1. SEMINAR ON GROWTH AND DEVELOPMENT OF NEONATE

2. INTRODUCTION 3. Principles of Growth and Development Growth is an orderly process, occurring in systematic fashion. Rates and patterns of growth are specific to certain parts of the body. Wide individual differences exist in growth rates. Growth and development are influences by are influences by a multiple factors Development proceeds from the simple to the complex and from the general to the specific. Development occurs in a cephalocaudal and a proximodistal progression. There are critical periods for growth and development. Rates in development vary. Development continues throughout the individual's life span. 4. Growth Pattern 5. Stages of Growth and Development 6. Terminologies 7. Adjustment to extra uterine life of all systems Immediate adjustments 8. 1, Respiratory System Chemical stimuli Thermal stimuli 9. Circulatory system 10. Structure Before Birth After Birth Umbilical Vein Brings arterial blood to the heart Obliterated; becomes round ligament of the liver Umbilical Arteries Bring arteriovenous blood to placenta Obliterated; becomes vesical ligaments on anterior abdominal wall Ductus venousus Shunts arterial blood into inferior vena cava Obliterated; becomes ligamentum venosum Ductus Arteriosus Shunts arterial and some venous blood from the pulmonary artery to aorta Obliterated; becomes ligamentum arteriosum 11. Foramen Ovale Connects right and left auricles Obliterated usually; at all times Lungs Contain no air and very little blood; filled with fluid Filled with air and well supplied with blood Pulmonary arteries Bring little blood to lungs Bring much blood to lungs Aorta Receive blood from both ventricles Receive blood only from left ventricle Inferior vena cava Brings venous blood from body and arterial blood from placenta Brings blood only to right auricle 12. Physiologic status of other systems 1, Thermoregulation 2, Hemopoetic Systems 3, Fluid And Electrolytes 4,Gastrointestinal System 5, Genito-Urinary System 6, Integumentary System 13. Birthmarks Hemangiomas - Are vascular tumors of the skin. Three types of hemangiomas occur: 1. Nevus Flammeus - Is a macular purple or dark-red lesion that is present at birth - Sometimes called a port-wine stain - These lesion typically appear on the face, although they often found on the face; it is less likely to fade. - Can be covered by a cosmetic preparation later in life or removed by laser therapy, although lesions may reappear after treatment. 14. 2. Strawberry Hemangioma - Are elevated areas formed by immature capillaries and endothelial cells. - Most are present at birth in term neonates, although may appear up to 2 weeks after birth. - Application of hydrocortisone ointment may speed the disappearance of the lesions by interfering with the binding of estrogen to its receptor site. 15. 3. Cavernous Hemangioma - Are dilated vascular spaces, they are usually raised and resemble a strawberry hemangioma in appearance. However they do not disappear with time as the strawberry hemangioma. - Suncutaneous infusions of interferon-alfa-2a can be used to reduce these lesions in size, or they can be removed surgically. - Usually their hematocrit levels assed at health maintenance to evaluate for possible internal blood loss 16. Mongolian Spot - Are collections of pigment cells that appears as slate- gray patches across the sacrum or buttocks and possibly on the arms and legs. - They disappear by school age without treatment. 17. Vernix Caseosa - Is a white, cream cheese- like substance that serves as a skin lubricant. - It is noticeable in on a term newborns skin, at least in the skin folds, at birth. 18. Lanugo - Is the fine hair, downy hair that covers a newborns shoulder, back and upper arm. It maybe found also on the forehead and ears. - A baby born after 37 to 39 weeks of gestation has more lanugo than a newborn of 40 weeks. - Is rubbed away by the friction of bedding and clothes against the newborns skin. - By 2 weeks of age it disappear 19. Desquamation - Within 24 hours after birth, the skin of most newborns has become extremely dry. The dryness is particularly evident on the palms of the hands and soles of the feet. - This results in areas of peeling similar to those caused by sunburn. 20. Milia - all newborn sebaceous glanda are immature. - At least one pinpoint white papule can be found on the cheek or across the bridge of the nose of every newborn. - Disappear by 2 to 4 weeks of age, as sebaceous glands mature and drain. 21. Erythema Toxicum - In most normal mature infants, a newborn rash - This usually appears in the first to fourth day of life, but may appear up to 2 weeks of age. - It begins with papule, increases in severity to become erythema by the second day, and then disappears by the third day - Sometimes called flea-bite rash - Caused by a newborns eosinophils reacting to the environment as the immune system matures. 