Maternal 1 Side-notes: Newborn Care

Kicking and Crying

Anthropometric Measurements ⁃ Increase metabolism and heat
1. Weight ⁃ Increase O2 and RR demand
⁃ Normal: 2.5-4kg
⁃ > 4.7kg = Macrosomic Mechanical Heat Conservation
⁃ 2nd born weighs more ⁃ Drying
⁃ Gains 2lbs per month 1st 6MONS ⁃ Wrapping
⁃ Warmed Cribs
2. Length ⁃ Radiant Heat Source
⁃ Normal: 44-55cm
Skin to Skin Contact
3. Head Circumference ⁃ Heat transfer from mother to
⁃ Normal: 33-35.5cm newborns

4. Chest Circumference 2. Pulse

⁃ Normal: 30-32cm ⁃ Utero: 120-160bpm
⁃ Nipple level ⁃ Birth: 180bpm
⁃ 1hr after: 120-140bpm
5. Abdominal Circumference ⁃ Crying: 180bpm
⁃ Normal: 30-33cm ⁃ Sleeping: 90-110bpm
⁃ NOT routinely measured ⁃ Irregular due to immaturity cardiac
regulatory center in medulla
Vital Signs ⁃ Brachial and femoral palpable
1. Temperature ⁃ Radial and temporal non-palpable
⁃ Below normal
⁃ Heat loss and immature Apical
thermoregulation ⁃ Accurate and reliable
⁃ Room temperature adds to heat loss ⁃ 1 full min

Insulation Transient Murmurs

⁃ conserving heat ⁃ incomplete closure fetal circulation
⁃ NOT EFFECTIVE (little SQ FAT) shunts

Shivering 3. Respiration
⁃ Adult mechanism ⁃ 1st Mins: 80bpm/min
⁃ increase metabolism ⁃ Rest: 30-60bpm/min
⁃ Rare newborns ⁃ Diaphragmatic breather

Vasoconstriction Periodic Respiration

⁃ Newborn mechanism
⁃ Disperse blood away
Brown Fat
⁃ Special Tissue
⁃ Mature newborns
⁃ Conserve body heat
⁃ Increase metabolism
⁃ Intrascapular region, thorax, perineal
area
⁃ Regulates temperature
(HIBERNATING)
⁃ Normal
⁃ Irregular with period of apnea
⁃ Without cyanosis
⁃ Last < 15 seconds
4. Blood Pressure
⁃ Birth: 80/46 mm Hg
⁃ 10th: 100/50 mm Hg
⁃ Inaccurate and NOT routinely
measured
⁃ Increase with crying
Proper Measurement ⁃ Bacteria cultured within 5hrs after
⁃ cuff width NOT > 2/3 length of arm birth within 24hrs life
or thigh ⁃ Bacteria = digestion and Vit. K

Doppler Meconium
⁃ to measure blood pressure ⁃ 1st stool within 24hrs
⁃ Greenish odorless accumulated from
Systemic Function intrauterine life
1. Cardiovascular System
⁃ Lungs inflates = decreased NOT PASSED Meconium
pulmonary artery pressure ⁃ Within 24-48hrs
⁃ Decrease pulmoartery pressure = ⁃ Meconium ileus, imperforate anus or
closure of ductus arteriosus (Fetal Shunt) volvulus
⁃ Increase Left side Pressure=
Closure of Foramen Ovale Transitional Stool
⁃ 2nd to 3rd day
Bilirubin ⁃ Green and loose
⁃ By-products RBC breakdown ⁃ “Diarrhea-like Stool”

Indirect Bilirubin Light-Yellowish Stool

⁃ Normal: 1-4mg/100mL ⁃ 4th day
⁃ ABNORMAL Level= excessive RBC ⁃ Breastfeeding babies
breakdown ⁃ Sweet smelling = High Lactic Acid

Indirect/ Unconjugated Bilirubin Lactic Acid

⁃ bound to plasma albumin ⁃ Reduces putrefactive organism in
⁃ Water insoluble stool
⁃ NOT directly excreted from body
Bright Yellow Stool
Direct/ Conjugated Bilirubin ⁃ 2nd to 3rd Day
⁃ Water soluble ⁃ Formula Milk
⁃ Conjugated with glucoronic acid ⁃ (+) Odor
⁃ Excreted in bile (NATATAE)
4. Urinary System
WBC ⁃ Voids within 24hrs (GOOD RULE)
⁃ Birth: 15,000-30,000/mm3 ⁃ NOT VOID: urethral stenosis, absent
⁃ >40,000 = stressful birth kidneys or ureters

