characteristics of newborn[1]

7/21/2019 Characteristics of Newborn[1]

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CHARACTERISTICS OF

THE TYPICAL NEWBORN

INFANT


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GENERAL

The nurse is in a unique position to aid the

newborn infant in the stressful transition

from a warm, dark, fluid-filled environment

to an outside world filled with light, sound,and novel tactile stimuli. During this period

of the newborn adjusting from intrauterine

to extrauterine life, the nurse must be

knowledgeable about a newborn's normalbiopschosocial adaptations to recogni!e

an deviations .


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To begin life as an independent being, the

bab must immediatel establish pulmonar

ventilation in conjunction with markedcirculator changes. These radical and rapid

changes are crucial to the maintenance of

life. "ll other neonatal bod sstems changetheir functions or establish themselves over

a longer period of time. The nurse performs

an initial assessment to evaluate the

neonate, its immediate postbirth adaptations,

and the need for further support


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TERMS:

Neonatal Period:

#irth --$ %& das of life

Term Infant:

& - (% weeks of gestation

Transition Period: )hases of instabilit

during the first *-& hours after birth


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VITAL SIGNS OF THE NEWBORNINFANT

a. Temperature +egulation.

The infant's bod temperature drops

immediatel after birth in response to the

extrauterine environment. /is internal organs are

poorl insulated and his skin is ver thin and does

not contain much subcutaneous fat. The infant's

heat regulating mechanism has not full developed.

/is temperature rapidl reflects that of his

environment. The flexed position that the infantassumes is a safeguard against heat loss because

it substantiall diminishes the amount of bod

surface exposed.


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0ursing implications are centered on

regulating an environment to provide constant

bod temperature of a neutral thermalenvironment. The infant is placed in blankets,

s and a controlled temperature environment

after birth to counteract the drop in bodtemperature that occurs immediatel after

birth. "fter admission to the nurser, the infant

is placed in isolation isolette and a

temperature probe ma be used for

continuous monitoring. The infant's axillar

temperature is maintained at *.( to 1.%o 2.


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03T45 "n isolette is a self-contained unit

that controls the temperature, humidit,

and oxgen concentration for an infant.


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Pulse

The normal pulse range for an infant is

%6 to (6 beats per minute bpm.

The rate ma rise to *6 bpm when the

infant is cring or drop to 66 bpm whenthe infant is sleeping.

The apical pulse is considered the most

accurate .


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Blood Pressure

The average blood pressure#) of an

infant at birth is 1%7(%.

" drop in sstolic #) of about 8 mm

/g the first hour after birth is common. The newborn's #) ma be taken with a

Doppler blood pressure device. This

greatl improves accurac .


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Respiratios

The respirations of a newborn infant are

irregular in depth, rate, and rhthm and var

from 6 to *6 beats per minute.

+espirations are affected b the infant's activitthat is, cring. 0ormall, respirations are

gentle, quiet, rapid, and shallow.

The are most easil observed b watching

abdominal movement because the infant'srespirations are accomplished mainl b the

diaphragm and abdominal muscles. 0o sound

should be audible on inspiration or expiration


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Respiratios


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!HARA!TERISTI!S OF THENEWBORN INFANT"S HEA#

The newborn infant's head represents

one-fourth of his total bod length.

9ts circumference is equal to that of his

abdomen or chest. The average si!e is to -8 cm.

The head is shaped or molded as it is

forced through the birth canal in vertexpresentations .


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Moldi$

During deliver, for the large head to

pass through the small birth canal, the

skull bones ma actuall overlap in a

process referred to as molding. :uch molding reduces the diameter of

the skull temporaril.

This elongated look usuall disappearsa few hours after birth as the bones

assume their normal relationships


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Mouldi$


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Fotaels

The infant's skull is separated into six bones one

from another along the suture lines .;here more

than two bones come together, the space is

called a fontanel.

This is the unossified space or soft spot

between the cranial bones of the skull in an

infant.

