 2.

TERMS: Neonatology: The branch of pediatrics that deals

with the diseases and care of newborns.
 Neonatal period: From birth to the 28th day of life (4 weeks
after birth).
 Perinatal period: From the 28th completed week of gestation
to the 7th day after birth.
 3. Classification of the neonates By both GA and BW By birth
weight By gestational age
 4. TERMS: Full term infant: An infant born at a gestational age
between 37 and 42 completed weeks
 Preterm infant: An infant that is born prior to 37 weeks of
gestation (22 -37 weeks or weight greater than 500g).
 Post-term infant: An infant that is born after the 42nd week of
gestation
 5. AGA ( appropriate for gestational age) Infants with birth
weight for their gestational age that falls between the 10th and
90th centiles.
 SGA ( small for gestational age) Infants with birth weight for
their gestational age that falls below the 10th centiles.
 LGA ( large for gestational age) Infants with birth weight for
their gestational age that falls above the 90th centiles.
 6. GA 40 w,GA 40 w, BW3000g BW3000g GA 34 w,GA 34 w,
BW2000gBW2000g
 8. Assessment: The initial assessment: APGAR scoring system
Purpose: is to assess the newborn´S immediate adjustment to
extrauterine life
 9. Apgar Score of the Newborn SIGNSCORE 0 1 2 Heart rate
Absent <100 beats/min >100 beats/min Respiratory effort
Absent Weak, irregular Strong cry Muscle tone Flaccid Some
flexion Well Reflex irritability (response to catheter in nostril)
No Grimace Cough or sneeze Skin colour Blue, pale extremities
blue pink
 10. Significance of Apgar score Healthy newborn: 7-10 at both
1 and 5 minutes Moderately depressed newborn: 3-6 (Need
resuscitation ) Severely depressed newborn: 1-3 (Intensive
resuscitation )
 11. The Apgar score is used to evaluate • brain function at birth
• circulatory status at birth • the effectiveness of respiratory
and circulatory adaptations thereafter • which babies need
active assistance (resuscitation).
 12. Purpose The APGAR scoring chart is used to evaluate the
conditions of the baby at birth, determine the need for
resuscitation, evaluate the effectiveness of resuscitative efforts,
to identify neonates at risk for morbidity and mortality.
 13. Transitional assessment (Periods of reactivity): First period
of reactivity: 13
 14. Stage 1: During the first 30 min. through which the baby is
characterized as Physiologically unstable ( ), very alert, cries
vigorously, may suck a fist greedily, & appears very interested in
the environment. 14
 15. 15 Stage 2: It lasts for about 2-4 hours, through this period;
all V.S & mucus production are decreased. The newborn is in
state of sleep and relative calm.
 16. Second period of reactivity It lasts for about 2-5 hours,
through which the newborn is alert and responsive, heart &
 respiratory rate, gastric & respiratory secretions are increased &
passage of meconium commonly occurs. 16
 17. Following this stage is a period of stabilization through
which the baby becomes physiologically stable & a vacillating
pattern of sleep and activity. 17
 18. Take Anthropometric Measurements Weight – 2, 500g – 4,
000g Physiologic weight loss - it is normal for the newborn
infant to loose 5-10% of weight in the first 4 to 5 days of life
(causes: low nutritional intake, defecation, urination); Length –
45-55 cm HC – 33-55 cm, 2-3 cm larger than chest CC – 30-
33cm, AC-29-33 cm
 19. Assessment of Growth
 20. Head Circumference HC – 33-55 cm, 2-3 cm larger than
chest
 21. Take Anthropometric Measurements Head Circumference
Chest Circumference Abdomen Circumference
 22. Fontanelles The anterior fontanel is located at the
intersection of the sutures of the two parietal bones and the
frontal bones. Anterior: diamond shape about 2- 3-4 cm, will
close in about 12 to 18 mos; The posterior fontanel is located
between of the sutures of the 2 parietal bones and occipital
bone. It is small, triangular shaped, normally closes at 1,5 to 3
mos of age.
