Immediate Care of the Newborn Goals: y
y
y
y
To establish, maintain and support respirations. To provide warmth and prevent hypothermia. To ensure safety, prevent injury and infection. To identify actual or potential problems that may require immediate attention.
y
3. A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry is weak. w eak. y
y
y
Establish respiration and maintain clear a irway
The most important need for the newborn immediately after birth is a clear airway to enable the newborn to breathe effectively since the placenta has ceased to function as an organ of gas exchange. It is in the maintenance of adequate oxygen supply through effective respiration that the survival of the newborn greatly depends. Newborns are obligatory nose breathers. The reflex response to nasal obstruction, opening the mouth to maintain airway, is not present in most newborns until 3 weeks after birth. To establish and maintain respirations:
1. Wipe mouth and nose of secreti ons after deliver y of the head. 2. Suction secretions from mouth and nose. y
Compress bulb syringe before inserting i nserting
y
Suction mouth first, then, the nose
Insert bulb syringe in one side of the mouth
Do
not slap the buttocks rather rub the soles of the feet. Stimulate to cry after secretions are removed. The normal infant cry is loud and husky. Observe for the following abnormal cry: o High, pitched cry indicates hypoglycemia, increased intracranial pressure. o Weak cry prematurity o Hoarse cry laryngeal stridor
4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions. y
y
Trendelenburg position head lower than the body Side lying position If trendelenburg position is contraindicated, place infant in side lying position to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position.
5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory nose breathers until they are about 3 weeks old. Care of the Eyes
It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal during delivery. This practice was
introduced by Crede, a German gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose. Erythromycin
or
tetracycline
Opthalmic
hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed after 48 hours when the cord has dried. The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days.
Ointment: Instruction to the mother on cord care:
1. These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis. 2. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes. Vitamin K or Aquamephyton
The newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinal bacteria that manufactures vitamin K which is necessary for the formation of clotting factors. This makes the newborn prone to bleeding. As a preventive measure, .5 (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborns vastus laterali s (lateral anterio r thigh) muscle. Care of the cord
The cord is clamped and cut approximately within 30 seconds after birth. In the delivery room, the cord is clamped twice about 8 inches from the abdomen and cut in between. When the newborn is brought to the nursery, another clamp is applied ½ to 1 inch from the abdomen and the cord is cut at second time. The cord and the area around it are cleansed with antiseptic solution. The manner of cord care depends on
1. No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by water or urine. 2. Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol. 3. Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine. 4. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air. 5. If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten. 6. Report any unusual signs and symptoms which indicates infection. Foul odor in the cord Presence of discharge Redness around the cord The cord remains wet and does not fall off within 7 to 10 days Newborn fever y y y y
y
THE APGAR SCORING SYST EM
The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the newborns adjustment to extrauterine life. It is taken at one minute and five minutes after birth. With depressed infants, repeat the scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits. The most important is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress. ASSESS HEART RATE RESPIRATION MUCLE TONE REFLEX IRRITABILITY COLOR
0 Absent Absent Flaccid No response Blue all over
1 Below 100 Slow Some flexion Grimace Body pink, Extremities blue
Score: y y y
7 10 Good adjustment, vigorous Moderately depressed infant, needs airway clearance Severely depressed infant, in need of resuscitation.
