Slide 1

Definition: New born (nb) is the child of the first month
of life (first 28 days).
Birth → traumatized n.b. → high mortality:
-in the first month = ½ of infant mortality
-the first week = 2/3 of the first month mortality
Criteria for evaluating the degree of maturity of the
Temporal criterion:
GA assessment calculation from the first day of last
menstrual period
full term: GA = 37 - 42 weeks
premature: GA <37 weeks
lower limit of viability (WHO criteria):
- GA = 22 weeks
- W over 500g
postmature GA > 42 weeks.
Criteria for evaluating the degree of
maturity of the n.b.
2. Morphofunctional criteria:
GA characteristics can be assessed by evaluating:
- skin
- flag ear
- genitals
- mammary glands.
The Ballard score used is to be performed at 3-42 hours
after birth.
Criteria for evaluating the degree of maturity of the
3. Neurological Criteria - findings passive posture and
tone → muscle tone increases with GA and has a caudocephalic development :
at 28 weeks of gestation → hypotonic;
at 32 weeks → all 4 extremities in extension;
at 34 weeks → batracian position;
at 40 weeks → all four extremities are in flexion.
Criteria for evaluating the degree of
maturity of the n.b.
4. Anthropometric Criteria
(interpretation of W, H according to GA)
After birth weight (Wb):
N.b. normal NG: 2500 - 4000 g (mean 3000 g)
N.b. macrosomia: greater than 4000 g Gn
N.b. small: less than 2500 g
After the value of WI at birth
IP = G (g) ∕ T (cm3) X 100
N.b. full term
N.b. premature
N.b. postmature
IP = 2,3 - 3
IP < 2,3
IP > 3
IP = 2 – 2,3
IP < 2
IP > 2,3
IP = 2,3 - 3
IP < 2,3
IP > 3
Criteria for evaluating the degree of
maturity of the n.b.
N.b. with Wb <2500 g:
N.b. LBW (Low Birth Weight): Wb = 25001500 g
N.b. VLBW (Very Low Birth Weight):
Wb = 1499-1000 g
N.b. ELBW (Extremly Low Birth Weight):
Wb below 1000 g.
Hight at birth (Hb): 47-55 cm, 50 cm on
The anatomic and physiological features of the
full term newborn
The face is small.
Anterior fontanelle (bregma)
FA = 3cm/4cm,
progressively closed until the age of 18 months.
Posterior fontanelle (lambda)
birth → closed / open (6-8 mm)
close to 6-8 weeks.
 Sagittal suture is sometimes wide – congenital soft
Nose: short, concave, nostrils look forward.
Ears: rule and implanted.
Neck: short.
Chest: almost cylindrical.
high, exceeding ribs,
abdominal wall muscle tone is low.
Umbilical cord (UC): mummification → training →
disposal trench to fall between the 6th and 10th-day
- the epidermization of umbilical wound → gradually from
periphery to center
- end-healing by the 3rd week
- umbilical scar vessels are clogged due to shrinkage
Lower limbs: short
Intern condyles are less developed limbs → încurbarea
Vertebral column → almost straight after birth.
- intense red (erythema newborn)
- blue palms and plants.
Redness n.b. is the result:
- abundance of short and wide capillaries,
- imperfection vasomotor function,
- thinness epidermis (stratum horn missing and
melanin pigment).
Vernix caseosa:
- fat blanket, yellowish, covering the skin especially on
dorsal region, chest, neck and flexion creases;
- secreted by the sebaceous glands and specialized cells
of the amnion;
- rich in glycogen, fatty acids, cholesterol and protein.
Vernix caseosa:
- fetal protection against the cold;
- protection against skin maceration by amniotic fluid;
- food intake;
- bactericidal and antihaemolytical.
If a stray → hypothrombin emphasized.
Physiological desquamation:
- appears a few days after birth;
- furfuraceous / lamellar.
N.b. toxic erythema (Erythema Neonatorum Toxicum)=
awareness of maternal protein / antigen passed through
the intestinal mucosa to which the child has formed an
- microscopic →infiltration of eosinophils;
- cultures are negative;
N.b. toxic erythema (Erythema Toxicum Neonatorum)
- onset 24-48 hours after birth;
- small erythematous areas, centered by a yellow
-located on the front, back, buttocks and extremities;
comply with plants and palms;
- ± other symptoms allergic coryza, swelling of
eyelid edema;
-resolves spontaneously without scarring;
- strict hygiene is recommended;
- not given any treatment.
Maternal nevi:
- red spots, badly defined;
- upper eyelid, bridge, neck;
- disappear after a few months ± brown spots.
Mongolian spot:
- blue stain;
- variable size;
- region lumbo - sacral;
- without pathological significance.