2. Respiratory System Urine

⁃ 1st breath requires pressure (cold ⁃ 15mL (single void)
receptors) ⁃ Gravity: 1.008 - 1.010
⁃ Intrauterine fluid ease surface ⁃ Daily: 30-60mL
tension on alveolar walls = alveoli inflate easily = ⁃ Weekly: 300mL
requires minimal pressure to breath ⁃ 1st void: pink and dusky (uric acid
⁃ 10mins after good residual volume crystals)

Cardiac Murmur 5. Immune System

⁃ Patent Ductus Arteriosus ⁃ Susceptible infections
⁃ Difficulty with respirations ⁃ Immature = No antibodies 2MONS
(No immunization <2MONS)
3. GI System ⁃ IgG (Mother)= passive antibodies
⁃ Sterile at birth ⁃ HBV 1st 12hrs after birth
 ⁃ Palm Grasp object
6. Neuromuscular System
⁃ Strong cry Step/ walk-in place Reflex
⁃ Newborn reflexes ⁃ Feet touching hard surface

Limpness/ Flaccid Plantar Grasp Reflex

⁃ Narcosis ⁃ Toes grasp object
⁃ Shock or cerebral injury ⁃ Walking preparation

7. Newborn Reflexes Tonic Neck Reflex

Extrusion Reflex
⁃ anterior tongue
⁃ Prevents swallowing inedible
substance
⁃ 4MONS: spitting or refusing
⁃ Head turn to side then opposite arm
and leg contract
⁃ AKA: Boxing/ fencing reflex
Moro/ Startle Reflex
⁃ Loud noise = head drops backward

Magnet Reflex Babinski Reflex

⁃ Put pressure on sole ⁃ Stoke letter “J”
⁃ Pushes against pressure ⁃ (+) Fanning of toes = Immature
⁃ Test spinal integrity nervous system

Crossed Extension Reflex Newborn Sense

⁃ Push away that irritates other leg 1. Vision
⁃ Legs raise and extend ⁃ Light and dark
⁃ Blinking strong light
Trunk Incurvation Reflex ⁃ Follows bright light
⁃ Flex trunk and swing pelvis
2. Touch
Laundau Reflex ⁃ Full developed
⁃ Test muscle tone ⁃ Reacts painful stimuli
⁃ Lift head or arch back while
supporting trunk 3. Taste
⁃ discriminate taste
Blink Reflex ⁃ Accepts sweet taste milk or glucose
⁃ Eye protection water
⁃ Taste buds developed before birth
Rooting Reflex
⁃ Touch corner of mouth 4. Smell
⁃ Sign of alertness
Sucking Reflex
⁃ finding food Appearance of Newborn
⁃ Diminish 6MONS 1. Skin

