Growth and Development: The Newborn Baby

Manal Kassab Nur. 346

Fetal Circulation: Circulatory Pathways

Placenta:
1. 2. 3.

The organ responsible for Delivery of nutrients Removal of waste products Delivery of oxygenated blood to the fetus.
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Circulatory Pathways:

Fetal lungs:

Are filled with fetal lung liquid not used to oxygenate blood. Because the alveoli are filled with liquid most of the arteries and arterioles are surrounded by liquid which increases resistance to blood flow through the vessel This results in most of the blood flow bypassing the lungs and therefore directed to the systemic periphery.
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http://www.youtube.com/watch?v=52DQHL7xrTI&feature=related

Placental Blood Supply

Blood flows to the :placenta
through a pair of umbilical arteries which enter umbilical cord

Blood returns from :placenta

in a single umbilical vein which drains into ductus (venosus (liver :Ductus venosus empties into inferior vena Figure 21-33a cava

Circulatory Pathways:

Umbilical vein & Ductus Venosus:

Average oxygen saturation of blood is 80% in the umbilical vein before it mixes with unoxygenated blood in the ductus venosus.

After mixing, the oxygen saturation is approximately 67%.

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Fetal Pulmonary 2 Circulation Bypasses

: Foramen ovale. 1 Inter-atrial opening covered by valve-like flap directs blood from right to left atrium : Ductus arteriosus. 2 short vessel connects pulmonary and aortic trunks

Circulatory Pathways:

Foramen ovale:

The majority of inferior vena cava blood flow crosses the foramen ovale and into the left atrium bypassing the lungs, some blood flow enters the right ventricle. The foramen ovale is anatomical opening between the right atrium and left atrium which closes shortly after birth.
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Circulatory Pathways:

Ductus arteriosus:

A vessel that connects the main pulmonary artery to the aorta.

Circulatory Pathways:

The blood flow that does enter the right atrium (mainly from the superior vena cava) enters the right ventricle and then the main pulmonary artery where the blood flow then enters the ductus arteriosus which connects to the aorta. Once again, most blood flow bypasses the lungs and is directed to the systemic circulation. Blood flow is flowing in a right to left direction. The ductus arteriosus should functionally close within 15 hours and structurally within a few weeks (in mature infants).
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Circulatory Pathways:

Umbilical arteries:

2 vessels that allows unoxygenated blood to flow from the descending aorta back to the placenta.

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Changes at Birth

The First Breath:

The lungs are filled with air instead of fluid. Higher oxygen levels in the blood and alveoli filled with air instead of fluid allows for vascular resistance to decrease. This results in a greater increase in pulmonary blood flow.

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Changes at Birth

Anatomical Changes:

Placenta is removed from circulation Higher pressure in the left atrium due to increased pulmonary blood flow cause the foraman ovale to close Higher concentrations of oxygen in the blood, decreased prostaglandin levels and decreased pulmonary vascular resistance closes the ductus arteriosus When the umbilical cord is clamped, the umbilical vein closes, systemic vascular resistance is increased and this causes the ductus venosus to close.
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Figure 28.13

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Physiologic adjustment to :extrauterine life

First period of reactivity:

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

Second period of reactivity:

Assessment of well being: Apgar Scoring

Is an assessment scale applied at 1 minute, 5 and 10 minutes after birth. Give a score (0,1, or 2) for each sign. It serves as a baseline for future evaluation.
http://www.youtube.com/watch?v=Vtxsxv1BQek&feature=related
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Apgar score

A score under 4 is in serious danger and need resuscitation. A score of 4-6 may need clearing of the airway and O2 supplement. A score of 7-10 is good
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The Newborn Baby

Weight:

differs depending on the race, nutritional, intrauterine and genetic factors. Normal rates 2.7-4.0 kg

Newborn loses 5-10% of birth weight during the 1st few days because of:

No longer under the influence of salt & fluid-retaining maternal hormones. Diuresis: to remove part of body fluids. Limited by low caloric content of colostrum. Time needed to establish sucking. Stools.

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The Newborn Baby

Recaptures birth wt within 10 days Head-to-heel length: birth

length is 48 53 cm

H.C: 33-35 cm. C.C: 2 cm less than H.C.

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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 2.500 gm

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Small for gestational age (SGA): any newborn whose weight is below the 10 th percentile (according to intrauterine growth curve) Appropriate for gestation age (AGA): any newborn whose intrauterine growth has been normal for that length of gestation Large for gestational age (LGA): any infant born whose weight is above the 90 th percentile regardless of gestation Intrauterine growth restriction (IUGR): failure of fetus to grow as expected during gestation
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Appearance of newborn

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

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Vital signs

Temp:

37.2 at birth fall because of heat loss, little s.c fat & immature tempreature. Regulating center (drying, wrapping, & put them under the radiant heat + kangaroo care).

Pulse:

120-160 bpm. at the moment of birth to 180 bpm. 1 hour after birth to 120-140 bpm.
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Vital signs

Respiration: first few minutes 80 b/m to 30-60 b/m when newborn at rest. Usually irregular with short periods of apnea Blood pressure: 80/60 mm/Hg at 10th day to 100/50 mm/Hg.

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Head
Large head, overridden sutures Head molded to fit cervix.

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Head

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 Disappear in few days

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Head

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

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Caput succedaneum

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cephalheamatoma

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Molding of infants head

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Fontanelles

6 fontanelles.