Maternal nevi
Mongolian spot
- baby fine hair covering the skin;
- after birth → shoulders, back, head, limbs;
- most abundant on n.b. premature
- not have longitudinal ribs;
-finger pulp outperforms the hands and feet barely
Sweat glands are less developed.
Sebaceous glands:
- are well developed;
- 3-6 days after birth in both sexes occur in the wings,
nose, cheeks, forehead and chin point elements, small
sebaceous gland cysts disappear spontaneously =
milium facial
Adipose panicle is developed on the face, limbs and no
less than the abdomen.
- incomplete development of cortical centers and
nerve pathways to the predominant physiological
muscle hypertonia → flexion;
→ hypotonic neck muscles → head support.
thorax → cylindrical
ribs → horizontal,
ant. diameter >post.
breathing type → abdominal.
Respiratory Rate (RR)
60 resp / min n.b.,
45 resp / min to 1 month
35 resp / min at 1 year.
Sometimes irregular pace → apnea crisis, rhythm
Cheyne - Stokes
→ sometimes unequal amplitude.
The mechanism first breaths:
- chemical and humoral factors = CO2 accumulation
lack of O2 by placental disruption;
- ambient excitations of free nerve terminations leather;
- thorax to relax, limbs. sup. pass the abduction →
volume increase of vacuum pleural rib → CRI air
suction → vagus nerve stimulation ends.
Heart → globular, situated transversely;
- apexian shock → sp. IV, at 1-2 cm outside m.c. l.;
-myocardium elastic and connective tissue →least
- epicardial → very thin;
- heart sounds → are more powerful charge.
Arteries → increased content of elastic fibers + large
calibre → hypotension general physiological size.
Peripheral Circulation:
-slow → cold extremities, cyanotic (SaO2 = normal)
- vascular permeability and capillary fragility ↑.
Heart rate:
160 beats / min. the n.b.,
120 beats / min at the end of the first month.
Blood pressure:
~ 70-80 mm Hg SBP
~ DBP 40-50 mm Hg
Hemoglobin (Hb) and hematocrit (Ht):
- higher values if the umbilical cord is pinched "late"
(after cessation of pulsations);
- shows changes in physiological function of Wb and
the child's age.
The values of hemoglobin, hematocrit and reticulocyte
count in the first week of life
Umbilical First 24
24 – 72
First week
Hb (g%)
17 - 18
18 - 19
17 - 18
Ht (%)
50 - 55
55 - 60
50 - 55
Retic. (%) 3 - 5
 birth = 5-6 mil/mm3
 after 24-48 hours → hemolysis → 4-5 mil/mm3
 increased mechanical fragility
 increased metabolic activity
 shortened life span.
 leukocyte number make changes quickly in the first
days of life
 PMN →structural and functional immaturity.
Leukocytes and leukocyte formula values at nb
First day
First week
Leukocyte /mm3
18 000 – 20 000
12 000
PMN (%)
55 – 60
45 – 50
Ly (%)
Mo (%)
5 – 10
Eo (%)
deficient in the first 6 months of life;
 platelets = 150 000 - 300 000/mm3;
 coagulation factors dependent on vitamin-K = low;
 clotting time = prolonged
The digestive system → features:
 mouth → adaptations for sucking;
 intestinal microbial flora;
 meconium.
Intestinal microbial flora:
 of the fetus intestinal tract = sterile.
 during birth colonize the oral cavity: Staphylococcus,
colibacillus, streptococci, etc..
After ~ 2 weeks:
 the n.b. breast-fed → bacillus bifidus,
 the n.b. bottle-feed → bacillus coli.
 n.b. stool within 2-3 days
 viscous and dark green;
 consists of:
- bile components: cholesterol, fat, mineral salts, bile
- amniotic elements: lanugo, squamous cell skin cells,
- elements of the digestive tract: intestinal cells, gastric
juice, intestinal, pancreatic, with their yeast.
is followed by a transitional stool, brown, curdled
typical human milk: yellow-orange
 occur in 2-3 days
 are 4-6 in 24 hours.
Transition stool
Salivary amylase:
 present at birth;
 and acts in the gut - compensates deficit amylase
Lingual lipase - normal activity at birth.
Gastric lipase:
 increased activity in n.b.
 preferentially hydrolyzes TG - compensates low
pancreatic lipase activity.
Pancreatic enzyme secretion:
 protease - normal activity;
 lipase - low activity;
 amylase - absence.
Intestinal enzyme secretion = complete
2 cm below the ribs;
are deficient at birth:
 liver detoxification activity
synthesis of coagulation factors, the lipoprotein and
Spleen - up to 1 cm below the rib.
Kidney - functional deficit:
 glomerular filtration - reduced (further increase);
 dilution capacity - normal
 ability to concentrate - limited;
 reduced capacity to excrete electrolytes;
 postnatal hemolysis - transient hyperuricemia infarcts uratic - brick-red deposit on the diapers.
