Characteristic Of Newborn

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 following characteristic appearance:

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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 have some ‘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

Proper Identification of the Newborn Proper Id is made in the delivery room before mother and baby are separated. o Identification Band o Footprints o Others – fingerprints, crib card, bead bracelet  Birth certificate  final identification check of the mother and infant must be performed before the infant can be allowed to leave the hospital upon discharge to ensure that the hospital is discharging the right infant. 

Preventing Infection Credes Prophylaxis – Dr. Crede prevent opthalmia neonatorum or gonorrhoeal conjunctivitis how transmitted – mom with gonorrhea drug: erythromycin ophthalmic ointment- inner to outer  It is part of the routine care of the NB to give prophylactic eye treatment against gonorrheal conjunctivitis or ophthalmia neonatorum within the first hour after delivery.  Neisseria gonorrhea, the causative agent,maybe passed on to the fetus when infected vaginal and cervical secretions enter the eyes as the baby passes the vaginal canal during delivery. This practice was introduced by Crede, German gynecologist in 1884. Silver Nitrate

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. Principles of cleanliness at birth:  Clean hands  Clean perineum  Nothing unclean to be introduced into the vagina  Clean delivery surface  Cleanliness in cutting the umbilical cord  Cleanliness for cord care of the newborn baby

Handwashing  Before entering the nursery or caring for a baby  In between newborn handling or after the care of each baby  Before treating the cord  After changing soiled diaper  Before preparing milk formula.

Preventing Hemorrhage  As a preventive measure, 0.5mg (preterm) to 1 mg (full term) Vit. K or Aquamephyton is injected IM in the NB’s vastus lateralis (lateral anterior thigh)muscle  Vit-K – to prevent hemorrhage R/T physiologic hypoprothrombinemia  Aquamephyton, phytomenadione or konakion  .1 ml term IM, vastus lateral or lateral ant thigh  .05 ml preterm baby  Vit K – synthesized by normal flora of intestine  Vit K – meds is synthetic due intestine is sterile Procedure for vitamin K injection. Cleanse area thoroughly with alcohol swab and allow skin to dry. Bunch the tissue of the upper outer thigh (vastus lateralis muscle) and quickly insert a 25-gauge 5/8-inch needle at a 90-degree angle to the thigh. Aspirate, then slowly inject the solution to distribute the medication evenly and minimize the baby’s discomfort. Remove the needle and gently massage the site with an alcohol swab. Care of the Cord The cord is clamped and cut approx. within 30 sec after birth. In the DR, the cord is clamped twice about 8 inches from the abdomen and cut in between. When the NB, is brought to the nursery, another clamp is applied . to 1 in from the abdomen and the cord is cut a second time. The cord and the area around it are cleansed w/ antiseptic solution. The manner of cord care depends on hospital protocol or the discretion of the birth attendant in home delivery, what is impt. Is that principles are followed. Cord clamp is removed after 48 hours when the cord has dried. The cord stump usually dries and falls off within 7-10 days leaving a granulating area that heals on the next 7-10 days. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and seperates more rapidly if it is exposed to air. Report any unusual signs & symptoms that indicate infection: Foul odor in the cord Presence of discharge Redness around the cord The cord remains wet and does not fall off within 7-10 days Newborn fever

“Tetanus microorganism thrives in anaerobic environment so you actually prevent infection if cord is exposed to air”. 3 cleans in community clean hand clean cord clean surface betadine or povidone iodine – to clean cord check AVA, then draw 3 vessel cord If 2 vessel cord- suspect kidney malformation leave about 1” of cord if BT or IV infusion – leave 8” of cord best access - no nerve check cord every 15 min for 1st 6 hrs – bleeding .> 30 cc of blood bleeding of cord – Omphalagia – suspect hemophilia Cord turns black on 3rd day & fall 7 – 10 days Faiture to fall after 2 weeks- Umbilical granulation Mgt: silver nitrate or catheterization clean with normal saline solution not alcohol don’t use bigkis – air persistent moisture-urine, suspect patent uracus – fistula bet bladder and normal umbilicus dx: nitrazine paper test – yellow – urine mgt: surgery Bathing • oil bath – initial • to cleanse baby & spread vernix caseosa Fx of vernix caseosa 1. insulator 2. bacterio- static

Babies of HIV + mom – immediately give full bath to lessen transmission of HIV • 13 – 39% possibly of transmission of HIV