Swallowing Reflex Ruday Complexion

⁃ Posterior tongue
Gag, cough, sneeze reflex
⁃ Maintain airway clearance
⁃ Pharynx free obstruction
Palmar Grasp Reflex
⁃ RBC concentrated
⁃ Decreased SQ Fat
⁃ Blood vessels more visible
Pale and Cyanotic
⁃ Poor CNS
Gray Color- Infection
Acrocyanosis
⁃ peripheral BLUES
⁃ Immature circulation
⁃ NORMAL 1st 24-48hrs
Central Cyanosis
⁃ Trunk cyanosis
⁃ Decreased oxygenation
⁃ Respiratory obstruction or underlying
condition
Hyperbilirubinemia
⁃ Jaundice or yellowish skin
⁃ 2nd to 3rd day
⁃ Physiologic Jaundice = FETAL RBC
BREAKDOWN
⁃ Immature liver CANNOT CONVERT
indirect bilirubin to direct bilirubin
⁃ Indirect bilirubin accumulation
Cephalhematoma
⁃ Blood collection under periosteum of
skull bone
⁃ “BRUISING” = heals and RBC
hemolyzed (JAUNDICE)
Note:
⁃ intestinal flora breakdowns bile
releasing indirect bilirubin into bloodstream
⁃ Early feeding prevents indirect
bilirubin accumulation from source
Abnormal Indirect Bilirubin
⁃ 20mg/100mL
⁃ Blocks chemical synthesis of brain
cells
⁃ KERNICTERUS = permanent brain
damage
⁃ 10-12mg/100mL = MEDICAL TX
NEEDED
Phototherapy
⁃ maturation of liver enzymes
⁃ Common therapy
Breastfeeding Baby
⁃ Difficult to converts bilirubin
⁃ PREGNANEDIOL= counteracts
GLUCURONYL TRANSFERASE
⁃ Rarely cause of jaundice
Pregnanediol- metabolite of progesterone
Pallor
⁃ anemia due to blood loss
⁃ Poor blood flow
⁃ Poor maternal nutrition = Low Iron
⁃ Blood incompatibility = RBC
hemolysis intrauterine
⁃ Internal bleeding
2. Birthmarks
Hemangioma
⁃ vascular tumor
⁃ 3 Types: Nevus Flammeus,
Strawberry Hemangioma, Cavernous
Hemangiomas
Nevus Flammeus
⁃ Macular purple/ dark red lesions
⁃ AKA: port-wine stain
⁃ Above NOSE (FADES)
⁃ Level skin surface
Telangiectasia (Nevus Flammeus)
⁃ AKA: Stork’s Beak Mark
⁃ Pink patches at nape of neck
⁃ DONT FADE
⁃ Common FEMALES
Strawberry Hemangioma
⁃ Elevated immature capillaries and
endothelial cells
⁃ ABSENT PRETERM
⁃ High Estrogen during pregnancy
⁃ Hydrocortisone Ointment (blocks
estrogen)
Cavernous Hemangiomas
⁃ Dilated vascular spaces
⁃ Resembles strawberry hemangioma
⁃ REMOVED SURGICALLY
⁃ Extends internal organs
⁃ Hct levels= internal blood loss
⁃ Interferon Alfa 2a (Vincristine) =
reduce lesions
3. Skin Conditions
Mongolian Spots
⁃ Collection melanocyte
 ⁃ Slate gray patches ⁃ Blood = Subdural Hematoma
⁃ Sacrum or buttocks
Molding
Vernix Caseosa ⁃ head engaged in cervix
⁃ follows color amniotic fluid ⁃ Fits cervix contour
⁃ Yellow = Bilirubin ⁃ Asymmetric
⁃ Green = Meconium ⁃ “DUNCE CAP”

Milia Cephalhematoma
⁃ Immature sebaceous glands ⁃ blood in periosteum of skull
⁃ Cheek or nose ⁃ Rupture periosteal capillary
⁃ Avoid scratching ⁃ “EGG SHAPE”
⁃ Black and blue (coagulated blood)
Erythema Toxicum ⁃ Lead to JAUNDICE
⁃ Newborn rash
⁃ AKA: Flea-bite rash Craniotabes
⁃ Sporadic and unpredictable ⁃ Softening cranial bones
⁃ Eosinophils reaction to environment ⁃ 1st Born Infant
⁃ Immature System matures ⁃ Indented by fingers

Skin Turgor Forceps Marks

⁃ Resilient = Hydrated
⁃ Elastic fold
⁃ Poor Turgor = Utero malnutrition
⁃ Metabolic disorders = adrenocortical
insufficiency
4. Head
⁃ Large forehead
⁃ Preterm lifeless hair
Fontanelles
⁃ skull bones join
⁃ Anterior: Diamond shape
⁃ Posterior: Triangular shape
⁃ Circular/ linear contusion
⁃ Rim of blade forceps on CHEEKS
5. Eyes
⁃ iris gray/ blue
⁃ Sclera blue (thin)
⁃ Clear without redness/ purulent
discharge
6. Ears
⁃ NOT completely form
⁃ Pinna recoil after bending
⁃ Top portion level of eye canthus
⁃ Low Set Ears= Trisomy 18 and 13

Note: Hearing Test

⁃ anterior fontanelle soft spot ⁃ bell rings 6inches away
⁃ Indention = dehydration ⁃ Respond: stop momentarily, blink
⁃ Bulging = Increased ICP, straining, eyes/ startle
crying vigorously
⁃ Pulsatile fontanelle = vigorous crying 7. Nose
⁃ Anterior = closes 12-18MONS ⁃ large
⁃ Posterior = 2nd MONS ⁃ (+) Milia

Suture Choanal Atresia

⁃ Separating lines of skull
⁃ Overriding due to pressure
⁃ Subside 24-48hrs
⁃ Wide separation = Increased ICP
⁃ FUSED = ABNORMAL
⁃ CSF = Hydrocephalus
⁃ Blockage rear of nose
⁃ Compress one nares while closing
mouth
Nasal Flaring
⁃ Respiratory distress
 8. Mouth Grunting Sound
⁃ Open evenly ⁃ Respiratory distress syndrome
⁃ Tongue large
⁃ Frenulum attached tip tongue = Stridor
Tongue Tied Apperance ⁃ Immature trachea
⁃ Intact palate ⁃ High crowding sound