22. Epsteins Pearls - One or two small round, glistening, well circumscribed cysts are present on the palate, as a result of the extra load of calcium that was deposited in utero. 23. 7, Musculoskeletal System 8, Immune Systems 9, endocrine system 10, Neurologic System 11, Sensory Functions 24. Psychosexual development of newborn 25. Cognitive development Personality type1: easy (about 40%of children) Personality type2: difficult child (about 10% of children) Personality type3: slow to warm up child (about 15% of children) 26. NURSING CARE OF THE NORMAL NEWBORN INFANT GENERAL 27. CARE OF THE NEWBORN IN THE DELIVERY ROOM 28. a. Establishing and Maintaining the Newborn's Airway 29. (1) Common characteristics of newborn respirations 30. (2) Signs and symptoms of newborn respiratory distress. 31. b. Maintaining Body Temperature 32. c. Identify the Infant After Delivery. 33. d. Establish Parent-Infant Bonding Process 34. VIRGINIA APGAR SCORING OF THE NEWBORN 35. Ballard Scoring 36. PROCEDURE FOR ADMISSION TO THE NURSERY 37. Newborn Reflex Blink Reflex - In a newborn serves the same purpose as it does in an adult-to protect the eye from any object coming near it by shining a strong light such as a flashlight or otoscope light on an eye. A sudden movement to ward the eye sometimes can elicit the blink reflex. 38. Rooting reflex - If the check is brushed or stroke near the corner of the mouth, a newborn infant will turn the head in that direction. This reflex serves to help a newborn find food: when a mother holds the child and allows her breast to brush the newborns cheek, the reflex makes the baby turn toward the breast. - This reflex disappear at about the sixth week of life. It about time, newborn eyes focus 39. Sucking reflex - When a newborn lips are touched, the baby makes a sucking motion. This reflex helps a newborn find food: when the newborn lips touch the mothers breast or bottle, the baby sucks and takes food. - The sucking reflex begins to diminish at about 6 months of age. 40. Swallowing reflex - In a newborn is the same as in adult. Food that reaches the posterior portion of the tongue id automatically swallowed. Gag, cough, and sneeze reflexes are present to maintain airway in the event that normal swallowing does not keep the pharynx free from obstructing mucous. 41. Extrusion Reflex - A newborn extrudes any substance that is placed on the anterior portion of the tongue. This protective reflex prevents the swallowing reflex of inedible substance. - It disappears at about 4 months of age 42. Palmar Grasp Reflex - Newborn grasp an object placed in their palm by closing fingers on it. - Mature newborn grasp so strongly that they can be raised from a supine position and suspended momentarily from an examiners fingers. - Reflex disappears at about 6 weeks to 3 months of age. 43. Step-in-place reflex - Newborn who are held in a vertical position with their feet touching a hard surface will take a few quick, alternating steps. - This reflex disappears by 3 months of age. Placing reflex - Is similar to the step-in-place reflex, except that it is elicited by touching the anterior surface of the newborns leg against a hard surface 44. Plantar Grasp Reflex - When an object touches the sole of a newborns foot at the base of the toes, the toes grasp in the same manner as the finger do. - Reflex disappears at about 8 to 9 months. 45. Tonic neck reflex - When newborn lie on their backs, their head usually turn to one side or the other. The arm and the legs on the side toward which the head turns extend, and the opposite arm and leg contract. - This is also called the boxer or fencing reflex - The reflex disappears between the second and third months of life. 46. Moro Reflex - Can be initiated by startling a newborn with a loud noise or by jarring the bassinet. The most accurate method to eliciting the reflex is to hold a newborns in a supine position and allow their heads to drop backward about 1 inch. In response to this sudden head movement, they abduct and extend their arms 47. Babinski Reflex - When the side of the sole of the foot is stroked in an inverted J curve from the heel upward, a newborn fans the toes - It remains positive until at least 3 months of age. 48. Magnet Reflex - If pressure is applied to the soles of the feet of a newborn lying in a supine position, he or she pushes back against the pressure. Crossed Extension Reflex - If one leg of a newborn lying supine is extended and the sole of that foot is irritated by being rubbed with a sharp object, the infant raises the other leg and extends it, as if trying to push away the hand irritating the first leg 49. Trunk Incurvation Reflex - When