 23. Respiratory system Fetal lung development Filled with fluid
Surfactant synthesis: begins at 24-28w, peak at 35w
Establishment of breathing after birth - opening of the alveoli
by mechanical,chemical,thermal, sensory stimuli Characteristics
of Newborn respirations Normal RR 30-60, shallow and
irregular, 5-15 second periods of apnea Apnea: no breathing for
 periods of greater than 15 sec Abnormal findings: retractions,
grunting, nasal flaring, more 15 sec apnea; abnormal rate
 24. Cardiovascular System
 25. Circulatory system Heart rate: ranges from 140 to 160 per
minute. Heart murmur: Transient murmurs may result from the
incomplete closure of the fetal circulation (the ductus arteriosis
or foramen ovale) 90% of all murmurs are transient and not
associated with anomalies. Blood pressure: from 46 to 80
mmHg (systolic)
 27. Hemotological system High: RBC 4.8-7.1; Hgb 14-24; Hct
44-64 18,000 @ birth; 23-25,000 @ 1 day with relative
neutrophilia Coagulation: Vit K dependent clotting factors are
decreased. Platelet counts ok (150,000-350,000) •These
characteristics are essential to provide adequate oxygenation in
utero and during the first few postnatal days before the lungs
expand fully. •Oxygenation improves during the first two weeks
of life to the extent that a high red cell count and hemoglobin
are no longer necessary, and haemolysis occurs. After the first
few days (5 days or so ) the white cell count is likely to be below
10 000/ mm3 with characteristically relative lymphocytosis of
infancy and early childhood. WBC:
 28. Gastrointestinal System sucking becomes coordinated @32
wks little saliva until 3 months of age Stomach hold 60 to 90 ml.
Regurgitates easily because of an immature cardiac sphinter
between the stomach and esophagus. Immature liver function
may lead to lowered glucosed and protein serum level.
 29. Alimentary system
 30. Hepatic Function Liver produces substances essential for
clotting of blood. Stores needed iron for the first few months.
Preterm & small infants have lower iron stores than full term
 (full term infants stores last 4-6 mo) Physiologic Jaundice - after
24-48 hs of age, d/t increased breakdown of RBC’s and
immature liver functioning. This is a yellow discoloration that
may be seen in the infant's skin or in the sclera of the eye.
Jaundice is caused by excessive amounts of free bilirubin in the
blood and tissue.
 31. JAUNDICE
 32. Urinary system Renal function: GFR - glomerular filtration
rate is lower, about one fourth to one half of that in an adult.
Kidneys not fully functional until child is 2 years of age. Urine
often contains protein in small amounts. Urine may contain an
abundance of urates which may give the diaper a pink stain
during the first week of life. The ability to dilute urine is good,
but the time taken to reach the maximal ability is relatively
long, so newborns are apt to become water overloaded.
 33. Kidneys and Urination initial urine: cloudy, scant amounts,
uric acid crystals-> reddish stain on diaper Urine pH ranges from
5 to 7, specific gravity ranges from 1.006 to 1.020. The first
urination occurs within 24 hrs. It ranges from 4 to 6 times/day
in the first days and 20 times or so /day in later days of the
neonatal period. Kidneys not fully functional until child is 2
years of age.
 34. Immune System Limited specific and Non-specific immunity
at birth passive immunity(from mom- IgG) for the first 3 months
of life ~ this will be reduced if baby is born premature
breastfeeding = ^ passive immunity (IgA)
 35. Neuromascular System Mature newborns demonstrate
neuromuscular function by moving their extremities,
attempting to control head movement, exhibiting a strong cry
and demonstrating newborn reflexes. A newborn occasionally
makes twitching or flailing movements of the extremities in the
 absence of stimulus because of the immature of the nervous
system.
 36. Newborn Reflexes Sucking reflex • When a newborn lips
are touched, the baby makes a sucking motion. • This reflex
helps a newborn find food: when the newborn lips touch the
mothers breast or bottle, the baby sucks and takes food. • The
sucking reflex begins to diminish at about 6 months of age
 37. Sucking place a finger in the neonate’s mouth neonate
sucks on the finger
 38. Newborn Reflexes Rooting reflex - If the check is brushed
or stroke near the corner of the mouth, a newborn infant will
turn the head in that direction. • This reflex serves to help a
newborn find food: when a mother holds the child and allows
her breast to brush the newborn’s cheek, the reflex makes the
baby turn toward the breast. • This reflex disappear at about
the sixth week of life.
 39. Rooting touch a finger to the neonate’s cheek or the corner
of mouth. neonate turns the head toward the stimulus, opens
the mouth and searches for the stimulus
 40. Newborn Reflex Blink Reflex - bright light shinning in eyes
or clap hands near eyes - closes eyelids quickly A sudden
movement to ward the eye can elicit the blink reflex.
