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NEWBORN
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EARLY NEWBORNASSESSMENT
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VITAL SIGNS
RESPIRATION : 30-60 cpm
HEART RATE : 120-160 bpm
TEMPERATURE : 36.5-37.40C
BP : 65-95 sys /30-60 dias
80/46mmHg at birth
100/50mmHg at 10th day
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THE FETAL SKULL
Fetal Bones and Fontannelles
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Anterior fontanelle
Diamond shape, found at the junctionof the two parietal bones and the two
fused frontal bones
2-3cm in width; 3-4cm in lengthCloses at 12 to 18 months
Posterior fontanelle
-triangular in shape, found at thejunction of parietal bones and the
occipital bones, 1cm
-Closes at 2 months
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FETAL HEAD MOLDING
MOLDING change in the shape of the fetal headthat allow it to pass through the birth canal, the headwill be restored to its normal shape within few daysafter birth.
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CAPUT SUCCEDANEUM
CAPUT SUCCEDANEUM (edema of the scalp) oftenappears over the vertex on the fetal head as a result ofthe pressure from the birth canal; normally resolves at
about the third day of life.
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CEPHALHEMATOMA
CEPHALHEMATOMA bleeding that occurs between theperiosteum of the skull (rupture of the periostealcapillary); normally appears 24 to 48 hours after birthand resolves slowly after several weeks
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CephalhematomaCephalhematoma
collection of blood under thecollection of blood under the
periosteumperiosteum of a cranial boneof a cranial bone
appearing 1appearing 1--2 d; does not cross2 d; does not cross
suture line; disappears in weekssuture line; disappears in weeks
to monthsto months
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CRANIOTABES Localized softening of the cranial bones. the bone is so soft that the pressure of an
examining finger can indent it
It corrects itself without treatment after a few
months It is probably caused by the pressure of the
fetal skull against the mothers pelvic bone inutero.
It is more common in 1st born infants than ininfant born later, because of the lower positionof the fetal head in the pelvis during the last 2weeks of pregnancy in Primiparous women.
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EARS
Top of ear should align with the inner
and outer canthus of the eye.
If ears are set lower, there could be akidney malformation or chromosomal
defect (Trisomy 18 and 13)
Sense of Hearing highly developed inNewborn
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MOUTHShould open evenly when crying. If not,
suspect Cranial Nerve VII Paralysis (BellsPalsy).
Palate should be intact;breaks on the lip = cleft palate; cleft lipEpstein Pearls small round glistening
cysts seen on palate and gums, due to extraload of maternal calciumIf with tooth (NATAL TOOTH=not covered
with gum membrane) should be extracted to
prevent aspirationOral thrush white gray patches usually on
the tongue and sides of cheeks due to Candidaalbicans acquired during the passage of thebaby through the birth canal of his mother
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Cleft lip
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Cleft Palate (Posterior)
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THE FETAL NECK
NECK of the newborn is short and often chubby; thenewborn should be able to raise the head briefly andturn it to both sides
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CHES
T
Usually smaller than the head
Symmetrically expands (retractionindicates respiratory distress)
Breasts may be engorged (due tomaternal hormones) There could bepassage of thin, watery fluid knownas WITCHS MILK.
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AbdomenNormally dome shaped; If scaphoid orsunken appearance, suspect missingabdominal contents or a DIAPHRAGMATICHERNIA (bowel sounds heard in the chest).
Bowel sounds should be present within 1hour after birth.
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THE UMBILICAL CORD
THE UMBILICAL CORD should contain AVA
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THE EXTREMITIES
EXTREMITIES should actively move equally; shouldsharply remain in flexed attitude and resist extensionduring examination
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EXTREMITIES
Should be symmetric and ofequal length
Fingers and toes in equal count.
Supernumery = POLYDACTYLY;
fused or webbed = SYNDACTYLY
Simean line single palmar
crease = DOWNS SYNDROME
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HANDS AND FEET
FINGERS AND FEET are examined for extra digits andwebbing
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SYNDACTYLY,POLYDACTYLY
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SYNDACTYLY
PO
LYD
ACTYLY
POLYDACTYLY &
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SENSESSight all newborns can see at birth although
they cannot see objects past the visual midline(not until 6-8 weeks).The visual field is 9-12inches;focus best on black and white objects.HearingHearing as soon as amniotic fluid has been
absorbed, the newborn can already hearTasteTaste as soon as secretions have beensuctioned, newborns can already taste becausetaste buds are developed and functioning even
before birth.SmellSmell as soon as the nose has been cleared ofmucus and fluid, newborns can smellTouchTouch the most developed of all the senses;also react on painful stimuli
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CARDIOVASCULAR SYSTEM
As the lung inflate for the 1st time,pressure decreases in the chest generally,and in the pulmonary artery specifically
The decrease in pressure in thepulmonary artery plays a role in promotingthe closure of the ductus arteriosus.
