SEMINAR

ON
PHYSIOLOGY,
CHARACTERISTICS
PHYSICAL AND BEHAVIORAL
ASSESSMENT OF NEWBORN
 DEFINITION
• A premature infant is a baby born before 37
completed weeks of gestation (more than 3
weeks before the due date).
• Term infants are those born at a gestational
age of 37 weeks or greater.
• A postterm pregnancy is one that extends
beyond 42 weeks (294 days) from the first day
of the last menstrual period
ESSENTIAL
NEWBORN
CARE
Cord Clamping & Cord Cutting:
Suctioning:
Drying the baby:
Maintaining Temperature:
APGAR Scoring:
Cont.,.,
Vitamin K Administration:
Check Birth Weight:
Initiation Of Breast Feeding:
Cont.,.,
Cont.,.,
Cont.,.,
Cont.,,,
Cont.,.,
Cont.,.,
Cont.,.,
Cont.,.,
Cont.,.,
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Cont.,.,
Cont.,.,
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 NEWBORN
ADAPTATION
 INTRODUCTION

•The immediate postpartum period is a time of

significant physiological adaptation for both the mother
and baby.
•The newborn must adapt from being completely
dependent on another for life sustaining oxygen and
nutrients to an independent being, a task accomplished
over a period of hours to days.
 INTRODUCTION

 Successful transition from fetal to neonatal life requires a complex

interaction between the following systems:
 • Respiratory.
 • Cardiovascular.
 • Thermoregulatory.

 • Immunologic.
 Respiratory System

• The most critical and immediate physiologic change

required of newborns is the onset of breathing.
• The stimuli that help initiate the first breath are
primarily chemical and thermal.
 Respiratory System
• Chemical factors in the blood (low oxygen, high
carbon dioxide, and low pH) initiate impulses
that excite the respiratory center in the medulla.
• The primary thermal stimulus, this abrupt change
in temperature excites sensory impulses in the
skin that are transmitted to the respiratory center.
 Respiratory System
• Tactile stimulation may assist in initiating respiration.

Acceptable methods of tactile stimulation include :

• Tapping or flicking the soles of the feet
• Gently rubbing the newborn’s back, trunk, or
extremities.
 Respiratory System
• As the chest emerges from the birth canal, fluid is
squeezed from the lungs through the nose and
mouth.
• After complete delivery of the chest air enters the
upper airway to replace the lost fluid.
• Remaining lung fluid is absorbed by the
pulmonary capillaries and lymphatic vessels.
Fetal Circulation
 Circulatory System
The transition from fetal to postnatal circulation
involves the functional closure of the fetal shunts:
• Foramen ovale
• Ductus arteriosus
• Ductus venosus
 Circulatory System
Increased blood flow

1. Dilates the pulmonary vessels.

2. Pulmonary vascular resistance decreases.

3. Systemic resistance increases.

4. Maintaining blood pressure (BP)

 Circulatory System
Ductus arteriosus

• It is a blood vessel connecting the pulmonary

artery to the proximal descending aorta.

• It allows most of the blood from the right ventricle

to bypass the fetus's fluid-filled non- functioning
lungs.
 Circulatory System
• With the increase in pulmonary blood flow and
dramatic reduction of pulmonary vascular
resistance,the ductus arteriosus begins to
close.
 Circulatory System
foramen ovale

• It is a hole in the wall between the left and right atria

of every human fetus.

• This hole allows blood to bypass the fetal

lungs, which cannot work until they are
exposed to air.
 Circulatory System
foramen ovale cont

• As the pulmonary vessels receive blood, the

pressure in the right atrium, right ventricle, and
pulmonary arteries decreases.
• Left atrial pressure increases above right atrial
pressure, with subsequent foramen ovale closure.
 Circulatory System
Ductus venosus
• a vein passing through the liver and
connecting the left umbilical vein with the
inferior vena cava of the fetus, losing its
circulatory function after birth.
 Circulatory System

• Failure of the ductus arteriosus or

foramen ovale to close results in
persistence of fetal shunting of blood away
from the lungs.
 Thermoregulation
• Next to establishing respiration, heat
regulation is most critical to the newborn’s
survival.
 Thermoregulation
factors predispose newborns to excessive heat loss:

• The newborn’s large surface area facilitates heat loss to the

environment.
• The newborn’s thin layer of subcutaneous fat provides
poor insulation for conservation of heat.
• The newborn’s mechanism for producing heat is different
from that of the adult, who can increase heat production
through shivering.
 Thermoregulation
The principal thermogenic sources are
• Heart.
• Liver.
• Brain.

