Growth and Development: The Newborn Baby

1. Growth and Development: The Newborn Baby

2. 1- Newborn stage Newborn stage is the first 4 weeks or first month of life. It is a transitional period from intrauterine life to extra uterine environment.

3. Normal Newborn Infant Physical growth - Weight = 2.700 – 4 kg - Wt loss 5% -10% by 3-4 days after birth - Wt gain by 10th days of life - Gain ¾ kg by the end of the 1st month

4. Weight: They loose 5 % to 10 % of weight by 3-4 days after birth as result of : • Withdrawal of hormones from mother. • Loss of excessive extra cellular fluid. • Passage of meconium (feces) and urine. • Limited food intake.

5. Height • Boys average Ht = 50 cm • Girls average Ht = 49 cm • Normal range for both (47.5- 53.75 cm) Head circumference 33-35 cm Head is ¼ total body length Skull has 2 fontanels (anterior & posterior)

6. Anterior fontanel • Diamond in shape • The junction of the sagittal, corneal and frontal sutures forms it • Between 2 frontal & 2 parietal bones • 3-4 cm in length and 2-3 cm width • It closes at 12-18 months of age

8. Soft Spots

9. Posterior fontanel • Triangular • Located between occipital & 2 parietal bones • Closes by the end of the 1st month of age

10. Head • Large head, overridden sutures. • Head molded to fit cervix. • Caput succedaneum: • Edema of the soft scalp tissue at the presenting part of the head. • Accumulation of serum in the tissues above the bone • Cross suture lines • Disapear in few days • Cephalhematoma: • Localized collection of blood between the skull bone and its periosteum • May involve one or both parietal bones • Weeks to resolve • Dose not cross sutures

11. Cephalohematoma Caput Succedaneum

13. Molding of infant’s head

14. Chest circumference It is 30.5 to 33cm (usually 2–3cm less than head circumference).

15. Proportion • Large: head and abdomen • Short/small: arms and legs • Head grows rapidly b/c brain development • Soft spots allow head to grow and close

16. Care of Newborn in Delivery Room: • Adequate breathing pattern established • Mouth suctioned 1st • Nurse wraps infant in warm blanket & places under radiant warmer • Drying motion usually stimulates 1st cry. Drying helps prevent heat loss • Note time of 1st cry & success at breathing attempts. • May need resuscitative attempts. • infant kept unwrapped on clean/dry radiant warmer to promote thermoregulation

17. Physiological growth • Vital signs - Temperature (36.3 to37.2C ). - Pulse ( 120 to 160 b/min ). - Respiration ( 35 to 50C/min) .

20. Simulation for vital signs

21. Apgar Score • Apgar score - assessment scale since 1958 to assess newborn well-being at 1 & 5 min. • Newborn observed & rated on 5 components . • Heart rate • Respiratory effort • Muscle tone • Reflex irritability • Color

22. APGAR scoring chart

23. Apgar score • Score of 0, 1, or 2 - each component • Five scores added & final number @ 1 & 5 min • 9/9 common - 2 on HR, Resp, reflexes, muscle tone & 1 on color d/t acrocyanosis. • Heavy sedation of mother may lower respiratory effort or reflex irritability score. • Score of 4 or less indication that infant most likely needs resuscitative efforts • Score of 4-6 may indicate suctioning and oxygen therapy.

25. Physiologic adjustment to extrauterine life: • First period of reactivity: • lasts for ½ hour, baby is alert & exhibit exploring searching activities, making sucking sounds, rapid H.R & R.R. • Resting period: • lasts 90 minutes, baby generally sleeps, slower H.R & R.R. • Second period of reactivity: • between 2-6 hours of life. Baby is a wake, gagging and choking on mucus. Gain alert & responsive and interest to surrounding.

26. Classification of infants based on gestational ages and birth weights • Preterm or premature: infant born before the end of 37 weeks, regardless of weight • Term or full term: born between 38 & 42 weeks, regardless of weight • Postterm: an infant born after 42 weeks regardless of weight • Low birth weight: any infant at birth who weighs less than 2500 gm

27. Small for gestational age (SGA): any newborn whose weight is below the 10th percentile, This means that they are smaller than 90 percent of all other babies of the same gestational age (according to intrauterine growth curve) regardless of gestation • Appropriate for gestation age (AGA): any newborn whose intrauterine growth has been normal (according to intrauterine growth curve) for that length of gestation • Large for gestational age (LGA): any infant born whose weight is above the 90th percentile regardless of gestation • Intrauterine growth restriction (IUGR): failure of fetus to grow as expected during gestation

28. Appearance of newborn • Flexion posture. • Looks , red or cyanotic. • Body covered with varying amount of lanugo and vernix caseosa.

