Definitions :A newborn baby from birth to age 28 days . : Neonate
if born after 37 (full term) A baby at term : Term babyweeks gestation and before 42 weeks gestation.
delivered infant Live born : baby (Premature) Pretermbefore 37 w eeks from the first day of the last menstrual
period. Those born before 28 weeks of gestation are
called (extreme prematurity).
born after 42 weeks gestation . An infant : Post term:). W. B. Low birth weight ( L
An infant whose birth weight is 25 00 g. or less .
Not all preterm infants are L.B.W. and not all L.B.W.
infants are preterm.
: (V.L.B.W.) Very low birth weightBirth weight is 1500 g. or less .
:). W. B. L. h weight (E Extremely low birtBirth weight is 1000 g. or less .
: small for date or (S.G.A.) Small for gestational ageBirth weight is below the 10 th. percentile for gestation .
:). A. G. Large for gestational age (L. percentile for age .th 90 the Birth weight is greater than
: rate tal mortality NeonaThe number of d eath s of infants in the period from birth
to 28 days of life and is expressed per 1000 of live births.
:). U. C.I. (N Unit are Intensive C NeonatalThe provision of life support systems such as assisted
ventilation , monitoring of heart rate ,respirato ry rate ,
blood gases , & total pare nteral nutrition (T .P.N .).
: (N.B.B.) Examination of the Newborn Baby- All newborns should be examined at least twice; one soon
after birth , and the other on the fifth day . The question to be
answered” is the infant normal ? In the first examination ,
you are rest ricted to elicit gross physical abnormalities , even
mild anom alies should be explained to parents to allay
anxiety . The baby should be kept warm during the
- A normal newborn should pass stool within 48 -72 hours
and urine within 24 hours after birth.
- General examination : The infant should cry lustily at
birth; weak cry may indicate severe respiratory distress ,
sepsis , hypot onia or birth asphyxia , while a high pitched cry
(cerebral cry or shrill) may indicate increased intracr anial
- A co nstant low pitched inspiratory stridor is heard in
cong enital lary ngomalacia which resolves by 12 -18
. cold and hot weather, is seen in polycythemia Plethora -
The skin is covered by a greasy material secreted byepithelial cells called vernix caseosa which protects the skin
from the effect of the amniotic fluid.
- Occasionally , one half of the body may ap pear red and theother half is pa le (harlequin color change) which is usually
. transient and of unknown significance
- Cyanosis :Central cyanosis is pathological and peripheral
or a crocyanosis is normal ( more in th e preterm babies ).
-Milia : Small sebaceous cysts , pinpoint in size , whitishspots seen on the nose , cheeks and forehead , it disappears in
a few weeks spont aneously , it is a normal finding.
-Erythema toxicum neonatorum : red blotchy , macularpatches with a white center seen all over the body ,
sparing the soles and palms . It affects 50% of full term
infants, less common in preterm infants. Pustules may be
seen in the center containing eosinophils .
T hey usually appear on the first few days and disappear
- Mongolian spots : blue , gray , flat , macular lesions seennormally over the sacrum, sometimes on th e upper back ,
legs , hands and rarely on the face .
T hey may be solitary , numerous or patchy .
They are seen in colored chi ldren much more than whites.
They usually fade during the first few years of li fe .
. be misdiagnosed as bruises They may
-- Occipito -Frontal Circumference ( O .F.C .):
Average head circumfere nce at birth is 35cm .
-Weight : average weight 3 .5 kg , neonates lose 5 -10%
birth weight in the first few days of life and regained by
Lengt h: average length of the newborn baby is 51cm. -
Fontanelle s: -
The average diameter of the anterior fontanelle is 3 cm , it
closes at 9 -18 mont hs. T he posterior fontan el le measures
about the tip of the finger usually closes by 3 months of age .
-Examination of the eyes :Ede ma of the upper eye lids is a result of birth process .
C onjunctival and scleral hemorrhages are commonly see n
and disappear by time .
L ook for cataract and glaucoma (m egalo cornea).
- Epstein pearls : are cysts containing keratin located on the
. soft and hard palate
-Capillary hemangioma :is commonly seen on the upper eye lids and forehead ,
it disappears in the first year.