ASSESSING THE AVERAGE NEWBORN Head Circumference
34 35 cm
Temperature Chest Circumference Heart Rate Respirations Weight Length
97.6 98.6 F axillary 32 33 cm 120 140 bpm 30 60 bpm 2.5 to 3.4 kg 46 to 54 cm
2 Above 100 Good crying Active motion Vigorous cry Pink all over
Newborn Screening Inborn Errors of Metabolism
G6PD Deficiency-Glucose Deficiency-Glucose 6 Phospate Dehydrogenase
· Sex linked recessive (X-linked kaya there is more boys than girls) (bakit boys? Remember that female contains XX genes while male contains X genes. So ibig sabihin if a female had a faulty X genes the other X genes can balance the effect. So with w ith this principles female are always carriers and her son would be affected, Then if the affected son had a female daughter she will be a carrier) · Lacks enzyme G6PD results in premature destruction of RBC if cells are exposed to oxidants, ASA, legumes and flava beans 2 forms: 1. Congenital Nonspherocytic Hemolytic anemia- group of congenital hemolytic anemias in which there is no abnormal hemoglobin hemogl obin or spherocytosis and in which there is a defect of glycolysis in the erythrocyte Characterized by: Hemolysis, jaundice, splenomegaly and aplastic
anemia 2. Drug induced Precipitating factors: 1. Illness: bacterial and viral infections 2. Anti-pyretic drugs (Aspirin and phenacitin) 3. sulfonamides 4. Anti-malarial drugs (Quinine) 5. Various medications such us Vit. K and Methylene blue 6. Flava beans and Napthalene (eto ung moth balls or naptalina na nilalagay sa cabinet) Dx Procedure
· Rapid enzymes screening test or electropoetic RBC
· Peripheral blood smear- reveals presence of Heinz bodies (hindi eto ung ketchup, this are RBCs that appears to have bite off the cytoplasm, thats why they are sometimes called bite cells) Nursing Management · Instruct to avoid foods such us flava beans, red wine, legumes, blueberries, soya foods, tonic water and other drugs that triggers the attack. Homocystinuria
· elevated excretion of amino acid homocystiene · It can lead to mental retardation (delays in reaching developmental milestones {e.g., crawling, walking, sitting}) REVIEW!!! Ireview natin ang mga level of Mental retardation... lumabas ito last June 06 board. Profound Mental retardation- IQ<20> thinks like an Infant. Cant be trained Severe Mental retardation- 20-35 Moderate 35-50-> can be trained. Mental age is 2-7y/o. Pre-operational stage Mild- 50-70 Metal age is 7-12. Educable and can go to school Borderline 70-90 Normal 90-110 (Balik ulit tayo sa Homocystinuria) · Inability to convert amino acid Methionine · Autosomal recessive (this means the gene defect is unknowingly passed down from generation to generation. This faulty gene only emerges when two carriers have children together and pass it to their offspring. For each pregnancy of two such carriers, there is a 25% chance that the child will be born with the disease and a 50% chance the child will be a carrier for the gene defect.) Signs/Symptoms · Mental retardation · Downward subluxation of lens (ectopia lentis)
· Slender built · Pectus excavatum (oist meron din nito ang may Down syndrome, the sternum appears sunken and the chest concaves.) · Abnormal thinning and weakness of the bone (osteoporosis and kyphoscoliosis) · Degeneration of the aorta Labtest: Bacterial inhibition assay for methionineNormal is <1mg>
Labtest: High 17-hydroxyprogesterone Low serum Na High serum K Treatment: Corticosteroid Diet: High sodium, low potassium
PHENYLKETONURIA Congenital Adrenal Hyperplasia
- A condition where the adrenal does not produce enough cosrtisol and aldosterone but there is an excessive production of androgens. - This is also autosomal recessive REVIEW!! Hormones of the Adrenal Cortex Ang ating code; SSS Salt- Mineralocorticoids (mainly aldosteroneresponsible for Na reabsorption and K excretion) Sugar-Glucocorticoids Sugar-Glucocortico ids (mainly cortisol, responsible for glycolisis and gluconeogenesis) Sex- Sex hormones Oversecretion- Cushings syndrome Undersecretion- Addisons disease Assessment: In female · Large clitoris, closed labial folds · Early appearance of pubic hair · Deep masculine voice · No breast development and menstruation · Excessive hair in face · (in short nagiging lalaki ung babae, pramis pag nakita nyo ung itsura, ung clitoris eh mukha nang penis) In male: at birth- normal 6 months signs of sexual precocity 3-4 have pubic hair and enlarged penis, scrotum and prostate but testes is not descended sterility