Swallowing reflex - food that reaches the posterior portion of
the tongue, automatically swallowed. Gag, cough, and sneeze
reflexes are present to maintain airway in the event that normal
swallowing does not keep the pharynx free from obstructing
mucous.
 41. Baby is held horizontally, then swiftly lowered a few inches,
or the head may be lowered a few inches, or a loud sudden
noise will make baby's arms fling out and then come together
 as hands open then clutch. MORO reflex Absence or weakness
of this reflex may suggest a severely disturbed CNS
 42. Startle reflex sudden loud noise causes abduction of the
arms wit flexion of elbow, hand remain clenched disappears by
age of 4 months
 43. Palmar Grasp Reflex • newborn grasp an object placed in
their palm by closing fingers on it. • Mature newborn grasp so
strongly that they can be raised from a supine position and
suspended momentarily from an examiner’s fingers. • Reflex
disappears to 3 months of age.
 44. Grasp place a finger in the neonates palm neonate grasps
the finger
 45. PLANTERS GRASP Pressing thumbs against the balls of
baby's feed will make his toes flex. Absence of this reflex may
indicate damage to the spinal chord.
 46. Stepping reflex • Hold the neonate in an upright position
and touch one foot lightly to a flat surface (such as the bed)
neonate makes walking motions with both feet
 47. BABKIN When both of baby's palms are pressed, her eyes
will close, mouth will open and her head will turn to one side.
Absence of this reflex or if it reappears after vanishing around
3-4 mos., it may signify a malfunctioning CNS
 48. BABINSKI Absence of reflex may suggest immaturity of the
CNS, defective spinal chord, or other problems. Baby's foot is
stroked from heel toward the toes. The big toe should lift up,
while the others fan out.
 49. When newborn lie on their backs, their head usually turn to
one side or the other. The arm and the legs on the side toward
which the head turns extend, and the opposite arm and leg
contract. This is also called the boxer or fencing reflex. The
 reflex disappears between the second and third months of life.
Tonic neck reflex Fencing posture
 50. Extrusion Reflex - newborn extrudes any substance that is
placed on the anterior portion of the tongue. This protective
reflex prevents the swallowing reflex of inedible substance. It
disappears at about 4 months of age Extrusion Reflex
 51. Thermoregulation Newborn physiology •Normal
temperature: 36.5–37.5°C •Hypothermia: < 36.5°C --Significant
contribution to deaths in low birth weight infants and preterm
newborns •Stabilization period: 1st 6–12 hours after birth The
body temperature is likely to be influenced by the
environmental temperature. Neutral environmental
temperature: the environmental temperature at which the core
temperature of the infant at rest is between 36.7 and 37.3°C
and oxygen consumption and caloric utilization are lowest
 52. Newborn’s temperature may drop several degrees after
delivery because the external environment is cooler than the
intrauterine environment Rapid heat loss in a cool environment
occurs by conduction, convection, radiation and evaporation;
Cold stress in the newborn → an increase in the metabolic rate
--> increased O2 demands and caloric consumption, metabolic
acidosis Temperature Regulation
 53. 53 the infant lost his/ her body temperature: 1-
Evaporation: Heat loss that resulted from expenditure of
internal thermal energy to convert liquid on an exposed surface
to gases, e.g.: amniotic fluid, sweat. Prevention: Carefully dry
the infant after delivery or after bathing.
 54. 54 Heat loss occurred from direct contact between body
surface and cooler solid object. Prevention: Warm all objects
before the infant comes into contact with them.
 55. 55 resulted from exposure of an infant to direct source of
air draft. Prevention: · Keep infant out of drafts · Close
one end of heat shield in incubator to reduce velocity of air.
 56. 56 4- Radiation: It occurred from body surface to relatively
distant objects that are cooler than skin temperature.
 58. SKIN Observation and palpation
 59. SKIN Common variations Acrocyanosis - result of sluggish
peripheral circulation.
 60. Physiologic jaundice Neonatal jaundice is often seen in
infants around the second day after birth, lasting until day 8 in
term births, or to around day 14 in premature births.
 61. Milia - all newborn sebaceous glands are immature. - White
papule can be found on the cheek or across the bridge of the
nose of every newborn. - Disappear by 2 to 4 weeks of age, as
sebaceous glands mature and drain.