29. Umbilical Cord • Umbilical Cord: After delivery, 2 clamps placed • Cord clamped again 1- 2 inches from umbilicus Vessels counted [2 arteries; 1 vein - AVA]. • Bleeding may occur if clamp not tight • umbilical stump; falls off by 7th - 10th day • Teach: do not bathe infant until site completely healed • Sponge bath

30. Identification of Newborn • Done immediately > delivery by same nurse assisting mother • Prevent giving wrong infant to wrong mom. Identification is 1 band on mom, one on significant other & 2 on baby.

31. Nurse’s Responsibilities in Delivery Room Eye Care: erythromycin ointment > delivery • Eliminates gonorrhea/chlamydia. Vitamin K Injection: produced in intestinal tract and used by body for coagulation. • Newborn @ risk for bleeding disorders during 1st wk of life. injection given IM within 1st hour [Dose = 0.5 mg. to 1.0 mg.] Site: vastuslateralis • In DR, infant given to mom to begin bonding process & breast feeding started.

32. Newborn Senses

33. Senses - Touch - Vision - Hearing - Taste - Smell

34. Touch • It is the most highly developed sense. • It is mostly at lips, tongue, ears, and forehead. • The newborn is usually comfortable with touch.

35. Vision • Pupils react to light • Bright lights appear to be unpleasant to newborn infant. • Follow objects in line of vision

36. Hearing • The newborn infant usually makes some response to sound from birth. • Ordinary sounds are heard well before 10 days of life. • The newborn infant responds to sounds with either cry or eye movement, cessation of activity and / or startle reaction.

37. Taste Well developed as bitter and sour fluids are resisted while sweet fluids are accepted. Smell Only evidence in newborn infant’s search for the nipple, as he smell breast milk.

39. Eyes: tearless cry (lacrimal ducts mature at 3 months) permanent eye color between 3-12 mon. • Ears: pinna tends to bend easily. • Nose: large for face. • Mouth: prominent, large, & short tongue. Natal teeth are unusual. Thrush indicates candida infection. • Neck: short & chubby with many folds. Head lags

40. Normal Newborn Infant

41. Skin • Vernix casoesa • Acrocyanosis • Lanugo • Bruising, petechiae from birthing • Mongolian spots—generally back and buttocks • Milia

42. Milia • Small, whitish-yellow papules found close to the skin surface • Particularly common around eyes and midface

43. Circulatory & hemopoietic • Resting hr 100-160 • Hr above 160 or below 100 should be reevaluated • Blood volume: 80-85 ml/kg, average about 300 ml but can have an additional 100 ml if cord is not cut in reasonable length of time • Fetus needs additional blood cells for O2 exchange • Hgb 14-24 g/dl • Infant Hgb F – higher O2 affinity • Hgb A production largely replaces Hgb F by 4 months • Iron stores good for 5 months • Blood coagulation: born with long coagulation time (lower level of vit. K).

44. GI SYSTEM • Baby learns to coordinate breathing, sucking and swallowing • Bacteria not present in gut vitamin k • Digestion-simple CHO and protein. (Starches and fats are not easily digested at this time) • Feeding varies—cues hand to mouth movement and sucking fingers intensify when hungry • Prevent regurgitation by not overfeeding, frequent burping and positioning the head slightly elevated

45. GI 2 • Stool—meconium—greenish black • Stools change and the stooling pattern change indicates good bowel functioning • Color time and character of first stool should be documented. • Diarrhea stool—loss of fluid quickly

46. Immune system • Passive immunity from mom • Immunoglobulins gradually develop • High risk of infection in first few month—abnormal discharges or rashes should be evaluated

47. Renal system • Should void in first 24 hour • Frequency depends on intake • Not able to concentrate urine • May see blood in diaper of female • Hypospadias

48. Hepatic system • Iron storage • Conjugation of bilirubin—function not well developed at birth— • Physiologic jaundice—after 24 hours—preterm increase and more severe • Pathologic jaundice—before 24 hours • Kernicterus—usually higher than 25 • Breastfeeding—may occur up to 2 weeks pp

49. Anogenital • Patent anus (check for imperforate anus). Meconium within 24 hour. • Male genitalia: edematous scrotum, check for undescended testicles, epi or hypospadias. • Female genitalia: swollen vulva (maternal hormones), pseudomenstruation.

50. Gross Motor Development Motor development: The newborn's movement are random, diffuse and uncoordinated. Reflexes carry out bodily functions and responses to external stimuli.