Immediate Care of the Newborn A irway B ody temperature C heck/ assess the newborn D etermine identification • Stimulate & dry infant • Assess ABCs • Encourage skin-to-skin contact • Assign APGAR scores • Give eye prophylaxis & Vit. K • Keep newborn, mother, & partner together whenever Newborn Assessment and Nursing Care Physical Assessment • Temperature - range 36.5 to 37 axillary • Common variations • Crying may elevate temperature o Stabilizes in 8 to 10 hours after delivery o Temperature is not reliable indicator of infection a temperature less than 36.5 Temp: rectal- newborn • to rule out imperforate anus • take it once only , 1 inch insertion Imperforate anus 1. atretic – no anal opening 2. agenetialism – no genital 3. stenos – has opening 4. membranous – has opening Earliest sign: 1. no mecomium 2. abd destention 3. foul odor breath 4. vomitous of fecal matter 5. can aspirate – resp problem Mgt: Surgery with temporary colostomy Heart Rate • range 120 to 160 beats per minute • Common variations • Heart rate range to 100 when sleeping to 180 when crying • Color pink with acrocyanosis • Heart rate may be irregular with crying • Although murmurs may be due to transitional circulation-all murmurs should be followed-up • and referred for medical evaluation • Deviation from range • Faint sound Cardiac rate: 120 – 160 bpm newborn Apical pulse – left lower nipple Radial pulse – normally absent. If present PDA Femoral pulse – normal present. If absent- COA coartation of aorta Respiration •

range 30 to 60 breaths per minute

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Signs of potential distress or deviations from expected findings o Asymmetrical chest movements o Apnea >15 seconds o Diminished breath sounds o Seesaw respirations o Grunting o Nasal flaring o Retractions o Deep sighing o Tachypnea - respirations > 60 o Persistent irregular breathing o Excessive mucus o Persistant fine crackles o Stridor Breathing ( ventilating the lungs) o check for breathlessness o if breathless, give 2 breaths- ambu bag o 1 yr old- mouth to mouth, pinch nose o < 1 yr – mouth to nose o force – different between baby & child o infant – puff Circulation Check for pulslessness :carotid- adult ¨ Brachial – infants CPR – breathless/pulseless Compression – inf – 1 finger breath below nipple line or 2 finger breaths or thumb CPR inf 1:5 Adults 2:30 Blood Pressure o not done routinely Factors to consider Varies with change in activity level Appropriate cuff size important for accurate reading 65/41 mmHg

General Measurements o Head circumference - 33 to 35 cm o Expected findings o Head should be 2 to 3 cms larger than the chest o Abdominal circumference – 31-33 cm o Weight range - 2500 - 4000 gms (5 lbs. 8oz. - 8 lbs. 13 oz.) o Length range - 46 to 54 cms (19 - 21 inches) Anthropometic measurement normal length- 19.5 – 21 inch or 47.5 – 53.75cm, average 50 cm head circumference 33- 35 cm or 13 – 14 “ Hydrocephalus - >14” Chest 31 – 33 cm or 12 – 13” Abd 31 – 33 cm or 12 – 13” Signs of increased ICP 1.) abnormally large head 2.) bulging and tense fontanel 3.) increase BP and widening pulse pressure #3 & #4 are Cushings triad of 4.) Decreased RR, decreased PR ICP 8 5.) projective vomiting- sure sign of cerebral irritation

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Common variations o Bilateral bronchial breath sounds Moist breath sounds may be present shortly after birth

Skin reddish in color, smooth and puffy at birth At 24 - 36 hours of age, skin flaky, dry and pink in color Edema around eyes, feet, and genitals 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 Lanugo -moderate in full term; more in preterm; absent in postterm; shed after 2 weeks in time of desquammation Turgor good with quick recoil Hair silky and soft with individual strands Nipples present and in expected locations Cord with one vein and two arteries Cord clamp tight and cord drying Nails to end of fingers and often extend slightly beyond

Skin color White – edema Grey – infection

Blue – cyanosis or hypoxia Yellow – jaundice , carotene

Acrocyanosis o Bluish discoloration of the hands and feet maybe present in the first 2 to 6 hours after birth o This condition is caused by poor peripheral circulation, w/c results in vasomotor instability & capillary stasis, esp. when the baby is exposed to cold.

6.) high deviation – diplopia – sign of ICP older child 4-6 months- normal eye deviation >6 months- lazy eyes 7.) High pitch shrill cry-late sign of ICp

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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. 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. 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 damage 2. cover genitals – prevent priapism – painful continuous erection 3. change position regularly – even exposed to light 4. increase fld intake – due prone to dehydration 5. monitor I&O – weigh baby 6. monitor V/S – avoid use of oil or lotion due- heat at phototherapy = bronze baby syndrometransient S/E of phototherapy

Care of Newborn in Jaundice Phototherapy o Is the exposure of the NB to high intensity light. If the central circulation is adequate, o Maybe used alone or in conjunction w/ the blood supply should return quickly exchange transfusion to reduce serum bilirubin when the skin is blanched with a levels. finger. Blue hands and nails are poor o Decreases serum bilirubin levels by changing indicator of oxygenation in NB. The nurse should assess the face & mucus bilirubin from the non-water soluble form to membranes for pinkness reflecting water-soluble by products that can be excreted. adequate oxygenation

Mongolian Spots

Patch of purple-black or blue-black color distributed over coccygeal and sacral regions of infants of AfricanAmerican or Asian descent. Not malignant. Resolves in time. They gradually fade during the first or second year of life. They maybe mistaken for bruises and should be documented in the NB’s chart.

Mottling lacy pattern of dilated blood vessels under the skin Occurs as a result of general circulation fluctuations. It may last several hours to several weeks or may come and go periodically. Mottling maybe related to chilling or prolonged apnea.