 62. Erythema Toxicum Erythematous macules and firm 1-3 mm
yellow or white papules or pustules Pustules contain
eosinophils and are sterile Appear in the first 3-4 days of life
Range: Birth to 14 days Benign and self limited
 63. Lanugo - Is the fine hair, downy hair that covers a newborn’s
shoulder, back and upper arm. - It maybe found also on the
forehead and ears. - A baby born after 37 to 39 weeks of
gestation has more lanugo than a newborn of 40 weeks. - By 2
weeks of age it disappear
 64. Vernix Caseosa - At birth the infant is generally covered
with vernix caseosa, a cream cheesy-white substance adherent
to the skin that serves as a skin lubricant. - It is helpful for
protecting the baby against infections, and should not be taken
off.
 65. Mongolian spots Are collections of pigment cells 90% of
African infants, 81% of Asian, and 9.6% of Caucasian infants
Slate-gray to blue-black lesions Usually over lumbosacral area
and buttocks Accumulation of melanocytes within the dermis
They disappear by school age without treatment
 66. Features in appearance of normal term neonate and
preterm neonate pink ， well-nurished ， Less fine-hair term
Dark-red,edema ， transparent ， more fine-hair preterm
SkinSkin
 67. soft ear stick to the skull, poor figuration preterm Good ear
figuration, well- developed cartilage term earear
 68. preterm Shallow and less term Obvious, over all the sole
Sole markingsSole markings
 69. Enlargement of the breasts • Enlargement of the breasts
and production of milk may occur at the age of 3 to 5 days in
some newborn 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.
 71. Essential Newborn Care Interventions • Clean childbirth
and cord care – Prevent newborn infection • Thermal
protection – Prevent and manage newborn hypo/hyperthermia
• Early and exclusive breastfeeding – Started within 1 hour after
childbirth • Initiation of breathing and resuscitation – Early
asphyxia identification and management
 2. TERMS: Neonatology: The branch of pediatrics that deals
with the diseases and care of newborns. Neonatal period: From
birth to the 28th day of life (4 weeks after birth). Perinatal
period: From the 28th completed week of gestation to the 7th
day after birth.
 3. Classification of the neonates By both GA and BW By birth
weight By gestational age
 4. TERMS: Full term infant: An infant born at a gestational age
between 37 and 42 completed weeks Preterm infant: An infant
that is born prior to 37 weeks of gestation (22 -37 weeks or
weight greater than 500g). Post-term infant: An infant that is
born after the 42nd week of gestation
 5. AGA ( appropriate for gestational age) Infants with birth
weight for their gestational age that falls between the 10th and
90th centiles. SGA ( small for gestational age) Infants with birth
weight for their gestational age that falls below the 10th
centiles. LGA ( large for gestational age) Infants with birth
weight for their gestational age that falls above the 90th
centiles.
 6. GA 40 w,GA 40 w, BW3000gBW3000g GA 34 w,GA 34 w,
BW2000gBW2000g
 8. 8  Assessment: The initial assessment: APGAR scoring
system Purpose: is to assess the newborn´S immediate
adjustment to extrauterine life
 9. Apgar Score of the Newborn SIGNSCORE 0 1 2 Heart rate
Absent <100 beats/min >100 beats/min Respiratory effort
Absent Weak, irregular Strong cry Muscle tone Flaccid Some
flexion Well Reflex irritability (response to catheter in nostril)
 No Grimace Cough or sneeze Skin colour Blue, pale extremities
blue pink
 10. Significance of Apgar score Healthy newborn: 7-10 at both
1 and 5 minutes Moderately depressed newborn: 3-6 (Need
resuscitation ) Severely depressed newborn: 1-3 (Intensive
resuscitation )
 11. The Apgar score is used to evaluate • brain function at birth
• circulatory status at birth • the effectiveness of respiratory
and circulatory adaptations thereafter • which babies need
active assistance (resuscitation).
 12. Purpose The APGAR scoring chart is used to evaluate the
conditions of the baby at birth, determine the need for
resuscitation, evaluate the effectiveness of resuscitative efforts,
to identify neonates at risk for morbidity and mortality.
 13. Transitional assessment (Periods of reactivity): First period
of reactivity: 13
 14. Stage 1: During the first 30 min. through which the baby is
characterized as Physiologically unstable ( ), very alert, cries
vigorously, may suck a fist greedily, & appears very interested in
the environment. 14
 15. 15 Stage 2: It lasts for about 2-4 hours, through this period;
all V.S & mucus production are decreased. The newborn is in
state of sleep and relative calm.
