The term newborn infant:
A healthy infant is one which is born at term (38-42weeks) having an average birth weight for the country(2500gm), cries immediately following birth, establishes independent rhythmic respiration and quickly adapts tothe changed environment.PHYSIC FEATURES AT BIRTH:
1. Weight-Va usually exceeds 2500gm. In this subcontinent varies between 2.7 to 3.1 kg (average 2.9kg).2. Length-50-52 cm.
3. OFC (occipitofrontal circumference)-35cm.
4. BPD (Biparietal diameter)-95cm.
5. Posture-Flexed extremities and fists clenched.
6. Skin-Slight initial cyanosis is common but soon becomes pinkish vernix caseosa covers the skin,lanugo hair is present over the face, back and Mongolian spots (benign bluish pigmentation) are present on the lower back region or buttocks.
7. Head-Evidence of moulding, caput may present.
8, Face-Face is comparatively smaller in relation to the head. The cartilage of the ears and nose are well developed, making them prominent. The cheeks are.
9. Neck and trunk-The neck is short. The full due to sucking pads of fat.Circumference of the chest is slightly less than OFC.The breast nodules are prominent (7mm) Breathing is abdominal with respiratory rate 30-60 per minute Heart rate is 120-140 per minute, apex beat is at left 3rd or 4th space lateral to midclavicular line Transient functional systolic murmur is common, B.P. is generally 80-85/50-55 mm of Hg. Abdomen s flat with palpable liver.
10. GenitaliaIn male child, rugae cover the scrotum, the testes are in scrotum. In femaie child, labia minora and clitoris are covered by labia majora
11. Sole creases-Present
12. Reflexes and tone-Normal reflexes (sucking reflex, swallowing reflex, etc) with normal tone.
13. Temperature-may tall to as low as 97"F.
14. Stool-Meconium may pass soon after birth.
15. Haematological findings-Blood volume is 80ml/kg body weight, RBC 6-8 million/cumm, Hb% 18-20 gm%, WBC 17000/cumm, platelets-3,50,000/cumm nucleated red cells 500/cumm, ESR-markedly elevated body.
CHANGES DURING THE FIRST WEEK
1. Position-Begins to assume an infantile position, the feet are less dorsifexed and the hands are less clenched.
2. Weight-Aproximately a 10% loss of birth weight by 4th-5th day which is gradually regained by 7th to 10th day. Subsequent weight gain rate is 25gm perday.
3. Skin-Colour changed from pinkish to pale brown.Non specific rashes may appear. Slightly yellowisn unge may appear (physiological jaundice) between 24
to 72 hours of age and disappears by 5th to 7th day Lanugo gradually disappears.
4. Head-Moulding gradually disappears within 24hours, as does the caput.
5. Temperature-Within a
few hours, the baby gradually acclimatizes to the external temperature,rectal temperature varies from 97-99°F,
6. Neonatal mastitis-The breasts of either sex may swell, engorged and secretion of white, viscid secretion may be expressed on 2nd-3rd day.
7. Abdomen-The cord becomes dry and shrivelled up by 5th day and falls off by 7th day by aseptic gangrenous process. The small granulating wound left behind heals by in growth of the surrounding epithelium and leaves a puckered scar, called umbilicus.
8. Genitalia-Vulval engorgement, leucorrhoea or at
times vaginal bleeding may occur during first week. It is due to withdrawal of maternal oestrogen from the newborn.
9.Neurological response A nomal term baby has got a well developed 'Moro reflex", sucking or rootin9 reBponse and grasp reflex.
10. Bt0ol Meconium is nomally passed 3-4 times a day for 2-3 days. From 3rd or 4th day "changing stool is passed Milk stool is passed by the end of first week.In breast-fed infants the stool is soft and golden yellow in colour, sour smelling and acid in reaction. In bottle-fed infant the stool is hard, pale, foul smelling and alkaline in reaction, The number of motion is 2-3 times a day may be upto 5-6 times.
11. Urine: During the first week, the urinary output is very low even to the extent of 60ml in 24 hours. The urinary output increase to 200-300 ml/day by the 7th
day.
12. Haematological findingsHaemoglobin level falls qradually to about 13 gm% With rise in bilirubin lovel Rilirubin level becomes highest on 2nd-3rd day heine
G mg% and thereater tals by 2 m9% at the end of 7th day.
Immediate care of the newborn
1. Soon after the delivery of the baby, it should be placed on a tray covered with clean dry linen with s en with the
head slightly downwards (15). It facilitates draina of the mucus accumulated in the tracheo-bronchial tree by gravity.
2. The try is placed between the legs of the mother and should be at a lower level than the uterus to facilitate gravitation of blood from the placenta to the infant.
3. Air passage should be cleared of mucus and liquor by gentle suction
4. Apgar rating at 1 & 5 minutes is to be recorded.
5. Clamping and ligature of the cord:
.The cord is clamped by two Kocher's forceps, the near one is placed 5 cm away from the umbilicus and is cut in between.
Two separate cord ligatures are applied with sterile cotton threads 1 cm apart using reef-knot. the proximal one being placed 2.5 cm away from the naval The cord is divided with scissors about 1 cm beyond the ligatures taking aseptic precautions.
6. Delay in clamping for 2-3 minutes or till cessation o the cord pulsation facilitates transfer of 80-100 m blood from the compressed placenta to a baby wne placed below the level of uterus en
7. Quick check is made to detect any qross abnore nality and the baby is wrapped with a dry warm towe.
8. The identification tape is tied both on the wrist baby and the mother.Wrist of the.
Care in Nursery
1. Observation: The infant should be examined Systematically beginning from the head followed by inspecting the whole body to detect any congenital abnomality.
2 To estimate the gestational age-This may be made SOon after delivery.
3 General care: The baby is placed in a cot where neutral thermal condition is maintained. Hypothermia must be avoided.
handling should be gentle and be kept to a
minimum.
4. Baby bath: Routine bath is delayed until the baby is able to maintain the body temperature and has started breast feeding
The excess vernix, blood or meconium are wiped off from the skin using sterile moist swabs and then make the skin dry by using a soft towel.
5 Weight Immediately following bath or cleaning thebaby should be weighed naked.
6. Care of the umbilical cord.
7. Clothing: Should be appropriate for the climate.
8. Care of the eyes: Eyes are kept clean with cotton wool soaked with sterile isotonic saline.
9 Medication: Intramuscular administration of vitami K 1 mg is given as a routine to minimise haemorrhagic disease. Prophylactic antibiotic therapy is considered in : Delivery y following premature rupture of the membranes.
10. Close observ rvation for at least 4-8 hours- to note:
Resuscitation of the newborn
For the baby who does not breathe at birth, resuscitation is initiated. Two cardinal principles of resuscitation of the newborn are.
1. Ensure patent airway
- Position of the infant after birth
-Mouth and the nose should be cleared by suction
2. Initiate breathing if required
-Tactile stimulation
-Positive pressure ventilation with Ambu bag
-Endotracheal intubation
Equipment for resuscitation
1. A suitable suction apparatus.
2. A plastic oesophageal airway.
3. An infant laryngoscope.
4. An endotracheal tube.
5 A supply of oxygen.
6. An infant mask and an Amboo bag of appropriate size.
0 Comments