newborns lie in a prone position and are touched along the paravertebral area by a probing finger, their trunk and swing their pelvis toward the touch. Landau Reflex - A newborn who is held in a prone with a hand underneath, supporting the trunk, should demonstrate some muscle tone. Babies may not be able to lift their head or arch their back in this position 50. Deep Tendon Reflex - A patellar reflex can be elicited in a newborn by tapping the patellar tendon with the top of the finger. - The lower leg moves perceptibly if the infant has an intact reflex. - Is a test for spinal nerve L2 through L4 51. ADMINISTRATION OF VITAMIN K The vastus lateralis muscle lies lateral to the midline of the thigh and wraps about 1/4 the distance around the thigh...from 12 o'clock to 3 o'clock 52. EYE PROPHYLAXIS FOR THE NEWBORN 53. INITIAL BATH 54. CORD CARE FOR THE NEWBORN INFANT 55. BONDING PROCESS 56. INFANT BAPTISM 57. COMPLETE INSPECTION OF THE NEWBORN 58. GOALS OF NEWBORN NURSING CARE a. To continue appraisal of the newborn throughout his hospital stay. (1) Observe and record the infant's vital signs. (2) Monitor weight loss or gain (daily by some local policy). (3) Monitor bowel and bladder function. (4) Monitor activity and sleep patterns. (5) Monitor interactions and bonding with parents. b. To provide safeguards against infection (that is, handwashing). c. To initiate feedings. d. To provide guidance and health instruction to parents 59. DISCHARGE CONSIDERATION FOR THE NEWBORN AND FAMILY 60. Nursing Diagnosis Risk for ineffective thermoregulation related to newborns transition to extrauterine environment Risk for ineffective airway clearance related to presence of mucus in mouth and nose at birth Risk for infection related to newly clamped umbilical cord and exposure of eyes to vaginal secretions 61. Newborn Screening 62. Summary of Recommendations Universal newborn screening should be introduced in phases in our country. Screening should be done after 2 days and before 7 days of age . Infants screened before 24 hours of life should be re-screened by 2 weeks of age to detect possible missed cases. Sick and premature babies should also have metabolic screening performed by 7 days of life. The disorders to be screened our country have been classified into three groups, depending on availability of resources. A positive screening test should always be followed with parental counseling, confirmatory test, genetic counseling and early dietary or other interventions. There is a need for comprehensive planning for NBS at state and national levels 63. What disorders does the Newborn Screening test for? Congenital Hypothyroidism - A lack or absence of thyroid hormone, which is necessary for growth of the brain and the body. Treatment is required within the first four weeks to prevent stunted physical growth and mental retardation. Congenital Adrenal Hyperplasia - An endocrine disorder that causes severe salt loss, dehydration, and abnormally high levels of male sex hormones. Left undetected and untreated, a baby may die within seven to 14 days. 64. Galactosemia - A condition in which babies are unable to process galactose. or the sugar present in milk. Increased galactose levels in the body lead to liver and brain damage, and to the development of cataracts. Phenylketonuria - The inability to properly utilize the enzyme phenylalanine, which may lead to brain damage. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency - A condition where the body lacks the enzyme called G6PD, which may cause hemolytic anemia resulting from exposure to oxidative substances present in certain drugs, foods and chemicals. Parents of G6PD-positive babies are given a list of these substances. 65. How is Newborn Screening administered? Your baby will be pricked at the heel and three drops of blood are taken. This process is ideally done during the 48th to 72nd hour of life. A negative screen means that results are normal. A positive screen will require the newborn to be brought back to her pediatrician for further testing. 66. Puncture site (X) on sole of infant's foot for heelstick sample. 67. Newborn assessment 68. Recent Research Study Neonatal Blue Light Phototherapy and Melanocytic Nevi: OBJECTIVE: Our goal was to conduct a twin study with the aim of better understanding the role of NBLP in melanocytic nevus development. We also investigated the roles of other environmental and constitutional factors in nevus formation. 69. CONCLUSIONS: Our data suggest that NBLP could well be a risk factor for melanocytic nevus development. Phototherapy with blue-light lamps is a standard and essential therapeutic modality in neonatal care; therefore, additional in vivo and in vitro studies are necessary to establish its potential long-term adverse effects. 70. CONCLUSION