CHAPTER 111 BRIEF OVERVIEW OF NEONATESA neonatefrom Latin neonatus is a baby

CHAPTER 11.1: BRIEF OVERVIEW OF NEONATESA neonate(from Latin, neonatus) is a baby who is 4 weeks old or younger also called a new born. The term applies to premature, mature and postmature infants. The neonatal period is the first 4 weeks of a child’s life and it is a time when changes are very rapid. During these first 4 weeks of life,the child is at highest risk of dying. It is therefore crucial that appropriate feeding and care are provided during this period, both to improve the child’s chances of survival and to lay foundations for a healthy life. Many critical events can occur in this period:• Feeding patterns are established.• Bonding between parents and infant begin.• The risks for infections that may become more serious are higher.• Many birth or congenital defects are first noted.After the first hour of life, newborns should receive eye care, vitamin K, and recommended immunizations (birth dose of OPV and Hepatitis B vaccine). They should be assessed for birth weight, gestational age, congenital defects and signs of newborn illness. Special care should be provided for sick newborns, those who are preterm and/or low birth weight, and those who are exposed or infected by HIV or have congenital syphilis.Apgar scoringThe Apgar score helps find breathing problems and other health issues. It is part of the special attention given to a baby in the first few minutes after birth. The baby is checked at 1 minute and 5 minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color. A baby who needs help with any of these issues is getting constant attention during those first 5 to 10 minutes. In this case, the actual Apgar score is given after the immediate issues have been taken care of.Each area can have a score of 0, 1, or 2, with 10 points as the maximum. Most babies score 8 or 9, with 1 or 2 points taken off for blue hands and feet because of immature circulation. If a baby has a difficult time during delivery and needs extra help after birth, this will be shown in a lower Apgar score. Apgar scores of 6 or less usually mean a baby needed immediate attention and care.Sign Score = 0 Score = 1 Score = 2Heart rate Absent Below 100 per minute Above 100 per minuteBreathing effort Absent Weak, irregular, or gasping Good, cryingMuscle tone Flaccid Some flexing of arms and legs Well-flexed, or active movements of arms and legsReflex or irritability No response Grimace or weak cry Good cryColor Blue all over, or pale Body pink, hands and feet blue Pink all overBirth weightA baby’s birth weight is an important marker of health. Full-term babies are born between 37 and 41 weeks of pregnancy. The average weight for full-term babies is about 7 pounds (3.2 kg). In general, very small babies and very large babies are at greater risk for problems. Babies are weighed every day in the nursery to look at growth, and the baby’s need for fluids and nutrition. Newborn babies may often lose 5% to 7% of their birth weight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 8 ounces in the first few days. Babies will usually gain this weight back within the first 2 weeks after birth. Premature and sick babies may not begin to gain weight right away.MeasurementsThe hospital staff takes other measurements of each baby. These include:• Head circumference. The distance around the baby’s head.• Abdominal circumference. The distance around the belly (abdomen).• Length. The measurement from top of head to the heel.The staff also checks these vital signs:• Temperature. This checks that the baby is able to have a stable body temperature in normal room.• Pulse. A newborn’s pulse is normally 120 to 160 beats per minute.• Breathing rate. A newborn’s breathing rate is normally 40 to 60 breaths per minute.Physical examA complete physical exam is an important part of newborn care. The healthcare provider carefully checks each body system for health and normal function. The provider also looks for any signs of illness or birth defects. Physical exam of a newborn often includes:• General appearance. This looks at physical activity, muscle tone, posture, and level of consciousness.• Skin. This looks at skin color, texture, nails, and any rashes.• Head and neck. This looks at the shape of head, the soft spots (fontanelles) on the baby’s skull, and the bones across the upper chest (clavicles).• Face. This looks at the eyes, ears, nose, and cheeks.• Mouth. This looks at the roof of the mouth (palate), tongue, and throat.• Lungs. This looks at the sounds the baby makes when he or she breathes. This also looks at the breathing pattern.• Heart sounds and pulses in the groin (femoral)• Abdomen. This looks for any masses or hernias.• Genitals and anus. This checks that the baby has open passages for urine and stool.• Arms and legs. This checks the baby’s movement and development.Gestational assessment The healthcare provider will check how mature the baby is. This is an important part of care. This check helps figure out the best care for the baby if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than he or she appears by size, and may need different care than a premature baby needs.Healthcare providers often use an exam called the Dubowitz/Ballard Examination for Gestational Age. This exam can closely estimate a baby’s gestational age. The exam looks at a baby’s skin and other physical features, plus the baby’s movement and reflexes. The physical maturity part of the exam is done in the first 2 hours of birth. The movement and reflexes part of the exam is done within 24 hours after birth. The provider often uses the information from this exam to help with other maturity estimates.Physical maturityThe physical maturity part of the Dubowitz/Ballard exam looks at physical features that look different at different stages of a baby’s gestational age. Babies who are physically mature usually have higher scores than premature babies.Points are given for each area of assessment. A low of -1 or -2 means that the baby is very immature. A score of 4 or 5 means that the baby is very mature (postmature). These are the areas looked at:• Skin textures. Is the skin sticky, smooth, or peeling?• Soft, downy hair on the baby’s body (lanugo). This hair is not found on immature babies. It shows up on a mature infant, but goes away for a postmature infant.• Plantar creases. These are creases on the soles of the feet. They can be absent or range up to covering the entire foot.• Breast. The provider looks at the thickness and size of breast tissue and the darker ring around each nipple (areola).• Eyes and ears. The provider checks to see if the eyes are fused or open. He or she also checks the amount of cartilage and stiffness of the ears.• Genitals, male. The provider checks for the testes and how the scrotum looks. It may be smooth or wrinkled.• Genitals, female. The provider checks the size of the clitoris and the labia and how they look.Maturity of nerves and musclesThe healthcare provider does 6 checks of the baby’s nerves and muscles.A score is given to each area looked at. Typically, the more mature the baby is, the higher the score. These are the areas checked:• Posture. This looks at how the baby holds his or her arms and legs.• Square window. This looks at how far the baby’s hands can be flexed toward the wrist.• Arm recoil. This looks at how much the baby’s arms “spring back”” to a flexed position.• Popliteal angle. This looks at how far the baby’s knees extend.• Scarf sign. This looks at how far the baby’s elbows can be moved across the baby’s chest.• Heel to ear. This looks at how near the baby’s feet can be moved to the ears.When the physical assessment score and the nerves and muscles score are added together