Introduction of

neonatal disease
G UA N GLIA NG BI M . D.
DE PARTMENT OF N EONATOLOGY
N A N FANG HOS P I TAL
1.Definition
A. Perinatal period
This is from the 28 completed week of pregnancy to the 7
day after birth
B. Neonatal period
The period from birth to the 28 day of life(4 weeks after
birth) is called neonatal period
First week of life(<7days)is known as early neonatal period.
Late neonatal period extends from 7 th to<28 th day.
 Neonatal period is the period when the
infant transfers from intrauterine to
extrauterine life and it is an important link in
the chain of events leading to adulthood:
thus there are some features which are
distinguished from those in other periods of
children's age.
The neonatal period is a highly vulnerable time for
an infant who is completing many of the physiologic
adjustments required for extrauterine existence.
The high neonatal morbidity and mortality rates
attest to the fragility of life during this period; in the
United States, of all deaths occurring in the 1st yr,
two thirds are in the neonatal period. The
predicament is worse in the developing countries,
where because of poor antenatal and neonatal care,
7 out of 100 infant do not see their first birthday.
An infant's intrauterine to extrauterine
transition requires many biochemical and
physiologic changes. No longer dependent on
maternal circulation via the placenta, a
newborn's pulmonary function is activated
for self-sufficient respiratory exchange of
oxygen and carbon dioxide.
Contain high oxygen
 Newborn infants also become dependent on
gastrointestinal tract function for absorbing
food, renal function for excreting wastes and
maintaining chemical homeostasis, hepatic
function, and of the immunologic system for
protecting against infection.
Unsupported by the maternal placenta
system the neonatal cardiovascular and
endocrine systems also adapt for self-
sufficient functioning. Many of a newborn’s
special problems are related to poor
adaptation due to asphyxia, premature birth,
life-threatening congenital anomalies, or
adverse effects of delivery.
expected date of childbirth?
Month +9 or -3 and Day +7 (First day of the Last
menstrual period)
2018-3-7 2018-12-14
 Classification of the neonate
A By gestational age
1.Full term:
A neonate bom between 37 and 42 weeks(259-293days, with an
average 280 days) of pregnancy irrespective of birth weight
（ 37w< Gestation < 42w ）
2.Preterm
A neonate born before 37th week (258days or less) of pregnancy
irrespective of birth weight. （ 28w <Gestation <37w ）
Extremely Premature : <28w
3.post-term
A neonate born at a gestation age of 42 weeks or more (294 days
or more irrespective of birth weight. （ Gestation>42w ）
 Classification of the neonate
B. By birth weight

1. Normal birth weight

This refers to all infants whose weight at birth is between 2500g and
4000g
2.Low Birth Weight: <2500g
3.Very Low Birth Weight: <1500g
4.Extremely Low Birth Weight :< 1000g
5.Macrosomia（Large baby）：>4000g
 Classification of the neonate

C. By the relationship between gestational age and birth weight

1 AGA( appropriate for gestational age)

birth weight varies 10%<AGA<90%
2 SGA( small for gestational age)
birth weight <10%
3 LGA( large for gestational age)
birth weight >90%
Physical features of the newborn

1 Measurements
The newborn baby is about 50 cm long. The head
circumference is approximate 34 to 35 cm and the
chest circumference is usually 3 cm less. The upper
segment to lower segment ratio is between 1.7 and
1.9 to 1. The mid point at the stature of the
newborn lies approximately at the level of the
umbilicus
The baby loses about 7-8 percent of the
birth weight (not exceeding 10 % during the
first week of life The baby regains his birth
weight by 10 day then continues to gain
weight at the rate of 20-30 g per day for the
next three months of the time in sleeping
2. Posture
The full term infant lies in an attitude of flexion
similar to the position assumed in utero. Cry of
the neonate is vigorous. feeble, soft or high
pitched shrieking cry is abnormal and indicates
neurological disorder. Normal newborn spends
80 % of the time in sleeping
B. Respiratory system

1. General
The most critical need of the newborn infant
activity is to establish adequate respirations
for the exchange of gases. The first
respiratory activity occurs immediately after
birth. Respiration is useful in other activities
including crying. sneezing, coughing,
yawning and stretching.
2. Respiratory
The respiration rate range is generally from
35/min to 50/min. Brief excursions well
outside this range are relatively common
3. Tidal volume
The tidal volume of neonates ranges from 6
to 8ml/kg which is almost the same as that
of adult calculated by body weight
C. Circulatory system
1 Heart rate
The heart rate ranges from 120 to 160 /min
2 Heart murmur
the cardiac adjustments of the neonatal period
are often associated with transient cardiac
murmurs(Patent Ductus Arteriosus, PDA etc)
C. Circulatory system
3 Heart size
The heart of the newborn infant often seems large
with respect to the size of the chest when measured
by adult standards
4 Cardiac output
Cardiac output ranges from 180 to 240ml/min, which
is suitable for neonatal oxygen consumption. This
rate is about twice to three times that of an adult
5 Blood pressure
Systolic blood pressure varies from 46 to 80 mmhg.
6. Pulmonary circulation
Pulmonary circulation is established at birth,
Pulmonary artery pressure is usually below
30 mmhg, but slightly higher during the first
few days after birth
D Urinary system

①Renal function: Renal function in the

newborn infant does not meet the standards
of later life ②GFR( glomerular filtration
rate )is lower, about one fourth to one half of
that in an adult, ③Urine often contains
protein in small amounts.④ Urine may
contain an abundance of urates which may
give the diaper a pink stain during the first
week of life.
D Urinary system

