shape and measures between 0.5 and 1 cm. It

normally closes by the end of the second month.

Other fontanels include mastoid and sphenoid fontanels.

Head lag is common in newborn.

Frontal baldness is common in neonates. Caput succedaneum: Swelling or edema of the presenting portion of the scalp, and may

be localized or fairly extensive. Usually disappears by the third day.

Cephalhematoma: Accumulation of blood between the flat skull bone and the periosteum.Collection of blood does not cross a suture line. The mass is soft and fluctuating.

Eyes:

Eyes are blue or gray at birth, changing to the permanent color in 3-6 months. Eye

movements are not co-ordinated. The eyelids may be edematous for about 2 days after birth,

until the excess fluid is eliminated by the kidneys. Sclera should be clear and white. Corneal

reflex is normally present at birth. The pupil will usually respond to light by constricting. The

pupils are usually malaligned. A searching nystagmus is common. Strabismus is a normalfinding because of the lack of binocularity. Sub conjunctival hemorrhage: Because of the

pressure on the neonates head during vaginal delivery, the venous return of blood may be

impaired and small capillaries may rupture in the sclera of the eye. This has no pathological

significance and the red areas will disappear in 2-3 weeks.


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Ophthalmia neonatorum: acquired mainly from maternal genital tract during delivery. Erythema

and edema of palpebral conjunctiva, purulent discharge in eyelids are the main features. This is

of mainly 4 types such as chemical conjunctivitis, bacterial conjunctivitis, chlamydial and viral

conjunctivitis. To prevent this instillation of silver nitrate drops can be used.

Ears:

Pinna: see for the correct placement. Low set ears may be an indication of mental retardation.

Nose: The nose is usually flattened after birth, and bruises are common. Most newborns are obligatory

nose breathers. The narrow nostrils of the new born may be slightly obstructed from an

accumulation of mucus. An unusual amount of nasal discharge should be removed.

Mouth and Throat: The palate is normally highly arched and somewhat narrow. Examine for

the presence of cleft lip or cleft palate. Elicit sucking reflex by placing nipple or non-latexgloved finger in the infants mouth. The uvula can be inspected while the infant is crying and the

chin is depressed.

See for the presence of natal teeth. It appears yellow because of the deficiency of enamel. It is

also seen in stotos syndrome, Ellis van creveld syndrome etc.

Pernicious dentition or supernumerary teeth may be observed in the lower incisor area.

Epstein Pearls (palatine cyst): Temporary accumulation of epithelial cells, on each side ofthe hard palate. Normally this disappears about a week after birth.

Neck: Neck appears short in comparison with the size of the baby.

Check for movements, sternomastoid hematoma or short neck (Turners syndrome).

Chest: It is almost circular because the anterio-posterior and lateral diameters are equal. The ribs

are very flexible and slight intercostals retractions are normally seen on inspiration. The xiphoid

process is commonly visible as a small protrusion at the end of the sternum. The sternum is

generally raised and slightly curved. The circumference is same as that of the abdomen and about

1 inch less than the head circumference.

Inspect the breast for size, shape and nipple formation, location and number. See forsupernumerary nipples.

See for witchs milk-i.e., pale milky fluid can be expressed from the infants breast. Thecondition disappears in 2-4 weeks without treatment.


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Lungs

The normal respiration of the newborn is irregular and abdominal, and the rate is between 30

and 60 breaths/minute. Pauses in respiration less than 20seconds is considered as normal.

Occasional irregularities occur in relation to crying, sleeping and feeding.

Heart

Heart rate is auscultated and may range from 100-180 beats per minute shortly after

birth and, when the infants condition has stabilized, from 120-140 beats/minute. The point of

maximum intensity (PMI) may be palpated and is usually found in the 4th

to 5th

intercostals

space, medial to the left midclavicular line. The PMI gives some indication of the location of the

heart. See for dextrocardia, where the heart is on the right side of the body, the abdominal organs

may also be reversed.

