Immediate Care of the Newborn

Goals:

To establish, maintain and support respirations.

To provide warmth and prevent hypothermia.

To ensure safety, prevent injury and infection.

To identify actual or potential problems that may require immediate attention.

Establish respiration and maintain clear airway

The most important need for the newborn immediately after birth is a clear airway to enable the newborn to breathe effectively since the placenta has ceased to function as an organ of gas exchange. It is in the maintenance of adequate oxygen supply through effective respiration that the survival of the newborn greatly depends.

Newborns are obligatory nose breathers. The reflex response to nasal obstruction, opening the mouth to maintain airway, is not present in most newborns until 3 weeks after birth.

To establish and maintain respirations:

1. Wipe mouth and nose of

secretions after delivery of the head.

2. Suction secretions from mouth and nose.

Compress bulb syringe before inserting Suction mouth first, then, the nose

Insert bulb syringe in one side of the mouth

3. A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry is weak.

Do not slap the buttocks rather rub the soles of the feet.

Stimulate to cry after secretions are removed.

The normal infant cry is loud and husky. Observe for the following abnormal cry:

o High, pitched cry – indicates hypoglycemia, increased intracranial pressure.

o Weak cry – prematurityo Hoarse cry – laryngeal stridor

4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions.

Trendelenburg position – head lower than the body

Side lying position – If trendelenburg position is contraindicated, place infant in side lying position to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position.

5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory nose breathers until they are about 3 weeks old.

Care of the Eyes

It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal during delivery. This practice was

introduced by Crede, a German gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose.

Erythromycin or tetracycline Opthalmic Ointment:

1. These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis.

2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.

Vitamin K or Aquamephyton

The newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinal bacteria that manufactures vitamin K which is necessary for the formation of clotting factors. This makes the newborn prone to bleeding. As a preventive measure, .5 (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborn’s vastus lateralis (lateral anterior thigh) muscle.

Care of the cord

The cord is

clamped and cut approximately within 30 seconds after birth. In the delivery room, the cord is clamped twice about 8 inches from the abdomen and cut in between. When the newborn is brought to the nursery, another clamp is applied ½ to 1 inch from the abdomen and the cord is cut at second time. The cord and the area around it are cleansed with antiseptic solution. The manner of cord care depends on

hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed after 48 hours when the cord has dried. The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days.

Instruction to the mother on cord care:

1. No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by water or urine.

2. Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol.

3. Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine.

4. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air.

5. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten.

6. Report any unusual signs and symptoms which indicates infection.

Foul odor in the cord Presence of discharge Redness around the cord The cord remains wet and does

not fall off within 7 to 10 days Newborn fever

THE APGAR SCORING SYSTEM

The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the newborn’s adjustment to extrauterine life. It is taken at one minute and five minutes after birth. With depressed infants, repeat the scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits. The most important is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.

ASSESS 0 1 2 HEART RATE Absent Below 100 Above 100RESPIRATION Absent Slow Good cryingMUCLE TONE Flaccid Some flexion Active motionREFLEX IRRITABILITY No response Grimace Vigorous cryCOLOR Blue all over Body pink,

Extremities blue

Pink all over

Score:

7 – 10 Good adjustment, vigorous Moderately depressed infant, needs airway clearance Severely depressed infant, in need of resuscitation.

ASSESSING THE AVERAGE NEWBORN

Head Circumference 34 – 35 cm Temperature 97.6 – 98.6 F axillaryChest Circumference 32 – 33 cmHeart Rate 120 – 140 bpmRespirations 30 – 60 bpmWeight 2.5 to 3.4 kgLength 46 to 54 cm

“Newborn Screening”Inborn Errors of Metabolism

G6PD Deficiency-Glucose 6 Phospate Dehydrogenase· Sex linked recessive (X-linked kaya there is more boys than girls)(bakit boys? Remember that female contains XX genes while male contains X genes. So ibig sabihin if a female had a faulty X genes the other X genes can balance the effect. So with this principles female are always carriers and her son would be affected, Then if the affected son had a female daughter she will be a carrier)

· Lacks enzyme G6PD results in premature destruction of RBC if cells are exposed to oxidants, ASA, legumes and flava beans

2 forms:

1. Congenital Nonspherocytic Hemolytic anemia- group of congenital hemolytic anemias in which there is no abnormal hemoglobin or spherocytosis and in which there is a defect of glycolysis in the erythrocyte

Characterized by:Hemolysis, jaundice, splenomegaly and aplastic anemia

2. Drug induced

Precipitating factors:

1. Illness: bacterial and viral infections2. Anti-pyretic drugs (Aspirin and phenacitin)3. sulfonamides4. Anti-malarial drugs (Quinine)5. Various medications such us Vit. K and Methylene blue6. Flava beans and Napthalene (eto ung moth balls or naptalina na nilalagay sa cabinet)

Dx Procedure

· Rapid enzymes screening test or electropoetic RBC

· Peripheral blood smear- reveals presence of Heinz bodies (hindi eto ung ketchup, this are RBC’s that appears to have bite off the cytoplasm, that’s why they are sometimes called ‘bite cells’)

Nursing Management

· Instruct to avoid foods such us flava beans, red wine, legumes, blueberries, soya foods, tonic water and other drugs that triggers the attack.

Homocystinuria

· elevated excretion of amino acid homocystiene· It can lead to mental retardation (delays in reaching developmental milestones {e.g., crawling, walking, sitting})

REVIEW!!! Ireview natin ang mga level of Mental retardation... lumabas ito last June 06 board.Profound Mental retardation- IQ<20> thinks like an Infant. Can’t be trainedSevere Mental retardation- 20-35Moderate 35-50-> can be trained. Mental age is 2-7y/o. Pre-operational stageMild- 50-70 Metal age is 7-12. Educable and can go to schoolBorderline 70-90Normal – 90-110(Balik ulit tayo sa Homocystinuria)

· Inability to convert amino acid Methionine· Autosomal recessive (this means the gene defect is unknowingly passed down from generation to generation. This faulty gene only emerges when two carriers have children together and pass it to their offspring. For each pregnancy of two such carriers, there is a 25% chance that the child will be born with the disease and a 50% chance the child will be a carrier for the gene defect.)

Signs/Symptoms· Mental retardation· Downward subluxation of lens (ectopia lentis)

· Slender built· Pectus excavatum (oist meron din nito ang may Down syndrome, the sternum appears sunken and the chest concaves.)· Abnormal thinning and weakness of the bone (osteoporosis and kyphoscoliosis)· Degeneration of the aorta

Labtest:Bacterial inhibition assay for methionine- Normal is <1mg>

Congenital Adrenal Hyperplasia

- A condition where the adrenal does not produce enough cosrtisol and aldosterone but there is an excessive production of androgens.- This is also autosomal recessive

REVIEW!! Hormones of the Adrenal CortexAng ating code; SSSSalt- Mineralocorticoids (mainly aldosterone- responsible for Na reabsorption and K excretion)Sugar-Glucocorticoids (mainly cortisol, responsible for glycolisis and gluconeogenesis)Sex- Sex hormonesOversecretion- Cushing’s syndromeUndersecretion- Addison’s disease

Assessment:In female· Large clitoris, closed labial folds· Early appearance of pubic hair· Deep masculine voice· No breast development and menstruation· Excessive hair in face· (in short nagiging lalaki ung babae, pramis pag nakita nyo ung itsura, ung clitoris eh mukha nang penis)

In male:at birth- normal6 months signs of sexual precocity3-4 – have pubic hair and enlarged penis, scrotum and prostate but testes is not descendedsterility

Labtest:High 17-hydroxyprogesteroneLow serum NaHigh serum K

Treatment:CorticosteroidDiet: High sodium, low potassium

PHENYLKETONURIA

(PKU) – deficiency of liver enzymes (PHT)Phenylalaninehydroxylase Transferase – liver enzyme that converts CHON to amino acid

9 amino acids:valine isolensine tryptophaselysine phenylalanine

Thyronine – decrease malanine production1.) fair complexion2.) blond hair3.) blue eyesThyroxine – decrease basal metabolism- accumulation of Phenyl Pyruvic acid4.) Atopic dermatitis5.) musty / mousy odor urine6.) seizure – mental retardation