Physiologic Jaundice o Hyperbilirubinemia not associated with hemolytic disease or other pathology in the newborn. Jaundice that appears in full term newborns 24 hours after birth and peaks at 72 hours. Bilirubin may reach 6 to 10 mg/dl and

Nursing Interventions: 1. Exposing as much of the NB’s skin as possible however genitals are covered & the nurse monitors the genitals area for skin irritation 2. Eyes are covered with patches or eye shields and are removed at least once per shift to inspect the eyes 3. Monitor temp. closely & ↑ fluids to compensate water loss 4. NB is repositioned q 2° and stimulation is provided. o NB will have loose green stools and green colored urine. Exchange Transfusion o Is the withdrawal and replacement of newborn’s blood with donor blood.

Milia which are exposed to sebaceous glands, appear as raised white spots on the face, esp. across the nose. No treatment is necessary, because they will clear within first month. Infants of African heritage have a similar condition called transient neonatal pustular melanosis.

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resolve in 5 to 7 days. If jaundice occurs within 2 days – pathologic jaundice If jaundice occurs at 3rd-7th days of life – physiologic jaundice

Erythema toxicum

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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.

It is often called “newborn rash” or “fleabite” dermatitis The rash may appear suddenly, usually over the trunk and diaper area and is frequently widespread. The lesions do not appear on the palms of the hands or soles of the feet. The peak incidence is 24-48 hours of life. Cause is unknown and no treatment

Harlequin Sign o

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

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Nevus vasculosus (strawberry mark) • 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.

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Telangiectatic nevi (stork bites) •

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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 Hemangiomas a.) Nevus Flammeus – port wine stain – macular purple or dark red lesions seen on face or thigh. NEVER disappear. Can be removed surgically b.) Strawberry hemangiomas – nevus vasculosus – dilated capillaries in the entire dermal or subdermal area. Enlarges, disappears at 10 yo. c.) Cavernous hemangiomas – communication network of venules in SQ tissue that never disappear with age. Flammeus (port-wine stain) • A capillary angioma directly below the epidermis, is a non-elevated, sharply demarcated, red-to-purple area of dense capillaries. • Macular purple

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.

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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

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 coating Eyes • 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 duration o Examine appearance and size of chest o 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 discharge Abdomen • Abdomen appears large in relation to pelvis o Note increase or decrease in peristalsis o 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 abdomen o Assess for signs of dehydration o Assess femoral pulses o Note bulges in inguinal area 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

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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 •

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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

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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

TALIPES – “clubfoot” a.) Equinos – plantar flexion –horsefoot b.) Calcaneous – dorsiflexion –heal lower that foot anterior posterior of foot flexed towards anterior leg c.) Varus- foot turns in d.) Valgus- foot turns out Equino varus- most common

Nursing Role Be knowledgeable about normal newborn variations and responses that indicate further investigation o Respiratory distress o Central cyanosis o Thermoregulation problems o Dehydration o Teaching During physical and behavioral assessment, identify family's need for teaching o Involve family early in care of infant o Process establishes uniqueness and allays concern Teaching o Feeding cues o Alert state o Cord care o Sleeping Neurological Status Assessment begins with period of observation Observe behaviors - note: o State of alertness o Resting posture o Cry o Quality of muscle tone o 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

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

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

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

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

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

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.

Immature central nervous system (CNS) of newborn is characterized by variety of reflexes o Some reflexes are protective, some aid in feeding, others stimulate interaction o Assess for CNS integration Protective reflexes are blinking, yawning, coughing, sneezing, drawing back from pain Rooting and sucking reflexes assist with feeding

Step reflex This 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.

“What reflexes should be present in a newborn? 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”

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.

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. Suck reflex Rooting 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.

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 posture o Skin o Lanugo o Sole (planar) creases o Breast tissue o Ear form and cartilage distribution o Evaluation of genitals Male genitals

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

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

Neuromuscular Components Square window sign A, This angle is 90 degrees and suggests an immature newborn of 28 to 32 weeks’ gestation. Score 0.

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

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.

Signs of Preterm Babies

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B, Term newborn’s testes are generally fully descended. The entire surface of the scrotum is covered by rugae. Score 3. Female genitals A, Newborn has a prominent clitoris. The labia majora are widely separated, and the labia minora, viewed laterally, would protrude beyond the labia majora. Score 1. The gestational age is 30 to 35 weeks.

Born after 20 weeks, after 37 weeks frog leg or laxed positon hypotonic muscle tone- prone resp problem scarf sign – elbow passes midline pos. square window wrist – 90 degree angle of wrist heal to ear signabundant lanugo-

Signs of Post term babies: > 42 weeks o classic sign – old man’s face o desquamation – peeling of skin o long brittle finger nails o wide & alert eyes Babies with special needs Some babies may need some extra attention from you and the doctor after birth. These include:

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Low birth weight babies (less than 2.5kg). Babies born too early (premature). Babies with pathological jaundice. Babies with infection. Those needing an operation soon after birth. Those with low blood sugar. Babies of diabetic mothers.