Auscultate for heart sounds s1 and s2. The second sound is higher in pitch and sharper

than the first.

Hematologic System: the vascular system and heart are larger in the neonate in comparison with

their size in adult life. The blood volume of the newborn infant is about 10-12 percent of body

weight. The total circulating blood volume at birth is 80ml/kg body weight. This percentage is

influenced by the amount of blood received from the placenta before clamping of the cord.

RBC (4.0-6.6millions of cells/mm3) and hemoglobin level (14.5-22.5g/dl) are high at birth.

Hematocrit: 48-69%

Physiologic Anemia: During the first 2-3 months of life, RBC and hemoglobin level continue tofall and results in physiologic anemia.

Leukocyte count at birth is 10,000/mm3.

During the first 24 hours, it increases to 25,000 to

35,000/mm3.

Vitamin K: Most new born babies have reduced levels of vitamin K in their blood, resulting in

prolonged prothrombin time. This is because their intestinal tracts are sterile at birth. So vitamin

K is given to the neonates after delivery. Intestinal flora begins to accumulate after their first

feedings. Therefore, normal synthesis of vitamin K is possible.

Esophagus, Stomach and Intestine:

The cardiac sphincter is not as well developed as the pyloric sphincter. So, the infant should be

bubbled several times while being fed so that air that has been swallowed may be eructed.

Capacity of the Stomach:


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At birth: 1-2 ounces.

At 2 weeks: 3 ounces.

At 5 month: 7 ounces.

At 10 month: 10 ounces.

Meconium It is the first fecal material passed from 8-24 hours after birth. It is a sticky and

odorless material, greenish black to brownish green in color.

The nature of the stool changes daily in the 1st

week. These are called transitional stools. From

the third to the fifth day, they are loose, contain mucus and are greenish yellow. After the 5th

day,

the nature and the frequency of the stool depend on feeding.

The stools of breast fed infants are yellow and pasty; between 2 and 4 are passed a day. Thestools of a formula fed infants are light yellow and hard and are passed once or twice daily.

Abdomen:

The normal contour of the abdomen is cylindric and usually prominent with few visible veins.

Bowel sounds heard soon after birth, usually within the first 15-20 minutes. Visible peristaltic

waves may be observed in some newborns.

The umbilical cord is a bluish white, gelatinous structure at birth. Normally 2 arteries and 1 vein

are present. After clamping, the cord begins to dry and appears dull, yellowish brown. Itprogressively shrivels in size and turns greenish black. It sloughs off by 6-10 days after birth.If

the umbilical cord appears unusually large in diameter at the base, inspect for the presence of a

hematoma or small omphalocele.

Palpate after inspecting the abdomen. The liver is normally palpable 1-3 cm below the

right costal margin. The tip of the spleen can sometimes be felt, but a palpable spleen more than

1 cm below the left costal margin suggest enlargement and warrants further investigation. The

lower half of the right kidney and the tip of the left kidney are 1-2 cm above the umbilicus.

Genitalia:

Male babies:

The scrotum appears edematous. The urethral opening at the tip of penis. Skin of the

scrotum is deeply rugated and darker in color than the surrounding skin. Smegma, a white cheesy

substance, is commonly found around the glans penis, under the fore-skin. An erection is


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common in the newborn. A noncommunicating hydrocele commonly occurs unilaterally and

disappears within a few months. Palpate the scrotum for the presence of testes.

Female babies:

Labia minora and clitoris appears large. Large amount of vernix caseosa may beevident. The vagina exudes a mucus discharge that occasionally may be blood- tinged called

pseudo menstruation. This is caused by the hormone s transmitted from mother to newborn

daughter and usually disappears by 2-4 weeks.

Urine:

The bladder contains urine at birth and may empty immediately or after several hours.

Urine is dilute because of the immaturity of the kidneys. Pink stain may be found on the diaper,

which is usually due to deposition of uric acid crystals.