Test – GUTHRIE TEST – specimen – blood- preparation increase CHON intake- test if CHON will convert to amino acid

specimen and urinemixed with pheric chloride, presence of green spots at diaper a sign of PKUDIET:Low phenylalanine diet- food contraindicated- meats, chicken, milk, legumes, cheese, peanutsGive Lofenalac- milk with synthetic protein

Galactosemia

– deficiency of liver enzyme- GUPT – Galactose Urovil Phosphatetranferase- Converts galactose to phosphate tranferace

glucoseGalactose – will destroy brain cells if untreated – death within 3 days

Dx:Beutler test – get blood -done after 1st feedingpresence of glucose in blood – sign of galactosemiagalactose free diet lifetimeneutramigen – milk formula

CELIAC DISEASE – gluten enteropathyCommon gluten food:Intolerance to food with browB- barleyR- ryeO- oatW- wheat

Pathophysiology:Gluten – glutamine ( normal absorption)-> Gliadin ( toxic to epithelial cells of villi of intestines, effects is malabsorption syndrome)

Malabsorption-> Fats-> steatorrhea->malnutrition and edema-> Vit D calcium->osteomalicia->Vitamin K->inadequate blood coagulation->bleeding->iron folic acid-> anemia

Early Sx:1. diarrhea – failure to gain wt ff diarrheal episodes2. constipation3. vomitingLate Sx:abd pain – protruberant abd even if with muscle wastingsteatorrhea

Celiac Crisis- exaggerated vomiting with bowel inflammationDx:lab studies – stool analysisserum antiglyadin – confirmatory of disease

gluten free diet – lifetimeall BROW – not allowedok – rice & corn

Mgt:vitamin supplementsmineral supplementssteroids

Characteristic of Newborn

The end of your journey has come after 40 weeks. The fruit of your labour (literally) will soon be in your hands.There are a few things you might want to know about your new arrival. Typically, a newborn baby has the followingcharacteristic appearance:

Weight: Average 2.8 kg for Indian babies (range 2.5 – 3.2 kg). Babies below 2.5 kg at birth are considered to be low birth weight and need special evaluation.

Length: Approximately 50 cm. Remember, small women have small babies and many genetic factors also play a role in determining the length of the baby.

Head: Your baby’s head appears large for the body and may have an elongated shape or appear to havesome ‘bumps’. This is due to changes called molding, which occurs in labour and delivery. Small bumps called ‘caput’ usually disappear in 1 – 2 days. Soon the head gets rounder. The head circumference is 33 – 35 cm.

Soft spots or Fontanelles: There are 2 areas on the head where bone formation is incomplete at birth. The larger one, in front of the head closes by 6 – 18 months. The smaller one at the back usually closes by 6 weeks.

Hair: As all people vary, so does their hair. Your baby may have lots of hair or none at all! It depends on familial and racial factors.

Heart beats: Usually the heart rate is 120 – 140 beats per minute. Respiratory rate (breathing): It is faster than adults, usually 30 – 40 breaths / minute. Breathing may be

noisy or stop for many seconds. This is not uncommon. Colour: Depending on the parents, the skin colour of newborn varies. In general, newborn babies look

flushed and pink all over. However, the palms and soles of the feet may look dusky or little bluish soon after birth.

Axillary temperature measurement. The thermometer should remain in place for 3 minutes. The nurse presses the newborn’s arm tightly but gently against the thermometer and the newborn’s side, as illustrated

Preventing Infection

Ophthalmia neonatorum Any conjunctivitis with discharge occuring during the first two weeks of life. It typically appears 2-5 days

after birth, although it may appear as early as the first day or as late as the 13th.

silver nitrate (used before) – 2 drops lower conjunctiva (not used now)Administering Erythromycin or Tetracycline Ophthalmic Ointment

These ointments are the ones commonly used nowadays for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis.

Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes. Wipe excess ointment after one minute Č sterile cotton ball moistened Č sterile water.