• An additional source, once believed to be unique to

newborns is known as brown adipose tissue, or
brown fat.
 Thermoregulation
• Heat generated in brown fat is distributed to
other parts of the body by the blood, which is
warmed as it flows through the layers of this
tissue.
 Thermoregulation
Superficial deposits of brown fat are located :
• Between the scapulae.
• Around the neck.
• In the axillae.
• Behind the sternum.
• Deeper layers surround the kidneys.
• Trachea
• Esophagus.

• Some major arteries, and adrenals.

 Hematopoietic System
• The blood volume of the newborn depends
on the amount of placental transfer of blood.

• The blood volume of a full-term infant

is about 80 to 85 ml/kg of body weight
Immediately after birth.

• The total blood volume averages 300

ml.
 Fluid and Electrolyte Balance
• Changes occur in the total body water
volume, extracellular fluid volume,
and intracellular fluid volume during
the transition from fetal to postnatal
life.
 Fluid and Electrolyte Balance
• At birth, the total weight of an infant is
73% fluid compared with 58% in an
adult.
• Infants have a proportionately higher ratio of
extracellular fluid than adults.
 Fluid and Electrolyte Balance
Factors making newborn more prone to dehydration:

• Infant’s rate of metabolism is twice that of an adult in

relation to body weight.

• As a result, twice as much acid is formed, leading

to more rapid development of acidosis.

• Immature kidneys cannot sufficiently concentrate urine

to conserve body water.
 Gastrointestinal System
The ability of newborns to digest, absorb, and metabolize
foodstuff is adequate but limited in certain functions.

• Enzymes are adequate to handle proteins and simple

carbohydrates.

• Deficient production of pancreatic amylase

impairs use of complex carbohydrates.

 Gastrointestinal System
• Deficiency of pancreatic lipase limits absorption of fats,
especially with ingestion of foods with high saturated fatty
acid content such as cow’s milk.

• Human milk, despite its high fat content, is easily digested

because the milk itself contains enzymes such as lipase,
which assist in digestion.
 Gastrointestinal System
The liver is the most immature of the
gastrointestinal organs.

• The activity of the enzyme glucuronyl

transferase is reduced

• Affects the conjugation of bilirubin with glucuronic

acid and contributes to physiologic jaundice of

newborns.
 Gastrointestinal System
The liver is also deficient in forming plasma
proteins.

The decreased plasma protein

concentration probably plays a role in
the edema usually seen at birth
 Gastrointestinal System
• The liver stores less glycogen at birth than
later in life.
• Consequently, newborns are prone to
hypoglycemia.
 Gastrointestinal System
• Some salivary glands are functioning at
birth, but the majority do not begin to
secrete saliva until about age 2 to 3 months,
when drooling is frequent.
 Gastrointestinal System
• Stomach capacity varies in the first few days of
life, from about 5 ml on day 1 to about 60 ml
on day 3.
• thus, infants require frequent small feedings
 Gastrointestinal System
• An infant’s intestine is longer in relation
to body size than that of the adult.