 16. Second period of reactivity It lasts for about 2-5 hours,
through which the newborn is alert and responsive, heart &
respiratory rate, gastric & respiratory secretions are increased &
passage of meconium commonly occurs. 16
 17. Following this stage is a period of stabilization through
which the baby becomes physiologically stable & a vacillating
pattern of sleep and activity. 17
 18. Take Anthropometric Measurements Weight – 2, 500g – 4,
000g Physiologic weight loss - it is normal for the newborn
infant to loose 5-10% of weight in the first 4 to 5 days of life
(causes: low nutritional intake, defecation, urination); Length –
45-55 cm HC – 33-55 cm, 2-3 cm larger than chest CC – 30-
33cm, AC-29-33 cm
 19. Assessment of Growth
 20. Head Circumference HC – 33-55 cm, 2-3 cm larger than
chest
 21. Take Anthropometric Measurements Head Circumference
Chest Circumference Abdomen Circumference
 22. Fontanelles The anterior fontanel is located at the
intersection of the sutures of the two parietal bones and the
frontal bones. Anterior: diamond shape about 2- 3-4 cm, will
close in about 12 to 18 mos; The posterior fontanel is located
between of the sutures of the 2 parietal bones and occipital
bone. It is small, triangular shaped, normally closes at 1,5 to 3
mos of age.
 23. Respiratory system Fetal lung development Filled with fluid
Surfactant synthesis: begins at 24-28w, peak at 35w
Establishment of breathing after birth - opening of the alveoli
by mechanical,chemical,thermal, sensory stimuli Characteristics
of Newborn respirations Normal RR 30-60, shallow and
irregular, 5-15 second periods of apnea Apnea: no breathing for
periods of greater than 15 sec Abnormal findings: retractions,
grunting, nasal flaring, more 15 sec apnea; abnormal rate
 24. Cardiovascular System
 25. Circulatory system Heart rate: ranges from 140 to 160 per
minute. Heart murmur: Transient murmurs may result from the
incomplete closure of the fetal circulation (the ductus arteriosis
 or foramen ovale) 90% of all murmurs are transient and not
associated with anomalies. Blood pressure: from 46 to 80
mmHg (systolic)
 27. Hemotological system High: RBC 4.8-7.1; Hgb 14-24; Hct
44-64 18,000 @ birth; 23-25,000 @ 1 day with relative
neutrophilia Coagulation: Vit K dependent clotting factors are
decreased. Platelet counts ok (150,000-350,000) •These
characteristics are essential to provide adequate oxygenation in
utero and during the first few postnatal days before the lungs
expand fully. •Oxygenation improves during the first two weeks
of life to the extent that a high red cell count and hemoglobin
are no longer necessary, and haemolysis occurs. After the first
few days (5 days or so ) the white cell count is likely to be below
10 000/ mm3 with characteristically relative lymphocytosis of
infancy and early childhood. WBC:
 28. Gastrointestinal System sucking becomes coordinated @32
wks little saliva until 3 months of age Stomach hold 60 to 90 ml.
Regurgitates easily because of an immature cardiac sphinter
between the stomach and esophagus. Immature liver function
may lead to lowered glucosed and protein serum level.
 29. Alimentary system
 30. Hepatic Function Liver produces substances essential for
clotting of blood. Stores needed iron for the first few months.
Preterm & small infants have lower iron stores than full term
(full term infants stores last 4-6 mo) Physiologic Jaundice - after
24-48 hs of age, d/t increased breakdown of RBC’s and
immature liver functioning. This is a yellow discoloration that
may be seen in the infant's skin or in the sclera of the eye.
Jaundice is caused by excessive amounts of free bilirubin in the
blood and tissue.
 31. JAUNDICE
 32. Urinary system Renal function: GFR - glomerular filtration
rate is lower, about one fourth to one half of that in an adult.
Kidneys not fully functional until child is 2 years of age. Urine
often contains protein in small amounts. Urine may contain an
abundance of urates which may give the diaper a pink stain
during the first week of life. The ability to dilute urine is good,
but the time taken to reach the maximal ability is relatively
long, so newborns are apt to become water overloaded.
