SEMINAR

ON

PHYSIOLOGICAL

AND

CHARECTERISTICS OF NORMAL
NEWBORN

SUBMITTED TO SUMMITED BY

Mrs. Bakkiyalatchmi.P Hirom Pratibha

1st year M.Sc Nursing

CON, JIPMER CON, JIPMER

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Introduction

A newborn infant is known as a neonate after the final stage of gestation throughout the first
month. A baby from birth to 28th days of life is called neonate or newborn. The first week of
life (<7days or 168hrs) is known as a neonatal period. The late neonatal period extends from
7th to 28th days. A healthy infant born at term (between 38-42 weeks) should have an average
birth weight for the country (usually exceeds 2-5kg) cries immediately the following birth
establishes interdependent rhythmic respiration and quickly adapts to the changing
environment. “Neonate,” is the name for newborn babies from birth till the age of one month.
If the neonate has a strong cry and moves actively, with pink skin and nails, that means he is
in a good health.

Physiological change in newborn baby

1. Respiratory system

In the uterus, the fetus receives oxygen through a placenta. The normal baby has a respiration
rate of 30-60breath per minute.

Most newborns breathe faster than adults, usually more than twice as fast. The respiratory
rate for new born (40-50 times/minute), and heart rate, (140-180 beat/minute). These vital
signs increase when the baby cries or when disturbed, due to any reason.
After the second month of birth, respiratory rate will decrease to (30-40/minute), and heart
rate decreases to (120-140 beat/minute).
Neonate body temperature is around 37c◦ (98.1f), and are very sensitive to the surrounding
temperature as their capacities to detect temperature adjustments are not yet well developed.
Thus, room temperature has to stay constantly warm, and the neonate shouldn’t be covered
completely. Put your hand behind his back if there is sweating. This means your child is too
warm, either due to high room temperature or heavy, warm clothes. Within days, the
umbilical cord dries and turns to a black color. It falls off within two weeks and ends at the
umbilicus. Before it falls off, it is advised to give the neonate a sponge bath. When it falls off,
clean the area with an alcoholic bandage once or twice daily until it heals completely.

You should ensure that the area does not become irritated when you change your baby. If it is
persistently red and it does not dry during the first three weeks, you should consult the
pediatrician immediately.

The initiation and establishment of respiration are of paramount importance to the survival of
the neonates. Effective establishment of respiration test the integrity of the respiratory,
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cardiovascular and central nervous system of the neonate and is best achieved when these
systems are both structurally and functionally normal. A patent airway is necessary to enable
ventilation of the lungs.

The respiration is initiated because of the following mechanism.

1. At term approximately, 20mg/kg of lung fluid is present within the respiratory tract.
Some fluid absorption is initiated on the lungs prior to the onset of labor.
2. During delivery compression of the chest wall assists in the expulsion of some of the
remaining fluid. Residual lung fluid may contribute to transient tachypnoea of the
newborn.
3. The presence of surfactant in the lungs reduces surface tension.
4. Compression of the chest wall during delivery followed by elastic recoil of the thorax
as the body delivered stimulates stretch receptors in the lungs.
5. Compression and decompression of the body’s head during delivery are thought to
stimulate the respiratory center in the brain which in turn maintains the stimulus to
respiratory effort.
6. Tactile stimulus is considered to be of minimal importance.

2. Circulatory system

The fetal circulation changes after birth. The heart rate is rapid 120-140/min and fluctuates in
accordance with the baby’s function, activity or sleep state.

Several temporary structures present in the fatal blood circulation are as follow:

 Foramen ovale
 Opening between the two atria allowing blood to flow from right to left atrium.
 Ductus Arteriosus
 A shunt between the pulmonary artery and aorta.
 Ductus Venosus
 A shunt between the umbilical vein and inferior vena cava (from a vein to vein)
 Hypogastric Arteries
 The branches of internal iliac arteries which are known as umbilical arteries when
they enter the umbilical cord.
 Umbilical Vein
 Leads from the umbilical cord to the underside of the liver and carries blood rich in
oxygen and nutrients.

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  It has a branch which joins the portal vein and supplies as the liver.

The fatal circulation changes soon after birth due to:

 Cessation of the placental blood flow.

 Initiation of respiration

The following changes occur in the vascular system:

1. Closure of the foramen ovale:

At birth when infants carries the lungs expand and the vascular field is increased.

 This reduces pulmonary vascular resistances.