• Therefore, there are a larger number of

secretory glands and a larger surface area for
absorption compared with an adult’s
intestine.
 CHANGE IN STOOLING
PATTERNS OF NEWBORNS
Meconium

• Infant’s first stool; composed of amniotic fluid and its

constituents, intestinal secretions, shed mucosal cells, and
possibly blood (ingested maternal blood or minor bleeding
of alimentary tract vessels)

• Passage of meconium should occur within the first 24 to 48

hours, although it may be delayed up to 7 days in very low–

birth-weight infants.
 CHANGE IN STOOLING
PATTERNS OF NEWBORNS
Transitional Stools
• Usually appear by third day after initiation of
feeding; greenish brown to yellowish brown,
thin, and less sticky than meconium; may
contain some milk curds.
 CHANGE IN STOOLING
PATTERNS OF NEWBORNS
Milk Stool
• Usually appears by fourth day In breastfed infants
stools are yellow to golden, are pasty in
consistency,and have an odor similar to that of sour
milk.
• In formula-fed infants stools are pale yellow to
light brown, are firmer in consistency, and have a
more offensive odor.
 Renal System
• All structural components are present in the renal
system, but there is a functional deficiency in the
kidneys’ ability to concentrate urine and to cope
with conditions of fluid and electrolyte stress such
as dehydration or a concentrated solute load.
 Renal System
• Total volume of urine per 24 hours is about 200 to
300 ml by the end of the first week.
• the bladder voluntarily empties when stretched by a
volume of 15 ml, resulting in as many as 20
voidings perday.
• The first voiding should occur within 24 hours.
• The urine is colorless and odorless and has a specific
gravity of about 1.020.
 Integumentary System
• At birth, all of the structures within the skin are present,
but many of the functions of the integument are immature.
• The growth phases of hair follicles usually occur
simultaneously at birth.
• During the first few months, the synchrony between hair
loss and re growth is disrupted, and there may be overgrowth
of hair ortemporary alopecia.
 Integumentary System
• The eccrine glands, which produce sweat in
response to heat or emotional stimuli, are functional
at birth, and palmer sweating on crying reaches
levels equivalent to those of anxious adults by 3
weeks of age.
• The eccrine glands produce sweat in response to
higher temperatures than those required in adults,
and the retention of sweat may result in miliaria.
 Musculoskeletal System
• At birth, the skeletal system contains more
cartilage than ossified bone, although the process
of ossification is fairly rapid during the first year.

• The six skull bones are relatively soft and are

separated only by membranous seams. The sinuses
are incompletely formed in newborns.
• muscular system is almost completely formed at
birth.
 Defenses Against Infection
Infants are born with several defenses against infection.

• The first line of defense is the skin and mucous membranes,

which protect the body from invading organisms.

• The second line of defense is the macrophage system, which

produces several types of cells capable of attacking a
pathogen.

• The neutrophils and monocytes are phagocytes, which

means they can engulf, ingest, and destroy foreign agents.

• The third line of defense is the formation of specific antibodies

to
an antigen.
 Endocrine System
Ordinarily, the endocrine system of newborns is adequately
developed,but its functions are immature.

• The effect of maternal sex hormones is particularly evident in

newborns.

• The labia are hypertrophied, and the breasts of both genders may
be engorged and secrete milk from the first few days of life to as
long as 2 months of age.

• Female newborns may have pseudomenstruation

(more often seen as a milky secretion than actual blood) from a
sudden drop in progesterone and estrogen levels.
 Neurologic System
• At birth, the nervous system is incompletely
integrated but sufficientlydeveloped to sustain
extrauterine life.
• Most neurologic functions are primitive reflexes.
• The autonomic nervous system is crucial during
transition because it stimulates initial respirations,
helps maintainacid–base balance, and partially
regulates temperature control.
 Sensory function
• Sensory Functions Newborns’ sensory
functions are remarkably well developed and
have a significant effect on growth and
development, including the
attachmentprocess.
 Sensory function
Vision
• At birth, the eye is structurally incomplete.

• Tear glands usually do not begin to function

until 2 to 4 weeks of age.

