Normal Newborn Baby

Presented by:
Vijay kumar (98)
Vishal Bhawani(97)
 Definition: A healthy infant born at term
(between 38-42 weeks) should have an average
birth weight for the country (usually exceed 2500
gm.), cries immediately following birth,
establishes independent rhythmic respiration
and quickly adapts to changed environment.
Physiology and characteristics of newborn
 Vital signs:

 Temperature : 97.7 to 98.8 degree Fahrenheit.

 Pulses: normal- 100-160 beats per min.
 Respiration: normal- 30-60 breaths /min.
 Blood pressure :normal range 45-60/25-40mmHg.
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
 External signs of maturity
Skin color and texture: rosy
Body hair: lanugo may be present, thinning, or mostly
absent
Eyes: open
Ears: well-formed pinna (auricular cartilage) that
instantly recoils
Breast: clearly discernible areola
Testicles: descended
Labia: labia minora covered by labia majora 
Plantar creases: cover the entire soles of the feet
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.
 Narrow chest .
 Protruding abdomen .
 Skin colour
The normal skin color of newborn is pink and covers with
vernix caseosa. The skin is velvet soft and elastic in texture
because of subcutaneous fat.

 Premature baby skin is thin ,red , shiny and cover with

lanugo.

 Post term baby will have less vernix caseosa and skin is
wrinkled and peeling.

.
. A. Pallor

 B. Cyanosis: 2 types

 Central cyanosis.
 Peripheral cyanosis (Acrocyanosis )
Jaundice: bilirubin level >5mg/dl
Extensive brushing
 Erythema toxicum

 
Skin finding
Head
 Anterior fontanelles
 Posterior fontanelles
 Caput succedaneum.
 Moulding.
 Cephalhaematoma.
 Craniosyntosis.
Depressed fontanel
 Bulging of fontanel
 Craniosynostosis
 Caput succedaneum
 Cephalheamatoma
 Moulding

Depressed fontanel
Craniosynostosis
 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 )
 low set ears (trisomy 9,18)
 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, circumoral cyanosis,
facial nerve paralysis
Chest: Is examined for
 any asymmetry(tension pneumothorax),
 tachypnea, grunting, intercostal
retractions(respiratory distress), and the breath
sounds. The white discharge from newborn’s breasts
known as“Witch’s milk”.
 Heart: Is examined for
 rate (normal 120-160 bpm),
 rhythm,
 the quality of heart sound
presence of any murmur. (VSD,PDA,ASD,TOF etc)
Abdomen: Is examined for any defects e.g.
omphalocele,
hepatomegaly(sepsis)
 splenomegaly (CMV, rubella infection)
 any other mass.

 Umbilicus: Is examined for any discharge, redness

or infection. A greenish – yellow coloured cord
suggests meconium staining (fetal distress).
Single umbilical artery (more common in twin births)
indicates genetic (trisomy 18)and congenital
anomalies.
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. It
is checked 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 within 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.
 Haematological findings – Blood volume
soon after birth is about 80ml/kg body weight, if
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.
 Reflexes
Reflexes are involuntry, instantaenous movement
of action in response to stimulus .
It help to identify normal brain & nerve activity.

Rooting reflex
Glabellar reflex
Grasp reflex (palmer grasp)
Moro reflex
Sukling and swallowing reflexes
 Resuscitation of newborn:
 Goals:
 1. Establish and maintain clear airway to ensure the
respiration, circulation and to correct the acidosis and to
prevent the hypothermia ,hypoglycemia and hemorrhage.
Need of resuscitation:
 1. Prolonged period of aspexia.
 2. Heart rates falls
3. Baby who didn’t cry immediately after birth.
 4. Baby born with below 7 Apgar score.
 APGAR Score
The Apgar score is typically used to gauge the clinical
status of newborn infants at one and five minutes
after birth using the following parameters:

 heart rate,
respiratory effort,
 muscle tone,
 reflex irritability to tactile stimulation,
 skin color
Immediate care of the newborn
Wipe the newborn's mouth and nose to clear airway
 secretions, use suction only if necessary.
Dry and stimulate the newborn.
Provide warmth. 
Skin-to-skin contact with mother and initiation of 
breastfeeding 
Clamp and cut the umbilical cord. 
Apgar score assessment at 1 and 5 minutes after birth
Begin resuscitation if onset of respirations has not yet
occurred within 30–60 seconds
Exclusive Breast feeding
Exclusive breast feeding means giving nothing orally other
than colostrum and breast milk.

The two vital consideration for the infants in tropical are

breast feeding and avoidance of infection .

All babies regardless of the types of delivery should be

given early and exclusive breast feeding up to 6 months of
age.


Composition of breast milk
 Water - 88.1%

 Fat - 3.8% : Small fat globules ,better digest

 Protein - 0.9 % : Rich in lactoalbumin ,lactoglobulin

 Lactose – 7.0% : Stimulate growth of intestinal flora

Minerals – 0.7% Low osmotic load (Na,K,Cl,Ca),less

burden to kidney
Frequency of feeding:
During the first 24 hours, the mother should feed
the baby at an interval of 2-3 hours .

Gradually, the regularity becomes established at 3-4

hour pattern by the end of first week. Baby should
be fed more on demand.

 Demand feeding – The baby put on breast as soon as

the baby becomes hungry.
 Colostrum is the yellowish breast milk that is first
produced in the first few days after baby’s birth and
before normal lactation begins.

Colostrum is especially rich in nutrients and

antibodies, and is the perfect food for a newborn
baby.
Foremilk: This is the milk which is drawn during a
feeding. It is generally thin and lower in fat content,
satisfying the baby’s thirst and liquid needs.

Hind milk: This is the milk which follows by the

foremilk during a feeding. It is richer in fat content
and is high in calories.

Hind milk is richer in the fat and supplies more

calories to the infant .It is important for baby’s
health and continuing growth..
Benefits of breastfeeding to the Baby
 Breast feeding is easy to digest and low osmotic
load.

 Colostrum and breast milk provides antibody

protection to the baby.

 Breastfeeding decreases the risk of the respiratory

infection and gastroenteritis.
Contraindications of breast feeding
when mother is taking medication for cancer,
HIV,
 Phenylbutazone
 Antiepileptic,
anticoagulant,
 antithyoride drug.
Radioactive materials
Atropine
Newborn immunization
 All infants should receive their first dose of hepatitis
B vaccine as soon as possible after birth, preferably
within 24 hours.

Oral polio vaccine, including a birth dose (known as

zero dose because it does not count towards the
primary series).

Single dose of BCG vaccine should be given to all

infants