The infant's pulse is sometimes visible there. The anterior fontanel is located at the

intersection of the sutures of the two parietal

bones and the frontal bones.


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Fotaels

9t is diamond-shaped and strongl pulsatile.

9t normall closes at < to & months of age.

The posterior fontanel is located at the

junction of the sutures of the % parietalbones and occipital bone.

9t is small, triangular shaped, and less

pulsatile. 9t normall closes at 7% to

months of age. The anterior fontanel is the larger of the two.


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%ep&al&e'ato'a

This is a collection of blood between a

cranial bone and its overling periosteum.

#leeding is limited to the surface of the

particular bone. 9t is caused b pressure of the fetal head

against the maternal pelvis during a

prolonged or difficult labor.

This pressure loosens the periosteum from

the underling bone, therefore rupturing

capillaries and causing bleeding.


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!ep&al&e'ato'a(

9t ma be apparent at birth but sometimes

are not seen until %( to (& hours of life

because subperiosteal bleeding is slow.

9t varies in si!e, rather firm to the touch andtends to increase in si!e from to das

and then become softer and more fluctuant.

=ost cephalhematomas are absorbed

within several weeks. 0o treatment is required in the absence of

unexplained neurologic abnormalities


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!aput Su%%edaeu'

This is an abnormal collection of fluid

under the scalp on top of the skull that

ma or ma not cross the suture lines,

depending on the si!e. )ressure on the presenting part of the

fetal head against the cervix during labor

ma cause edema of the scalp . This diffuse swelling is temporar and

will be absorbed within % or das


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!HARA!TERISTI!S OF THE NEWBORNINFANT"S E)ES AN# EARS

4es.

The infant's ees ma be folded and

creased and ma seem out of shape

because the contain little hardenedcartilage.

The infant's ees ma not track properl

and ma cross strabismus or twitchnstagmus. This will cause concern if it

extends beond six months.


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!olor

"t birth, the iris color is usuall graish-

blue in 2aucasians and graish brown

or brown in dark-complexioned races.

" gradual deposition of pigmentproduces the final ee color of the bab

at the age of three to six months and

sometimes it ma take a ear .


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Pupils

The pupils do react to light and the

infant can focus on objects about eight

inches awa. The infant's blinking is a

natural protection reflex.


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La%ri'al apparatus

The lacrimal apparatus is small and

nonfunctioning at birth and tears are not

usuall produced with cring until one to

three months of age.


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Ears

The infant's ears tend to be folded and

creased.

" line drawn through the inner and

outer canthi of the ee should come tothe top notch of the ear where it joins

the scalp.

The infant usuall responds to sound atbirth.


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Stru%ture o* i*at"s ear


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!HARA!TERISTI!S OF THENEWBORN INFANT"S S+IN

The infant has delicate skin at birth that

appears dark red because it is thin and

laers of subcutaneous fat have not et

covered the capillar beds. This redness can be seen through

heavil pigmented skin and becomes

even more flushed when the bab cries.


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Veri, !aseosa

This is a soft, white, chees, ellowish cream on

the infant's skin at birth .

9t is caused b the secretions of the sebaceous

glands of the skin.

9t offers protection from the water environment

of the uterus, is absorbed in the skin after birth,

and serves as a natural moisturi!er.

9f there is a large amount of vernix caseosa

present, it should be meticulousl removed as it is

thought to be a good culture medium for bacteria.


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Veri, !aseosa


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Lau$o

This is a long, soft growth of fine hair on

the infant's shoulders, back, and

forehead. 9t disappears earl in

postnatal life.


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Lau$o


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Mo$olia Spots

These are blue-black colorations on the

infant's lower back, buttocks, and

anterior trunk. The are often seen in

infants of #lack, 9ndian, =ongolian, or=editerranean ancestr. These spots

occur less frequentl in 2aucasian

babies. The spots are not bruises nor are

the associated with mental retardation.

