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NEW BORN

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NEW BORN

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  1. NEW BORN

  2. Definition: New born (nb) is the child of the first month of life (first 28 days). Birth → traumatized n.b. → high mortality: -in the first month  = ½ of infant mortality -the first week = 2/3 of the first month mortality

  3. Criteria for evaluating the degree of maturity of the n.b. • Temporal criterion: GA assessment calculation from the first day of last menstrual period full term: GA = 37 - 42 weekspremature: GA <37 weeks lower limit of viability (WHO criteria):- GA = 22 weeks- W over 500gpostmature GA > 42 weeks.

  4. Criteria for evaluating the degree of maturity of the n.b. 2. Morphofunctional criteria: GA characteristics can be assessed by evaluating:- skin- flag ear- genitals- mammary glands.The Ballard score used is to be performed at 3-42 hours after birth.

  5. Criteria for evaluating the degree of maturity of the n.b. 3. Neurological Criteria - findings passive posture and tone → muscle tone increases with GA and has a caudo-cephalic development :  at 28 weeks of gestation → hypotonic; at 32 weeks → all 4 extremities in extension; at 34 weeks → batracian position; at 40 weeks → all four extremities are in flexion.

  6. Criteria for evaluating the degree of maturity of the n.b. 4. Anthropometric Criteria (interpretation of W, H according to GA) After birth weight (Wb):N.b. normal NG: 2500 - 4000 g (mean 3000 g)N.b. macrosomia: greater than 4000 g GnN.b. small: less than 2500 g

  7. After the value of WI at birthIP = G (g) ∕ T(cm3) X 100

  8. Criteria for evaluating the degree of maturity of the n.b. N.b. with Wb <2500 g: N.b. LBW (Low Birth Weight): Wb = 2500-1500 gN.b. VLBW (Very Low Birth Weight): Wb = 1499-1000 gN.b. ELBW (Extremly Low Birth Weight): Wb below 1000 g.Hight at birth (Hb):47-55 cm, 50 cm on average.

  9. The anatomic and physiological features of the full term newborn

  10. Head: The face is small.Anterior fontanelle (bregma) FA = 3cm/4cm, progressively closed until the age of 18 months.Posterior fontanelle (lambda) birth → closed / open (6-8 mm) close to 6-8 weeks.

  11. Sagittal suture is sometimes wide – congenital soft skull.Nose: short, concave, nostrils look forward.Ears: rule and implanted.Neck: short.Chest: almost cylindrical.

  12. Abdomen: high, exceeding ribs, abdominal wall muscle tone is low.Umbilical cord (UC): mummification → training → disposal trench to fall between the 6th and 10th-day- the epidermization of umbilical wound → gradually from periphery to center  - end-healing by the 3rd week - umbilical scar vessels are clogged due to shrinkage

  13. Lower limbs: short Intern condyles are less developed limbs → încurbarea axis.Vertebral column → almost straight after birth.SKIN:- intense red (erythema newborn)- blue palms and plants.

  14. Redness n.b. is the result:- abundance of short and wide capillaries,- imperfection vasomotor function,  - thinness epidermis (stratum horn missing and melanin pigment).

  15. Vernix caseosa:- fat blanket, yellowish, covering the skin especially on dorsal region, chest, neck and flexion creases; - secreted by the sebaceous glands and specialized cells of the amnion; - rich in glycogen, fatty acids, cholesterol and protein.

  16. Vernix caseosa:Features:  - fetal protection against the cold; - protection against skin maceration by amniotic fluid;  - food intake; - bactericidal and antihaemolytical. If a stray → hypothrombin emphasized.

  17. Physiological desquamation: - appears a few days after birth; - furfuraceous / lamellar.N.b. toxic erythema (Erythema Neonatorum Toxicum)= awareness of maternal protein / antigen passed through the intestinal mucosa to which the child has formed an antibody;  - microscopic →infiltration of eosinophils;- cultures are negative;

  18. N.b. toxic erythema (Erythema Toxicum Neonatorum)- onset 24-48 hours after birth;  - small erythematous areas, centered by a yellow papule;  -located on the front, back, buttocks and extremities; comply with plants and palms;  - ± other symptoms allergic coryza, swelling of eyelid edema; -resolves spontaneously without scarring; - strict hygiene is recommended;- not given any treatment.

  19. Maternal nevi:- red spots, badly defined;  - upper eyelid, bridge, neck;- disappear after a few months ± brown spots.Mongolian spot: - blue stain; - variable size; - region lumbo - sacral;- without pathological significance.

