neonatal characteristics and essential of care

Neonatal characteristics and essential of care

Dr. Mingyuan WuDepartment of NeonatologyWomen’s Hospital,School of Medicine,Zhejiang University

• Basic conception• Physiological characteristics• Special physiological phenomena• Essential of neonatal care

Agenda

• Basic conception• Physiological characteristics• Special physiological phenomena• Essential of neonatal care

Agenda

Basic Conception -------Categories

•Gestational age•Birth weight•Weight for gestational age •High risk vs normal neonate •Early vs late neonate

ØPre-term infant/ Premature-----less than 37 weeks gestation

28w-<37w(196-259 days）Ø Extremely premature (viable infant) <28wØ Very premature 28-32wØ Near-term premature (late preterm infant) 34-36w

Ø Full-term infant/Term newborn-----completed 37 weeks gestation till 42 week

37w-<42w(260-293days) ØPost-term infant：completed 42 weeks gestation ≥42w(＞294days）

Gestational age

Full term

Post-term

Pre-term

GA

Birth weight

•Low-birth- weight <2500g *Very low birth weight <1500g *Extremely low birth weight <1000g (very very low birth weight)

•Normal birth weight 2500-3999g•Giant newborn 4000(4500)g

Normal birth weight

Low birth weightVery low birth weight

ExtremelyVery low birth weight

4kg

2.5kg

BIRTH WEIGHT

Weight for gestational age

•Newborn appropriate for gestational age(AGA) 10-90th centiles•Newborn small for gestational age(SGA) <10th centile•Newborn large for gestational age(LGA) >90th centile

Weight and GA

1 .Infants born by the mother with

abnormal pregnancy history

2. Infants with abnormal delivery course

3. Infants with abnormal condition at birth

4. Sick newborns: If infants have abnormal clinical symptoms or signs.

High- risk neonate

SGA problems

• Stillbirth• More RDS• High mortality• Hpoglycemia• Hypocalcemia• Polycythemia• Depression needing resuscitation at birth• Low Apgar score

LGA problems

• Associated with maternal diabetes• High fetal insulin even in absence of maternal

diabetes• Morbidity

– Birth trauma– Hypoglycemia– Polycythemia– Congenital heart disease TGA– High cesarean delivery – Sacral agenisis

Maternal History

• Maternal diabetes– Metabolic and congenital defect

• Polyhydramnios– Swallowing defect, GI obstruction

• Oligohydramnios– Renal disease, pulmonary hypoplasia

• Maternal age– Old age and chromosomal

• Breach presentation • FGR • Consanguinity, family history

• Rupture of membrane– sepsis

• Delivery type– c/s and TTN

• Prenatal care• Maternal blood group

– ABO, Rh disease• Infection risk

– Maternal Hepatitis carrier– Maternal GBS colonization

Maternal History

Normal full Term infant

•GA37-42w•Weight: 2.5-4.0 kg•Length: Approximately 50 cm•Head Circumference: Approximately 35 cm•Heart Rate: 120-140 bits per minutes•Respiratory Rate: 30-40 per minutes•No diseases•No malformations•No high risk factors

• Early neonate before 7days• Late neonate ≥7days

Early newbornLate newborn

• It is important to assess every newborn in the delivery room to make sure and documented:

i. Health status of mother.ii. Suspected fetal malformation.iii. Labor complication.iv. Gestational age.v. Duration of labor and ruptured membrane.vi. Medication and anesthetic drug given.vii. Any difficulty with delivery.

üLow birth weight infantü(extremely low, or very very low)

üPreterm infant ü(very premature)

üSmall for gestational age

üHigh risk or sick neonate

üEarly(≤7d) /late(>7d) neonate

Example:Baby wang, gestational age is 28wBirth weight is 550g.Apgar score 6-9

• Basic conception• Physiological characteristics• Special physiological phenomena• Essential of neonatal care

Agenda

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

Temperature instability ●At birth it is slightly higher than its mother‘s ● It drops immediately after birth and then rises to normal within about eight hours. ● The newborn's hands and feet are colder than the rest of its body since its circulation is poor.

Radiat warmer

Drying

Skin to skin contact after birth

Enviromental temperature control in NICU：

Neutral environmental temperature

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

●The mechanism of respiration is established before birth

● stimulation –hypoxia, light, tactile stimulation

RESPIRATION

● it undergoes changes at birth. ● The first breath(usually within 30s） helps to expand the collapsed lungs.

RESPIRATION

• Irregular in depth, rate and rhythm • Gentle and quiet, rapid and shallow. (RR 35–50/minute) • crying

RESPIRATION

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

•Pulmonary vessels constricted• Lung fluid clearance• Alveoli filled with air• Oxygen enter into capillaries• Pulmonary vessels dilated

Foetal→adult circulation

Foetal→adult circulation

oval foramen

● RBC (HB , Hct ) because of relative hypoxia.● Haemolysis and physiologic anemia because of oxygenation improved.