The disappear in earl childhood


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Mo$olia Spots


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-audi%e

This is a ellow discoloration that ma

be seen in the infant's skin or in the

sclera of the ee. >aundice is caused b

excessive amounts of free bilirubin inthe blood and tissue


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Pete%&iae

These are small, blue-red dots on the

infant's bod caused b breakage of tin

capillaries. The ma be seen on the

face as a result of pressure exerted onthe head during birth. True petechiae

does not blanch on pressure.


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Pete%&iae


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Milia

These are tin sebaceous retention

csts. The appear as small white or

ellow dots and are common on the

nose, forehead, and cheeks of the infant.The are of pin head si!e and

opalescent. =ilia is due to blocked sweat

and oil glands that have not begun to

function properl. The disappear

spontaneousl within a few weeks


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Milia


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Birt&'ar.s

These are small, reddened areas

sometimes present on the infant's eelids,

mid-forehead, and nape of the neck. The

ma be the result of local dilatation of skincapillaries and abnormal thinness of the

skin. The are sometimes called stork bites

or telangiectasia. These marks usuall

fade and disappear altogether. The mabe noticeable when the infant blushes, is

extremel warm, or becomes excited


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Birt&'ar.s


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He'a$io'a

" /emangioma or strawberr mark is a

tpe of birthmark that is characteri!ed b

a dark or bright red raised, rough

surface. The do not develop for severaldas. The ma regress spontaneousl

or ma even increase in si!e. :urgical

removal is not recommended. There is a

wait-and-see attitude advocated before

surgical removal


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He'a$io'a


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GASTROINTESTINAL S)STEM

=outh.

The infant's lips should be pink and the tongue

smooth and smmetrical.

The tongue should not extend or protrude

between the lips.

The connective tissue attached to the underside

of the tongue should not restrict the mobilit of

the tip of the tongue.

The gums ma have tooth ridges along them,

and rarel a tooth or two ma have erupted

before birth .

GASTROINTESTINAL


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GASTROINTESTINALS)STEM The roof of the mouth should be closed,

and the uvula should be present.

:ometimes there are glistening spots

firm white or graish-white nodules,usuall multiple on the palate that are

referred to as 4pstein's pearls.

" common site for them is at thejunction of the hard and soft palates


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Sto'a%&

The capacit of the infant's stomach is

about one to two ounces 6 to *6 ml at

birth, but increases rapidl.

=ilk passes through the infant'sstomach almost immediatel.

The infant is capable of digesting

simple carbohdrates and proteins, buthas a limited abilit to digests fats.


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Itesties

9rregularit in peristaltic motilit slows

stomach empting.

)eristaltic increases in the lower ileum,

which results in one to six stools a da. The first stools after birth and for three

to four das afterwards are called

meconium. =econium is string,tenacious, and black and has a tarr

texture.


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Itesties

;ith the ingestion of colostrum or

formula, a gradual transition occurs.

There ma be few greenish stools and

the stools will graduall become moreellow. ?ormula stools are lemon ellow

and curd. #reast milk stools are ellow-

orange, soft, and more frequent.


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03T45 )eristalsis is referred to as

progressive wavelike movement that

occurs involuntaril in hollow tubes of

the bod, especiall the alimentarcanal.


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I*at/s Stool


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!IR!0LATOR) S)STEM

#lood ?low.

;hen the umbilical blood stops flowing at birth,

sudden pressure differences occur within the

circulator sstem.

These differences cause the blood flowing to thelungs and liver to increase and the blood flowing

through the bpass channels to decrease.

)eripheral circulation refers to residual canosis in

hands and feet. This ma be apparent for one to twohours after birth and is due to sluggish circulation.

#lood is shunted to vital organs immediatel after

birth


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Blood !oa$ulatio

During the first few das of life, the prothrombin

level decreases and clotting time in all infants is

prolonged.

This process is most acute between the second

and fifth postnatal das. 9t can be prevented to a

large extent b giving vitamin @ to the infant

after birth.