  20. Maternal nevi • Mongolian spot

  21. Lanugo: - baby fine hair covering the skin; - after birth → shoulders, back, head, limbs;- most abundant on n.b. prematureNails: - not have longitudinal ribs; -finger pulp outperforms the hands and feet barely touching.Sweat glands are less developed.

  22. Lanugo

  23. Sebaceous glands: - are well developed; - 3-6 days after birth in both sexes occur in the wings, nose, cheeks, forehead and chin point elements, small yellowish-white sebaceous gland cysts disappear spontaneously = milium facialAdipose panicle is developed on the face, limbs and no less than the abdomen.

  24. Muscle:- incomplete development of cortical centers and nerve pathways to the predominant physiological muscle hypertonia → flexion;  → hypotonic neck muscles → head support.

  25. Respiratory:thorax → cylindrical ribs → horizontal, ant. diameter >post. breathing type → abdominal.Respiratory Rate (RR) 60 resp / min n.b., 45 resp / min to 1 month 35 resp / min at 1 year.

  26. Sometimes irregular pace → apnea crisis, rhythm Cheyne - Stokes→ sometimes unequal amplitude.

  27. The mechanism first breaths: - chemical and humoral factors = CO2 accumulation lack of O2by placental disruption; - ambient excitations of free nerve terminations leather;- thorax to relax, limbs. sup. pass the abduction → volume increase of vacuum pleural rib → CRI air suction → vagus nerve stimulation ends.

  28. Cardiovascular:Heart → globular, situated transversely;- apexian shock → sp. IV, at 1-2 cm outside m.c. l.;-myocardium elastic and connective tissue  →least developed; - epicardial → very thin; - heart sounds → are more powerful charge.Arteries → increased content of elastic fibers + large calibre → hypotension general physiological size.

  29. Peripheral Circulation:  -slow → cold extremities, cyanotic (SaO2 = normal) - vascular permeability and capillary fragility ↑.Heart rate: 160 beats / min. the n.b., 120 beats / min at the end of the first month.Blood pressure: ~ 70-80 mm Hg SBP ~ DBP 40-50 mm Hg

  30. Hemoglobin (Hb) and hematocrit (Ht): - higher values if the umbilical cord is pinched "late" (after cessation of pulsations); - shows changes in physiological function of Wb and the child's age.

  31. The values of hemoglobin, hematocrit and reticulocyte count in the first week of life

  32. Erythrocytes: • birth = 5-6 mil/mm3 • after 24-48 hours → hemolysis → 4-5 mil/mm3 • increased mechanical fragility • increased metabolic activity • shortened life span. Leukocytes: • leukocyte number make changes quickly in the first days of life • PMN →structural and functional immaturity.

  33. Leukocytes and leukocyte formula values at nb

  34. Haemostasis: • deficient in the first 6 months of life; • platelets = 150 000 - 300 000/mm3; • coagulation factors dependent on vitamin-K = low; • clotting time = prolonged

  35. The digestive system → features: • mouth → adaptations for sucking; • intestinal microbial flora; • meconium. Intestinal microbial flora: • of the fetus intestinal tract = sterile. • during birth colonize the oral cavity: Staphylococcus, colibacillus, streptococci, etc.. • After ~ 2 weeks: • the n.b. breast-fed → bacillus bifidus, • the n.b. bottle-feed → bacillus coli.

  36. Meconium: • n.b. stool within 2-3 days • viscous and dark green; • consists of: -bile components: cholesterol, fat, mineral salts, bile pigments, - amniotic elements: lanugo, squamous cell skin cells, flat -elements of the digestive tract: intestinal cells, gastric juice, intestinal, pancreatic, with their yeast.

  37. It is followed by a transitional stool, brown, curdled milk. • Stools typical human milk: yellow-orange • occur in 2-3 days • are 4-6 in 24 hours.

  38. Meconiu • Transition stool

  39. Salivary amylase: • present at birth; • and acts in the gut - compensates deficit amylase pancreas. Lingual lipase- normal activity at birth. Gastric lipase: • increased activity in n.b. • preferentially hydrolyzes TG - compensates low pancreatic lipase activity.

  40. Pancreatic enzyme secretion: • protease - normal activity; • lipase - low activity; • amylase - absence. Intestinal enzyme secretion = complete

  41. Liver: 2 cm below the ribs; are deficient at birth: • liver detoxification activity • synthesis of coagulation factors, the lipoprotein and cholesterol. Spleen - up to 1 cm below the rib.