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To know about term Lecture

1. 2mnts physiology and come
charactaristics discussio
PHYSIOLOGY AND CHARECTERISTICS OF NEW BORN
n
Listening
INTRODUCTION: and note
taking
The physiology and the characteristics of newborns is fundamentally
different than the older children and adults. Perhaps the reason it is so Black
different is that it constantly changes, with the biggest change from board
intrauterine to extrauterine life. While some aspects, such as
cardiovascular alterations, change the moment the newborn takes its
first breath, other aspects, such as modifications in hemoglobin, change
within a few months. The purpose here is to discuss the physiology of
newborns, particularly how it differs from than that of adults. Major
organ systems that will be discussed include cardiovascular, pulmonary,
blood, and lymph, with special considerations in energy metabolism and
thermoregulation.

Physiology
The average weight at birth is 3.5 kg, with a normal range of 2.7–4.6 kg.
The average length is 50 cm and the average occipitofrontal head
circumference is 35 cm. The heart rate is between 110 and 160 beats/minute.
The respiratory rate is 30–50 breaths/minute. Respiration is noiseless;
respiratory ‘grunting’ must be investigated at once. The average systolic
blood pressure is 75–100 mg/Hg, and the circulating blood volume is 85–
90 mL/kg. The normal body temperature range is from 36.5 to 37.4°C
(axillary).
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Physiology and characteristics of newborn.

To list out the Vital signs:
15mnts general and specific Listening
2. ikipediastic Lecture and note
 Temperature : 97.7 degree Celsius i.e. 100 degree and taking
Fahrenheit. Pulses: normal- 120-160 beats per min. discurssi
on
 Respiration: normal- 40-60breats /min.

 Blood pressure : normal range 60-70/31-45mmHg. BP is

directly related to gestational age and birth weight of the
infant.

Anthropometric measurements :

Height – 45- 55 cm
 Weight – 2.7 – 3.1 kg
 Head circumference – 33- 35 cm
 Chest circumference – 31- 33 cm
 Posture The newborn assumes the attitude of its intrauterine life ,
i.e. extremities flexed and fists clenched.
  General examination: The overall appearance of newborn is must
be noted , the following should be found in normal newborn
 Body symmetrical and cylindrical contour.
 Head is large in proportion to the body. PPT
 Narrow chest . Protruding abdomen .
 skin color: the normal skin color of newborn is pink and covers
with vernix caseosa.
 The skin is velvet soft and elastic texture because of subcutaneous
fat
 Premature baby skin is thin ,red , shiny and cover lanugo
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 Post term baby will have less vernix caseosa and skin is wrinkled
and peeling.
 It the single most important parameter of cardio respiratory
function.
  A. Pallor
 B. Cyanosis:
 Central cyanosis.
 Peripheral cyanosis (Acrocyanosis )
 Acrocynosis centralcynosis
 C. Plethora
 D. Yellow
 E. Extensive bruising
 F. Vascular nev
 Stoke bite
Strawberry marks
 Port wine stain
 Pigmented nevi
 Milia
 Mongolian spots
 Erythema toxicum
 Trauma
 Extensive brushing Erythema toxicum
 plethora Jaundice
 Mongolian spots Milia
 Head
 Anterior fontanelles
 Posterior fontanelles
 Caput succedaneum
 Moulding
 Cephalhaematoma
 Craniosyntosis.
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 Depressed fontanel Bulging of fontanel

  Craniosynostosis
Caput succedaneum Cephalheamatoma
 Moulding
  Raised intra cranial pressure is diagnosed by the following signs: i.
Bulging anterior fontanelle. Ii. Sepration of suture lines. Iii.
Paralysis of upward gaze. Iv. Prominent veins of the scalp
 Face : Face is looked for hypertelorism ( eyes widely separated ) or
low set ears (trisomy 9,18) or facial nerve injury..  Neck: It is
checked for movement, goiter, thyroglossal cysts, sternomastoid
hematoma or short neck (Turner’s syndrome) webbed neck .
 Eyes: Are examined for congenital cataract, brushfield’s spots in
the iris (Down syndrome) or subconjunctival hemorrhage
(traumatic delivery) Nose : cartilage of nose , flaring of nostrils. 
Ears : cartilage of ears, hearing ability. Mouth : the gums are
smooth, tongue is red. Mouth is checked for clefts (palate, lips),
deciduous teeth, linguinal frenulum (tongue-tie), oral thrush,
Epstein pearl, pulling of saliva, circumoral cyanosis, facial nerve
paralysis
  Cleft lip Cleft palate
 Chest: Is examined for any asymmetry(tension pneumothorax),
tachypnea, grunting, intercostal retractions(respiratory distress),
pectus exacavatum and the breath sounds. The newborn’s breasts
may “witch’s milk”. Heart: Is examined for rate (normal 120-160
bpm), rhythm, the quality of heart sound and presence of any
murmur. Significance of murmur in the new born is less. In case of
doubt a chest X-ray is helpful for further.
Abdomen: Is examined for any defects or e.g. omphalocele,
hepatomegaly(sepsis) splenomegaly (CMV, rubella infection) or
any other mass. Umbilicus: Is examined for ikipedian, any
discharge, redness or infection. A greenish – yellow coloured cord
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suggests meconium staining (fetal distress). Single umbilical