• The pupils react to light, the blink reflex is

responsive to minimal stimulus, and the corneal
reflex is activated by a lighttouch.
 Sensory function
Hearing
• After the amniotic fluid has drained from the
ears, infants probably have auditory acuity
similar to that of adults
 Sensory function
Smell
• Newborns react to strong odors such as
alcohol and vinegar by turning their heads
away.
• Breastfed infants are able to smell breast milk
and will cry for their mothers when they smell
leaking milk
 Sensory function
Taste
• The newborn has the ability to distinguish
among tastes.
Touch
• At birth, infants are able to perceive tactile
sensation in any part of the body, although
the face (especially the mouth), hands, and
soles of the feet seem to be most sensitive.
NEWBORN ASSESSMENT

84
 DEFINITION
• A healthy infant born at term ( b/w 38-42
weeks) should have an average birth weight
( usually exceeds 2500g), immediately
following birth , establishes independent
rhythmic respiration and quickly adapts to the
changed environment.

85
 Physical Features Of The Newborn
• The newborn must be examined thoroughly within 24 hrs of
birth.
• Before the actual examination, the important maternal and
perinatal history should be reviewed.
 Maternal history: age, parity, medical disorders…
 Pregnancy problems: present & past drugs, IUFD, pre-
eclampsia, IUGR, prematurity.
 Labor & delivery history: duration, anesthesia, APGAR score
should be obtained.s

86
Assessment:
• The Initial Assessment:
APGAR SCORING SYSTEM.
Purpose:
 To assess the immediate status of the
newborn.

87
88
 Cont.,.,
• Examination of vital signs:
 Temperature: ( rectal, oral or axillary).
 Respiration: Normal- 30-60 breaths/min.
 Pulse: Normal- 100-160 beats/min.
 Blood pressure: Normal range- 45 to 60/25-40
mmHg. BP is directly related to the gestational age
and birth weight of the infant.

89
 Cont.,.,
• General Examination:
Posture:
Flexion of head & extremities, taking them
toward chest & abdomen.

90
Posture

91
Head Circumference

92
Chest circumference

93
 Cont.,.,
• Skin color: It is the single most parameter of
cardiorespiratory function.
• Pallor.
• Cyanosis.
• Jaundice
• Extensive bruising.

94
Skin color

95
Cont.,.,

96
Physiological Jaundice

97
Milia

98
 Cont.,.,
• Small white or yellow pinpoint spots.
Common on the nose, forehead, &
chin of the newborn infants due to
accumulations of secretions from the sweat &
sebaceous glands that have not yet drain
normally.
They will disappear within 1-2 weeks,
they should not expressed.

99
Mangolian Spots

100
 Cont.,.,
• Black coloration on the lower back, buttocks,
anterior trunk, & around the wrist or ankle.
• They are not bruise marks or a sign of mental
retardation, they usually disappear during
preschool years without any treatment.

101
Erythema Toxicum

102
Diaper Rash

103
Vernix Caseosa

104
 Cont.,.,
• Soft yellowish cream layer that may thickly
cover the skin of the newborn, or it may be
found only in the body creases and between
the labia.

105
Lanugo

106
 Cont.,.,
• The more premature baby is, the heavier the
presence of lanugo is.
- It disappears during the first weeks of life.

107
Desquamation

108
 Cont.,.,
• Peeling of the skin over the areas of bony
prominence that occurs within 2-4 weeks of
life because of pressure and erosion of sheets.

109
 Head
• The Anterior fontanel: is diamond in shape,
located at the junction of 2 parietal & frontal
bones. It is 2-3 cm in width & 3-4 cm in length.
It closes between 12-18 months of age.
The posterior fontanel: is triangular in shape,
located between the parietal & occipital
bones.
It closes by the 11/2nd month of age.

110
 Cont.,.,
• Two conditions may appear in the head:
Caput succedaneum & cephalhemtoma.

111
112
Caput succedaneum

113
 Cont.,.

• An edematous swelling on the presenting portion of

the scalp of an infant during birth, caused by the
pressure of the presenting part against the dilating
cervix. The effusion overlies the periosteum with
poorly defined margins.
• Caput succedaneum extends across the midline and
over suture lines. Caput succedaneum does not usually
cause complications and usually resolves over the first
few days. Management consists of observation only.

114
Cephalhematoma

115
 Cont.,.,
• Cephalhematoma is a subperiosteal collection
of blood secondary to rupture of blood vessels
between the skull and the periosteum, in
which bleeding is limited by suture lines
(never cross the suture lines).