(PKU) deficiency of liver enzymes (P HT) Phenylalaninehydroxylase Transferase liver enzyme that converts CHON to amino acid 9 amino acids: valine isolensine tryptophase lysine phenylalan phenylalanine ine Thyronine decrease malanine production 1.) fair complexion 2.) blond hair 3.) blue eyes Thyroxine decrease basal metabolism m etabolism - accumulation of Phenyl Pyruvic acid 4.) Atopic dermatitis 5.) musty / mousy odor urine 6.) seizure mental retardation Test GUTHRIE TEST specimen blood - preparation increase CHON intake - test if CHON will convert to amino acid specimen and urine mixed with pheric chloride, presence of green spots at diaper a sign of PKU DIET: Low phenylalanine diet- food contraindicatedmeats, chicken, milk, legumes, cheese, peanuts Give Lofenalac- milk with synthetic protein Galactosemia
deficiency of liver enzyme - GUPT Galactose G alactose Urovil Phosphatetranferase - Converts galactose to phosphate tranferace
glucose Galactose will destroy brain cells if untreated death within 3 days
gluten free diet lifetime all BROW not allowed ok rice & corn
Dx:
Beutler test get blood -done after 1st feeding presence of glucose in blood sign of galactosemia galactose free diet lifetime neutramigen milk formula CELIAC DIS EASE gluten enteropathy Common
gluten food: Intolerance to food with brow B- barley R- rye O- oat W- wheat Pathophysiology: Gluten glutamine ( normal absorption)-> Gliadin ( toxic to epithelial cells of villi vi lli of intestines, effects is malabsorption syndrome) Malabsorption -> Fats-> steatorrhea ->malnutrition and edema -> Vit D calcium->osteomalicia ->Vitamin K->inadequate blood coagulation>bleeding ->iron folic acid-> anemia
Early Sx: 1. diarrhea failure to gain wt ff diarrheal episodes 2. constipation 3. vomiting Late Sx: abd pain protruberant abd even if with muscle wasting steatorrhea Celiac Crisis-
exaggerated vomiting with bowel inflammation Dx: lab studies stool analysis serum antiglyadin confirmatory of disease
Mgt: vitamin supplements mineral supplements steroids
Characteristic haracteristic of
Newborn
The end of your journey has come after 40 weeks. The fruit of your labour (literally) will soon be in your hands. There are a few things you might want to know about your new arrival. Typically, a newborn baby has the following characteristic appearance: y
y
y
y
y
y y
y
Weight:
Average 2.8 kg for Indian babies (range 2.5 3.2 kg). Babies below 2.5 kg at birth are considered to be low birth weight and need special evaluation. Length : Approximately 50 cm. Remember, small women have small babies and many genetic factors also play a role in determining the length of the baby. Head: Your babys head appears large for the body and may have an elongated shape or appear to have some bumps. This is due to changes called molding, which occurs in labour l abour and delivery. Small bumps called caput usually disappear in 1 2 days. Soon the head gets rounder. The head circumference is 33 35 cm. Soft spots or Fontanelles: There are 2 areas on the head where bone formation is incomplete at birth. The larger one, in front of the head closes cl oses by 6 18 months. The smaller one at the back usually closes by 6 weeks. Hair: As all people vary, so does their hair. Your baby may have lots of hair or none at all! It depends on familial and racial factors. Heart beats: Usually the heart rate is 120 140 beats per minute. Respiratory rate (breathing): It is faster than adults, usually 30 40 breaths / minute. Breathing may be noisy or stop for many seconds. This is not uncommon. uncommon. Colour: Depending on the parents, the skin colour of newborn varies. In general, newborn babies look flushed and pink all over. However, the palms and soles of the feet may look dusky or little bluish soon after birth.
Axillary temperature measurement. measurement. The thermometer should remain in place for 3 minutes. The nurse presses the newborns arm tightly but gen tly against the thermometer and the newborns side, as illu strated
Preventing Infection
Ophthalmia neonatorum
Any conjunctivitis with discharge occuring during the first two weeks of life. It typically appears 2-5 days after birth, although it may appear as early as the first day or as late as the 13th. silver nitrate (used before) 2 d rops lower conjunctiva (not used now)
Administering Erythromycin or Tetracycline Ophthalmic Ointment
These ointments are the ones commonly used nowadays for eye prophylaxis because they do not cause eye irritation and are more m ore effective against Chlamydial conjunctivitis. conjunctivitis. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes. Wipe excess ointment after one minute sterile cotton ball moistened sterile water.