Skeletal Structure: Bones are soft, because they are composed mainly of cartilages.

Back and anus

Inspect the spine with the infant prone. The shape of the spine is gently rounded. Any abnormal

opening, masses, dimples are noted. A protruding sac anywhere along the spine, but most

commonly in the sacral area indicates some area of biostatistics.

With the infant prone note symmetry of the gluteal folds. Test for developmental dysplasia of thehip are performed. The presence of an anal orifice and passage of meconium during the first 24

to 48 hours of life indicates anal patency. Anal patency can be checked by inserting a small

catheter into the anal opening.

Extremities

Examine the extremities for symmetry, range of motion and reflexes. Count the fingersand toes, and note supernumerary digits (polydactyly), or fusion of digits (syndactyly).

The nail beds should be pink, although slight blueness is evident in acrocyanosis. The

palms of the hand should have the usual creases. The full term newborn usually has

creases covering the entire sole of the foot.

Observe the range of motion of the extremities. The absence of arm movement signals apotential birth injury paralysis such as klumpke or erbs palsy. Examine the lower

extremities for limb length, symmetry and hip abduction and flexion.

Assess muscle tone:


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Hypotonia suggests some degree of hypoxia or neurologic disorder and is common in

down syndrome. Asymmetry of muscle tone may indicate a degree of paralysis from

brain damage or nerve damage.

Failure to move the lower limbs suggest a spinal cord lesion or injury.

Tremors, twitches and myoclonic jerks characterize neonatal seizure or may indicate

neonatal narcotic withdrawal syndrome.

COMMON NEWBORN REFLEXES:

Reflexes are involuntary movements or actions. Some movements are spontaneous, occurring as

part of the baby's usual activity. Others are responses to certain actions. Reflexes help identify

normal brain and nerve activity. Some reflexes occur only in specific periods of development.The following are some of the normal reflexes seen in newborn babies:

LOCALIZED REFLEXES

EYES:

Blinking or corneal reflexExposure of eyes to bright light or sudden movement of object towards eye causes the closure of

eyelid, persist throughout life.

Dolls eyeWhen the infants head is turned slowly to the right or left side, normally eyes lag behind and do

not immediately adjust to new position of head; disappears as fixation develops; if persists,

indicates neurological damage.

Pupillary reflexPupils constrict when a bright light shines towards it; persist throughout life.

NOSE

SneezeSpontaneous response of nasal passages to irritation or obstruction; persist throughout life.


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GlabellarTapping briskly on glabella (bridge of nose) causes eyes to close tightly.

MOUTH AND THROAT

RootingreflexThis reflex begins when the corner of the baby's mouth is stroked or touched. The baby

will turn his/her head and open his/her mouth to follow and "root" in the direction of the

stroking. This helps the baby find the breast or bottle to begin feeding. This reflex

disappears by 3-4 months.

Rooting reflex will be absent in developmental defects.

SuckingreflexRooting helps the baby become ready to suck. When the roof of the baby's mouth

is touched, the baby will begin to suck. This reflex does not begin until about the 32nd

week of pregnancy and is not fully developed until about 36 weeks. Premature babies

may have a weak or immature sucking ability because of this. Babies also have a hand-to-

mouth reflex that goes with rooting and sucking and may suck on fingers or hands.

Disappears by 6 month.

Swallowing reflexThis accompanies the sucking reflex. Food reaching the posterior of the mouth is

swallowed.

Abnormal response in neurological depression, hypotonia, bulbar palsy.

Gagging reflexStimulation of posterior pharynx by food, suction, or passage of a tube causes infant to

gag; persist throughout life.

Extrusion:When substance is placed on the anterior position of the tongue, baby pulls the tongue

out. This disappears by 4 months.

YawnSpontaneous response to decreased oxygen by increasing amount of inspired air; persist

throughout life.