As pressure in the left side of the heartfrom increased blood volume, theForamen Ovale closes because of thepressure against the lip of the structure.
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Pulse using apicalpulse =
PMI: Point ofMaximum Impulse(located at
MCL 5th ICS or below the left nipple line)This is done using a stethoscope.Radial pulse is normally not prominent. If it is, it
may be a sign of congenital heart anomaly(i.e.,PDA).Femoral or brachial pulses if absent,indicates,coarctation of the aorta and hip
dislocation.
PulseisIRREGULAR, RAPID
>160-180 beats/min. at birth
120-140 (stable)
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Increased pressure on the left side of the
newborns heart results in:
Closure of the foramen ovale (fossaovale)
Change of the ductus arteriosus into amere ligament (ligamentum arteriosum)Ductus venosus becomes ligamentum
venosum
Since no more blood goes through theumbilical vein and arteries, these bloodvessels atrophy and degenerate
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GI SYSTEM
Newborns stomach holds about 60-90 ml
Has limited ability to digest fat and starch
because the pancreatic enzymes, lipase
and amylase, are deficient for the 1st fewmonths of life.
Because milk, the infants main diet for
the 1st
year is low in Vit. K, the intestinalsynthesis is necessary for blood
coagulation.
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Initial Feedinggiven 1-6 hours after
birth 1 oz ofsterile water to begiven to
find out ifnewborncanswallow withoutaspirating. Glucose water has been found
to beirritating to thelungs if aspirated.
Purposes of breastfeeding:
Primarily to promote bonding
Facilitates uterinecontraction
through sucking because of releaseof oxytocin byneurohypophysis
Facilitates release ofcolostrums
(contains antibodies-IgA).
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TYPES OF STOOLS PASSED BY NB
Meconiuma sticky,tarlike, blackish-green,odorless material formed from mucus, vernix,
lanugo, hormones and carbohydrates thataccumulated during intrauterinelife;take note of
time when meconium first passed(should bewithin 24 hours)Transitionalpassed from 2nd to 3rd day of
life,become green and loose stool.
Milk stoolBreast fed infant stool loose light yellow incolor with sweet odor; 3-4x/dayBottle fed infant stool formed, bright yellow
with a typical odor; usually passed 2-3x /day
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URINARY SYSTEMThe average newborn voids within 24 hrs
after birthNewborns who do not void within this time
should be examined for the possibility ofureteral stenosis or absent kidneys or
ureterA single voiding in a newborn is only about
15 mlThe dailyurinary output for the 1st1-2
days is about 30-60 ml total. after a week a total of 300ml/dayThe 1st voiding may be pink or dusky
because of uric acidcrystals that were
formed in the bladder in utero
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CONGENITAL MALFORMATIONS
OF THE URINARY TRACT
Epispadias -
urethral openingon the dorsal
surface of the
penis
Surgical correction
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HYPOSPADIA
Male urethralopening on the
ventral surface ofpenis, or femaleurethral opening invagina
Surgicalreconstruction
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HYPOSPADIA
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FemaleG
enitalia May have swollen labia andmay pass a slightly bloody vaginaldischarge known as
PSEUDOMENSTRUATION (due to
maternal hormones)Male Genitalia Scrotum may be edematousdue to maternal hormones.Foreskin should be retracted to test for
PHIMOSIS (tight foreskin)
Testes should be present: if undescended thecondition is called CRYPTORCHIDISM.
The GENITALS
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Conditions for CRYPTORCHIDISM:
Agenesis absence of an organ
Ectopic testes testes cannot enter the
scrotum because the opening of the scrotalsac is closed.
Undescended testes- Vas deferens or
artery is too short to allow the testes todescend.
