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
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.
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.
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.
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
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.
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.
Sagittal suture is sometimes wide – congenital soft skull.Nose: short, concave, nostrils look forward.Ears: rule and implanted.Neck: short.Chest: almost cylindrical.
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
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.
Redness n.b. is the result:- abundance of short and wide capillaries,- imperfection vasomotor function, - thinness epidermis (stratum horn missing and melanin pigment).
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.
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.
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;
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.
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.
Maternal nevi • Mongolian spot
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.
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.
Muscle:- incomplete development of cortical centers and nerve pathways to the predominant physiological muscle hypertonia → flexion; → hypotonic neck muscles → head support.
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.
Sometimes irregular pace → apnea crisis, rhythm Cheyne - Stokes→ sometimes unequal amplitude.
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.
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.
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
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.
The values of hemoglobin, hematocrit and reticulocyte count in the first week of life
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.
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
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.
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.
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.
Meconiu • Transition stool
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.
Pancreatic enzyme secretion: • protease - normal activity; • lipase - low activity; • amylase - absence. Intestinal enzyme secretion = complete
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.