Skin
o o o
o o
o
o o o o o o
Skin reddish in color, smooth and puffy at birth At 24 - 36 hours of age, skin flaky, dry and pink in color Edema around eyes, feet, and genitals Venix Caseosa -whitish, cheese-like substance, covers the fetus while in utero and lubricates the skin of the NB. The skin of the term or postterm nb has less vernix and is frequently dry; peeling is common, esp. on the hands & feet Lanugo -moderate in full term; more in preterm; absent in postterm; shed after 2 weeks in time of desquammation Turgor good with quick recoil Hair silky and soft with individual strands Nipples present and in expected locations Cord with one vein and two arteries Cord clamp tight and cord drying Nails to end of fingers and often extend slightly beyond
Skin color White edema Grey infection
Blue cyanosis or hypoxia Blue Yellow Yellow jaundice , carotene
Acrocyanosis o
Bluish discoloration of the hands and feet maybe
o
his T his
present in the first 2 to 6 hours after birth condition is caused by poor peripheral circulation, w/c results in vasomotor instability &
capillary stasis, esp. when the baby is exposed to cold. If the central circulation is adequate, the blood supply should return quickly when the skin is blanched with a finger. Blue hands and nails are poor indicator of oxygenation in NB. The nurse should assess the face & mucus membranes for pinkness reflecting adequate oxygenation Mongolian
Spots
Patch of purple-black or blue-black color distributed over coccygeal and sacral regions of infants of AfricanAmerican or Asian descent. Not malignant. Resolves in time. They gradually fade during the first or second year of life. They maybe mistaken for bruises and should be documented in the NB¶s chart
o
o
Jaundice is first detectable on the face (where skin overlies cartilage) and the mucus membranes of the mouth and has a head-totoe progression. Evaluate it by blanching the tip of the nose, the forehead, the sternum, or the gum line. This procedure must be done with appropriate lighting. Another are to assess is the sclera. Jaundice maybe related to breastfeeding, hematomas, immature liver function, bruises from forceps, blood incompatibility, incompatibility, oxytocin induction or severe hemolysis process.
Nsg Resp: 1. cover eyes prevent retinal damage 2. cover genitals prevent priapism painful continuous erection 3. change position regularly even exposed to light 4. increase fld intake due prone to dehydration 5. monitor I&O weigh baby 6. monitor V/S avoid use of oil or lotion due- heat at phototherapy = bronze baby syndrometransient S/E of phototherapy Care
of Newborn in Jaundice
Phototherapy o
o
o
Is the exposure of the NB to high intensity light. Maybe used alone or in conjunction w/ exchange transfusion to reduce serum bilirubin levels. Decreases serum bilirubin levels by changing bilirubin from the non-water soluble form to water-soluble by products that can be excreted.
Nursing Interventions: Interventions: 1. Exposing as much of the NBs skin as possible
Mottling
lacy pattern of dilated blood vessels under the skin Occurs as a result of general circulation fluctuations. It may last several hours to several weeks or may come and go periodically. Mottling maybe related to chilling or prolonged apnea.
however genitals are covered & the nurse monitors the genitals area for skin irritation 2. Eyes are covered with patches or eye shields and are removed at least once per shift to inspect the eyes 3. Monitor temp. closely & fluids to compensate water loss 4. NB is repositioned q 2° and stimulation is provided. o NB will have loose green stools and green colored urine. Exchange o
Transfusion
Is the withdrawal and replacement of newborns blood with donor blood.
Milia which are exposed to sebaceous glands, appear as raised white spots on the face, esp. across the nose. No treatment is necessary, because they will clear within first month. Infants of African heritage have a similar condition called transient neonatal pustular melanosis.
