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Newborn
The Normal Newborn
| The newborn extends from birth to 4 weeks (28 days). Under the Newborn Screening Act (R.A. 9288), the newborn is a child from the time of complete delivery to 30 days old. It is also called the | Neonatal stage |
| The NB infant is called the | Neonate |
| ESSENTIAL IMMEDIATE CARE OF THE NB | Essential procedures during second stage of labor at perineal bulging Essential newborn care within the first 30 seconds after birth Essential newborn care within 1-3 minutes after birth (or while on SSC contact) |
| ESSENTIAL IMMEDIATE CARE OF THE NB (2) | Essential newborn care within 90 minutes Essential non-immediate newborn care from 90 minutes to 6 hours Unnecessary procedures in the immediate care of the newborn |
| DNA genotyping & human leukocyte antigen tests can better serve the purpose of identification according to the American Academy of Pediatrics (AAP) & the American College of Obstetricians & Gynecologists (ACOG). | Footprinting. |
| This is a scoring method that gives a numerical expression of the NB’s adaptation to the extrauterine life performed at 1 & 5 minutes after birth; a 10-minute Apgar is performed when the 5-minute score is under 7. | PERFORM APGAR SCORING |
| Detects the cardiorespiratory function of the NB, his general condition, & the need for resuscitation. But resuscitation must be initiated immediately & must not be delayed for the assessment of the 1-minute score. | 1-minute scoring |
| Detects the NB’s adjustments to the new environment; detects prognosis. In nursing care planning, use the second Apgar score. | 5-minute scoring |
| Interpretation of Apgar Score | 0-3: poor, needs resuscitation 4-6: fair, may need suctioning & oxygenation; condition guarded 8-10: good, no signs of immediate distress; needs only admission care, no special care |
| Take the Weight & Other Measurements | Weigh the Newborn Take the Newborn’s Length Take the Head Circumference (HC) Take the Chest Circumference Take the Abdominal Circumference Check Vital Signs |
| Head Abnormalities | Macrocephaly Microcephaly/SGA Microcephaly w Hydrocephaly/LGA Hydrocephaly Anencephaly |
| Caput Succedaneum | Scalp edema Present at birth From pressure of soft cervix against presenting head Bilateral; crosses the suture line Disappears in few days, 3 to 4 days (upper limit: 5 days) No intervention needed |
| Cephalhematoma | Collection of blood b/w a skull bone & its periosteum Appears 12 to 24 hours after delivery From pressure of hard pelvis/forceps against presenting head Unilateral; does not cross suture line Regresses in few weeks: 2 to 3 weeks |
| Procedure to determine if the newborn infant has a heritable congenital metabolic d/o that may lead to serious physical health complications, mental retardation, & even death if left undetected & untreated. | NEWBORN SCREENING (NBS) |
| An endocrine d/o caused by an inborn defect in the biosynthesis of adrenal CORTISOL that causes severe salt or sodium losses, dehydration & abnormally high levels of male sex hormones in both boys & girls | Congenital Adrenal Hyperplasia (CAH) |
| Inborn error of metabolism characterized by lack of enzyme PHENYLALANINE HYDROXYLASE needed to breakdown phenylalanine – elevated serum phenylalanine – brain damage & mental retardation | Phenylketonuria (PKU) |
| Inborn error of metabolism | Galactosemia (GAL) |
| Type 1: deficient GALACTOKINASE | inability to convert galactose to glucose – galactosemia – galactosuria |
| Serious deficiency of URIDYL TRANSFERASE | Type 2: “Classic” galactosemia |
| Deficiency in G6PD – RBC lack of protection from the harmful effects of oxidative substances found in drugs, foods & beverage – severe anemia & hyperbilirubinemia – kernicterus (jaundice of the brain) & mental retardation, convulsion, coma. | Glucose -6-phosphate-dehydrogenase deficiency (G6PD) |
| also called “white eye,” when the red reflex appears to be white in color instead of the normal red or red-orange, is a sign of neuroblastoma; this requires immediate medical attention. | Leukocoria |
| Red spot on sclera due to the rupture of small capillaries during the delivery: reabsorbed in about 2 weeks. | Subconjunctival hemorrhage |
| eyes that appear to be protruding slightly from the periorbital area & feel hard and firm on palpation or cornea greater than 1 cm in diameter. | Congenital glaucoma |
| can result in blindness; prevented by Crede’s prophylaxis | Gonorrheal conjunctivitis |
| white or yellow papules commonly seen over the nose (also over the cheeks & forehead) due to obstructed sebaceous glands; disappear in a few weeks | Milia |
| small epithelial cysts/pearls (like on hard palate or gums): disappears at 1-2 weeks | Epstein’s pearls |
| generally caused by local infection & may lead to septicemia if not treated early. | Foul drainage |
| abnormal connections b/w the umbilicus & bladder; danger signs: moisture or draining urine at the base of the cord. | Patent urachus |
| penile opening on the dorsal or upper segment | Epispadias |
| penile opening on the ventral or under surface | Hypospadias |
| extra fingers or toes | Polydactyly |
| webbed fingers or toes | Syndactyly |
| absence of fingers or toes | Adactyly |
| Long bone are absent | Phocomelia |
| All limbs are present but abnormally short | Micromelia |
| Partial absence of limbs | Meromelia |
| Complete Absence of limbs | Amelia |
| Fine downy hair on the skin: more on the shoulders, back, forehead, upper arms, cheeks; more in preterm; gradually disappears close to term | Lanugo |
| Whitish, cheesy, odorless substance usually on folds of the skin; gradually absorbed or washed-off after birth; protects skin & prevents heat loss, but excess can be a good culture for bacterial growth | Vernix caseosa |
| Grayish-blue patch/pigmentation over the buttocks & the sacrum regions | Mongolian spot |
| Erythema toxicum neonatorum, white or pink popular rash on the body appearing within 24 to 48 hours after birth | NEWBORN RASH |
| quiet common & mostly benign & self-limiting | SKIN RASHES/MARKS/SIGNS |
| Red spots found at the back of the neck & eyelids; disappear spontaneously before the end of infancy | Nevi (stork bites) |
| May occur extensively after breech extractions & forceps deliveries; if severe, may decrease circulating volume – anemia & hypotension | Bruising |
| Dry peeling of the skin particularly on the palm & soles | Desquamation |
| When the NB is placed on the side, the lower, dependent portion of the body is darker in shade than the upper, independent portion; due to sluggish peripheral circulation. | Harlequin sign |
| is a macular purple, or dark red lesion (port-wine stain) that is present at birth, generally over the face or over the thigh region; while the lesion over the bridge of the nose tends to fade, others are less likely to. | A nevus flammeus |
| are elevated areas formed by immature capillaries & endothelial cells present at birth; may be present up to 2 weeks following birth; | Strawberry hemangiomas |
| INFECTIOUS LESIONS | Bullous impetigo Miliaria Hepes simplex virus |
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