 All of the cardiac output is sent to the heart from lungs increases the pressure in the
left atrium.
 At almost the same time, pressure on the right atrium is lowered because blood ceases
to flow through the cord.
 As a result, a functional closure at the foramen ovale is achieved soon after birth but
anatomical closure occurs in about 1 year time.
 In same individuals perfect anatomical closure may never be achieved.
a. Closure of the duct arteriosus

 Within few hours of respiration, the muscle wall of the ducts arteriosus contracts
probably in responses to rising Oâ‚‚ tension and reduction on circulating
prostaglandin.
 Functional closure of the ducts may occur after the establishment of pulmonary
circulation, the anatomical obliteration takes about 1-3 and becomes ligamentum
arteriasum.

b. Closure of the umbilical vein:

 It occurs a little later than the arteries.

 The ductus venous collapse and the venous pressure at the inferior vena cava fail and
in right atria.

c. Closure of the umbilical arteries:

 Functional enclosure is almost immediately and very quickly preventing an even

slight amount of fetal blood drain out.
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  Actual abliceration takes about 2-3 months.
 The distal part forms the lateral umbilical ligaments and the proximal parts remain
open as superior vesical arteries.

1. Hypogastric arteries

 Close functionally in few minutes after birth and clamping of the cord.

3. Thermal adaptation

Thermal control in the neonate remains poor in some time. Infant is at risk to hypothermia
due to insufficient temperature regulation by a various factor like environment, cold so need
to keep warm

A delivery room temperature of 24°c contrast sharply with intrauterine temperature and
ceases rapid cooling of the infant as amniotic fluid evaporates from his skin. Each millimeter
which evaporates removes 560 calories of heat. The newborn subcutaneous fat layer is thin
and provides poor insulation, allowing rapid transfer of core heat to the skin and to the
environment and also cooling of his blood.

The heat-regulating center in the baby’s brain has the capacity to promote heat production in
response to stimuli received from thermoreceptor. The neonate has brown adipose tissue
which assists in the rapid mobilization of heat resource, namely fatty acid and glycerol; in
times of cold stress. This mechanism is called non-shivering thermogenesis. Browm adipose
tissue is found in the mediastinum, around the nape of the neck, between the scapulae, along
the spinal column and suprarenal.

4. Haemopoietic system

The blood volume depends on upon the amount of placental transfer. The blood volume is
80-85 ml/kg body weight. Immediate after birth the normal volume is 300ml. The average
RBC count is 5 million/mm3. The mean Hb is 16-20mg/dl, hematocrit is 45-60mg/dl and
WBC count is 20000mm3.

PHYSICAL FEATURES AND CHARACTERISTICS OF NEW BORN

1. General appearance

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Baby is pinkish red in color. Vernix caeseosa is a white creamy, natural covering of the skin
of the fetus during the last trimester of pregnancy.

2. Posture

The newborn will have extremities flexed and clenched fists.

3. Skin

Slight peripheral skin cyanosis is quite but soon becomes pinkish with the establishment of
cardiopulmonary function. vernix has protected action and mostly absorbed in few hours.

4. APGAR score

The normal baby should get 7-10 Apgar score. Below 7 score indicate a degree of asphyxia.

Signs 0 1 2

Body pink, blue

Color ( appearance) Blue, pale Complete pink
extremities

Pulse (heart rate) Absent Slow (below 100) Over 100

Grimace (response to
No response Grimace Cry
stimuli)

Active body
Activity (muscle tone) Flaccid Flexion of extremities
movements

Respiratory efforts Absent Slow, irregular Good, crying

5. Weight: The normal weight of the newborn baby is 2.5 to 3 kg. 100-200gm weight is
a loss by the 2nd day of birth because of the loss of fluid by physiological loss,
deficiency of fluid intake and loss of fluid in the form of meconium and urine.
6. Length: The average length of the normal baby is approximately 50-52 cm. the baby
is measure from vertex to heel.
7. Head circumference: Head circumference is measured encircling at the occipital
protuberance at the supraorbital ridge measuring tape. The normal head circumference
is 33-35 cm.
8. Chest circumference: The size of the chest is smaller than a head. The normal
circumference of a chest is 30-31cm. The spacing of the nipple should be recorded.

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 S.N Measurement Range Average

1. Weight 2.5 – 3kg 3kg

2. Height 48-53cm 50cm

3. Chest circumference 30-33cm 31cm

4. Head circumference 32-35cm 33cm

5. Abdomen circumference 33-34cm 34cm

Fig: general measurement

6. Face

The face is comparatively smaller than the head. The eyes remain closed most of the times, a
papillary light reflex is present. The gums are smooth. The cheeks are full due to sucking
pads of fat.