;ith the ingestion of food, establishment of

digestion, and maturation of the liver, vitamin @

is manufactured b the bab and clotting time

stabili!es within a week to ten das.


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RESPIRATOR) S)STEM

Antil the infant's first breath of air is taken, the

alveoli air sacs in the lungs are in an almost

complete state of collapsed.

The lungs should be in this state because the

lung must not fill with amniotic fluid or other

liquids. /owever, the fluid7liquid that flows in the

lungs during normal deliver is squee!ed or

drained from the infant lungs.

The major portion of the fluid is absorbed after

deliver b the alveolar membranes into the

blood capillaries


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RESPIRATOR) S)STEM

The most frequent cause of respirator

difficult in the first few hours of birth has

been due to the too liberal use of

sedatives, tranquili!ers, analgesics, andanesthetics that affect not onl the

mother, but pass over the placenta to

the infant.

These drugs make the bab sleep and

disinclined to take the first breath.


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EN#O!RINE S)STEM

The endocrine glands are considered

better organi!ed than other sstems

. Disturbances are most often related to

maternall provided hormonesestrogen, luteal, and prolactin that ma

cause the following conditions


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EN#O!RINE S)STEM

Baginal discharge and7or bleeding ma

occur in female infants.

This discharge is white mucoid in color.

#leeding ma occur as a result ofwithdrawal from maternal hormones at

the time of birth.

There are usuall onl a few blood spotsseen on the diapers. The entire process

terminates in one to two das


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EN#O!RINE S)STEM

4nlargement of the mammar glands ma

occur in both sexes.

This is particularl noticeable about the

third da of life. #reast secretion ma also occur. :welling

usuall subsides in two to three weeks.

The breast should not be squee!edC it

onl increases the chances of infection

and injuries to the tender tissue.


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NE0ROM0S!0LAR S)STEM

The newborn infant exhibits remarkable

sensor development and an ama!ing

abilit for self-organi!ation in social

interactions. The infant's muscles are firm and resilient.

/e has the abilit to contract when

stimulated, but lacks the abilit to control

them. /e wiggles and stretches, but movements

are uncoordinated.

NE0ROM0S!0LAR


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NE0ROM0S!0LARS)STEM

2ephalo-2audal /ead to Toe in

Development.

ross motor development occurs first,

followed b finer motor development. +eflex actions present at birth serve the

infant until neuromuscular development

is improved. "bsence of reflex activit often

indicates some form of brain damage


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!o''o I*at Re1e,es

.+ooting. The infant turns his head to the side

when the side of his face is touched.

% =oro reflex. The infant's total bod responds

to a startling event. /is arms extend out and up,

legs flex toward abdomen. This reflex is usuall

lost b three months of age.

Tonic neck reflex. The infant assumes a

fencer's position. /is arm and leg on one side is

extended, the opposite side is flexed. /is head

is turned toward extended side. This is not

evident after four months of age

!ARE OF THE NORMAL


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!ARE OF THE NORMALNEWBORN INFANT

The practical nurse has a unique opportunit of

closel observing and providing care for the

newborn infant after deliver.

#ecause of the newborn infant's helplessness, his

needs must be met initiall b nursing personnel. =an nursing assessments and evaluations are

conducted for the well-being of the infant.

0ursing care does not stop with the newborn

infant. 9nteraction with the parents is also important in

the development of a famil unit


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The 0ewborn 9nfant

!ARE OF THE NEWBORN IN THE


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!ARE OF THE NEWBORN IN THE#ELIVER) ROOM

There are several needs of a newborn

infant that require close attention.

4stablishing and maintaining

respirations are the two needs that mustbe met immediatel.

Esta2lis&i$ ad Maitaii$ t&e


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( Esta2lis&i$ ad Maitaii$ t&eNe32or"s Air3a4(

The phsician suctions the infant before it is

completel born with a bulb sringe or a

DeEee trap.

" DeEee trap is used if meconium waspresent in the amniotic fluid.

The infant's mouth is suctioned first and

then his nose.

