Care of the Newborn Term Infant

Question 1

Gestation that is considered term?

Answer 1

Term is after 37 weeks completed gestation

Question 2

Gestation that is considered post-term?

Answer 2

After 41 week

Question 3

Normal weight for a baby?

Answer 3

Normal weight 2.5 - 4.0kg

Large for gestational age (LGA) >4.0kg

Small for gestational age (SGA) <2.5kg

Question 4

Importance of reaching term gestation?

Answer 4

During the 3rd trimester, the baby importantly gains weight and fat (24g of daily weight gain and ~7g of fat gained per day in the last 4 weeks)

There is also transplacental transfer of iron, vitamins, calcium, phosphate and Abs

Question 5

Important points to consider when caring for a term newborn?

Answer 5

If delivery was at term, was it:
• Spontaneous or IOL
• Position / presentation during pregnancy / labour - cephalic or breech
• If vaginal delivery, was it spontaneous or assisted
• If caesarian section, what was the reason

Question 6

Why is labour such a great physiological stress for the baby?

Answer 6

Each time a contraction occurs, the baby becomes hypoxic

Prolonged labour reduces foetal reserves

Cortisol and adrenaline levels increase to enhance adaptation

NOTE - growth restriction or excess further increases the physiological stress, e.g: a big baby can lead to placental insufficiency and obstructed, prolonged labour

Question 7

Cardiorespiratory perinatal adaptations that occur following delivery?

Answer 7

Baby takes first breath / cry; this floods the lungs with +ve pressure, leading to alveolar expansions

Also, there is a change from foetal to newborn circulation (3 shunts) and the result is a decreased pulmonary arterial pressure and increased PaO2

Question 8

Immediate measures put into place for a newborn?

Answer 8

APGAR score

Dry the baby and place in skin-to-skin contact with the mother, as well as encouraging breastfeeding immediately

The baby may not feed well/much in the first 24 hours but this is inconsequential, as long as they are well and are given opportunities to feed (well-grown, term infants have alternative fuels)

Question 9

What is the APGAR score?

Answer 9

Objective measure of perinatal adaptation, with a score out of 10

A normal score is ≥8

Question 10

Occurrence of haemorrhagic disease of the newborn?

Answer 10

Rare but there is potential morbidity and mortality assoc. with it, due to bleeding into the GI tract, lungs and CNS

Question 11

Why does haemorrhagic disease of the newborn occur?

Answer 11

Vitamin K deficiency, which all newborns have to some extent

Question 12

Prevention of haemorrhagic disease of the newborn?

Answer 12

All newborns are given IM vitamin K at delivery

Question 13

Infections of the newborn, from the mother?

Answer 13

Hepatitis B - within the first 24 hours, the baby can be vaccinated or given Ig; this reduces the risk of vertical transmission

Hepatitis C - no treatment available to reduce risk of transmission

HIV - risk of transmission is greatly reduced with treatment

Syphilis

TB

Group B Strep. - most pathological organism of the newborn (high mortality)

Question 14

Methods of anticipating and reducing risk of infection?

Answer 14

Newborn snuggle bundle

Newborn Early Warning - observation chart for newborn infants

Question 15

Vaccinations for mother and newborn?

Answer 15

Maternal pertussis and influenza vaccines

Routine vaccination schedule for newborns; now, changes mean that the hep B vaccine is given at birth

BCG is given to babies at risk of TB infection

Question 16

Examination and screening tests carried out in newborn babies?

Answer 16

Newborn examination - performed within the first 24 hours of birth; this includes a clinical examination of the hip +/- USS

Universal hearing screening

Guthrie test (AKA heel prick test):
• Congenital hypothyroidism
• CF
• Haemoglobinopathies (sickle cell disease)
• Metabolic diseases (PKU, MCADD, MSUD, IVA, GA1, HCU)

Question 17

Newborn examination of the head?

Answer 17

Occipital-frontal circumference (OFC) - 3 measurements are taken

Overlapping sutures

Fontanelles are felt

Moulding (benign)

Ventouse / forceps marks from instrumental delivery

Caput succedaneum (benign) - extraperiosteal fluid collection with poorly defined margins

Cephalhaematoma (pathological) - hemorrhage of blood between the skull and the periosteum

Question 18

Differentiating caput succedaneum and cephalhaematoma?

Answer 18

Caput succedaneum has poorly defined margins and is more diffuse

Question 19

Newborn examination of the eyes?

Answer 19

Size

Red reflex - to rule out, e.g:
• Congenital cataract
• Retinoblastoma

Conjunctival haemorrhage (benign)

Squints - common

Iris abnormality, e.g: coloboma

Question 20

Newborn examination of the ears?

Answer 20

Position of the ears and presence of the external auditory canal

Tags (if these are large, they may be assoc. with renal anomalies)

Pits

Folding (consider Treacher-Collins syndrome)

FH of history loss

Question 21

Newborn examination of the mouth?

Answer 21

Shape of the mouth and inspection & palpation of the palate

Philtrum, tongue tie

Presence of neonatal teeth

Epstein’s pearls - whitish-yellow cysts that form on the gums and roof of the mouth in a newborn

Check a sucking / rooting reflex

Question 22

Newborn examination of the face?

Answer 22

Dysmorphism

Asymmetry of the face (facial palsy)

Question 23

Newborn examination of the respiratory system?

Answer 23

Chest shape, in-drawing

Nasal flaring, grunting

Tachypnoea

Breath sounds (auscultate)

Question 24

Newborn examination of the CV system?

Answer 24

Colour / saturation (SaO2)

Pulses:
• Femoral (aortic coarctation)

Apex beat (left mid-clavicular line), thrills/heaves, heart sounds (auscultate)

Question 25

Newborn examination of the abdomen?

Answer 25

Moves with respiration Abdominal distensions, hernias Inspect the umbilicus Bilious vomiting (explain the colour) Passage of meconium, i.e: meconium history Anus (correct position)

Question 26

Newborn examination of the GU system?

Answer 26

Normal passage of urine and normal genitalia Undescended testes Hypospadius

Question 27

Newborn examination of the MSK system?

Answer 27

Movements, posture, limbs & digits, spine Hip examination NOTES - check the spine for evidence of spina bifida

Question 28

Newborn examination of the neurological system?

Answer 28

Alert, responsiveness Cry Tone Posture and movements ``` Primitive reflexes (the absence of these indicate serious neuro issues): • Rooting • Suck • Moro • ATNR • Stepping • Grasp ```

Question 29

Newborn examination of the skin?

Answer 29

Erythema toxicum - common rash in neonates (does not occur outside of the neonatal period); it is benign Check for birth marks, e.g: • Strawberry naevi - benign birthmark • Mongolian blue spot - very common in dark-skinned babies • Port-wine stain (AKA firemark) -discoloration of the human skin caused by a vascular anomaly

Question 30

Important parenting advice on sleeping position of the newborn?

Answer 30

Should sleep on their back Must not sleep on their front or in their parents death (strong assoc. with cot death)