Newborn pinking up

APGAR scores Each category can rate either 0, 1, or 2,

with the higher numbers being better. Scores can range from 0 to 10 Babies are assessed 1 minute and 5

minutes after birth Score of 7 or greater at 5 minutes—baby

is in good shape. 4-6: baby needs help breathing 3 or lower: baby needs emergency

medical attention.

More about APGAR The most unreliable of the signs is color,

especially for non-Caucasian babies.

APGAR is especially good at 2 things: Identifying high-risk babies who need

resuscitation Assessing the newborn’s ability to respond

to the stress of delivery & its new environment.

Breathing Fluid fills lungs before birth Fluid is absorbed into lymph and

bloodstream immediately after birth

Lungs start filling with air, and baby takes first breath

Babies who can’t breathe well go to NICU—neonatal intensive care

Cutting the cord Umbilical cord is still attached to

placenta when baby is born. Continues to pulse for several

minutes, supplying baby with oxygen until baby takes first breath

Once pulsing stops, cord is cut. Then the stump is clamped for 24-48 hours.

Picture of the umbilical cord

Preventing eye disease Gonorrheal eye infections were leading

cause of blindness until early 20th century, when it became mandatory to treat newborn’s eyes.

Until 1970s, silver nitrate was used, but solution was irritating. Also doesn’t protect against chlamydia.

Today either tetracycline or erythromycin is used.

Vitamin K injections Babies receive vitamin K injections

to stop blood from clotting. Babies have low levels of vitamin K for the first few weeks after birth.

Injection prevents serious bleeding inside the skull.

Unrelated to hemophilia; only occurs in baby’s first year of life.

Newborn’s appearance Newborn is slippery, wet, covered

with blood and mucus. Might be covered in vernix/lanugo. Head may be cone-shaped from

birth (this is called “molding”) Eyelids are puffy; nose is flattened Baby’s eyes are slate blue or dark

bluish-brown.

The newborn appearance

Vernix on the newborn

Bonding There’s a sensitive period for bonding in

the first hour after birth; baby is alert and responsive then

Early research (Klaus & Kennell, 1976; 1982) suggested that first 6-12 hours after birth was a critical time for bonding.

Later research said that bonding can occur at any time; bonding in the first few hours only increases maternal responsiveness toward baby for the first 3 days.

“Rooming In” with baby Mid-twentieth century: American hospitals did

not offer the option to have the baby in the room with you.

Today you can choose to “room in” with the baby or have the baby sent to the nursery.

Pros of rooming in: increased bonding with baby, helps with breastfeeding

Cons: Mom doesn’t get as much sleep. Lamb (1994): Whether you room with baby or

not does not affect bonding or harm baby emotionally.

Bonding

Three threatening conditions Low birth weight (less than 5 lbs. at birth)

Very low birth weight – less than 3 lbs. Extremely low birth weight—less than 2 lbs.

Preterm birth—born 3 weeks or more before due (in 2009, 12.2% of U.S. infants were premature; among African-Americans, the rate was 17.5%)

Being small for date Weigh less than 90% of all babies of same gestational

age May be preterm or full term Have a 400% greater risk of death

Classifications of Prematurity “Very Preterm”—born at less

than 33 weeks gestational age “Extremely Preterm”—born at

less than 28 weeks gestational age Survival rates for these infants

have risen but have come at a price of increased rates of severe brain damage

Consequences of Low Birth Weight and Prematurity Most are healthy but have more

developmental & health problems as a group than normal-weight babies

More likely to develop… ADHD Asthma or other breathing problems Learning disabilities 2012 study linked it with autism 50% are in some kind of special education

program

Incidence of Low Birth Weight Varies from country to country In developing countries where poverty and

malnutrition are rampant, up to 50% of babies are low birth weight.

U.S. rate is 8.1% as of 2011, much higher than that of many other developed countries.

Recent research is focusing on the role of progestin as a buffer against low birth weight

Kangaroo Care Involves 2-3 hours of daily skin-to-skin

contact with baby held upright against parent’s bare chest

Helps baby regulate temperature, heartbeat, and breathing

Kangaroo care babies gain more weight and have a lower risk of dying than babies that don’t receive such care.

Baby receiving kangaroo care

Massage in Preterm Infants Substantial research by Tiffany Field et al. 1st study: Babies got firm massage with palms

of hands 3 times a day for 15-minute increments.

