Student -- The Normal Newborn

The Normal Newborn By Lorain McKay, RN, BSN

Definitions • Neonatal: The time from birth to 29 days of life.

Initiation of Respirations •

Fetal Respiratory Lungs do not oxygenate the blood; blood oxygenates the lungs. – Lungs filled with fluid in order to keep alveoli expanded during pregnancy. – –

Needs surfactant to maintain expansion after birth.

Initiation of Respiration • Neonatal Respiratory:

– The first breath requires greater negative pressure that subsequent breathing

• Causes: – – – –

Chemical Mechanical Thermal Sensory

Cardiovascular System • Fetal Circulation Review • Neonatal Cardiovascular Adaptation – – – –

Ductus Venosus Foramen Ovale Pulmonary blood vessels Ductus Arteriosus

Thermoregulation Conduction

Evaporation

Convection

Radiation

Decreased body temperature and cold stress Metabolic Rate

Use of Glucose

Hypoglycemia

Metabolism of Brown Fat

O2

Use of

Production of Surfactant

Vasoconstriction

Production of acids

Hypoxemi a

Respirator y Distress

Metabolic Acidosis

Displacement of bilirubin from albumin binding sites

Peripheral vessels

Pulmonary vessels

Pale, Cold, mottled Skin

Jaundice Return to fetal circulation patterns

Assessments in the Newborn • Immediate assessment is cardiorespiratory status, thermoregulation and the presence of anomalies. – Infant should be crying – Infant heart rate should be more than 100 – Infant should be pink on the trunk

Assessments in the Newborn Apgar Score Heart Rate Respiration Muscle tone Reflex Response

Color

0 Absent

1

2

Below 100/min Above 100/min

No spontaneous Slow Respiration Spontaneous resp respirations or weak cry & strong, lusty cry

Limp No response to suction or gentle slap on soles

Pallor or cyanosis on Trunk

Min Flexion of ext with sluggish movement Min response to suction or flicking feet

Flexed body posture; spont vigorous move Responds promptly to suction or flicking feet

Bluish hands and Pink throughout. feet only

Assessments in the Newborn • Initial Assessment – Vital Signs

• Temperature 97.7 to 99.5 Axillary • Heart Rate 120-160 • BP Average 65-95 Systolic 30-60 Diastolic • Resp Rate 30-60 Average is 40

Lungs & Heart http://newborns.stanford.edu • Select Professional Education • Select Photo Gallery • Select Lungs

– Go through and you can hear the different lung sounds. It is very good.

• Select Heart

– Go through and you can hear the different heart sounds

Inspect Chest Shape

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Resp Distress Intercostal Retractions

Subcostal Retractions

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Mottling

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Mottling (Cutis Marmorata)

Measurments • Weight 2500-4000 grams • Length 48-53 cm or 19-21 inches – SGA and LGA

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Assessments in Newborn • Measurement (Cont) – Head Circumference 33-35.5 cm 13-14 inches – Chest Circumference 30.5-33 cm 12-13 inches • Should be 2-3 cm less than head circumference

Head Circumference

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Molding

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Bruising

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Caput Succedaneum

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Caput Succedaneum

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Cephalhematoma

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Eyelid Edema

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Ears Etc

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Positional Nasal Deformity

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Mouth

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Cleft Palate

Cleft Lip

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Normal Tongue

Ankyloglossia

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Natal Teeth

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

3 Vessel Umbilical Cord

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Hips

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Hypospadias

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Hydrocele

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Undescended Testes

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Female Genitalia

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Ambiguous Genitalia

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Hands

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Hands

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Toes

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Positional Deformities

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Club Foot

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Sacral examination

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Facial Palsy

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Erb's Palsy

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Skin The downy hair seen over the shoulder is lanugo. Although this is present to a much greater degree in premature infants, term babies also have variable amounts of lanugo present at birth, as evidenced in this photo

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Skin A dry, flaky, peeling appearance of the skin is very common in newborns. Although this can be distressing to parents, it does not need treatment and will spontaneously resolve.

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Skin -- Mongolian Spots

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Salmon Patches

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Port Wine Stain

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Milia

Sebaceous Hyperplasia

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Erythema Toxicum

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Petechiae

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Petechiae

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Hemangioma

a central area of telangiectasia surrounded by a halo of pallor.

Cafe Au Lait Spot

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Jaundice

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Meconium Stools • First stool excreted by the newborn • Greenish black with a thick, sticky, tarlike consistency. • Usually passes in the first 12 hours • Failure to pass meconium—suspect obstruction

What is this?

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

What about this??

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

What caused this??

This material was compiled by Janelle Aby, MD for educational purposes only.  Reproduction for commercial purposes is prohibited.  Utilization and copying of the materials for educating those who care for newborns is permitted with proper citation of source. http://newborns.stanford.edu/PhotoGallery/

Reflexes • • • • • • • •

Moro Reflex Palmar grasp reflex Plantar grasp reflex Babinski reflex Rooting reflex Sucking reflex “Fencing” reflex—Tonic Neck Stepping reflex

Ballards Scale