The breasts might be large in both sexes , this is caused bymaternal hormones and is usu ally evident on day 2 or 3 of
life , they may persist for a month .
M ilk may be expressed from it by parents (witches milk) ,
this habit should be avoided because it may lead to abscess
(neonatal mastitis) .
- Hips : exam ine hips for dysplasia(dislocation).- F emoral artery : palpate both femorals by the index
fingers in the mid inguinal region , their absence indicates
coarctation of the aorta .
- CNS : Neonates may sleep up to 20 hours out of 24 hours if
left undisturbed .
Check activity, primitive (neonatal) reflexes, convulsions or
: LOW BIRTH WEIGHT BABIES(Normal Birth Weight:2500 -4000g. )
Definition of L.B.W. : A birth weight less than 2. 5Kg.
They are 20 times more li kely to die than normal infants & it
can affect the life of the individual by increasing diseases like
diabetes mellitus , hypertension, and C .V . diseases .
LBW is an indicator of public health sta tus and is a cause of
70% of neonatal deaths.
Maternal causes of LBW:1-Previous LBW
3-Low level of education.
4-No antenatal care.
5-Maternal age: <16 & >35 years.
RETARDATION(I.U.G.R.): INTRAUTERINE GROWTHDefinition:
Fetal growth below the 10 th.centile for gestational age
and ab dominal circumference is below 2.5 th centile .
So S .G .A . is a statistical definition , while IUGR is a
clinical definition (clinical evidence of malnutritio n).
CAUSES of IUGR:
Causes: etal a.F
1-Congenital infection s.
3-Congenita l malformations.
4-Twin to twin transfusion.
Placental causes: b.
1-Chronic abrutpio placentae .
). cause he commonest (t Constitutional c.
The majority of cases are normal but small , and t he
diagnosis is made after delivery by exclusion.
Maternal causes: d.
Problems of IUGR :Treatment of I.U.G.R. :
1-Give more calories.
2-Monitor blood sugar level 2 -4 hourly until it is stable.
3-Monitor serum calcium level.
Outcome of IUGR:1-Most of t hem have normal growth in infancy and childhood.
2-Many are born prematurely.
3-Defective mental development .
Fetal death.--Temperature instability.
-Perinatal asphyxia (the most important
: PREMATURITYThe p roblems of prematurity are due to poor
adaptation to extra uterine life due to immaturity of
a-R .D .S.(respiratory distress syndrome).
b-Chronic lung disease: B .P.D .(bronch opulmonary
Neurologic problems:a-Hypoxic -ischemic encephalopathy (H.I.E.).
b-In traventricular hemorrhage (I.V.H.) .
Cardiovascular complications :
b-P.D .A .(patent ductus arteriosus).
c-Organ hemorrhage .
d-D .I.C .
Nutritional problems (especially in those born before
32 weeks of gestation).
G .I. problems (N .E .C . : necrotizing enterocolitis).
Hypoglycemia , Hypoca lcemia.
Renal problems :low G .F.R .15
Temperature regulation e.g. hypothermia.
Ophthalmologic e.g. R .O .P.(retinopathy of prematurity).MANAGEMENT OF THE PREMATURE INFANT :
1-Delivery: should be in a hospital well equipped with
resuscitation tools and highly experienced staff.
2-Neonata l management:
a-Thermal regulation either by overhead radiant warmer
or a n incubator. The accepte d skin temperature is
b-Oxygen therapy and assisted ventilation.
c-Fluid and electrolytes therapy.
d-Nutrition : enteral, N .G . tube or pare nteral.
e-Management of hyperbilirubinemia .
f-Control of infection s.
LONG TERM PROBLEMS OF PREMATURITY :
1-Poor growth and development.
4-Increased rate of post neonatal illness es.
5-Increased frequency of congenital anomalies.
Immunizations :The timing of immunizati ons of premature babies is
based on the infant's chronologic age, not on the
It may be advisable to delay administration of hepatitis B
va ccine until the infant weighs 2000 g. or more.
The full dose s of all immunizations should be given .