Epstein’s Pearls 11. Abdomen

⁃ Round glistening cyst
⁃ (+) Palate
⁃ Extra calcium deposits in utero
⁃ Confuse with THRUSH (Candida
Infection)
⁃ slight protuberant
⁃ (+) Bowel Sound 1hr
⁃ Liver = below left costal margin
⁃ Umbilical cord (white) = breaks free
6-10 days

Candida Infection Diaphragmatic Hernia

⁃ White/ gray patches ⁃ Sunken appearance
⁃ Tongue or side cheek ⁃ Missing abdominal content
⁃ Anti-fungal drug therapy ⁃ Bowel displaced into CHEST

9. Neck Septicemia
⁃ Creased skin folds ⁃ Cord infection enters bloodstream
⁃ Rotate freely
⁃ NOT strong to support head Abdominal Reflex
⁃ Follows stroking directions
Nuchal Rigidity ⁃ Spinal nerve test: T8-T10
⁃ (+) Meningitis ⁃ Last 10th day

Congenital Torticollis 12. Anogenital

⁃ injury of sternocleidomastoid muscle
⁃ ROM >24hrs before birth
10. Chest
⁃ 2inches smaller to head
⁃ Symmetric
⁃ RR: 30-60bpm (Rapid NOT distress)
⁃ (+) supernumerary nipple
⁃ Breast engorgement (maternal
hormones)
⁃ (-) Retractions
Crepitus
⁃ Separation of clavicle
⁃ Fracture and calcium deposition
Witch’s Milk
⁃ newborn breast
⁃ Anus NOT covered
Meconium Ileus
⁃ imperforate anus
⁃ NO MECONIUM PASS 1st 24hrs
Male Genitalia
⁃ Scrotum edematous and rugae
⁃ Hyperpigmentation
⁃ (+) Both testes
Cryptochirdism
⁃ (-) Testes
⁃ Agenesis/ absence of organ
Ectopic Testes
⁃ closed scrotal sac
⁃ Testes cannot enter

Retraction Undescended Testes

⁃ Drawing in chest wall ⁃ vas deferens too short for testes to
⁃ Force to pull air = pulling anterior descend
chest muscle
Cremasteric Reflex Polydactyl
⁃ Testes follows stroking movement ⁃ extra digits
⁃ Spinal Nerve Test: T8-T10 ⁃ Unusual spacing
⁃ Absent <10 days age ⁃ Chromosomal disorders

Penis Flat sole- extra pad of fat

⁃ 2cm long
⁃ >2cm = consult endocrinologist Note:
⁃ Urethral opening tip of glans ⁃ crease <2/3 foot/ absent =
IMMATURITY
Epispadias
⁃ opening at DORSAL SURFACE Hips Subluxation
⁃ Fountain ⁃ Shallow and poor acetabulum
⁃ Lack short distance
Hypospadias ⁃ 160-170°
⁃ opening at VENTRAL SURFACE
⁃ Faucet (Giripo) Hips
⁃ Flexed and abducted 180°
Female Genitalia ⁃ Knees touch bed surface
⁃ Swollen vulva (maternal hormones)
⁃ Mucus vaginal secretions Ortholani’s Sign
⁃ Discharge NORMAL (No infection) ⁃ abduct hip
⁃ CLUNK = femur head striking
13. Back acetabulum
⁃ Flat lumbar and sacral
⁃ Curve = Sitting and walking Barlow’s Sign
⁃ Breech = straighten legs and knees ⁃ Hip felt slip in socket

Spinal Bifida Newborn Parameters

⁃ Dermal sinus HR: 90-160 rpm
RR: 30-60 rpm
True Neural Tube Defects O2sat: 60-90%
⁃ Lack folic acid (pregnancy)

14. Extremities
⁃ Short
⁃ Clenched into fist
⁃ Fingernails soft and smooth over
fingertips
⁃ Arm flexed immediately after birth
⁃ Fingertips reached proximal thigh

Achondroplastic Dwarfism
⁃ short arms

Simian Crease
⁃ Single palmar crease
⁃ DOWN SYNDROME

Syndactylyl
⁃ Webbing of hands