3nce the infant is delivered, his head isheld slightl downward to promote drainage

of mucus and fluid.


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The infant's face is wiped thoroughl clean.

9f the infant doesn't breathe spontaneousl,

he should be stimulated to cr b slapping

his heels, lightl tapping the buttocks, and7orrubbing his back gentl.

The infant is then positioned with his head

slightl down when placed in the radiant

warmer. The bulb sringe is used to remove mucus

from his mouth and nose

Re'o i$ 'u%us *ro' i*at"s ose


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Re'o5i$ 'u%us *ro' i*at"s ose(

!o''o %&ara%teristi%s o*


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!o''o %&ara%teristi%s o*e32or respiratios

a 0ose breathers. :leeps with mouth closed,

does not have to interrupt feedings to breathe.

b 9rregular rate.

c Asuall abdominal or diaphragmatic incharacter.

d +anges from (6 to *6 breathers per

minute. e #reathing is quiet and shallow.

f 4asil altered b external stimuli. g )eriods of apnea less than 8 seconds is

normal.


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. "crocanosis ma occur during periods of cring."crocanosis refers to canotic look of the bab's

hands and feet when he is cring. ;hen the bab

stops cring, his hands and feet get pink again.

% :igns and smptoms of newborn respiratordistress.

a 9ncreased rate or difficult breathing-growing

and seesaw breathing. 9n normal respirations, the

infant's chest and abdomen rise. ;ith seesawrespirations, the infant's chest wall retracts and his

abdomen rises with inspirations.


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b :ternal or subcostal retractions.

c 0asal flaring.

d 4xcessive mucus, drooling.

e 2anosis.


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See6sa3 respiratios(


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Maitaii$ Bod4 Te'perature

Dr the infant thoroughl immediatel

after deliver.

The infant is extremel vulnerable to

heat loss because his bod surface areais great in relation to his weight and he

has relativel little subcutaneous weight.

/eat loss after deliver is increased bthe cool deliver room and the infant's

wet skin


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% )lace the infant in a radiant heat

warmer. )lace a stockinette cap on

the infant's head to prevent heat loss

through the head. ( ;rap the infant snugl in a warm

blanket. 8 )lace the infant closel to

the mother's skin. :kin-to-skin contact

with the mother will help prevent heat

loss .


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Ideti*4 t&e I*at A*ter #eli5er4

The infant must be properl identified

before leaving the deliver room.

"n identification 9D band is placed on

the infant's wrist and leg. "n identical band matching the infant's

band is placed on the mother's wrist

The infant's footprints or palm prints placed


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The infant s footprints or palm prints placed

next to the mother's thumb print is rarel

done in most facilities.4ach facilit has its own instant

identification method


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4stablish )arent-9nfant #onding

)rocess.

)arent-infant bonding is the initial step

in the process of attraction andresponse between the newborn and the

parents.

This paves the wa for development oflove and affiliation that forms a strong

famil unit.

FThis process should begin as soon after


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FThis process should begin as soon after

deliver as possible.

F9n the deliver room as soon as the infant isdr and identified, he should be given to the

parents.FThe infant is more alert during the first hours

approximatel four after birth than in the

immediate subsequent hours .

VIRGINIA APGAR S!ORING OF


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VIRGINIA APGAR S!ORING OFTHE NEWBORN

The initial ")"+ scoring is performedin the deliver room b the phsician.

")"+ scoring is a method of

evaluating the condition of the newbornat one minute and at five minutes after

deliver.


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P


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Purpose

The ")"+ scoring chart is used toevaluate the conditions of the bab at

birth, determine the need for

resuscitation, evaluate the effectivenessof resuscitative efforts, and to identif

neonates at risk for morbidit and

mortalit.

O27e%ti5e Si$s 0sed *or


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O27e%ti5e Si$s 0sed *orE5aluatio

/eart rate.

% +espirator effort.

=uscle tone.

( +eflex irritabilit.

8 2olor.

S i


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S%ori$

4valuations at each of the fivecategories are initiall done at one

minute after birth.