Diuresis = 75-100 ml / kg
 appear to achieve reflex
bladder capacity;
 the number of 10 20/day.
External genitalia:
 penis is short
 scrotal skin? cross-ply
 testicles are descended
into the scrotum / channels
are palpeaza inghino-scrotal
 hydrocele? frequently
 phimosis? considered
 vulvar region - completely
 large labia, clitoris and
labia minora cover
Nervous System
 myelination of axons - CNS maturation
Immature nervous system expression:
 exaggerated reflexes;
 plantar reflex = positive (Babinski reflex);
 spontaneous motor activity = generalized, anarchic
Babinski reflex
catatonia (attitudes → persistent tendency);
 subcortical phenomena (sucking and swallowing,
screaming and crying) are present at birth
(phylogenetically older segments are more developed
than the crust).
Primitive reflexes:
 signifies the integrity of subcortical centers;
disappear after 4-5 months (cortical inhibition occurs);
their asymmetry indicates SN lesions (intracranial
hemorrhage, brachial plexus palsy).
Sense organs:
 n.b. not to color, but the eyes react to light;
eye movements are uncoordinated (convergent
strabismus is almost physiological transient);
lacrimal glands are small and secret tears after 3
weeks age.
 present at birth;
 n.b. react to strong auditory stimuli;
 ear - anatomical features:
- ear canal = narrow, directed obliquely;
- trunk = wide, short, horizontal
- mastoid = small and compact;
 pneumatization ear occurs with the first inspiration
and swallowing.
 n.b. different from the sweet bitter taste.
Sense of smell:
 present at birth (olfactory centers → among the first
Sense of touch:
 well developed at birth;
 stand out in some archaic reflexes (the cardinal
points, and lashing).
Thermal Adaptation:
n.b. - thermal instability
 is limited;
 major role - brown fat (interscapular, neck, axilla,
mediastinum, between the esophagus and trachea,
around the pancreas, kidneys and adrenal glands);
 low ambient temperature - cutaneous receptors catecholamines release and oxidation of fatty acids in
brown fat → heat;
 immaturity of neural centers→ often n.b. not
respond to infection by fever.
Thermolysis - rated:
 large skin surface;
 with abundant blood supply;
reduced subcutaneous fat tissue.
New born can maintain constant temperature (36.5
°C at the abdominal skin and central temperature 37
° C) in terms of thermal ambient comfort from 21 to
26 °C.
Nonspecific immunity: mechanical barrier (skin and
mucous membranes) - low:
 extreme thinness of the stratum corneum;
 extremely reduced sweat secretion;
 mucosa - important degree of permeability.
Nonspecific cellular immunity - small role in n.b.:
 reduce leukocyte response to an infection;
 low phagocytic capacity;
 absence of limiting infectious process;
 infections tend to generalize.
nonspecific humoral immunity:
 Lysozyme inhibits some bacteria - saprophytic
colonization of normal mouth flora;
 serum complement system, and properdin
opsoninelele - poor;
 interferon synthesis - normal.
Specific immunity:
 cell: T and B lymphocytes - functional maturity.
Ig G:
 values equal to those in maternal blood;
 only crossing the placenta (third trimester of
 Ac contain - antibacterial, antiviral, antitoxin
depending on the degree of stimulation of the mother;
 decrease around the age of 3 months and then
increase (immunogenesis own).
Ig M:
 does not cross the placenta;
 own synthesis begins 5-6 days after birth.
The serum IgA:
 do not cross the placental barrier,
 appear in blood n.b. age 2 weeks.
Secretory Ig A (IgAs):
 between the serum and secretory Ig A correlation
does not exist;
 IgAs synthesis is a priority in respiratory and
gastrointestinal mucosa;
 at 2 weeks they are found in appreciable amounts in
all mucous membranes.
Ig E:
 does not cross the placenta;
 is synthesized in the mucosa, tonsils, adenoids and
lymph nodes.
Ig D:
 are produced in cells in palatine tonsils and lymph
 found in small amounts in serum.
Phenomena characteristic of newborn period
1. Physiological decrease in weight
 n.b. within 3-4 days lose 6-10% of Wb (150-200g);
 8-10 days after returns to the original weight.
Determined by:
 fluid losses (urine, meconium, perspiration,
respiration, evaporation from the skin);
 regime of starvation and thirst in the early days
(maternal lactation failure) - ± book burning tissues of
its own tissues;
 massive destruction of leukocytes and erythrocytes.
