Peculiarities Of The Neonatal Period.



Neonatal Period.

The neonatal period starts from birth of a newborn and separation him from a mother, binding the umbilicus cord.

Duration of the neonatal period – 28 days

• Early neonatal period – 7 days

• Late neonatal period – from 8 day to 28 day

determination of the duration of neonatal period done

according recommendation of WHO.


Nomenclature of conditions of a newborn

Gestation age – age of a fetus in weeks of pregnancy.

Normal gestation age – 40 ± 2 weeks .

Full term newborn is born in term of gestation 40 ± 2

weeks .

Preterm newborn is born in term of gestation 22 – 37

weeks .

Postterm newborn is born in term of gestation after 42

weeks .

Perinatal period – from 22 weeks of gestation up to 7

days after birth.


Morphofunctional peculiarities of a newborn.

Newborn period is the very important period in the

life of a person. It is period of adaptation to new

environment.


Serious change of environment conditions takes

place in this period.


A newborn starts independent lung’s ventilation,

changes function of the cardiovascular system

take place: stopping the hemoplacental

circulation, small circle of hemocirculation starts

action.


§ newborn starts enteral feeding with mother’s milk. microbe’s colonization of the alimentary canal takes place.


§ low excitement and easiness of inhibition of the cerebral cortex are typical, weak development of receptor’s apparatus is marked. However first condition reflexes start to formed in this time.


§ there are peculiarities of functions of the urorenal,

endocrine, hemopoietic, immune systems, peculiarities of metabolism which accompanied with so-called ”transient conditions”.


Arrangement after birth

After finish pulsation the umbilicus cord a midwife presses, clamps and cuts the umbilicus cord and puts a

newborn to a mother chest if condition of a newborn is

satisfactory.


Apgar score

Apgar score permits to estimate the condition of a newborn in figures from 0 up to 10 bulls/points.

Estimation must be done at the end of 1-st and 5-th minute after birth. All newborns must be estimated

according Apgar score.

Apgar score was advised by Verginia Apgar,

doctor of medicine, anesthesiologist, it was in 1953 year.


Arrangement after birth .

If rooting and sucking reflexes are presented (a

newborn rises the head, opens the mouth, looks for mother’s breast) midwife helps to make first early putting a newborn to the mother’s breast.


Method of examination of a newborn

The main aim of primary evaluation the condition of a newborn in labor room – to get answer for next question.

Does a newborn have defects of development or other pathological condition, which demands urgent investigation or treatment?

Has early physiological adaptation of newborn happened?


Care of a newborn

After finish contact “skin to skin” midwife puts a newborn on the warmer dressing table and makes cleaning and clamping the umbilical cord, measures head and chest circumference, checks the weight, puts the clothes.


Arrangement after birth

§ In 30 min after birth in time contact “skin to skin”

midwife measures the body temperature of a newborn in axillar region and makes prophylaxis of the ophtalmia with use 0,5% erythromycin ointment.


§ Contact “skin to skin” continues not less 2

hours in labour room.

Warmth chain .

Warm labor room, napkins and clothes for a newborn .

Urgent dry a newborn .

Contact “skin to skin” .

Breast feeding must be started early .

To postpone weighting and bathing .

Clothing and swaddling must be correct .

Joint stay with mother .

Transport in warm condition, together with mother or in incubator .

Resuscitation in warm condition .

Training of the medical personal.


Primary medical examination has aims:

To determine the presence or absence the congenital malformations, signs of infection, other pathologic conditions which demands medical

treatment.


Morphofunctional peculiarities of newborn

Unmaturity of the thermoregulation (trend to

hypothermia).

Change morphological contents of the blood (physiological leukocytosis, changes in leucocytes formulas).

Chain of actions which reflect adaptation to the extra uterus environment.

All main physiological functions are not stable what demand the creation of the special hygienic conditions.

Physiologic barriers – skin, mucous membranes, lymphatic system are unmature what causes penetration the microbe to the organism.

Newborns are very sensitive to some viruses, E. coli and microbe of purulent diseases. Epidemiological regime of the neonatal department must be very tough, control of the regime must be very serious.


Physiological (borderline) conditions

1.The first breath and transient hyperventilation

2.Skin changes: skin catarth with following skin desquamation (physiological erythema).

3.Toxic erythema .

4. Physiological jaundice (hyperbilirubinemia)

5. Disorder of temperature balance (hypo – or hyperthermia) .

6. Physiological loosing of the weight (5-6%, not more8% from birth weight) .

7. Renal function peculiarities (oliguria, proteinuria, renal infarction).

8. Transient hemopoesis (polycytemia) .

9. Hormone crisis .

10. Dysbacteriosis and transient dyspepsia.

11. Transient metabolic peculiarities (catabalism trend, hypoglycemia, hypocalciemia) .

12. Transient peculiarities of hemostasis (vit K deficiency).


Signs full term and preterm newborns

Full term newborn – gestation age 40±2 weeks.

Morphologic signs are mature, a newborn keeps body temperature in adequate temperature of environment .

A newborn has good sucking and swallowing reflexes, cry is loud and emotional .

A newborn has stable rhythm of heart beat and respiration .

A newborn has good movement activity .

Preterm newborn – gestation age less 37 weeks

Frame is not proportional

Umbilical ring places low

Lanugo is abundant

Small and lateral fontanelles are open, scalp bones are soft.

Nails do not cover phalanxes, ear helixes are soft.

Testis do not come down to scrotum in boy, big labium pubertum do not cover small labium pubertum in girl.


Routine medical interference

Majority of newborns does not need passing routine medical interference .

Every interference must be substantiated.

Aspiration of mucous from oral cavity and rhinopharynges.

Consequence of this manipulation can be arrhythmia, bradycardia, laryngospasm, high risk of infection.

Checking permeability of esophagus. Indications are such clinical signs as foam discharging from the mouth, vomiting, cough. Negative consequence: arrhythmia, laryngospasm, risk of infection.

Bacteriological investigation of stool, skin, umbilical wound.

Laboratory investigation: roentgenologic, USI, consultation of specialists.


Peculiarities of adaptation of the newborns of the

groups of high risk.

Group of high risk include:

Preterm newborn.

Asphyxia .

Birth trauma .

Syndrome intrauterus retardation of development .

Anomaly of development .

Infections .

Fetopathy .

Chromosome aberration .

Inherited anomaly of metabolism.

This newborns demand stage treatment (maternity house – department pathology of newborns – department of rehabilitation), dyspanserization in out-patient clinic and special system of treatment.


Peculiarities of pathology of newborns.

The most frequent diseases of newborns are:

Asphyxia .

Birth trauma .

Anomaly of development .

Infection – inflammatory diseases:

• Intrauterus (group TORCH) .

• Postnatal infections (omphalitis, sepsis, meningitis,

gastroenteritis, pneumonia and other).

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