NEONATAL CARE

SUBMITTED BY:

DR. ADWAIT PAITHANKAR

DR. ABDUL SATTAR KHAN
INTERN BATCH 2024-25
 IMMEDIATELY AFTER BIRTH...
Within seconds after birth of the healthy
newborn, the umbilical cord is clamped and
cut, mucous is suctioned from the nose and
throat, and a cap is placed on the head to
help prevent heat loss and stabilize body
temperature. Some doctors commonly Antiseptic ointment may
prescribe an injection of Vitamin K. This be put in the eyes to
would prevent any incidence of prevent infections of the
hemorrhagic disease ( heavy bleeding). cornea that might result
during vaginal delivery.
This replaces the diluted
silver nitrate formerly
used.
One minute, and again at five
minutes after birth, the infant is
assessed using the APGAR
scale.
 APGAR SCALE...
Score 0 Score 1 Score 2
Heart rate absent <100 >100
Respiration absent weak or irregular strong
Muscle tone none some flexion active movement
no response grimace/feeble sneeze/cough/pulls
Reflex irritabilit
to cry away
y

Skin color Loading…

stimulation
blue all over
when stimulated when stimulated
blue at extremities normal

The Apgar score was devised in 1952 by Virginia

Apgar as a simple and repeatable method to
quickly and summarily assess the health of
newborn children immediately after childbirth.
The Apgar score is determined by evaluating the
newborn baby on five simple criteria on a scale
from zero to two and summing up the five values
thus obtained. The resulting Apgar score ranges
from zero to 10.

The purpose of the Apgar test is to
determine quickly whether a newborn
needs immediate medical care; it was
not designed to make long-term
predictions on a child's health.
Some ten years after the initial
publication, the acronym APGAR was
coined in the US as a “mnemonic”
learning aid:
The APGAR test is generally done at
one and five minutes after birth, and
may be repeated later if the score is,
and remains, low. Scores of 0-2 are
generally regarded as critically low
or “poor”, with 3 to 7 indicating
“fair” condition and 8-10 generally
normal or “good”. The one minute
scores usually indicate how well the
baby tolerated the delivery. The 5
minute scores indicate their
adaptation to the new environment.
A score of “0” at both 1 and 5
minute intervals might generally
indicate a stillborn baby.
Appearance (skin color)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration.
 HEART RATE & RESPIRATION...

Heart rate - range 120 to 160 beats per minute

Common variations:
Heart rate range to 100 when sleeping to 180 when crying
Heart rate may be irregular with crying

Respiration - range 30
to 60 breaths per
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minute
Common variations
Bilateral bronchial breath
sounds
Moist breath sounds may be
present shortly after birth
Babies in distress may be placed in an incubator for
relief and constant monitoring of vital signs.
 Muscle tone... We would expect to see well-flexed,
full range of motion, spontaneous
movement

Signs of potential distress or deviations from expected findings

Posture limp Asymmetry of movement
Persistent tremor, twitching
 REFLEX IRRITABILITY...
Reflex irritability is scored on the basis of the infant’s
response to stimuli, such as a mild pinch.

No response to a pinch= a
score of 0 points.
A grimace or feeble cry = a
score of 1 point.
A lusty cry scores 2
points on the APGAR!

To “pinch” baby and encourage crying is in conflict with the Leboyer method of
childbirth. This method is used to minimize trauma to the infant during and after
delivery. The room is dimly lit and quiet, the baby’s head is not pulled. The
infant is massaged or given a warm water bath. This is all in direct contrast to
the outdated method of smacking baby’s bottom to encourage deep breaths!
SKIN COLOR... Expected findings:
Skin reddish in color, smooth and puffy at birth
At 24 - 36 hours of age, skin is flaky, dry and
pink in color; it is excessively flaky in babies that were overdue
Edema (excess fluid causes swelling) around eyes, feet, and genitals
Some vernix caseosa or lanugo may remain
Common variations:
Acrocyanosis – blue colored fingers, toes, hands,
and/or feet are the result of sluggish
peripheral circulation
Mongolian spots – Patches of purple-black or blue-
black color distributed over backside of infants of
African-American or Asian descent. Resolves in
time.
Mottling -
Generalized red
and white
discoloration of
skin of chilled
infants with fair
complexion
 Jaundice...
Jaundice is a yellow discoloring of the skin, mucous
membranes, and eyes, caused by too much bilirubin
(a breakdown product of hemoglobin made by the
liver) in the blood. High levels of bilirubin circulating
in the blood stream dissolve in the subcutaneous
fat (the layer of fat just beneath the skin), causing a In newborns, jaundice
yellowish appearance of the skin and the whites of often exists due to an
the eyes. immature liver.