artery (more in twin births) indicates genetic (trisomy 18)and
congenital anomalies, and IUGR.
 Genitalia: Should be examined carefully before gender
assignment. Male is examined for penis (normal>2cm),testes
within the scrotum, any hydrocele and hypospadias, epispediasis.
Foreskin covers the glans penis. Female is examined for any
clitorial enlargement (maternal drug),fused labia with clitorial
enlargement (adrenal hyperplasia). Blood stained vaginal
discharge may be due to maternal estrogen withdrawal. Normally
labia majora cover the labia minora and clitoris.
 Back: normal newborns back is smooth and firm seen for spine
congenital anomalies, spina bifida, pilonidal dimple, tufts of hairs
may indicate fistula. Anus and Rectum: Is checked to rule out
imperforation and their position. Meconium should pass with in 48
hours of birth. Extremities : are examined for syndactyly (fusion of
digits),polydactyl, simian crease (down syndrome), hip
dislocation(ortolani and barlow maneuvers), symmetry of both
extremities.
 Nervous system is examined for any irritability, abnormal muscle
tone , reflexes, cranial and peripheral nerves. Neurological
development is dependent on gestational age.
 Haematological findings – Blood volume soon after birth is about
80ml/kg body weight, it immediate cord clamping is carried out.
RBC- 6-8 milllion /cumm, Hb% -18-20gm%, WBC-
10,000-17,000/cumm, Platelets – 3,50,000/cumm, nucleated red
cells 500/cumm, sedimentation rate – markedly elevated. Clotting
power may be poor because of deficient vitamin K which is
necessary for production of prothrombin from the liver.
 Physical and behavioral assessment of newborn The American
academy of pediatrics recommended since 1967 the all newborn
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are classified by birth weight and gestational age and it scored by

the Ballard scoring tool. A baby whose lies in between 10th and 90th
percentile this is described as appropriate gestational age(AGA). If
the baby weight is greater than 90 percentile this described as
large for gestational age (LGA) baby who weights bellow 10
percentile is described as small gestational age (SGA)
 Assessment of neuromuscular maturity Posture Square window
Arm recoil Popliteal angle Scarf sign Heal to ear
 Posture : posture is the natural position that the newborn
assumes on its back. It observed with the infant quiet and in spine
position. Square window: wrist flexibility and/or resistance to
extensor stretching are responsible for the for the resulting angle
of flexion at wrist. Arm recoil: this maneuver focuses on positive
flexor tone of biceps muscles by measuring the angle of recoil
following very brief extension of upper arm
 Posture Square window
  Arm recoil
 Popliteal angle: this is the maneuver assess maturation of positive
flexor tone about knee joint by testing for resistance to extension
of the lower extremities. Scarf sign : in the supine position hold
the baby’s elbow and move the arm across the midline of the
chest towards the opposite side. Heel to ear : this maneuver
assesses hip flexibility in infants.
 Popliteal angle
  Scarf sign
  Heel to ear
 REFLEX STIMULUS RESPONSE SEEN NOT SEEN Moro Infant lying
on back, slightly raised head suddenly released; infant lowered
abruptly Arms extended, head thrown back, fingers fat out; arms
brought back to center with hands clenched; legs extended Birth 4
months Startle Loud noise Similar to Moro response Birth 4
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months Rooting Lightly stroke cheek with finger Head turns

toward stimulus Birth 4 months Sucking Insert finger into infant’s
To learn and Listening
mouth Rhythmic sucking Birth 7 months Extrusion reflex Touch
3. 5mnts identifie the reflexex and
the tongue of newborn with finger or nipple Newborn pushes the
gaining
tongue outwards Birth 4 months Newborn reflexes knowledg
 swallowing Put the nipples in the mouth of newborn Try’s to e
swallow the sucking product Birth Life long Blinking Light flash demonsta
Eyelids close Birth ----- Glabellar reflex Tap gently on glabella Blink rion
the eyes Birth 4 months Tonic neck (fencing) Head turned to one
side while infant lies on back Arm and leg extend on the side infant
faces. Opposite arm and leg extend. 2 months 6 months Ventral
suspension Hold the baby in prone position in hand Baby shortly
hold his head at the level with his body and flexed his limbs Birth 3
months
 Stepping Infant supported in an upright position with feet
touching flat surface. Rhythmic stepping movements Birth 6
weeks Babinski Stroke the sole of foot from heel to toe laterally
Toes fan out Birth 12 mo. Palmar (grasp) Touch palm with finger or Lecturing
object Grasp object, holds tightly Birth 6 months Plantar (grasp)
Place one object in between toes of baby Baby try’s to hold that
object in the toes. Birth 12 months
 Assessment of physical maturity
 Skin Lanugo , Palmar surface ,Breast ,Eyes and ears , Genital
 Skin – scoring in this category is based on the palpation and visual
inspection skin texture, transparency, relative thickness, flacking
and peeling of epidermis is noted. Lanugo – lanugo is the fine
hairs seen mostly on the back and arms of premature infants. It is
eventually things out in the lumbar region and disappears.
Palmar surface – creases on the soles of both feet’s are scored Listening
according to the extent to which the creases cover the surface of and
demonstr understa
sole.
ation
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 Breast – breast tissue is approximated by gently measuring the nding