 33. Kidneys and Urination initial urine: cloudy, scant amounts,
uric acid crystals-> reddish stain on diaper Urine pH ranges from
5 to 7, specific gravity ranges from 1.006 to 1.020. The first
urination occurs within 24 hrs. It ranges from 4 to 6 times/day
in the first days and 20 times or so /day in later days of the
neonatal period. Kidneys not fully functional until child is 2
years of age.
 34. Immune System Limited specific and Non-specific immunity
at birth passive immunity(from mom- IgG) for the first 3 months
of life ~ this will be reduced if baby is born premature
breastfeeding = ^ passive immunity (IgA)
 35. Neuromascular System Mature newborns demonstrate
neuromuscular function by moving their extremities,
attempting to control head movement, exhibiting a strong cry
and demonstrating newborn reflexes. A newborn occasionally
makes twitching or flailing movements of the extremities in the
absence of stimulus because of the immature of the nervous
system.
 36. Newborn Reflexes Sucking reflex • When a newborn lips
are touched, the baby makes a sucking motion. • This reflex
helps a newborn find food: when the newborn lips touch the
mothers breast or bottle, the baby sucks and takes food. • The
sucking reflex begins to diminish at about 6 months of age
 37. Sucking place a finger in the neonate’s mouth neonate
sucks on the finger
 38. Newborn Reflexes Rooting reflex - If the check is brushed
or stroke near the corner of the mouth, a newborn infant will
turn the head in that direction. • This reflex serves to help a
newborn find food: when a mother holds the child and allows
her breast to brush the newborn’s cheek, the reflex makes the
baby turn toward the breast. • This reflex disappear at about
the sixth week of life.
 39. Rooting touch a finger to the neonate’s cheek or the corner
of mouth. neonate turns the head toward the stimulus, opens
the mouth and searches for the stimulus
 40. Newborn Reflex Blink Reflex - bright light shinning in eyes
or clap hands near eyes - closes eyelids quickly A sudden
movement to ward the eye can elicit the blink reflex.
Swallowing reflex - food that reaches the posterior portion of
the tongue, automatically swallowed. Gag, cough, and sneeze
reflexes are present to maintain airway in the event that normal
swallowing does not keep the pharynx free from obstructing
mucous.
 41. Baby is held horizontally, then swiftly lowered a few inches,
or the head may be lowered a few inches, or a loud sudden
noise will make baby's arms fling out and then come together
as hands open then clutch. MORO reflex Absence or weakness
of this reflex may suggest a severely disturbed CNS
 42. Startle reflex sudden loud noise causes abduction of the
arms wit flexion of elbow, hand remain clenched disappears by
age of 4 months
 43. Palmar Grasp Reflex • newborn grasp an object placed in
their palm by closing fingers on it. • Mature newborn grasp so
 strongly that they can be raised from a supine position and
suspended momentarily from an examiner’s fingers. • Reflex
disappears to 3 months of age.
 44. Grasp place a finger in the neonates palm neonate grasps
the finger
 45. PLANTERS GRASP Pressing thumbs against the balls of
baby's feed will make his toes flex. Absence of this reflex may
indicate damage to the spinal chord.
 46. Stepping reflex • Hold the neonate in an upright position
and touch one foot lightly to a flat surface (such as the bed)
neonate makes walking motions with both feet
 47. BABKIN When both of baby's palms are pressed, her eyes
will close, mouth will open and her head will turn to one side.
Absence of this reflex or if it reappears after vanishing around
3-4 mos., it may signify a malfunctioning CNS
 48. BABINSKI Absence of reflex may suggest immaturity of the
CNS, defective spinal chord, or other problems. Baby's foot is
stroked from heel toward the toes. The big toe should lift up,
while the others fan out.
 49. When newborn lie on their backs, their head usually turn to
one side or the other. The arm and the legs on the side toward
which the head turns extend, and the opposite arm and leg
contract. This is also called the boxer or fencing reflex. The
reflex disappears between the second and third months of life.