Phenomena characteristic of newborn lives
2. Physiologic jaundice:
 occurs in 70-80% of n.b. between the 2nd and 4th day
of life;
 maximum intensity on day 4-5;
 disappear within two weeks (sometimes 3-4 wks.)
 clinical manifestations of BT values> 40 mg / l;
 him to be called physiological → BT <120 mg / l;
 no hepato / splenomegaly;
 normal colored urine and stool;
 drowsiness, muscle weakness (not to disrupt
Phenomena characteristic of newborn lives
2. Physiologic jaundice:
Extrahepatic Causes:
 absence of placenta as a way to eliminate bilirubin;
 crisis of massive destruction of red cells = red blood
cells - training in excess of bilirubin;
 capillary permeability - jaundice is most evident on
the skin.
Hepatic causes:
 uridindifosfatglucuroniltransferaza deficiency
 glucuronic acid deficiency.
Phenomena characteristic of newborn lives
Predisposing factors:
 Late removal of meconium (↑ BT);
 eating late (↑ BT);
 CO pinching late↑ blood volume ↑ hemolysis ↑ BT;
 Wb under 3kg and over 4.5 kg ↑ intense jaundice.
Treatment: usually not necessary.
Exception: phototherapy in some n.b. prematurely
(preventing kernicterus).
Phenomena characteristic of newborn lives
3. Genital crisis (hormone):
 occurs 3-6 days after birth in both sexes;
 lasts ~ 2 weeks;
 caused by maternal hormones that go into circulation
nn uterine contractions during birth.
Clinic in both sexes:
 milium facial
 mammary gland swelling (pressure ~ colostrum
secretion, wringing favors infection).
Phenomena characteristic of newborn lives
3. Genital crisis (hormone)
vulva and vagina:
 edema
 congestive mucosa
 ± whitish vaginal
discharge, sometimes with
bloody streaks
swollen testicles
hydrocele uni / bilateral
swelling of the penis
Phenomena characteristic of newborn
4. Albuminuria Physiology:
 disappears after a week;
 is due to increased glomerular permeability.
5. Infarcts uratice:
 and white tissue damage in the early days? increased
elimination of uric acid and urate in the urine;
 urine = cloudy → red brick warehouse on the diaper
(amorphous urate and uric acid salts).
Phenomena characteristic of newborn lives
6. Transient fever:
 sometimes occurs in the 3rd, 4th day;
 lasts between 12-48 hours;
 can reach 39-40 °C.
Cause = dehydration:
- insufficient intake of fluids
- loss of fluids from the first days of life.
Disappears after hydration.
7. Meconium = stool in the first 2-3 days.
Assessment of infant health
APGAR score evaluates:
 Appearance (skin color)
 Pulse (heart beat frequency)
 Grimace (reflex response to stimuli)
 Attitude (muscle tone)
 Respiration (breathing frequency)
These parameters:
 Inquire at 1, 5, 10 and 20 min after birth;
 Is marked with 0, 1 or 2.
(Skin Color)
Blue-gray, pale Normal,
all over
except for
Normal over
entire body
Below 100
Above 100
Sneeze, cough,
pulls away
No Response
(Muscle Tone)
Arms and Legs Active
Slow, irregular Good, crying
New born care
New born care
Delivery room:
 aseptic;
 temperature of 24-26 ° C.
 application of the umbilical cord clamps, 2-3 cm from
its insertion (after cessation of pulsations), then cutting
 the newborn is welcomed into the fields / sterile
napkins on the table with radiant heat.
 vacuum nasopharyngeal secretions after expulsion, a
suction probe / para rubber.
 assessment of health status n.b. by performing the
Apgar score.
New born care
New born care
New born care
New born care
Prophylaxis of gonococcal oftalmy:
 Ag nitrate solution 1% (1 drop in each
conjunctival sac bottom);
 Ophthalmic ointment erythromycin /
Prevention of haemorrhagic disease - 1 mg vit. K1
i.m. antero-external face of the thigh at all n.b.
New born care
 Hepatitis B vaccination → 0.5 ml, i.m, antero-
external face of the thigh.
 Wb,
Hb, HCb, TCb
detection of possible malformations.
In the newborn section → neonatologist:
 correct classification;
 detection of possible pathologies.
New born care
New born care
Screening - detection of genetic
diseases, metabolic, hematologic and endocrine
 Washing
n.b. immediately after birth is not
indicated for not remove vernix caseosa.
 After
the fall of the umbilical cord, the wound is
to fully epidermization daily.
 The
first is general bathroom after umbilical
wound healing (until then → toilet partial).
New born care
Rooming-in system:
 emotional tie between
mother and child;
 acquisition of correct
habits and nutrition care.
New born care
BCG vaccine
(age 4-7 days)
 all n.b. G> 2500g;
 no signs of acute
febrile infections /
New born care
Prevention of rickets:
 is initiated in the 7-10 day life
 Vitamin D ~ 500 U.I. Daily (2 Vigantol drops /
day p.o.).
 Perfect – breast-feeding;
 In special cases - combined / bottle-feeding.
New born care

similar documents