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MEASUREMENTS
HEAD CIRCUMFERENCE : 33-35cm
CHEST and ABDOMEN : 31-33cm
LENGTH : 47-54cm
WEIG
HT : 2500-4000 grams
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VERNIX CASEOSA
White, cream-cheese-like substance that
serves as a skin lubricant, usually
noticeable on a newborn skin, prominently
seen in the skin folds, at birth in a term
neonate.
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VERNIX CASEOSA
The cheesy-white substance found on the newbornsskin
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LANUGO
Is the fine downy, hair that covers a newborns
shoulder, back and upper arms
Found also in the forehead and ears.
The newborn of 37-39 wks has more lanugo
than the 40th wks old infant.
Post-mature infants have rarely have lanugo
By age of 2 wks. It has disappear.
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LANUGO
The fine hair of the newborn
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DESQUAMATION
Within 24 hrs. of birth, the skin of most
newborns has become extremely dry
The dryness is particularly evident on thepalms of the hands and soles of the feet.
this is normal and needs no treatment.
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FORCEPS MARK
There may be a circular or linear contusion
matching the rim of the blade of the forcep
on the infants cheek.
The mark disappears in 1-2 days along
with the edema that accompanies it.
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HARLEQUIN SIGN
HARLEQUIN SIGN clown suit-like appearance of thenewborn
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HARLEQUINSIGN
- BECAUSEOF IMMATURITYOFCIRCULATION, ANINFANT WHOHAS
BEEN LYINGONHISSIDE WILL APPEAR
REDONTHEDEPENDENTSIDE & PALE
ONTHEUPPER SIDE.
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MOTTLING
MOTTLING map-like appearance on the skin of thenewborn
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CUTISMARMORATA
- TRANSITORYMOTTLINGONNBSSKIN WHENITISEXPOSEDTOCOLD.
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MILIA
Newborn sebaceous gland is immature. Atleast one pin-point white papule (a plugged
orunopened sebaceous gland) can befound in the cheek or across the bridge ofthe nose of every newborn.
Disappears by 2-4 wks of age as the
sebaceous glands mature and drain. Parents should be instructed to avoid
scratching or squeezing the papules toprevent secondary infection.
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MILIA
MILIA pimple like spots that may be found on theface of the newborn
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MONGOLIAN SPOTS
bluish gray or dark nonelevated pigmentation
area over the lower back and buttocks present at
birth, primarily nonwhite, disappear at SCHOOL
AGE
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MONGOLIAN SPOT
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NEWBORN REFLEXES
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NEUROMUSCULAR SYSTEM
Reflexes
Blink Reflex- to protect the eye fromany object coming near it by rapid eyelidclosure
Tonic Neck Reflex- the arm and the leg
on the side toward which the head turnsextend, and the opposite arm and leg
contract
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RootingReflex turnstoward anyobject touching/strokingcheek/mouth,opens mouth,and sucksrhythmicallywhen finger/nipple isinserted intomouth (usuallydisappears by 6wks.)
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Sucking Reflex-
when newborns
lips are touched,
the baby makes
a sucking motion.It diminishes at
about 6 months
of age
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Swallowing Reflex- food that reaches theposterior portion of the tongue is automatically
swallowed.
Placing Reflex- similar to step-in-place Reflex,except it is elicited by touching the anterior
surface of a newborns leg against the edge of a
bassinet or table A newborn will make a few quick lifting motions as if to
step onto the table
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PLACING REFLEX
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Palmar grasp
pressure on palm
elicits grasp
(disappears atabout 6 weeks to
3 months of age)
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Moro orStartleReflex
elicited by suddendisturbance in theinfants immediateenvironment, bodywill stiffen, arms intense extensionfollowed by embracegesture with thumband index finger ac formation(disappears by 4th-5th months)
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MORO OR STARTLE REFLEX
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EXTRUSION REFLEX
a newborn will extrudeany substance that is
placed in the anterior
portion of the tongue.
Protective reflex prevents
the swallowing of inedible
substance
Disappears at 4 mos.
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Step (walk)-in-
place reflex when held upright
with one foot
touching a flatsurface, withalternating step(fades 3 months of
age)
Babinski Reflex stroking the sole of the foot from heel
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Babinski Reflex stroking the sole of the foot from heelupward like an inverted J across ball of foot will cause all
toes to fan (positive Babinski sign)
(remains positive until 3 months of age)
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THE END