NCM213: THE NEWBORN – CONTINUATION

Appearance of the Newborn

➢ Skin:

a. Ruddy Complexion: normal within a month; increase RBCs, decrease in

subcutaneous fat
b. Cyanosis:
o Central cyanosis: bluish in trunk; it means decrease oxygenation
o Acrocyanosis: bluish extremities; normal within 24-48 hrs after birth

c. Jaundice:
o yellowish in the skin
o experiencing hyperbilirubinemia
o 2nd & 3rd day of life
o results of breakdown fetal RBCs
o normal physiologic jaundice within 3 months

d. Pallor: results from anemia

o common causes:
1. when excessive blood loss from cord
2. in adequate flow of blood from cord to baby
3. fetal – maternal transfusion
4. low iron stores
5. blood incompatibility

e. Harlequin Sign:
o Difference in color of the skin; the other portion of the body is red
(dependent side), and the other side is pale/white (non-dependent side)
o Normal sign

f. Birthmarks (Hemangiomas)
o Types of birthmarks:
▪ Nevus Flammeus: macular purple or dark red lesion / port-wine stain;
occurs in the face, thighs, nape
▪ Strawberry Hemangioma: elevated; formed due to immature
capillaries; increase levels of estrogen during pregnancy; if the child
reaches 7 y.o it will disappear
▪ Cavernous Hemangioma: does not remove in time but it can be
removed by surgery; it happens due to dilated vascular spaces

g. Mongolian Spots:
o collection of pigments cells / melanocytes
o it appears grayish
 o it may be visible to sacrum, buttocks, thighs, arms

h. Vernix Caseosa:
o white cream cheese – like substance
o serves skin lubricant in the utero
o Try to check if it’s yellow (stained); if green (stool of the baby)

i. Lanugo:
o fine downy hair that covers the shoulder, back and upper arms of the
baby
o 40 weeks – less lanugo
o Post mature – rare lanugo
o It can be removed by the babby by rubbing in the beddings

j. Desquamation:
o 24 hrs after birth, the baby skin become extremely dry
o evident in the palm & soles of the baby

k. Milia: pinpoint white papule, visible in the nose or cheeks due to immature
sebaceous glands; disappears within 2-4 wks

l. Erythema Toxicum:
o it’s like flea bite rash
o it doesn’t have a pattern, sporadic (all over the body)
o it can be visible all over the body
o it will last in an hour

m. Skin turgor: to determine whether the baby is dehydrated or not; pinching

the skin

➢ Head
- Large prominent
a. Fontanelles: A & P openings where skull bones are joined
o Posterior Fontanel: 2 parietal and occipital; 2-3 months
o Anterior Fontanel: junction of 2 parietal & 2 frontal bones; 2-3 cm
width & 3-4 length; diamond shape

b. Suture: lines separate the skull; if its wide, there’s increase intracranial
pressure

c. Molding: elongated head of the baby; after 24 hrs mobalik ra; it depends
how mother push; “pihing” – how the mother position the baby when
sleeping
 d. Cephalohematoma: collection of blood between new-born’s scalp & skull;
appears 24hrs after birth – see pediatrician to assess finding

e. Craniotabes: localized softening of cranial bones; nothing to worry, it will

correct itself, no need for treatment

➢ Eyes
o Cry tearlessly – 2 to 3 months; lacrimal glands are immature
o Permanent eye color can be observed in 3-12 months
o Administer erythromycin to protect from chlamydial infection &
opthalmia neomatorum
o Small tube, 2 cotton balls, open the eyes, apply from inner to outer
canthus

➢ Ears
o Top pinna should be align with outer canthus of the eye
o

➢ Nose
o Observe nasal flaring

➢ Mouth
o Natal Teeth: observe if there’s a presence of it

➢ Chest
o Measure respiratory rate and chest circumference
o Super numerary nipple: extra nipple
o Witch’s milk – think watery fluid
o Engorged breast – influenced by mother’s hormones

➢ Abdomen
o Umbilical cord: in 1st hour after birth, it appears white gelatin
o Observe umbilical stamp, appears white w/ red & blue
o 2 to 3 days turns to black
o 6 to 10 days it can be remove already and let it dry by air
➢ Anogenital Area:
o Should pass out 24 hours
o Check temperature

➢ Male Genitalia
a. Cryptorchidism – undescended testis
b. Epispadias – urethral opening on dorsal surface
c. Hypospadias – urethral opening on ventral surface

➢ Female Genitalia
o Pseudomenstruation: caused by the actions of maternal hormones

➢ Back
o Spina bifida occulta: dimpling opening at the back/tail; usually happens to
mother’s lack of folic acid during pregnancy

➢ Extremities
o Simian Crease: common among children with down syndrome
o Syndactyly: webbing of fingers
o Polydactyly: extra digit in fingers / feet; it can be removed if there are
no bones affected
o Club foot: talipes deformity / turns inward; not aligned

Care of a Newborn at Birth

➢ Newborn Identification
o It contains the hospital number, mother’s full name, gender, date & time
of birth
➢ Birth Registration
o Signed by the doctor & assistance

➢ Bathing
o To remove the vernix caseosa, blood, amniotic fluid or etc
o 6hrs after birth

➢ Sleeping
o Place baby on back to prevent SID

➢ Diaper Area Care

o Common to have diaper rash
o Change it frequently

➢ Metabolic Screening Test

o Within 24hrs to produce enough amount of blood for metabolic disorder;
filt paper
➢ Vaccination
o Hepa B & Vitamin K (reducing bleeding)

➢ Breastfeeding