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THE NEWBORN: Physiologic Responses Prepared by: Lailanie C.

Pablo, RN NEWBORN: a baby in the neonatal period, the first 28 days of life PROFILE: A. WEIGHT  approx 75- 90% of the newborn s weight is fluid  Average birth weight (FEMALE) 3.4 kg/ 7.5 lbs  Average birth weight (MALE) 3.5 kg/ 7.7 lbs  NEWBORN OF OTHER RACES weigh approx. 0.5 lb less  PHYSIOLOGIC WEIGHT LOSS- newborns lose 5- 10% of birth weight during the first few days after birth B. LENGTH  FEMALE: 53 cm (20.9 inches)  MALE : 54 cm (21.3 inches)  C. HEAD CIRCUMFERENCE  34- 35 cm (13.5- 14 inches)  Greater than or less than 33 cm investigated for neurologic involvement  Measured with a tape measure drawn across the center  of the forehead and around the most prominent portion of the posterior head D. CHEST CIRCUMFERENCE  2 cm (0.75- 1 inch) less than the Head circumference  measured at the level of the nipples VITAL SIGNS A. TEMPERATURE  37.2 C at the moment of birth  falls almost immediately to below normal METHODS OF HEAT LOSS  CONVECTION  CONDUCTION  RADIATION  EVAPORATION SHIVERING -is rarely seen in newborns. BROWN FAT- a special tissue found in mature newborns which helps to produce and conserve heat B. PULSE  as rapid as 180 bpm  an hour after birth 120- 140 bpm  heart rate is often irregular  TRANSIENT MURMURS related to incomplete closure of the fetal  circulation shunt

green.  The daily urinary output for the first 1 or 2 days is about 30. . oxygenated blood flows through the infant's body in the same manner as that of the adult. The circulation of the pulmonary system is perfected and shortly after birth. 000 cells/ mm3 as a response to the trauma of birth and is non pathogenic  Born with a prolonged coagulation or prothrombin time because of a lower than normal Vitamin K levels GASTROINTESTINAL SYSTEM  MECONIUM first stool of a newborn and usually passed within 24 hours after birth (sticky. 80/ 46 mmHg  tenth day 100/ 50 mmHg  not significant unless a cardiac anomaly is suspected PHYSIOLOGIC FUNCTION CARDIOVASCULAR SYSTEM  At birth. tarlike. blackish. mucus.  Single voiding in a newborn is only about 15 ml and may easily be missed in a thick diaper. RESPIRATION  first few minutes--. the circulatory pattern must change from fetal dependency on the placenta to include the expanding lungs.60 cpm  irregular with short periods of apnea PERIODIC RESPIRATIONS D.000 to 30.60 ml total. hormones and carbohydrates  TRANSITIONAL STOOL-.  Newborns placed under phototherapy lights be treated for jaundice will have bright green stools because of increased bilirubin excretion  Clay colored stools indicate bile duct obstruction  Blood flecked stool indicates anal fissure.BLOOD PRESSURE  approx.second/ third day of life and becomes green and loose  Fourth day. lanugo.  Acrocyanosis cyanosis in the feet and the hands because of sluggish peripheral circulation during the first 24 hours  Has an equally high WBC count at birth about 15. odorless material formed from vernix. breastfed babies pass three or four light yellow stools per day and is sweet smelling because of high lactic acid content of breast milk while a newborn receiving formula usually passes two or three bright yellow stools a day and has a more noticeable odor. URINARY SYSTEM  The average newborn voids within 24 hours after birth and newborns who do not void at this time may be examined for the possibility of urethral stenosis or absent kidney/ ureters.80 cpm  settles to 30. apical pulse most accurate pulse for assessment C.

NEUROMUSCULAR SYSTEM Reflex Blink Reflex How to Elicit Lost Shine a strong light such as a flashlight or otoscope light in the eye Brush a newborn s cheek or Sixth week stroke near the corner of the mouth Touch the newborn s lips Sixth month Food at the posterior portion of the tongue is automatically swallowed Extrudes any substance Fourth month placed on the anterior portion of the tongue Placing an object on the 6 weeks to third month newborn s palm Placing an object on the sole Eighth to ninth month of the newborn foot Hold baby in a vertical position with their feet touching a hard surface.Kidneys of newborn do not concentrate urine well thus the urine is usually light colored and odorless.  TASTE has the ability to discriminate taste because taste buds are developed and functioning before Place Reflex . The Senses  HEARING--. they lose track of objects easily.  SMELL newborns turn toward their mother s breast partly out of recognition of the smell of breastmilk and partly as a manifestation of the rooting reflex.  TOUCH is well developed at birth and this is demonstrated by quieting at a soothing touch and by positive sucking and rooting reflexes. newborn will take a few.a fetus is able to hear in utero. A newborn turns away from bitter taste and readily accepts the sweet taste of milk.  VISION ---newborns see as soon as they are born and possibly have been seeing light and dark in utero for the last few months or pregnancy as the uterus and abdominal wall were stretched  thin. The first voiding may be pink or dusky because of uric acid crystals that were formed in the bladder in utero. so it is sometimes reported that theycannot see. Because they cannot follow past the midline of vision. Rooting reflex Sucking reflex Swallowing reflex Extrusion reflex Palmar Grasp Reflex Plantar Grasp Reflex Step. As soon as amniotic fluid drains or is absorbed from the middle ear by way of the eustachian tube within hours after birth. Newborns calm in response to a soothing voice and startle at loud noises.