Skino Skin reddish in color, smooth and puffy at birtho At 24 - 36 hours of age, skin flaky, dry and pink

in coloro Edema around eyes, feet, and genitalso Venix Caseosa -whitish, cheese-like substance,

covers the fetus while in utero and lubricates the skin of the NB. The skin of the term or postterm nb has less vernix and is frequently dry; peeling is common, esp. on the hands & feet

o Lanugo -moderate in full term; more in preterm; absent in postterm; shed after 2 weeks in time of desquammation

o Turgor good with quick recoilo Hair silky and soft with individual strandso Nipples present and in expected locationso Cord with one vein and two arterieso Cord clamp tight and cord dryingo Nails to end of fingers and often extend slightly

beyond

Skin colorWhite – edema Blue – cyanosis or hypoxia Grey – infection Yellow – jaundice , carotene

Acrocyanosiso Bluish discoloration of the hands and feet maybe

present in the first 2 to 6 hours after birtho This condition is caused by poor peripheral

circulation, w/c results in vasomotor instability & capillary stasis, esp. when the baby is exposed to cold.

Mongolian Spots

Mottling

o Jaundice is first detectable on the face (where skin overlies cartilage) and the mucus membranes of the mouth and has a head-to-toe progression.

o Evaluate it by blanching the tip of the nose, the forehead, the sternum, or the gum line. This procedure must be done with appropriate lighting. Another are to assess is the sclera.

o Jaundice maybe related to breastfeeding, hematomas, immature liver function, bruises from forceps, blood incompatibility, oxytocin induction or severe hemolysis process.

Nsg Resp:1. cover eyes – prevent retinal damage2. cover genitals – prevent priapism – painful continuous erection3. change position regularly – even exposed to light4. increase fld intake – due prone to dehydration5. monitor I&O – weigh baby6. monitor V/S – avoid use of oil or lotion due- heat at phototherapy = bronze baby syndrometransient S/E of phototherapy

Care of Newborn in JaundicePhototherapy

o Is the exposure of the NB to high intensity light.

o Maybe used alone or in conjunction w/ exchange transfusion to reduce serum bilirubin levels.

o Decreases serum bilirubin levels by changing bilirubin from the non-water soluble form to water-soluble by products that can be excreted.

Nursing Interventions:1. Exposing as much of the NB’s skin as possible however genitals are covered & the nurse monitors the genitals area forskin irritation2. Eyes are covered with patches or eye shields and are removed at least once per shift to inspect the eyes3. Monitor temp. closely & ↑ fluids to compensate

lacy pattern of dilated blood vesselsunder the skinOccurs as a result of generalcirculation fluctuations. It may lastseveral hours to several weeks ormay come and go periodically.

If the central circulation is adequate, the blood supply should return quickly when the skin is blanched with a finger. Blue hands and nails are poor indicator of oxygenation in NB. The nurse should assess the face & mucus membranes for pinkness reflecting adequate oxygenation

Patch of purple-black or blue-blackcolor distributed over coccygeal andsacral regions of infants of African-American or Asian descent. Notmalignant. Resolves in time. Theygradually fade during the first orsecond year of life. They maybemistaken for bruises and should bedocumented in the NB’s chart.

lacy pattern of dilated blood vesselsunder the skinOccurs as a result of generalcirculation fluctuations. It may lastseveral hours to several weeks ormay come and go periodically.

Erythema toxicum

o It is often called “newborn rash” or “fleabite” dermatitis

o The rash may appear suddenly, usually overo the trunk and diaper area and is frequently

widespread.o The lesions do not appear on the palms of the

hands or soles of the feet.o The peak incidence is 24-48 hours of life.o Cause is unknown and no treatment

Harlequin Signo The color of the newborn's body appears to be

half red and half pale. This condition is transitory and usually occurs with lusty crying. Harlequin Coloring may be associated with to an immature vasomotor reflex system.

BIRTH MARKS

Telangiectatic nevi (stork bites)

Appear as pale pink or red spots and are frequently found on the eyelids, nose, lower occipital bone and nape of the neck

These lesions are common in NB w/ light complexions and are more noticeable during periods ofcrying.

3 types Hemangiomasa.) Nevus Flammeus – port wine stain – macular purple or dark red lesions seen on face or thigh. NEVER disappear. Can be removed surgicallyb.) Strawberry hemangiomas – nevus vasculosus – dilated capillaries in the entire dermal or subdermal

The size & shape vary, but it commonly appears on the face. It does not grow in size, does not fade in time and does not blanch. The birthmark maybe concealed by using an opaque cosmetic cream.