116
 Eyes
• Usually edematous eye lids
- Gray in color. True color is not determined
until the age of 3-6 months.
- Pupil: React to light
- Absence of tears
- Blinking reflex is present in response to touch
- Can not follow an object (Rudimentary
fixation on objects).

117
Normal Eye

118
Eyelid Edema

119
Dysconjugate Eye Movements

120
Subconjunctival Hemorrhage

121
Congenital Glaucoma

122
Congenital Cataracts

123
Ears

124
Ear Tag

125
 Nose
• Nasal Patency (stethoscope).
• Nasal discharge – thin white mucous

126
Dislocated Nasal Septum

127
 Mouth & Throat
• Intact, high arched palate.
• Check for any cleft lip or palate.
• Epstein pearls.(are brittle, white, shine spots near
the center of the hard palate. They mark the
fusion of the 2 hollows of the palate. If any; it will
disappear in time).
• Natal teeth.
• Lingual Frenulum ( tongue tie).
• Oral thrush.
128
Epstein Pearls & cheeks

129
Normal Tongue Ankyloglossia

130
 Neck
• Short, thick, usually surrounded by skin folds.

131
 Abdomen
• Cylindrical in shape.

132
 Normal Umbilical Cord

• Bluish white at
birth with 2
arteries & one
vein.

133
Meconium Stained Umbilical Cord

134
 Respiratory system

• Slight substernal
retraction evident
during inspiration

135
 Cont.,.,

• Xiphesternal
process evident

136
Female genitalia

137
 Cont.,.,
• Labia & Clitoris are
usually edematous.
• Urethral meatus is
located behind the
clitoris.
• Vernix caseosa is
present between
labia

138
 Maternal hormonal withdrawal

• Female
genitalia,
normal with
vaginal
discharge

139
 Male genitalia
• Urethral opening is at
tip of glans pens.
• Testes are palpable in
each scrotum.
• Scrotum is usually
pigmented, pendulous
& covered with rugae.

140
 Endocrine system

• Swollen breasts:
Appears on 3rd day in both sex, & lasts for 2-3
weeks and gradually disappears without
treatment.
N.B: The breasts should not be expressed as
this may result in infection or tissue damage.

141
 The Central Nervous system
• Reflexes:
Successful use of reflex mechanism is a
strong evidence of normal functioning CNS.

142
NEUROMUSCULAR MATURITY
REFLEXES

145
Cont.,.,

146
NEWBORN REFLEXES
 THE TERM NEWBORN INFANT
DEFINITION:
A healthy infant born at term ( b/w 38-42 weeks)
should have an average birth weight ( usually
exceeds 2500g), immediately following birth ,
establishes independent rhythmic respiration and
quickly adapts to the changed environment.
 Cont.,..
Reflex behaviours:
a) Muscle tone:
• Hypotonia (floppiness) or hypertonia
(increased resistance).
b) Reflexes:
• A reflex is an involuntary or automatic, action
that the body does in response to something
without even having to think about it.
 Cont.,.,
Types of Reflexes:

GENERAL BODY REFLEXES FACIAL REFLEXES

ORAL REFLEXES
General reflexes:
S.no. Name of the reflex Stimuli Response
1. Moro Reflex Change infant’s position Bilateral symmetrical
suddenly or place on back extension and
on flat surface abduction of all
extremities, with thumb
and fore finger forming
characteristic followed
by adduction of
extremities to relaxed
flexion
 Cont.,.,
S.no. Name of the reflex Stimuli Response

2. Startle Reflex Expose infant to Infant adducts and

sudden movement or flexes all extremities
loud noise and may begin to cry
 Cont.,.,
S.no. Name of the reflex Stimuli Response

3. Palmar grasp Reflex Place finger in palm of Infant’s finger will

infant’s hand curl around object
and hold
momentarily.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

4. Stepping/Dancing Hold infant in upright Infant will step with

Reflex position and touch one one foot and the
foot to flat surface other in walking
motion.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