Physiologic Jaundice o
Hyperbilirubinemia not associated with
o
hemolytic disease or other pathology in the newborn. Jaundice that appears in full term newborns 24 hours after birth and peaks at 72 hours. Bilirubin may reach 6 to 10 mg/dl and resolve in 5 to 7 days. If jaundice occurs within 2 days pathologic jaundice
o
If jaundice occurs at 3rd-7th days of life physiologic jaundice
Erythema toxicum
y
o
Is an eruption of lesions in the area surrounding a hair follicle that are firm, vary in size from 1-3 mm, and consist of a white or pale yellow papule or pustule w/ an erythematous base.
o
It is often called newborn rash or fleabite dermatitis The rash may appear suddenly, usually over the trunk and diaper area and is frequently widespread. The lesions do not appear on the palms of the hands or soles of the feet. The peak incidence is 24-48 hours of life.
o
Cause is unknown and no treatment
o
o o
o
y
The size & shape vary, but it commonly appears on the face. It does not grow in size, does not fade in time and does not blanch. The birthmark maybe concealed by using an opaque cosmetic cream. If convulsions and other neurologic problem accompany the nevus flammeus,----5th cranial nerve involvement.
Harlequin Sign
Nevus vasculosus (strawberry mark) y
y
A capillary hemangioma, consists of newly formed and enlarged capillaries in the dermal and subdermal layers. It is a raised,clearly delineated, dark-red, rough-surfaced birthmark commonly found in the head region.
o
The color of the newborn's body appears to be half red and half pale. This condition is transitory and usually occurs with lusty crying. Harlequin Coloring may be associated with to an immature vasomotor reflex system.
y
y
BIRTH MARKS
Telangiectatic nevi (stork bites) y
y
Appear as pale pink or red spots and are frequently found on the eyelids, nose, lower occipital bone and nape of the neck These lesions are common in NB w/ light complexions and are more noticeable during periods ofcrying.
y
Such marks usually grow starting the second or third week of life and may not reach their fullest size for 1 to 3 months; disappears at the age of 1 yr. but as the baby grows it enlarges. Birthmarks frequently worry parents. The mother maybe especially anxious, fearing that she is to blame (Is my baby marked because of something I did?) Guilt feelings are common when parents have misconceptions about the cause. Identify and explain them to the parents. Providing appropriate information about the cause and course of bir thmarks often relieves the fears and anxieties of the family. Note any bruises, abrasions,or birthmarks seen on admission to the nursery.
HEAD y
y
y y y
3 types Hemangiomas
a.) Nevus Flammeus port wine stain macular purple or dark red lesions seen on face or thigh. NEVER disappear. Can be removed surgically b.) Strawberry hemangiomas nevus vasculosus dilated capillaries in the entire dermal or subdermal area. Enlarges, disappears at 10 yo. c.) Cavernous hemangiomas communication network of venules in SQ tissue that never disappear with age. Flammeus (port-wine stain) y
y
A capillary angioma directly below the epidermis, is a non-elevated, sharply demarcated, red-to-purple area of dense capillaries. Macular purple
Head
circumference should be 2 cm greater than chest circumference Assess fontanelles and sutures - observe for signs of hydrocephalus and evaluate neurologic status Craniosynostosis Microcephaly Macrocephaly
Face, Mouth, Eyes, and Ears y y y y y
y
y y y
Assess and record symmetry Assess for signs of Down syndrome. Low set ears Assess history for risk factors of hearing loss Test for Moro reflex- elicited by a loud noise or lifted slightly above the crib and then suddenly lowered. In response, the NB straightens arms and hands outward while the knees flexed. Slowly the arm returns to the chest as in embrace. The fingers spread, forming a C and the newborn may cry. This lasts up to 6 months of age. Check for presence of gag, swallowing reflexes , coordinated with sucking reflex Check for clefts in either hard or soft palates Check for excessive drooling Check tongue for deviation, white cheesy coating
