Student - The Normal Newborn

The Normal Newborn
By Lorain McKay, RN, BSN

Definitions
• Neonatal: The time from birth to 29
days of life.
Initiation of Respirations
Fetal Respiratory
•
Lungs do not oxygenate the blood; blood oxygenates the lungs.
–
Lungs filled with fluid in order to keep alveoli expanded during pregnancy.
–
Needs surfactant to maintain expansion after birth.

–
Initiation of Respiration
• Neonatal Respiratory:
– The first breath requires greater negative
pressure that subsequent breathing
• Causes:
– Chemical
– Mechanical
– Thermal
– Sensory
Cardiovascular System
• Fetal Circulation Review
• Neonatal Cardiovascular Adaptation
– Ductus Venosus
– Foramen Ovale
– Pulmonary blood vessels
– Ductus Arteriosus
Thermoregulation
Evaporation Conduction Convection Radiation
Decreased body temperature and cold

stress
Metabolic Rate Metabolism of Brown Fat Vasoconstriction
Use Production Peripheral Pulmonary

Use of of of acids vessels vessels
Glucose O2
Production Hypoxemi Metabolic Displacement Pale, Cold,

of
a Acidosis of bilirubin mottled
Hypoglycemia Surfactant from albumin
binding sites
Skin
Respirator
y Distress Jaundice
Return to fetal
circulation
patterns
Assessments in the Newborn
• Immediate assessment is cardio-
respiratory status, thermoregulation
and the presence of anomalies.
– Infant should be crying
– Infant heart rate should be more than
100
– Infant should be pink on the trunk
Apgar Score 0 1 2
Heart Rate Absent Below 100/min Above 100/min
Respiration No spontaneous Slow Respiration Spontaneous resp

respirations or weak cry & strong, lusty cry
Muscle tone Limp Min Flexion of ext Flexed body

with sluggish posture; spont
vigorous move
movement
Reflex Response
No response to suction Min response to Responds promptly
or gentle slap on soles suction or flicking to suction or
feet flicking feet
Color
Pallor or cyanosis Bluish hands and Pink throughout.
on Trunk feet only
• Initial Assessment
– Vital Signs
• Temperature 97.7 to 99.5 Axillary
• Heart Rate 120-160
• BP Average 65-95 Systolic
30-60 Diastolic
• Resp Rate 30-60 Average is 40
Lungs & Heart
http://newborns.stanford.edu
• Select Professional Education
• Select Photo Gallery
• Select Lungs
– Go through and you can hear the different lung sounds. It
is very good.
• Select Heart
– Go through and you can hear the different heart sounds
Inspect Chest Shape
This material was compiled by Janelle Aby, MD for educational

purposes only. Reproduction for commercial purposes is
prohibited. Utilization and copying of the materials for
educating those who care for newborns is permitted with
proper citation of source.
http://newborns.stanford.edu/PhotoGallery/
Resp Distress
Intercostal Retractions Subcostal Retractions

Mottling

Mottling (Cutis Marmorata)
Measurments
• Weight 2500-4000 grams
• Length 48-53 cm or 19-21 inches
– SGA and LGA

educating those who care for newborns is permitted with proper
citation of source. http://newborns.stanford.edu/PhotoGallery/
Assessments in Newborn
• Measurement (Cont)
– Head Circumference 33-35.5 cm
13-14 inches
– Chest Circumference 30.5-33 cm
12-13 inches
• Should be 2-3 cm less than head
circumference
Head Circumference
This material was compiled by Janelle Aby, MD

for educational purposes only. Reproduction for
commercial purposes is prohibited. Utilization
and copying of the materials for educating those
who care for newborns is permitted with proper
citation of source.
Molding

Bruising

Caput Succedaneum

Caput Succedaneum

Cephalhematoma

Eyelid Edema

Ears Etc

Positional Nasal Deformity

Mouth

Cleft Palate Cleft Lip

Ankyloglossia
Normal Tongue

Natal Teeth

3 Vessel Umbilical Cord

Hips

Hypospadias

Hydrocele

Undescended Testes

Female Genitalia

Ambiguous Genitalia

Hands

Hands

Toes

Positional Deformities

Club Foot

Sacral examination

Facial Palsy

Erb's Palsy

Skin
The downy hair seen

over the shoulder is
lanugo. Although this is
present to a much
greater degree in
premature infants, term
babies also have variable
amounts of lanugo
present at birth, as
evidenced in this photo

Skin
A dry, flaky, peeling
appearance of the skin
is very common in
newborns. Although
this can be distressing
to parents, it does not
need treatment and will
spontaneously resolve.

Skin -- Mongolian Spots

Salmon Patches

Port Wine Stain

Sebaceous
Milia Hyperplasia

Erythema Toxicum

Petechiae

Petechiae

Hemangioma
a central area of telangiectasia

surrounded by a halo of pallor.
Cafe Au Lait Spot

Jaundice

Meconium Stools
• First stool excreted by the newborn
• Greenish black with a thick, sticky,
tarlike consistency.
• Usually passes in the first 12 hours
• Failure to pass meconium—suspect
obstruction
What is this?

What about this??

What caused this??

Reflexes
• Moro Reflex
• Palmar grasp reflex
• Plantar grasp reflex
• Babinski reflex
• Rooting reflex
• Sucking reflex
• “Fencing” reflex—Tonic Neck
• Stepping reflex
Ballards Scale

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The Normal Newborn

By Lorain McKay, RN, BSN

Needs surfactant to maintain expansion after birth.

Decreased body temperature and cold

Metabolic Rate Metabolism of Brown Fat Vasoconstriction

Use Production Peripheral Pulmonary

Production Hypoxemi Metabolic Displacement Pale, Cold,

Respiration No spontaneous Slow Respiration Spontaneous resp

Muscle tone Limp Min Flexion of ext Flexed body

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

The downy hair seen

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

a central area of telangiectasia

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

This material was compiled by Janelle Aby, MD for educational

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