Cough


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Irritation of mucous membrane of larynx or tracheobronchial tree causes coughing.

EXTREMITIES

PlantarGraspreflexTouching the sole of the foot at the base of the digits causes the toes grasp around the

very small objects. It disappears by 8-9 months.

Absent in spinal cord defects, asymmetrical in CNS defects.

Palmar grasp:When object is placed in the newborns arm, the baby grasps the object by closing fingers

around it. Palmar grasp lessens after age 3 months.

Abnormal response in case of cerebral injury.

BabinskireflexWhen the sole of the foot is firmly stroked, the big toe bends back toward the top of the

foot and the other toes fan out. This is a normal reflex up to 1 year of age.

Ankle clonus

Briskly dorsiflexing foot while supporting knee in partially flexed position results in 1-2oscillating movements.

MASS REFLEX

Mororeflexsudden jarring or change in equilibrium causes sudden extension and abduction of

extremities and fanning of fingers, with index finger and thumb forming a c shape,

followed by flexion and adduction of extremities. Infant may cry. Disappear after 3-4

months.

Incomplete moro reflex indicates prematurity (only abduction and extension)

Startle reflexA sudden loud noise causes abduction of the arms with flexion of elbows; hands remain

clenched, disappear by 4 months.

TonicneckreflexWhen a baby's head is turned to one side, the arm on that side stretches out and the


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opposite arm bends up at the elbow. This is often called the "fencing" position.

Disappears by 18 -20 weeks.

Abnormal response occurs when brain damage in hemisphere opposite to extended limbs.

StepreflexThis reflex is also called the walking or dance reflex because a baby appears to take steps

or dance when held upright with his/her feet touching a solid surface.

Perez reflexWhile infant is prone on a firm surface, thumb is pressed along side from sacrum to neck;

infant response by crying, flexing extremities, and elevating pelvis and head as well as

defecation and urination may occur, disappear by 4-6 months.

Trunk incurvation reflex (gallant): stroking infants back alongside spine causes hip tomove towards stimulated side; disappears by age 4 weeks.

Crawl reflexWhen placed on abdomen, infants make crawling movement with arms and legs;

disappears about age 6 weeks.

CONCLUSION

The nurse is in a unique position to aid the newborn infant in the stressful transition from

a warm, dark, fluid-filled environment to an outside world filled with light, sound, and

novel tactile stimuli. During this period of the newborn adjusting from intrauterine to

extra uterine life, the nurse must be knowledgeable about a newborn's normalbiopsychosocial adaptations to recognize any deviations. To begin life as an independent

being, the baby must immediately establish pulmonary ventilation in conjunction with

marked circulatory changes. These radical and rapid changes are crucial to the

maintenance of life. All other neonatal body systems change their functions or establish

themselves over a longer period of time. The nurse performs an initial assessment to

evaluate the neonate, its immediate post birth adaptations, and the need for further

support.

BIBLIOGRAPHY

Marlow, D.R; Redding B.A. (2010). TEXT BOOK OF PEDIATRIC NURSING. (6THed). India: Elsevier Publishers.

Assuma Beevi, T.M. (2010). Text Book of Pediatric Nursing. India: Elsevier Publishers. Bennet, V.R, Brown, L.K. (1999).Myles Text BookforMidwives.(13th ed). New York:

Churchill Livingstone Publishers.

Lowdermilk, D.L, Perry, S. Maternity Nursing. (7th ed).USA: Elsevier Publishers.


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PEDIATRIC NURSING.

TOPIC: PROFILE AND CHARACTERISTICSOF NEW BORN

SUBMITTED TO: SUBMITTED BY:

MRS. SAJINA, ASHA JOSE,

ASSO. PROFESSOR, 1ST

YEAR M.Sc. NSG,

MIMS COLLEGE OF NURSING. MIMS CON.

SUBMITTED ON: 22-05-2012.

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New Born-profile and Chara