% 4ach item has a maximum score oftwo and a minimum score of !ero.

The final ")"+ score is the sum

total of the five items, with a maximumscore of ten. The higher the final ")"+

score, the better condition of the infant.

i


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s%ori$

( 4valuations at one minute quicklindicate the neonate's initial adaptation

to extrauterine life and whether or not

resuscitation is necessar. 8 The five-minute score gives a more

accurate picture of the neonate's overall

status, including obvious neurologic

impairment or impending death.

M i i * t


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Measuri$ i*at


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% +ecord measurements in inches andcentimeters.

Document the information in the appropriate

areas on 0ursing 0otes, the deliver room record,

and the instant data card. ( Take infant's vital signs and document on

0ursing 0otes and the deliver room record.

a Temperature-onl the first one is done rectall,

the remainder are axillar. b /eart rate and respirations-count a full minute

because of the irregularities in rhthm.

Ta.i$ i*at"s


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Ta.i$ i*at ste'perature

Nor'al eoatal 5ital


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o a eo a a asi$s


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f. "spirate fluids. "spirate the infant's mouth and nose gentl

with a bulb sringe.

% 9nsert a number 8 ?rench catheter into the

bab's nares to check for patenc.

9nsert a number & ?rench catheter in the

bab's mouth down into the stomach and gentl

aspirate stomach contents.

( +ecord the color and amount of aspirate on,

0ursing 0otes and on the deliver record sheet.

E5aluate t&e i*at"s p&4si%al


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E5aluate t&e i*at s p&4si%al%oditio assess'et

. "ssessment % Do a complete head-to-toe assessment,

looking for an gross abnormalities on his hands,

feet, palate, spine, and so forth.

Document if the infant voids or passesmeconium.

( Document presence of reflexes dealt with

more extensivel in the tpical newborn.

a =oro. b :ucking. c rasping. 8 2ount the number of vessels in the cord and

document

"ssess head for molding, caput


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"ssess head for molding, caput

succedaneum, or cephalhematoma and

document in appropriate records.1 3bserve and record an birthmarks.

h. )lace the infant on his side .

To promote drainage of mucus.

0ote that he is supported b a pillow to his

backside.

I*at pla%ed o &is


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pside(


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)rovide for infant's safet while in openwarmer.

)lace the infant in an isolette if his

temperature is below


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!o''o i*at re1e,es

A#MINISTRATION OF VITAMIN +


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A#MINISTRATION OF VITAMIN +

Bitamin @ is given as a prophlaxis forhemorrhagic disease.

9t is administered intramuscular 9= in

the vastus lateralis muscle


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E)E PROPH)LA8IS FOR THE


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NEWBORN

This procedure is required b law in allstates as prophlaxis against

gonorrhea .

Er4t&ro'4%i Op&t&al'i%


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4 4 pOit'et

a. 4rthromcin 3phthalmic 3intment.This has become the drug of choice and

is received in a sterile sringe from the

pharmac. 9t is injected into each ee from the

inner to outer canthus immediatel after

birth.

9t does not appear to cause much ee

irritation


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I :ilver 0itrate :olution. Two drops areapplied in each ee in the conjunctival sac,

not the cornea.

The infant ees ma or ma not beirrigated after instillation, depending on

local polic. The infant ma get profused

discharge and chemical conjunctivitis for a

few das with no residual damage. 3ne percent silver nitrate solution is no

longer recommended for use

Ad'iistratio o* er4t&ro'4%i


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4 4op&t&al'i% oit'et

INITIAL BATH


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INITIAL BATH

The amount of time required for theinitial bath is determined b local polic.

9f the infant's temperature is greater than


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INITIAL BATH

The procedure for actuall completingthe bath is also determined b local

polic.

"llow the parent to participate ifpossible.

+emove as much of the vernix as

possible.

:ome ma not come off during the first

bath because it is so stick.


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Thank ouJ.

characteristics of newborn[1]

Documents