⑤The ability to dilute urine is good. The

maximum diluting ability is nearly the same as
that of an adult(50mosm/L ) but the time taken
to reach the maximal ability is relatively long, so
newborns are apt to become water overloaded
⑥urine pH ranges from 5 to 7, specific gravity
ranges from 1.006 to 1.020. ⑦The first
urination occurs within 24 hrs. It ranges from 4
to 6 times/day in the first day and 20 times or
so /day in later days of the neonatal period
E Hemotological system
1 Blood volume
Blood volume of neonates ranges from 80 to 100 ml/kg
2 Hemoglobin
The hemoglobin level of the newborn infants ranges around
15-22g/dl.
3 RBC
RBC range from 5 to 7×103 /mm3
4 WBC
Leukocyte number may be about 7× 103 / mm3 or
so at birth, and generally increase in number for
the first 24 hrs with relative neutrophilia Counts as
high as 25 to 35 × 103 / mm3 may be encountered.
After the first few days(5 days or so) the white cell
count is likely to be below 14 × 103 / mm with
characteristically relative lymphocytosis of infancy
and early childhood
F Alimentary system

①the first stool will generally be passed within 12 hrs of life

and consists of meconium; ②Meconium stools begin to be
replaced by transitional stools on the third or fourth day.
With the establishment of milk feeding, typical milk stool
follows after an interval of 3 or 4 days；③the frequency of
stools in newbom infants average 3 to 5 times a day by the
end of the first week. It is unusual for an infant to have as
many as 6 or 7 stools after the 2 day④The first feeding
should be at 6 hrs of postnatal age for a full term baby, 12
hrs for a premature baby
 G Nervous system
1 Head
The head is relatively large, i. e. from 10 to 12% of body
weight
2 Spinal cord
The spinal cord is relatively long. The end of it reaches
the level of the third of forth lumbar vertebra
3 Physiological reflex
A number of primitive neonatal reflexes can be elicited in
healthy term neonate and disappear at 4 months of life
 Primitive reflex
(1)Moro reflex
Moro reflex is elicited by placing the
infant supine upon the examining
table, the head supported by the
eximiner’s hand. the support is
withdrawn suddenly, and reflex
consists of extension of the trunk
and extension abduction followed by
flexion and abduction of the arms,
with less regular participation of the
legs. It is unobtainable at 3 months
of life
(2)Sucking reflex
Sucking reflex is
initiated by stroking
the lips
(3)Rooting reflex
Stroking the cheek produces
the rooting reflex, which
consists of turning the mouth
toward the stimulus
(4)Grasp reflex
Grasp reflex is elicited by
light pressure on the palms
or on the soles of the feet
H. Immune system

Normal or slightly higher level of IgG is due to active

transfer from the mother to fetus via the placenta,
but IgM and IgA are low(they cannot pass through
the placenta); therefore the newborns are at high risk
for gram negative bacterial infection.
T lymphocyte functions are somewhat reduced in
newborn infants.
White blood cells display low function in killing
microorganisms
 I. Thermoregulation

①At delivery the body temperature of the newborn and mother

are likely to be virtually the same. After I hr of delivery the infants
temperature falls 2.5 ℃ transiently and then usually restores
within 4 to 8 hrs.
②the body temperature is likely to be influenced by the
environmental temperature.
③Neutroenvironmental temperature:The lowest temperature in
the newborn is 32℃-34℃( adult 26℃-31℃)
J. Skin
①at birth the infant is generally covered with
vernix caseosa, a cheesy- white substance adherent
to the skin. It is helpful for protecting the baby
against infections and should not be taken off. ②
keeping the skin of the baby clean is very important
because it is apt to be infected
K. Umbilical cord
①After the ligation of the umbilical cord, it comes
off from 1 to 7 days of postnatal age.
②It has to be prevented against contamination
and be kept it from bleeding
L. Water metabolism
Water may contribute up to 75% of body
weight(40% extracellular). During the first few days
there are a loss of fluid leading to about 6% loss of
body weight (physiologic) and usually do not
exceed 10%. Insensible water loss is about
40ml/100cal
M. High risk neonates
The term designates infants who should be under
close observation by experienced physicians and
nurses.
 A. Physiologic jaundice
Serum bilirubin concentration rises from near-maternal levels at
birth to 7.5 to 8.8 mg/dl by the fourth day in normal newbom
infants. This rise and fall in bilirubin concentration is called
physiologic jaundice The appearance of visible jaundice before
24 hrs, or a serum concentration exceeding 12 mg/dl at any
time of neonatal period are considered to be abnormal. For
premature infants, the serum bilirubin concentration exceeding
15 mg/dl is abnormal
Pathologic jaundice:
too early <24h
too fast>5mg/dl per day (5×17.1= 85umol/L per day)
too long>14d (term)/28d (preterm)
too high> 12 or 15mg/dl(220umol/L or 255umol/L)
B pseudomenstruation
menstrual-like bleeding may occur from the third
to seventh day of life. As this is attributed to
transplacental passage of hormones and estrogen
withdrawal after birth.
no therapy is required
C Enlargement of the breasts
Enlargement of the breasts, and production
of milk may occur at the age of 3 to 5 days in
some newbom boys or girls. This stops at the
postnatal age of 2 to 3 weeks.
This is also caused by transmission and
withdraw of maternal hormones.
This no requires management.
Thanks for your attention!