If convulsions and other neurologic problem accompany the nevus flammeus,----5th cranial nerve involvement.

Nevus vasculosus (strawberry mark)

Such marks usually grow starting the second or third week of life and may not reach their fullest size for 1 to 3 months; disappears at the age of 1 yr. but as the baby grows it enlarges.

Birthmarks frequently worry parents. The mother maybe especially anxious, fearing that she is to blame (“Is my baby marked because of something I did?”) Guilt feelings are common when parents have misconceptions about the cause. Identify and explain them to the parents.

Providing appropriate information about the cause and course of birthmarks often relieves the fears and anxieties of the family. Note any bruises, abrasions,or birthmarks seen on admission to the nursery.

HEAD Head circumference should be 2 cm greater

than chest circumference Assess fontanelles and sutures - observe for

signs of hydrocephalus and evaluate neurologic status

Craniosynostosis Microcephaly Macrocephaly

A capillary hemangioma, consists of newly formed and enlarged capillaries in the dermal and subdermal layers.

It is a raised,clearly delineated, dark-red, rough-surfaced birthmark commonly found in the head region.

o Is an eruption of lesions in the area surrounding a hair follicle that are firm, vary in size from 1-3 mm, and consist of a white or pale yellow papule or pustule w/ an erythematous base.

Face, Mouth, Eyes, and Ears Assess and record symmetry Assess for signs of Down syndrome. Low set ears Assess history for risk factors of hearing loss Test for Moro reflex- elicited by a loud noise or

lifted slightly above the crib and then suddenly lowered. In response, the NB straightens arms and hands outward while the knees flexed. Slowly the arm returns to the chest as in embrace. The fingers spread, forming a C and the newborn may cry. This lasts up to 6 months of age.

Check for presence of gag, swallowing reflexes, coordinated with sucking reflex

Check for clefts in either hard or soft palates Check for excessive drooling Check tongue for deviation, white cheesy

coatingEyes

Assess for PERLA (pupils equal and reactive to light and accommodation)

Assess cornea and blink reflex Note true eye color does not occur before 6

months May have blocked tear duct

Heart and Lungs Assess and maintain airway Assess heart rate, rhythm - evaluate murmur:

location, timing, and durationo Examine appearance and size of chesto Note if there is funnel chest, barrel

chest, unequal chest expansion Assess breath sounds and respiratory efforts -

evaluate color for pallor or cyanosis Breasts are flat with symmetric nipples - note

lack of breast tissue or dischargeAbdomen

Abdomen appears large in relation to pelviso Note increase or decrease in

peristalsiso Note protrusion of umbilicus

Measure umbilical hernia by palpating the opening and record

o Note any discharge or oozing from cord

o Note appearance and amount of vessels

Auscultate and percuss abdomeno Assess for signs of dehydrationo Assess femoral pulseso Note bulges in inguinal area

Epispadias: if the opening is at the dorsal surface

Hydrocele – swelling due to accumulation of serous fluid in the tunica vaginalis of the testis or in the spermatic cord

Anus Inspect anal area to verify that it is patent and

has no fissure Digital exam by physician or nurse practitioner

if needed Note passage of meconium

Extremities Tic dwarfism : very short arms Amelia : absence of arms Phocomelia : absence of long arm Polydactilism: more fingers; extra digits on

either hands or feet Syndactilism: webbing; fusion of fingers or

toes

Inspect the hands for normal palmar creases. A single palmar crease called SIMIAN line is frequently present in Down’s syndrome

Adactyl : no foot Down’s syndrome: inward rotation of little

fingers Clubfoot/ talipes deformity – inward rotation

of foot fingers. Erb-Duchenne paralysis (Erb’s palsy) :

resulting from injury to the 5th and 6th cervical roots of the brachial plexus; usually from a difficult birth; it occurs commonly when strong traction is exerted on the head of the NB in an attempt to free a shoulder lodged behind the symphysis pubis in the presence of shoulder dystocia

