Neonatal

• Neonatal Development


  The first 28 days following birth
• Normal Growth and Development
• Initial assessment of newborn

  • Apgar score
• Physical characteristics


  • Head and skull
  • Length and weight
  • Skin
  • Genitals
  • Face
  • Abdomen
  • Vernix caseosa
  • Milia
  • Lanugo
  • Mongolian spot
  • Physiological jaundice

  
• Neurological characteristics


  • Primitive reflexes
• The newborn's states


  • Alert inactivity
  • Waking activity
  • Crying
  • Sleeping
• Apgar score


  Assessment of a new-born after delivery
• Apgar score criteria


  • Heart Rate
  • Respiratory effort
  • Muscle tone
  • Reflex irritability
  • Skin color
• Apgar score interpretation


  1. 10 (good adjustment): No intervention required
  2. 6 (moderate adjustment): Gently stimulate, rub newborn's back, administer O2

  0-3 (difficult adjustment): Infant requires resuscitation
• New Ballard Scale


  Assesses maturity level to indicate the gestational age

  
• Classification of gestational age

  • Appropriate gestational age (AGA)
  • Large for gestational age (LGA)
  • Small-for-gestational-age (SGA)
• Gestational Age Growth Chart

  
• Physiological Status


  • Pulse
  • Temperature
  • Respiratory
  • Blood pressure
• Physical Characteristic


  • Weight
  • Length
  • Head Circumference
  • Chest circumference
  • Posture
  • Skin
  • Vernix Caseosa

  
• Physiological jaundice


  Newborn produce as twice bilirubin as adults do, liver ability to conjugate bilirubin is reduced, lower plasma binding capacity to bilirubin due to lower albumin concentration, less effective excretion in neonates
• Types of jaundice


  • Breast-feeding associated jaundice (early-onset jaundice)
  • Breast milk jaundice (late-onset jaundice)
• Manifestation of jaundice


  • Yellowish discoloration of sclera, nails and the skin
• Other physical characteristics


  • Lanugo hair
  • Mongolian Spots
  • Milia
• Head


  • Round, symmetric, soft and moves easy
  • Fontanels
• Birth head injuries


  • Cephalohematoma
  • Caput succedaneum
• Eyes, Ear, Mouth


  • Edematous eye lid
  • Eye color not determined until 3-6 months
  • Pupils react to light
  • Absence of tears
  • Blinking reflex present
  • Pinna flexible, cartilage present
  • Epstein Pearls
• Chest and Abdomen


  • Chest shape almost circular
  • Slight intercostal retraction
  • Cylindrical abdomen shape
  • Liver palpable
  • Umbilical cord drops off 7-10 days
  • Bowel sounds heard shortly after birth
  • Meconium stool to yellow stool
• Urinary System and Genitalia

  • Voids at birth or after a few hours
  • Urethral opening at tip of glans penis
  • Testes palpable
  • Edematous labia and clitoris
  • Urethral meatus behind clitoris
• Back and Rectum


  • Spine intact, no opening or masses
  • Presence of anal orifice and passage of meconium
• Endocrine and Extremities


  • Swollen breasts
  • Infantile female menstruation
  • Symmetry, range of motion, sign of malformation of extremities
• Primitive Reflexes


  • Rooting
  • Sucking
  • Moro
  • Grasping
  • Tonic Reflex
  • Babinski Reflex
  • Coughing and Sneezing Reflex
• The Newborn's States


  • Alert inactivity
  • Waking activity
  • Sleeping
  • Crying
• Sudden Infant Death Syndrome (SIDS)


  Refers to a healthy baby who dies suddenly for no apparent reason, causes unknown, may be due to disappearance of primitive reflexes
• Temperament


  A consistent style or pattern to an infant behavior, varies from one infant to another based on personalities
• Needs of the Newborn


  • Patent air way
  • Free from infection and vaccination
  • Nutrition, or feeding, sucking
  • Love and security
  • Warmth and physical comfort
  • Parent attachment
  • Safety
  • Sleep and rest
• Nursing Care


  • Vital signs
  • Temperature maintenance
  • Growth measurements
  • Protection from infection
  • Observation of abnormalities
  • Promotion of parent/infant bonding
  • Feeding
  • Body hygiene
  • Play (sensory motor stimulation)
  • Health promotion visits
• Prenatal Development


  The entire process of growth, maturation, differentiation and development that occurs between conception and birth

  
• Prenatal development refers to the entire process of growth, maturation, differentiation and development that occurs between conception and birth
• Objectives


  • Explain hereditary and the gene environment interaction
  • List Factors influencing prenatal and postnatal development
  • Discuss Genetic counseling
  • Explain the stages of prenatal development
  • Recognize the characteristics and the developmental milestones of each stage
• Heredity


  • One sperm (X or Y chromosomes) and one ovum (X chromosome) contribute to 23 chromosomes (22 autosomal and 1 sex chromosome), which makes a single celled zygote
  • The sex of the zygote is determined by the X and Y chromosome
  • Chromosomes carry the genes: which transmit the genetic information from the parents to the child
  • Genes are either dominant (expresses their trait over other genes), or recessive (can transmit their trait if they exist in pairs)
  • If one gene of a pair is dominant, it will express its trait over the other
  • Genes come in different forms that are known as alleles
  • The alleles in the pair of chromosomes are the same, it is called homozygous. If not the same, it is called heterozygous
  • The complete set of genes in an organism is referred to as Genotype
  • Genotypes with environmental factors produces an individual physical, behavioral, and psychological features, which is referred to as Phenotype
  • Many diseases are a result of defects on recessive genes (single pair of genes mechanism): a child must have a copy of the gene from both parents to develop the disease

  
• Karyotyping


  Mapping the chromosomal structure of an organism, which can be used in genetic counselling

  
• Environmental factors


  • Maternal factors (mother's age, maternal health practices, teratogens)
  • Post-natal environment (socioeconomic level, nutrition, climate, infections, culture, emotional factors)
• Stages of prenatal development

  1. Pre-embryonic stage (first 2 weeks after conception)

  2. Embryonic stage (3rd - 8th weeks)

  3. Fetal stage (after 8th week)

  
• Pre-embryonic stage


  • The fertilized ovum (zygote), divides into 2, then 4, then 8 cells and so on until it reaches 16-cell stage (morula)
  • The outer cells of the morula secrete fluid and form a sac of cells, the blastocyst
  • The inner cell mass of the blastocyst develops into the fetus and the outer layer of cells into the placenta and membranes
  • Three primary tissue layers form: ectoderm, mesoderm, endoderm

  
• Embryonic stage


  • Organogenesis - the embryo progresses from undifferentiated cells to differentiated (simple to complex) or specialized body cells
  • The 3-week-old embryo is about 2 millimeters long
  • The embryo inside the amnion, which is filled with amniotic fluid that cushions the embryo and maintain a constant temperature
  • The central nervous system develops faster than other systems
  • Early heart development begins
  • The rest of the body catches up with growth of the central nervous system
  • Formation of the face and upper respiratory tract begins
  • The upper extremities appear as buds on lateral body walls
  • Partitioning of the heart into four chambers begins
  • The lower respiratory tract develops and the trachea branches to form the right and left bronchi
  • The lungs develop through continued branching
  • The lower limbs form slightly later than the upper limbs
  • The four chambers of the heart are completed
  • Upper and lower limbs continue to develop
  • Facial development begins with eyes, ears, and nasal pits
  • General growth and refinement of all systems occur during the 7th week
  • The face becomes more human looking
  • Eyelids begin to grow
  • Ears are low set but approaching their final location