Anterior fontanelle, diamond shaped, 2.5-4 cm, will closes at 12-18 mon. Posterior fontanelle, triangular, 0.5-1.0 cm, closed at 2 mon. Pair of anteriolateral fontanelle close at 3 mon. Pair of posteriolateral fontanelle close at 12 mon. http://www.youtube.com/watch?v=KfrLqTzaXq0

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Head Lag
http://www.youtube.com/watch? v=WkoGQldC8qU&NR=1

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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

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Skeletal system

Arms are slightly longer than legs. Hands clenched into fists. 3 normal creases. Flat sole of the feet Hips inspect for symmetryskin folds should match ortolani maneuver for hip dysplasia Check for tufting of hair at base of spine (spina bifida, occulta) Clubfoot Absence of limb or digit

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Skin

Vernix casoesa Acrocyanosis Lanugo Bruising, petechiae from birthing Mongolian spots generally back and buttocks Milia
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Milia

Small, whitishyellow papules found close to the skin surface Particularly common around eyes and midface
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Skin

Down syndrome simian crease on palm Strawberry marknevous Vasculosushemangioma Erythema toxicum-newborn rash
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Strawberry marknevous

Vasculosushemangioma

Vasculosushemangioma

Erythema toxicum

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Appearance of newborn

Chest:
looks small (compared to head), Engorged breasts (maternal hormone) Ronchi because of mucus

Abdomen:
protuberant. Bowel sound should be present within an hour. Umbilical cord white gelatinous structure with red & blue streaks for the 1st hour. Begin to dry breaks free by 6th- 10th day. Check for concave abdomen
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Circulatory & hemopoietic

Resting 100-160 > 160 or < 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 Hg 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).
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GI SYSTEM

Baby learns to coordinate breathing, sucking and swallowing Bacteria not present in gut vitamin k Digestion of simple CHO and protein (Starches and fats are not easily digested at this time) Feeding variescues hand to mouth movement and sucking fingers intensify when hungry Prevent regurgitation by not overfeeding, frequent burping and positioning the head slightly elevated
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GI 2

Stoolmeconiumgreenish black Stools change and the stooling pattern change indicates good bowel functioning Color time and character of first stool should be documented. Diarrhea stoolloss of fluid quickly
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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. blood tinged vaginal discharge caused by maternal estrogen's effect on a baby girl's
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Immune system

Passive immunity from mom (IgG) Immunoglobulins gradually develop and completed about 6 months old High risk of infection in first few month abnormal discharges or rashes should be evaluated
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Renal system

Should void in first 24 hour Frequency depends on intake Not able to concentrate urine (1st 3 mon) May see blood in diaper of female

Birth defect Hypospadias (Male only) Extrophy of bladder (bladder inside-out)

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Hepatic system

Iron storage Conjugation of bilirubinfunction not well developed at birth Physiologic jaundiceafter 24 hrspreterm increase and more severe Pathologic jaundicebefore 24 hrs

Kernicterusbilliruben higher than 25 (neurological condition that occurs in some newborns with severe jaundice) Early stage: Extreme jaundice; Absent startle reflex; Poor feeding

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Neuromuscular system

The newborn is born with certain specific responses that are triggered by specific stimuli Some of these reflexes, such as rooting and sucking, appear to have survival implications Other reflexes appear to be precursors for later voluntary motor behavior The newborns reflexes may also give information about the health of the childs nervous system.
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Sucking

Onset: ~28weeks GA Well-established: 32-34 weeks GA Disappears: starting around 12 months Elicited by the examiner stroking the lips of the infant.

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Rooting

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.
http://www.youtube.com/watch? v=xneStHZ0Kho&feature=related
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Moro 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 & legs, with fingers extended in c shape, cries, then pulls the arms and legs back in. lasts about five to six months.

http://www.youtube.com/watch?v=PhOleckx1-Y&feature=re

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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
http://www.youtube.com/watch?v=FVqWSVNFt8&NR=1
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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. lasts about six to seven months. http://www.youtube.com/watch? v=UWqafotPxTg&feature=related

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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.

http://www.youtube.com/watch?v=oI_ONptx2Ns&NR=1

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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.
http://www.youtube.com/watch? v=cZYHwCWSKiE&feature=related

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Senses

Hearing: able to hear in utero, within days after birth hearing become acute Vision: see as soon as they are born (blinking reflex). Cant follow objects past the midline. Best focus on black & white. Newborns see best using peripheral vision (out of the corner of their eyes) and when objects are about 9-12 in. (22.86-30.48 cm( away.
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Senses

Touch: The sense of touch in newborns is well developed, particularly around the mouth. They are sensitive to temperature, pressure, and pain. Smell: well developed, newborns are often able to recognize the smell of their mother within the first few days of life. Taste: prefer sweet tastes and usually do not like sour, bitter, and salty tastes.
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The Newborns States

Sleeping Newborns sleep an average of 16-18 hours daily. Newborns usually follow a sleep-wake cycle of around 4 hours of sleep followed by 1 hour of wakefulness. By 3 or 4 months newborns usually sleep through the night.
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The Newborns States

Crying Basic Cry Starts softly and builds in volume and intensity. Often seen when the child is hungry Mad Cry More intense and louder Pain Cry Starts with a loud wail, followed by long pause then gasping. Be calm and patient Do not shake baby Know signs of emergencies
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