tissues present on the infants using the measuring tape in
millimeters. Eyes and ears – eye lids should be open easily in
mature infants ears are inspect for curving the pinna and palpate
for any determination of thickness of cartilage. Genitalia Male –
the testes are descended in to the scrotum deep creases are
gradually develops on the scrotum as the infant more mature.
Female – assessed for covering of the clitoris and size of labia
mejora and minora , the distance between edge of labia mejora
and minor.
Reflexes
Appropriate neurological development is indicated by the presence of
primitive or primary reflexes. Some, such as the sucking reflex, are essential
To introduce to survival. These reflexes can be elicited in the healthy term infant and
neurological should disappear with increasing maturity. Their absence in the neonate is
4. 10mnts development based suggestive of depression of the central nervous system. Similarly,
reflexex of newborn persistence of primitive reflexes beyond infancy may be a sign of central
nervous system pathology.Sucking reflex
 Rooting reflex
 Moro (startle) reflex
 Palmar grasp reflex
 Plantar grasp reflex lecturing

 Stepping reflex
 Placing reflex
 Asymmetric tonic neck reflex.
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Feeding
Breastfeeding is the optimal method of infant nutrition and provides all the
fluid and nutrient requirements for the infant. It also encourages proximity Lecturing
to the mother thus helping maintain body temperature and normal heart and and
respiratory rate. Some babies will not be breast fed, either from maternal demonstr
choice or from necessity. For these babies safe, suitable breast milk ating
substitutes are available. Listening
and
observin
Elimination g
The infant will usually pass urine and meconium within 24 hours of birth.
Once milk feeding starts the stools change from dark green meconium to
brownish (changing stools) then to yellow, usually at around 5 days of life.
Urinary output is usually approximately 100–200 mL/kg/day by 7 days of
life. However, as the renal cortex is relatively immature at birth the neonate
has limited ability to concentrate urine and conserve water or electrolytes. A
dehydrated infant will therefore still produce an adequate volume of urine.
Urate crystals appear as a brick-red deposit in the nappy and are usually
harmless.

Minor abnormalities:
5 10mnts
Some variations in appearance of the newborn are considered normal These
include:
 Head shape: moulding and caput succedaneum should resolve
quickly. Sutures and fontanelles are palpable.
To introduce the
visible  Skin: white spots (milia) may appear on the face, naevi such as
abnormalities of a ‘stork bites’ and ‘port wine stains’ may be visible. Mouth: teeth
newborn are occasionally present. The presence of tongue-tie may be seen
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 Limbs: positional talipes may be present.

 Genitalia:in female babies a white vaginal discharge may be seen
and pseudomenstruation may occur. In male babies the testes
should be descended.
Trunk: transient breast enlargement may be seen in babies of either sex.
There may be an umbilicus.

Summery:

“Physiology and the characteristic of newborn is the study of how the

human body quality as well features aligned and also how it works. It
describes the chemistry and physics behind basic body functions, from how
molecules behave in cells to how systems of organs work together. It helps
us understand what happens in a healthy body in everyday life.

Conclusion:

newborn in Gaining knowledge on the topic physiology and the

characteristics of newborn very much need for providing better
nursing care and promt treatment to save the life of time.
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BIBLIOGRAPHY:

1. Annama ikip , “ a ikipediane textbook of midwifery and

gynecological nursing”;jaypee publications:3rd edition :445- 495.
2. Dutta D.C, “Textbook of obstetrics”; central ikipedian: 6th edition
445-455 .
3. Handerson ikipedi and jones katheleen, “Essential midwifery” ;
mosby publications;250-283.
4. Singh meherban, “Care of Newborn”;sagar publications:7th
edition 1-31.
5. https://en.m.wikipedia.org/wiki/ballard_maturational_assessme
nt.
6. http://googleweblight.com/i?u=http://www.indianpediatrics.net
dec2013.
7. http://www.google.co.in/search – for images.
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