Tonic neck reflex Fencing posture
 50. Extrusion Reflex - newborn extrudes any substance that is
placed on the anterior portion of the tongue. This protective
reflex prevents the swallowing reflex of inedible substance. It
disappears at about 4 months of age Extrusion Reflex
 51. Thermoregulation Newborn physiology •Normal
temperature: 36.5–37.5°C •Hypothermia: < 36.5°C --Significant
contribution to deaths in low birth weight infants and preterm
newborns •Stabilization period: 1st 6–12 hours after birth The
body temperature is likely to be influenced by the
environmental temperature. Neutral environmental
temperature: the environmental temperature at which the core
temperature of the infant at rest is between 36.7 and 37.3°C
and oxygen consumption and caloric utilization are lowest
 52. Newborn’s temperature may drop several degrees after
delivery because the external environment is cooler than the
intrauterine environment Rapid heat loss in a cool environment
occurs by conduction, convection, radiation and evaporation;
Cold stress in the newborn → an increase in the metabolic rate
--> increased O2 demands and caloric consumption, metabolic
acidosis Temperature Regulation
 53. 53 the infant lost his/ her body temperature: 1-
Evaporation: Heat loss that resulted from expenditure of
internal thermal energy to convert liquid on an exposed surface
to gases, e.g.: amniotic fluid, sweat. Prevention: Carefully dry
the infant after delivery or after bathing.
 54. 54 Heat loss occurred from direct contact between body
surface and cooler solid object. Prevention: Warm all objects
before the infant comes into contact with them.
 55. 55 resulted from exposure of an infant to direct source of
air draft. Prevention: · Keep infant out of drafts · Close
one end of heat shield in incubator to reduce velocity of air.
 56. 56 4- Radiation: It occurred from body surface to relatively
distant objects that are cooler than skin temperature.
 57. 57 ‫إستخدامه يتم ومتي‬.3 ‫تابع‬: ‫التعليميه الدهداف‬
‫وكيف أبجار لمقياس المكونه العناصر معرفة أهميته إدراك ثم‬
‫ثبات علي‬.5 .‫السري بالحبل العنايه كيفية معرفة‬.4 .‫ومن‬
‫الطبيعيه معدلتها‬. ‫المطمئنان فور للمولود الروتينيه العنايه تقديم‬
‫الرضاعه إعطاء في المبكر البدء‬.6 ‫حول الحيويه العلمات‬
‫أ لل م بالنسبه سواء الطبيعيه‬, ‫المولود‬. ‫ومميزات أهمية إدراك‬
 58. SKIN Observation and palpation
 59. SKIN Common variations Acrocyanosis - result of sluggish
peripheral circulation.
 60. Physiologic jaundice Neonatal jaundice is often seen in
infants around the second day after birth, lasting until day 8 in
term births, or to around day 14 in premature births.
 61. Milia - all newborn sebaceous glands are immature. - White
papule can be found on the cheek or across the bridge of the
nose of every newborn. - Disappear by 2 to 4 weeks of age, as
sebaceous glands mature and drain.
 62. Erythema Toxicum Erythematous macules and firm 1-3 mm
yellow or white papules or pustules Pustules contain
eosinophils and are sterile Appear in the first 3-4 days of life
Range: Birth to 14 days Benign and self limited
 63. Lanugo - Is the fine hair, downy hair that covers a newborn’s
shoulder, back and upper arm. - It maybe found also on the
forehead and ears. - A baby born after 37 to 39 weeks of
gestation has more lanugo than a newborn of 40 weeks. - By 2
weeks of age it disappear
 64. Vernix Caseosa - At birth the infant is generally covered
with vernix caseosa, a cream cheesy-white substance adherent
to the skin that serves as a skin lubricant. - It is helpful for
protecting the baby against infections, and should not be taken
off.
 65. Mongolian spots Are collections of pigment cells 90% of
African infants, 81% of Asian, and 9.6% of Caucasian infants
Slate-gray to blue-black lesions Usually over lumbosacral area
and buttocks Accumulation of melanocytes within the dermis
They disappear by school age without treatment
 66. Features in appearance of normal term neonate and
preterm neonate pink ， well-nurished ， Less fine-hair term
Dark-red,edema ， transparent ， more fine-hair preterm
SkinSkin
 67. soft ear stick to the skull, poor figuration preterm Good ear
figuration, well- developed cartilage term earear
 68. preterm Shallow and less term Obvious, over all the sole
Sole markingsSole markings
 69. Enlargement of the breasts • Enlargement of the breasts
and production of milk may occur at the age of 3 to 5 days in
some newborn 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.
 71. Essential Newborn Care Interventions • Clean childbirth
and cord care – Prevent newborn infection • Thermal
protection – Prevent and manage newborn hypo/hyperthermia
• Early and exclusive breastfeeding – Started within 1 hour after
childbirth • Initiation of breathing and resuscitation – Early
asphyxia identification and management
 72. The End