Using bili lights is a therapeutic procedure

performed on newborns to reduce elevated levels
of bilirubin, which tends to accumulate in the
brain tissue, and can cause permanent brain
damage.
The bili lights, like sunlight, allow the body to
manufacture Vitamin D. This vitamin is
manufactured by the body when the skin is
exposed to sunlight, and affects liver function. In
very mild cases of jaundice, baby might simply be
placed in the window on a sunny day.
 On average, the newborn
General Measurements... infant weighs 7 pounds and is
20 inches long.
Weight range - 2500 - 4000 gms (5 lbs.
8oz. - 8 lbs. 13 oz.)

Length range - 48 to 53 cms (19 - 21

inches)

Head circumference - 33 to 35 cm
Expected findings:
Head should be 2 to 3 cms larger than chest

Chest circumference - 30.5 to 33 cm

Common variations:
Molding of head may result in a lower head circumference measurement: Fontanelles should be soft, f
or deviation from normal
Head and chest circumference may be equal for the first 24 to 48 hours of life.

Once the APGAR scores and general measurements are determined,

additional reflexes will be tested. In fact, they will continue to be tested
throughout the first year of life in order to evaluate neurological function and
development. Absent or abnormal reflexes in an infant, persistence of a reflex
past the age where the reflex is normally lost, or redevelopment of an infantile
reflex in an older child or adult may suggest problems with the nerve system.
 Moro Response/Startle Reflex...
The Moro response is a normal reflex for an infant when he or she is startled,
feels like they are falling, or their head drops back. A loud noise should also
elicit this reflex. The infant will have a "startled" look and the arms will fling
out sideways with the palms up and the thumbs flexed OR are quickly drawn
upward. Absence of the Moro reflex in newborn infants is abnormal and may
indicate an injury or disease.

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Remember the correct definition of reflex: an automatic and involuntary

reaction as the result of the nervous systems’ response to a stimulus.
Tonic Neck Reflex...

When your baby's head is

turned to one side, the arm
on that side stretches out
and the opposite arm
bends up at the elbow.
This is often called
"fencing." Baby's may
sleep in this position for
years, but when awake,
this reflex usually
disappears by the age of 4
months.
Grasp Reflex...

Palmer Grasp
reflex…put
something
against baby’s
palm and they Plantar Grasp reflex…
grip fingers and put something on sole
hold it of baby’s foot; they
clench their toes in an
effort to hold it
 Step Reflex...

The stepping or walking reflex is present at birth. If the infant is held erect
and the feet come in contact with a surface, the infant will make step-like
movements. Some parents incorrectly interpret this movement as a desire to
stand and walk. It is important that this motion is not allowed to be weight-
bearing, as leg muscles are not developed. It is interesting that this reflex
occurs even if the baby is held upside down and the feet come in contact
with a surface.
 Crawl Reflex...

When your baby is placed on his/her stomach, they will automatically

assume a "crawling" position. This usually disappears by 4 months.
When the position reappears, it is closer to 6 – 10 months. At that point
the baby will actually be learning to crawl rather than just exhibiting a
reflex movement.
Flexion Reflex...

A mild pinch or slapping on the

bottom of the foot elicits the
flexion reflex. This causes the
body to automatically draw back
from the painful stimulus. It is a
reflex for protection or survival.
 Sucking Reflex...
This reflex will
allow the infant to
ingest food from
the nipple of a
bottle or breast.

As shown in the
The sucking reflex picture above, this
may have been reflex occurs when
present long any nipple-sized
before birth, as object is placed on
shown above in the baby’s lips.
this fetus.
 Rooting Reflex...

1. 2.

Rooting reflex When you stroke the corner of your baby's mouth
and move your finger slowly toward his ear you will see his tongue,
mouth, and sometimes even his head follow the direction of your
hand. They also open their mouth. This reflex helps babies to locate
the nipple for feeding. This usually disappears by 3-4 months.
Babinski Reflex... Also known as the Extensor Plantar
Reflex or Toe Sign

When you stroke the bottom of your baby's foot, the big toe flexes
toward the top of the foot, the other toes fan out, and the leg extends
outward. This usually disappears by 9 months to 2 years, when the
toes curl under and the leg is pulled back.
Blink reflex...

The infants’ eyes will

open and close in
response to a touch on
the face, a bright light, a
loud sound, a strong
odor, or a bitter taste.
This reflex serves to help
protect the eyes, and is
present during the entire
lifetime.
 Pupillary Reflex...
The infants’
pupils open
automatically
in response to
weak light
and contract
in response to
bright light.
This reflex
not only
allows for
better vision,
but protects
the eyes. It is
present
throughout
the lifetime.
 Stork Bites...