Eyes y
y
y
Assess cornea and blink reflex Note true eye color does not occur before 6 months May have blocked tear duct
Heart and Lungs y y
y
y
Assess and maintain airway Assess heart rate, rhythm - evaluate murmur: murmur: location, timing, and duration o Examine appearance and size of chest o Note if there is funnel chest, barrel chest, unequal chest expansion Assess breath sounds and respiratory r espiratory efforts evaluate color for pallor or cyanosis Breasts are flat with symmetric nipples - note lack of breast tissue or discharge
Abdomen y
Epispadias: if
the opening is at the dorsal
surface y
Hydrocele swelling due to accumulation of
serous fluid in the tunica vaginalis of the testis or in the spermatic cord Anus y
y
y
Inspect anal area to verify that it is patent and has no fissure Digital exam by physician or nurse practitioner if needed Note passage of meconium
Extremities y y y y
y
Tic dwarfism : very short arms Amelia : absence of arms Phocomelia : absence of long arm Polydactilism: more fingers; extra digits on
either hands or feet Syndactilism: webbing; fusion of fingers or toes
Assess for PERLA (pupils equal and reactive to light and accommodation) accommodation)
y
y
Abdomen appears large in relation to pelvis o Note increase or decrease in peristalsis
y
y y
y
y
Inspect the hands for normal palmar creases. A single palmar crease called SIMIAN line is frequently present in Downs syndrome Adactyl : no foot Downs syndrome: inward rotation of little fingers Clubfoot/ talipes deformity inward rotation of foot fingers. Erb-Duchenne paralysis (Erbs palsy) : resulting from injury to the 5th and 6th cervical roots of the brachial plexus; usually from a difficult birth; it occurs commonly when strong traction is exerted on the head of the NB in an attempt to free a shoulder lodged behind the symphysis pubis in the presence pre sence of shoulder dystocia
Note protrusion of umbilicus Measure umbilical hernia by palpating the opening and record o Note any discharge or oozing from cord o Note appearance and amount of vessels Auscultate and percuss abdomen o Assess for signs of dehydration o Assess femoral pulses o Note bulges in inguinal area o Percuss bladder 1 to 4 cm above symphysis o Voids within 3 hours of birth or at time of birth o
y
y
The asymmetry of gluteal and thigh fat folds see
A. A.
B.
Barlow's (dislocation) maneuver. Baby's thigh is grasped and adducted (placed together) with gentle downward C ,
Dislocation is palpable as femoral head slips out of acetabulum.
Genitals y
y y
y y
y
y
y y
Pseudomenstruation: the discharge w/c can
become tinged w/ blood and is caused by withdrawal of maternal hormones Smegma : a white cheeselike substance is often present between labia. Removing it may traumatize tender tissue Phimosis : tight foreskin or prepuce; w/c sometimes lead to early circumcision Cryptoorchidism: undescended testes ;if the testes did not go down Orchidopexy: repair of undescended testes before 2 y/o Penis: urethra should be at the tip of the penis Hypospadias : if the opening is at the ventral surface
D,
Ortolani's maneuver puts downward pressure on the hip and then inward rotation. If the hip is dislocated, this maneuver forces the femoral head over the acetabular rim
Clubfoot
o Nurse examines feet for evidence e vidence of talipes deformity (clubfoot) o Intrauterine positions can cause feet to appear to turn inward - "positional" clubfoot o To determine presence of clubfoot, nurse moves foot to midline - if resists, it is true clubfoot
TALIPES clubfoot
a.) Equinos plantar flexion horsefoot b.) Calcaneous dorsiflexion heal lower that foot anterior posterior of foot flexed towards anterior leg c.) Varus- foot turns in d.) Valgus- foot turns out Equino varus- most common
- 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 n ormal reflex up to about 2 years of age. Babinski ref lex
Tonic neck ref lex - 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. This is often called the "fencing" position. The tonic neck reflex lasts about six to seven months.