Led to 47% greater weight gain than standard medical treatment; more active & alert; did better on developmental tests

Experiments show benefits to children born from depressed adolescent moms, moms with HIV, and babies born addicted to cocaine

More on massage therapy Two consistent findings

Increased weight gain as a result of massage therapy due to stimulation of the vagus nerve (one of the 12 cranial nerves leading to brain) and in turn the release of insulin

Discharge from the hospital 3-6 days earlier.

Jaundice A yellow color of the skin that is common

in newborns because they have too much bilirubin (a pigment produced as red blood cells break down) in their blood

Either too much bilirubin is produced or the immature liver doesn’t get rid of it quickly enough.

Starts at the head and goes downward (face appears yellow before the rest of the body)

2 kinds of jaundice Physiological jaundice—not harmful;

very common in newborns; seen during first 3-5 days of life; disappears as liver matures.

Pathological jaundice—this type is harmful; occurs when the bilirubin levels are too high Can affect brain cells, cause baby to be less

active Can result in seizures, deafness, cerebral palsy,

& mental retardation

Treatment for Jaundice Phototherapy—exposing baby to light In mild cases, you can simply put the

baby in sunlight for a time each day. Sometimes it is done in the hospital,

with the baby’s eyes protected by eye patches.

Loose bowel movements and skin rashes can occur with phototherapy.

Blood transfusions may be necessary.

Risk Factors that make Jaundice More Harmful Babies born at less

than 37 weeks Babies who weigh

less than 5 lbs. 8 oz. (2500 grams)

Babies whose blood group is incompatible with Mom’s (Rh factor)

Babies who have an infection

Babies who needed resuscitation at birth

Babies who displayed jaundice within the first 24 hours of life

Call Doctor If… Baby won’t take breast or bottle (jaundice

is especially common in breastfed babies before Mom’s milk comes in)

Baby is sleepy all the time Baby has lost more than 10% of birth

weight Baby’s arms, legs, or eyes look yellow Rectal temperature is greater than 100

degrees F (37.8 degrees C).

Metabolic Disease Screening The March of Dimes recommends screening

for 29 different metabolic diseases. How many are actually screened varies by

state. (Georgia screens for all 29.) All newborns in Georgia get the “heel stick

test” in which 9-10 drops of blood are collected.

This test is mandatory, even for parents who can’t afford the $50 fee.

Benefits of Metabolic Screening Metabolic diseases can cause

mental retardation, seizures, hyperactivity, intellectual delays, smaller head size, a “musty” odor, and other health problems.

Benefits of screening entire newborn population outweigh the costs.

Circumcision A procedure in which the foreskin of the

penis is surgically removed, exposing the glans.

Usually performed some time during the first 2-3 weeks of birth and usually within first 488 hours.

Commonly done in the United States, Canada, Israel, and the Middle East.

Less common in Europe, Asia, South America, and Central America.

Current Circumcision Rates in U.S. Latest statistics (from 2010) show declining

rates of circumcision in the U.S. with a current rate of 58.3% being circumcised.

This varies by region Highest is in Midwest with 71% and

Northeast (66%) Rate in the South is 58% and in the West is

40%.--Figures are from the National Center for

Health Statistics

American Academy of Pediatrics’ stance In 1999, AAP reversed its previous

decision recommending routine circumcision.

They now say that there is not sufficient medical evidence to recommend circumcision OR argue against it. It is up to the parents.

Pros and ConsPros

Prevents retraction problems with the foreskin and inflammation of glans & foreskin.

May result in decreased incidence of urinary tract infections.

May result in lower incidence of STDs and HIV.

May decrease risk of penile cancer and cervical cancer in women (sexual partners).

Cons Risk of meatitis

(inflammation of penis opening) and meatal stenosis (disorders related to urination) may be as high as 8-21%.

Injury to the penis such s partial amputation.

Some say it results in decreased sensation during sexual intercourse.

Pain Control During Procedure Until the 1980s, it was felt that infants didn’t feel

pain, and anesthesia during surgery was not used. Brain scans, heart rate measures, & cortisol tests

show that newborns DO feel pain. AAP now recommends anesthesia, but only 45% of

doctors (usually obstetricians) routinely use it. Babies who get no anesthesia during circumcisions

show increased pain responses to vaccinations later compared to girls, non-circumcised boys, and boys who received anesthesia.

Types of Anesthesia Available 55% of doctors only use a pacifier dipped in

sugar water (NOT effective) An injection of lidocaine into the base of the

penis or around the penis shaft is the most effective, but it’s painful.

A numbing cream can be applied to the head of the penis. Not as effective as the nerve block.

No anesthesia is effective at controlling post-operative pain.