● The blood pressure is characteristically low. ● It is difficult to determine accurately and may vary with the size of the cuff

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

●Meconium passage *from 8 to 24 hours after birth *greenish black to brownish green *sticky, odourless ● transitional stools● normal yellow stools

Gastrointestinal system

•Physiological regurgitation *The cardiac sphincter not well developed compared with the pyloric sphincter.Therefore, the infant should be made to expel the air it has swallowed.*General condition is good, weight gain is satisfactory.

Gastrointestinal system

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

---blinking reflex ---coughing and sneezing---yawn reflex ---sucking、swallowing、 gagging reflex

－－essential to the infant‘s life, and many are protective。

physiological reflexes

blinking reflex--- when subjected to bright light

reflexes of coughing and sneezing---to clear the respiratory tract

yawn reflex----protective in a sense, providing an added supply of oxygen.

sucking、swallowing、 gagging reflex

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

An infant can feel pressure, temperature change and pain.

The sense of touch is the most highly developed of the special senses and is most acute on the lips, tongue, ears and forehead.

The baby's eyes are only half open and the lids are swollen.

The pupils react to light.

The eye movements are not coordinated and both may momentarily turn inward or outward.

Hearing only begins after the first cry. The infant normally makes some response to sound from the third day. Hearing screening program, important for language development

The infant‘s sense of taste is more highly developed than that of sight or hearing.

a wide difference among infants in their apparent ability to l.

highly sensitive to organic stimulation(hunger and thirst are the most common causes of crying）

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

sleep time：15 to 20 h/day. waking every 2h, but fewer and shorter during the night (fewer external stimuli). #At most time, awakened by internal discomfort (hunger, pain) # As the baby grows older, the length of unbroken periods of sleep and also of wakefulness increases.

physiological characteristics

1.Temperature2.Respiratory system 3.Circulatory system4.Gastrointestinal system 5.Nervous system 6.Special sense7.Sleep8.Immunity

Passive immunity and Active immunity Antibodies from mother (smallpox, mumps, diphteria, and measles) lasts from a few weeks to several months.

• Basic conception• Physiological characteristics• Special physiological phenomena• Essential of neonatal care

Agenda

Special physiological phenomena

•Physiological weight loss

•Physiological jaundice

•Physiological breast enlargement

•Fake menstruation

Physiological weight loss

Physiological jaundice

Physiological Breast

enlargement

Fake menstruation

•Neonatal uterine bleeding (NUB).

•Neonatal menstrual-like bleeding (NMB).

•Usually occurs in day 5-7 days, lasting 2-3 days.

•Caused by progesterone withdrawal.

• Basic conception• Physiological characteristics• Special physiological phenomena• Essential of neonatal care

Agenda

Essential of Neonatal Care----Routine care of newborn in the delivery room

• Thermal management. Including dry,use of radiant warmer, or skin-skin contact.

• Cord cut and care.• Airway open.• Vitamin K prophylaxis （1mg，im）

• Apgar score

Score 8-10：Normal; 4-7：Mild asphyxia; 3 or below：Severe asphyxia

-----Neonatal Measurement

• Weight • Head circumference • Length

Essential of Neontal Care

----Top to toe check of newborn

• Assess color, firm tone, response to handling, and established respiration with normal heart rate.

Essential of Neontal Care

• Head for moulding, caput, scalp edema and hematoma and birth trauma. The suture lines，

anterior and posterior fontanell.• Eyes for stickiness, cataract, subconjunctival

hemorrhage, albinism and the location. • Ears for tags shape and position. • Mouth for cleft lip, cleft palate, congenital

teeth.

-----Top to toe check of newborn

Essential of Neontal Care

• Chest for shape, recession, nipple location, respiration pattern, clavicle fracture.

• Abdomen for hernia, shape, umbilical clamp, 3 vessels in cord.

• Genitalia passing of urine and meconium, boys for hypospadias, hydrocele, descended testis. Girls for urethra, vagina.

-----Top to toe check of newbornEssential of Neontal Care

• Back to check vertebra, skin, spina bifida, sacrococcygeal dimple, anus, passage of meconium.

• Limbs for symmetry, fingers and toe count, palmer crease, webbing, overlapping digits, talipes.

• Skin for laceration, birth marks, rashes, bruising, birth trauma.

-----Top to toe check of newbornEssential of Neontal Care

-----Newborn Screening and Prophylaxis

• Screening is done in the hope of early diagnosis and intervention to improve the prognosis.

• Standard newborn screening test are the following: üPhenylketonuria.üCongenital hypothyroidism.üHearing loss

Essential of Neontal Care

----Routine Care in postnatal ward

• Temperature • Care of cord • Skin care• Feeding• Contraindications of Breastfeeding Ø HIV infection Ø Active tuberculosis infection Ø Some medication (APP Lactmed )

Essential of Neontal Care

• Voiding and stooling• Weight• Jaundice• Immunization: BCG and hepatitis B-1

-----Routine Care in post natal ward

Essential of Neontal Care