alternating steps Let newborn lie on their back. ADJUSTMENT TO EXTRAUTERINE LIFE Newborns move through periods of irregular adjustments in the first six hours of life before their body systems stabilize  FIRST PERIOD OF REACTIVITY: 30 minutes baby is alert. often makes a sucking sound and with rapid heartbeat and respiratory rate  RESTING PERIOD Heartbeat and respiratory rate slows down .Tonic neck/ Boxer/ Fencing Reflex Moro ( Startle) Reflex Babinski Reflex Landau Reflex quick.  Males with one or both undescended testicles (Cryptorchidism ) need further referral. head will turn to one side.  Some newborns have mucus vaginal secretions that are blood tinged (pseudomenstruation). exhibits exploring and searching activity.  The cremasteric reflex is elicited by stroking the internal side of the thigh. arm and leg on the side which head turns extend and opposite arm and leg contract Startling newborn with a loud noise or by jarring the bassinet/ hold newborn in supine position and allow head to drop backward an inch or so.  Circumcision is not done in cases of epispadias and hypospadias. newborns will abduct and extend their arms and legs Stroke side of the sole of the foot in an inverted J curve from the heel upward.  The prepuce should be examined to be certain that it is not stenosed. FEMALE GENITALIA  The vulva in female newborns may be swollen because of the effect of maternal hormones. (+) when toes fan A newborn held in prone position with a hand underneath supporting the trunk should demonstrate some muscle tone Second to Third Month Fourth or fifth month (+) until three months ANOGENITAL AREA MALE GENITALIA  The newborn s scrotum is edematous and has rugae  Both testes should be present in the scrotum.

a newborn lying on his or her side will appear red on the dependent side of the body and pale on the upper side due to immature circulation BIRTH MARKS  NEVUS FLAMMEUS: port.75% of this lesion has disappeared  CAVERNOUS HEMANGIOMAS. and may last for several days. white.white.Are dilated vascular spaces. It takes on the color of amniotic fluid.The condition may be present in the first few hours of life. generally appears after the first day. Subcutaneous infusion of alpha.May appear in 50 percent or more of all normal newborn infants.  LANUGO.  MONGOLIAN SPOTS.48 hours of life  PHYSIOLOGIC JAUNDICE. 50. This is a normal and self-limiting condition of the newborn and disappears over a period of months.Fine. back and upper arms  MILIA.Areas formed by immature capillaries and endothelial cells .Milia is seen in a newborn infant as tiny. storkbite  STRAWBERRY HEMANGIOMAS.occurs on the second or third day of life in about 50% of newborns because of RBC breakdown  CEPHALHEMATOMA. typically not formed in premature newborn because of the immaturity of the epidermis.Newborn sleeps for about 90 minutes  SECOND PERIOD OF REACTIVITY Between 2 and 6 hours of lifeBaby wakes up again Often gags and chokes on mucus that accumulates on the mouth APPEARANCE OF THE NEWBORN  ACROCYANOSIS. there may be a narrow red halo around the substance that serve as a skin lubricant. By the time the child is 7 years old. they are usually raised and resemble a strawberry hemangioma in appearance but they do not disappear in time. elevated spots in the skin.  ERYTHEMA TOXICUM. On occasion.Are collections of pigment cells that appear as stain.2a interferon can be used to reduce its size or they can be removed surgically. Its cause is unknown. a collection of blood under the periosteum of the skull bone  CAPUT SUCCEDANEUM is swelling of the scalp in a newborn. cream. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. . It usually appears in term infants between the ages of 3 days and 2 weeks.gray patches across the sacrum and buttocks and possibly the arms and legs  VERNIX CASEOSA. a normal phenomenon in the first 24.  Harlequin sign. cheese. downy hair that covers the newborn s shoulders.

A score of 7. pale Body normal pigment.10 is considered good. irregular. A score of 4.6 means that the neonate is guarded and a baby may need clearing the airway and supplementary oxygenation. A newborn whose total score is under 4 is in serious danger and needs resuscitation. newborns are observed and rated according to the APGAR score. . extremities blue At 1 and 5 minutes after birth.APGAR SCORING CHART SIGN 0 HEART RATE RESPIRATORY EFFORT MUSCLE TONE REFLEX IRRITABILTY Response to catheter in nostril or Slap to sole of the foot COLOR Absent Absent Flaccid No response SCORE 1 Slow (<100) Slow. strong cry Well Flexed Cough or Sneezes/ Cry and withdrawal of foot Normal skin colouring Blue. weak cry Some flexion of Extremities Grimace 2 > 100 Good.