5. Limb placement When the front of the The infant lifts the
Reflex leg below the knee, or limb over the edge.
arm below the elbow is
brought into contact
with edge of the table.
 Cont.,.,
S.no. Name of the reflex Stimuli Response
7. Tonic Neck Reflex Turn infant’s head to one Extremities on side to
side when infant is resting which head is turned
will extend and
opposite extremities
will flex. Response may
be absent or incomplete
immediately after birth
 Cont.,.,
S.no. Name of the reflex Stimuli Response

8. Babinski Reflex Stroke one side of foot Infant’s toes will

upward from heel and hyper external and
across ball of foot. fan apart from
dorsiflexion of big
toe.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

9. Parachute Reflex Holding the infant in Arms extend as

ventral suspension and defensive action.
suddenly lowering him
downwards.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

10. Landau Reflex Infants when held Extension of neck,

horizontally in the prone trunk and hips
position with the head, (superman appearance).
legs and spine extended.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

11. Withdrawal Reflex A pinprick or sharp Flexion and

painful stimulus to sole withdrawal of
of foot stimulated leg
 Cont.,.,
S.no. Name of the reflex Stimuli Response

12. Babkin Reflex Deep pressure applied Infant will response by

simultaneously to the flexion or forward
palms of both hands while bowing of head,
the infant is in supine opening of the mouth
position. and closing of the eyes.
 Cont.,.,
S.no. Name of the reflex Stimuli Response
13. Trunk in curvature Reflex Placing the infant on the Infant’s trunk curving
stomach or lightly supporting toward the stimulated
him or her under the side.
abdomen with a hand and,
using a fingernail, gently
stroking one side of the
neonate's spinal column from
the head to the buttocks.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

14. Gallant Reflex Gently stimulate along the Infant will laterally flex
paraveterbral area from towards the stimulated
the C7 area to the buttocks side
 Cont.,.,
S.no. Name of the reflex Stimuli Response

15. Tendon Reflex Stimulated by a tap on the An involuntary upward

tendon located just below swinging of the lower
the knee. leg and foot.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

16. Tonic Labyrinthine Position the baby Supine – Maximal

Reflex either in a supine extensor tone
position or prone Prone – Maximal
flexor tone
 Cont.,.,
S.no. Name of the reflex Stimuli Response

17. Neck righting Reflex Turn head when the Body logrolls
infant is in supine. towards the same
side.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

18. Body righting Reflex Turn the infant to one Infant will rotate the
side. head in the direction
in which the body is
rotated.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

19. Otolith Righting Tilting of the body Infant will turns the
Reflex when the infant is in head to return to the
erect position. upright position.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

20. Cremasteric Reflex Stroking in the upper Elevation of

thigh towards the groin ipsilateral testicle.
Facial reflexes:
S.no. Name of the reflex Stimuli Response

1. Glabellar/Blinking Tap the bridge of Infant will blink with

Reflex infant’s nose when eyes first four or five taps.
will open.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

2. Nasal Reflex Stimulation of the face It produces apnea for

or nasal cavity with the neonates, exhibits
water or local irritants. bradycardia and
lowering of cardiac
output.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

3. Dolls eye reflex When the infant’s head Infant’s eyes lag
is slowly turned to right behind and do not
or left. immediately adjust to
a new position of
head.
Oral reflexes:
S.no. Name of the reflex Stimuli Response

1. Rooting Reflex When the corner of Infant turns head in

mouth is gently stroked direction of stimulus/
with finger or nipple. opens mouth & begin
to suck.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

2. Sucking Reflex Place a finger or nipple Infant will starts to

into the infant’s mouth. suck immediately.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

3. Swallowing Place fluid on back of Infant swallow, in co-

tongue. ordination with
sucking.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

4. Gag Reflex When the posterior part Infant will thrust his
of the tongue is tongue forward.
stimulated.
 Cont.,.,
S.no. Name of the reflex Stimuli Response

5. Extrusion When the tip of the Infant pushes tongue

tongue is touched with outwards.
the finger or nipple.
HUNGER CUES
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