A. The asymmetry of gluteal and thigh fat folds see

B. Barlow's (dislocation) maneuver. Baby's thigh is grasped and adducted (placed together) with gentle downward

o Percuss bladder 1 to 4 cm above symphysis

o Voids within 3 hours of birth or at time of birth

Genitals Pseudomenstruation: the discharge w/c can

become tinged w/ blood and is caused by withdrawal of

maternal hormones Smegma: a white cheeselike substance is often

present between labia. Removing it may traumatize tender

tissue Phimosis : tight foreskin or prepuce; w/c

sometimes lead to early circumcision Cryptoorchidism: undescended testes ;if the

testes did not go down Orchidopexy: repair of undescended testes

before 2 y/o Penis: urethra should be at the tip of the penis Hypospadias : if the opening is at the ventral

surface

Clubfooto Nurse examines feet for evidence of talipes deformity (clubfoot)o Intrauterine positions can cause feet to appear to turn inward - "positional" clubfooto To determine presence of clubfoot, nurse moves foot to midline - if resists, it is true clubfoot

D, Ortolani's maneuver puts downward pressure on the hip and then inward rotation. If the hip is dislocated, thismaneuver forces the femoral head over the acetabular rim

C, Dislocation is palpable as femoral head slips out of acetabulum.

TALIPES – “clubfoot”a.) Equinos – plantar flexion –horsefootb.) Calcaneous – dorsiflexion –heal lower that foot anterior posterior of foot flexed towards anterior legc.) Varus- foot turns ind.) Valgus- foot turns outEquino varus- most common

Nursing Role Be knowledgeable about normal newborn

variations and responses that indicate further investigation

o Respiratory distresso Central cyanosiso Thermoregulation problemso Dehydrationo Teaching

During physical and behavioral assessment, identify family's need for teaching

o Involve family early in care of infanto Process establishes uniqueness and

allays concern Teaching

o Feeding cueso Alert stateo Cord careo Sleeping

Neurological Status Assessment begins with period of observation Observe behaviors - note:

o State of alertnesso Resting postureo Cryo Quality of muscle toneo Motor activity

Jitteriness – feeling of extreme nervousness Differentiate causative factors Examine for symmetry and strength of

movements Note head lag of less than 45 degrees Assess ability to hold head erect briefly

Palmar & Plantar Grasp Reflex

Step reflex This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when

Tonic neck reflex - When a baby's head is turned to one side, the arm on that sidestretches out and the opposite arm bendsup at the elbow. This is often called the "fencing" position. The tonic neck reflex lasts about six to seven months.

Babinski reflex - When 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 about 2 years of age.

The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his/her head,extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him/her and begin this reflex. This reflex lasts about five to six months.

Grasp reflex - Stroking the palm of a baby'shand causes the baby to close his/her fingers ina grasp. The grasp reflex lasts only a couple ofmonths and is stronger in premature babies.Palmar & Plantar

Step reflex This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when

ASSESSMENT OF PHYSICAL MATURITY CHARACTERISTICS OF NEWBORN

Observable characteristics of newborn should be evaluated while not disturbing baby

Gestational assessment tools examine the following physical characteristics

o Resting postureo Skino Lanugoo Sole (planar) creaseso Breast tissueo Ear form and cartilage distributiono Evaluation of genitals

Male genitals

A, Preterm newborn’s testes are not within the scrotum. The scrotal surface has few rugae. score 2.

Neuromuscular Components

Square window sign

Signs of Preterm Babieso Born after 20 weeks, after 37 weekso frog leg or laxed positono hypotonic muscle tone- prone resp problem

C, A 0-degree angle can occur from 40 to 42 weeks. Score 4. (C) Used with permission from V.Dubowitz, MD,Hammersmith Hospital,London, England.

B, A 30- to 40-degree angle is commonly found from 39 to 40 weeks’ gestation. Score 2-3.

A, This angle is 90 degrees and suggests an immaturenewborn of 28 to 32 weeks’ gestation. Score 0.

C, The term newborn has well-developed, large labia majora that cover both clitoris and labiaminora. Score 3.

B, The clitoris is still visible.The labia minora are now covered by the larger labia majora. Score 2. The gestational age is 36 to 40 weeks.

Suck reflex Rooting helps the baby become ready tosuck. When the roof of the baby's mouth istouched, the baby will begin to suck. This reflex does not begin until about the 32ndweek of pregnancy and is not fully developed until about 36 weeks. Premature babies mayhave 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.

Root reflex - This 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.