A stork bite is a vascular lesion quite common in newborns consisting of one

or more pale red patches of skin. Most often stork bites appear on the
forehead, eyelids, tip of the nose, upper lip or back of the neck. They are
usually gone within 18 months of birth. Some may be attributed to birth
injuries such as stretch marks.
Also called “salmon patches”, they occur in about one third of all newborn
infants. They are flat, pink areas with irregular borders, and may become
darker with crying or room temperature changes. They fade with pressure, but
the reddish appearance returns when the pressure is removed. Stork bites
clear up spontaneously over a period of months and are usually gone
completely by 18 months with the exception of those at the nape of the neck.
Those may persist for years, but are generally covered by hair.
 When experts talk about bonding, they're
Bonding... referring to the intense attachment the parent
develops with the baby, in particular the
mother, due to the biological connection.
Some of the experts believe bonding must happen immediately after birth, but most
believe it is truly an individual experience. It should be considered a process rather than
a specific moment, involving cuddling, holding, talking to, etc.
Some research indicates that
Infants who have a deep bonding
with their mothers tend to become
very independent at a young age
and display a higher sense of
confidence, positive attitude, and
self-esteem. They appear self-
reliant and enjoy good
relationships with peers, even when
under stress or unstable home
conditions. These children seem to
be more successful in school,
especially in mathematics. They
have good school attendance and
high achievement scores in
comparison to children that did not
bond as deeply with the mother.
 Father-Newborn Bonding
Most of the bonding research has focused on mother-infant bonding, but in
recent years father-infant bonding has received increased attention. A special
term is used to describe the father-infant relationship at birth--
"engrossment." Engrossment involves the holding and comforting of the
baby and the display of a greater level of sensitivity in the father.
Studies on father bonding show that fathers who
are given the opportunity and are encouraged to
take an active part in caring for their newborns can
become just as nurturing as mothers. A father's
nurturing responses may be less automatic and
slower to unfold than a mother's, but fathers are
capable of a strong bonding attachment to their
infants during the newborn period. Fathers have
their own unique way of relating to babies, and
babies seem to thrive on this difference.

There is also some scientific evidence to support bonding. Cortisol is a hormone

that is regulated by the pituitary-adrenal system. It influences stress reactions, the
immune system, sugar levels in the blood, motor skills, and memory. During the
average day a typical child’s cortisol level peaks in mid- morning and decreases in
the evening. In children who have no parental attachment, the cortisol levels
continue to increase all morning and only decrease slightly by evening.
 REACTIVE ATTACHMENT DISORDER...
If there is no bonding with a child, the result seems to have a profound and
long-lasting negative effect, often referred to as Reactive Attachment Disorder.
The essential feature of RAD (Reactive Attachment Disorder) is the "markedly disturbed
and developmentally inappropriate social relationships that begin before age 5 years and
are associated with grossly pathological care". By definition, the grossly pathological
care may take the form of persistent disregard of the child’s basic emotional needs for
comfort, stimulation, and affection; the persistent disregard of the child’s basic physical
needs; or repeated changes of primary caretaker that prevent formation of stable
attachments.

Long term hospitalization

of newborns may prevent
bonding, as well as
“Holding therapy” during episodes of rage is
neglect or abandonment.
one form of treatment being used for RAD.

Children can exhibit poor peer relations, rage, poor eye contact, limited to no
remorse for destructive or assaultive behaviors, chronic lying, agitating, and
stealing; and preoccupation with morbid topics, destruction or cruelty to animals.
 Postpartum Depression...
Postpartum depression (PPD) is quite common after a
baby's birth. It can range from mild "baby blues" which
affect between 50 and 80 percent of all mothers, to
psychosis. In general, over 10 percent of mothers
experience some level of postpartum adjustment
problems. When these problems begin to interfere with
a mother's ability to take care of her baby and her daily
tasks, it is time to seek professional help. Depression
is a very real mental condition, not imagined or
voluntary.
The postpartum period begins after the delivery
of the baby and ends when the mother's body
has returned as closely as possible to its pre-
pregnant state…a period of six weeks to two
years. It involves the mother’s adjustment to
physical, emotional, and hormonal changes, as
well as learning how to care for a newborn and
function in this new family unit. She will need
to rebuild her strength, getting plenty of rest,
good nutrition, exercise, and help during the
 The mammary gland of the breast, upon
LACTATION receiving a hormonal signal after the
birth of the baby, begins making
secretions. This process is called
lactation.

The very first secretion from the breast is

called COLOSTRUM. It is sticky, and a milky-
yellow color. It is nature’s perfect baby food:
1. Provides baby with perfect nutrition
2. It is easily digestible
3. Contains immunities from the mother

After several days, the colostrum is replaced

with milk. Although breastfeeding contributes
to bonding the mother and child, it may be limit
how much the father is able to participate in
his baby’s care.
NEONATAL EVALUATION & CARE...

THE END