Nursing Role Be knowledgeable about normal newborn Ð variations and responses that indicate further investigation o Respiratory distress o Central cyanosis o Thermoregulation problems o Dehydration o Teaching Ð During physical and behavioral assessment, identify family's need for teaching o Involve family early in care of infant o Process establishes uniqueness and allays concern Teaching Ð o Feeding cues o Alert state o Cord care o Sleeping Neurological Status Assessment begins with period of observation Ð Ð Observe behaviors - note: o State of alertness o Resting posture o Cry o Quality of muscle tone o Motor activity Ð Jitteriness feeling of extreme nervousness Differentiate causative factors Ð Ð Examine for symmetry and strength of movements Ð Note head lag of less than 45 degrees Ð Assess ability to hold head erect briefly Ð
Ð
Ð W hat hat
Immature central nervous system ( CNS) of newborn is characterized by variety of reflexes o Some reflexes are protective, some aid in feeding, others stimulate interaction o Assess for CNS integration Protective reflexes are blinking, yawning, coughing, sneezing, drawing back from pain Rooting and sucking reflexes assist with feeding reflexes should be present in a newborn? Reflexes are
involuntary movements or actions. Some movements are spontaneous, occurring as part of the baby's usual activity. Others are responses to certain actions. Reflexes help identify normal brain and nerve activity. Some reflexes occur only in specific periods of development. The following are some of the normal reflexes seen in
Grasp ref lex - Stroking
the palm of a baby's hand causes the baby to close his/her fingers in a grasp. The grasp r eflex lasts only a couple of months and is stronger in premature babies. Palmar & Plantar
Palmar & Plantar Grasp Reflex
The Moro ref lex 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 and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him/her and begin this reflex. This reflex lasts about five to six months.
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. Step ref lex
newborn babies
- 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. Suck ref lex Rooting helps the baby become ready to suck. When the roof of the baby's mouth is touched, the baby will begin to suck. This reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Babies also have a handto mouth reflex that goes with rooting and sucking and may suck on fingers or hands.
B, The clitoris is still
R oot oot ref lex
visible.The labia minora are now covered by the larger labia majora. Score 2. The gestational age is 36 to 40 weeks.
ewborn C , The term n ewborn has well-developed, well-developed, large labia majora that cover both clitoris and labia
Neuromuscular Components
Square window sign
ASSESSMENT OF PHYSICAL MATURITY CHARACT ERISTICS OF NEWBORN Ð
Ð
Observable characteristics of newborn should be evaluated while not disturbing baby Gestational assessment tools examine the following physical characteristics characteristics o Resting posture o Skin o Lanugo o Sole (planar) creases o Breast tissue o Ear form and cartilage distribution o Evaluation of genitals
Male genitals
A,
Preterm newborns testes are not within the Signs of Preterm Babies scrotum. The scrotal surface has few rugae. score 2.
A,
This angle is 90 degrees and suggests an immature newborn of 28 to 32 weeks¶ gestation. Score 0.
B,
A 30- to 40-degree angle is commonly found from 39 to 40 weeks¶ gestation. Score 2-3.
C ,
A 0-degree angle can occur from 40 to 42 weeks. Score 4. (C) Used with permission from V.Dubowitz, MD, Hammersmith Hospital,
o o o o o o
Born after 20 weeks, after 37 weeks frog leg or laxed positon hypotonic muscle tone- prone resp problem scarf sign elbow passes midline pos. square window wrist 90 degree angle of wrist heal to ear signabundant lanugo-
Signs of Post term babies:
B, Term newborns testes are generally fully descended.
The entire surface of the scrotum is covered by rugae. Score 3. Female genitals
> 42 weeks classic sign old mans face o desquamation peeling of skin o long brittle finger nails o wide & alert eyes o Babies
A,
Newborn has a prominent clitoris. The labia majora are widely separated, and the labia minora, viewed laterally, would protrude beyond the labia majora. Score 1. The g estational age is 30 to 35 weeks.
with special needs
Some babies may need some extra attention from you and the doctor after birth. These include: o o o o o o
o
Low birth weight babies (less than 2.5kg). Babies born too early (premature). Babies with pathological jaundice. Babies with infection. Those needing an operation soon after birth. Those with low blood sugar. Babies of diabetic mothers.
