The Normal Newborn

Apgar Scoring

Newborn Sleep Cycles

Defined according to duration, length of cycle dependent on age of the
newborn.
First period of reactivity
Period of inactivity/sleep phase
Second period of reactivity
Sleep States:
Deep/Quiet sleep - regular breathing, no movement except sudden
body jerks
Active REM- irregular breathing, body twitching, may cry out but not
awake
Topics exam
Quiet alert - Infant awake and involved with the surroundings blueprint
Awake/Crying state
Apgar scoring
NEWBORN ADAPTATION
Sleep cycle
-Temperature regulation
Thermoregulation
convection
Rashes/marks
conduction
Cephalohematoma
radiation
Caput
evaporation
Newborn
-Management
appearance
-Cardiovascular changes
Reflexes
Nutrition
SGA
LGA
Metabolic disorders

VITAL SIGNS:
Temperature: Per axila 36.5 37.0 C/ 97.7 98.6 F. Rectal 97.8F-99.0F
Pulse/Heart Rate: Apical 120 160 bpm. Varies with sleep/crying
Respirations: 30 60 breaths/min
Blood Pressure: In arm/ thigh. Thigh maybe higher. 65/41 mmHg
The Newborn Appearance
Head: 32 37 cm / about 2 3 cm larger than chest.
Fontanels anterior & posterior .
Caput succedaneum
Cephalohematoma
Eyes, ears, nose, mouth & throat
alignment, symmetry
Birthmarks, milia, newborn rash
Neck - vernix
Chest: circumference 30 35 cm. Evident xiphoid.
Breast enlargement- witchs milk
Sternal retractions.
ABDOMEN: Umbilical cord 2 arteries,1 vein. Brachial and femoral pulses.
BACK: Spine intact. Patent anus. Passes meconium within 48hrs.
Lanugo, mongolian spots
GENITALIA: Urination within 24 hrs
Male: Testes palpable in scrotum. Scrotum pendulous, rugae,
hypospadias/ epispadias
Female: labia & clitoris edematous pseudomenstruation, hymenal
tag.
Extremities
Syndactyl / polydactyl
Barlow-Ortolanis maneuver
Newborn Reflexes
Blink
Rooting
Sucking
Palmar & Plantar Grasp
Stepping
Tonic Neck/ Fencer
Moro
Babinski
Trunk incurvation
Newborn Nutrition

Breast milk :
colostrum - in the first 3-4 days after birth. Rich in protein, low in sugar
and fat, also has minerals, vitamins, and maternal antibodies.
Transitional - Seen day 2nd - 4th
Mature milk - by day 10
fore milk hind milk - higher in fat allows for rapid growth of the newborn

Newborn Stools:
-Meconium - sticky, tarry, blackish green appearance. Passed within the
first 24 hrs.
-Transitional - 2nd or 3rd day of life color and consistency changes to greenish
brown loose stools
-Breast Fed Stools - More liquid, seedy yellow
-Bottle Fed Stools - Formed, pasty, brownish yellow

LGA (At/above the 90th %) Large for gestational age

Predisposing Factors:
Genetics
Multiparous women
Male infants
Infants with erythroblastosis fetalis
LGA Complications:
-Birth trauma - prone to shoulder dystocia, CPD, breech
-More C/S and/or pitocin induction
-Hypoglycemia
-Polycythemia
SGA (at/below the 10th %) Small for gestational age
Predisposing Factors:
Genetics
Malnutrition
Vascular changes in PIH/DM
Maternal factors
Environmental factors
Placental factors
Fetal factors
SGA Complications:
-Perinatal asphyxia

-Aspiration
-Heat loss
-Hypoglycemia
-Hypocalcemia
-Polycythemia
- These infants are prone to infections, malformations, disabilities
and growth difficulities.

Metabolic Conditions:
-Hereditary disorders - increased metabolites toxic to the newborn
PKU - phenylketonuria
Galactosemia
Hypothyroidism
Others: MST - Done in first 72 hrs of birth