7. Genitalia and breasts

Both boys and girls have nodules of breast tissue around the nipple. In boys, the testicles are
descended into the scrotum which has plentiful rugae. The urethral meatus opens at the tip of
the penis and the prepuce has adhered to the glans. In girls born at term, the labia majora
normally cover the labia minora. The hymen and clitoris may appear disproportionally large.

8. Renal regulation

The kidneys are functional in fetal life. The glomerular filtration rate is low and tubular
reabsorption capabilities are limited.

9. Gastrointestinal system

Sucking, swallowing reflex especially present after birth, they are co-ordinated. Meconium
should be passed within 2-3 days of birth then stool change to mustard color after 4-5 days.

10. Immunological system

There is three main type of immunoglobulin IgG, IgA, and IgM. It protects the infant up to 2
months. Breast milk especially colostrums provide the infant with passive immunity in the
form of lacto bacillus difidus.
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 11. Neurological adaption

After birth brain growth is rapid requiring constant and adequate supplies of oxygen and
glucose. There is various reflex are:

 Moro reflex: It can be elicited by holding the baby at the angle of 45degree and then
permitting the head to drop 1 or 2 cm.
 Rooting reflex: In response to stroking of the cheeks or side of the mouth, the baby
will turn towards the source of stimulus and open his mouth ready to suckle.
 Sucking and swallowing reflexes: are well developed in the normal baby and is co-
ordinate with breathing. This is essential for safe feeding and adequate nutrition.
 Gag, cough, and sneeze reflex: Protect the infant from airway obstruction.
 Blinking and corneal reflexes protect the eyes from trauma.
 Grasp reflexes: A palmer grasp is elicited by placing a finger or pencil in the palm of
the baby’s hand. The finger is grasped firmly.
 Walking and stepping reflexes: When supported upright with his feet touching a flat
surface the baby stimulates walking. If held with the tibia in contact with the edge of a
table the infant will step up onto the table (limp-placement reflex).
 Traction response: When pulled upright by the wrist to a sitting position, the head
will lag initially then right itself monetarily before falling forward onto the chest.
 Ventral suspension: When the baby held prone suspended over the examiner’s arm,
the baby momentarily holds his head level with his body and flexes his limbs.

12. Special senses

 Vision: Thought immature, vision is present and functional at birth. The baby is
sensitive to birth lights. His focusing distant is 15-20cm which allows him to see the
mothers face when being nursed.
 Hearing: The baby turns his head eyes towards sound on hearing a high pitched
sound, he first still and then becomes
 Smell and taste: Babies prefer the smell of milk yo that other substance and show a
preference for human milk.
 Touch: Infants are acutely sensitive to touch, enjoying skin to skin contact,
immersion in water, stroking, cuddling and rocking movements.

13. Brain development in newborns:

Brain cells that are responsible for mental processes start developing early in fetal
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development. Studies have shown that the highest rate of brain cell development is at 18
weeks of pregnancy and continue until the first two years after birth.

During the second stage of development, from 2 to 4 years, further developments are still fast
but occur at a slower rate than experienced during the first stage.

At 8 years of age, these cells are barely growing. Full brain development is reflected by the
feeling of stability, strong curiosity, the ability for accurate observation and conclusions as
opposed to, “stuffed information.”

What is the parent's role in helping their child during the rapid stage of brain
development?

Parents should make their baby feel their endless love and concern. Also, recognize his
movements and signals. And, the most important thing they should give them is the
nutritional supplements necessary for brain growth, during this period.

Stimulus and response for newborns:

It has always been thought that the most important senses for the newborn appear late, but it
has been found that they do start developing early, since birth. For example, if the newborn
hears a voice, he turns his head and eyes toward the voice. This means that he wants to know
what he is hearing.

Visibility for the newborn is limited, usually from 20-30cm. He is able to see shades and can
observe darkness and light. But it is so important to know that vision and hearing are quite
joyful for your baby. Hearing develops gradually for the fetus. That is when he hears his
mother's heart beat. The experienced mother knows how to calm her baby with soft
synchronized voices, such as soft music to sleep. The ticking clock, pillows and colored
covers, voice activated moving toys, all these things can affect the baby.

Touching is the most developed sense for the newborn. If you touch the newborn, you will
notice his reaction immediately, or his happy reaction when his parents hold him in their
arms. It might seem a natural thing, but it is a major necessity for the development of our
touching sensation. When the baby feels his parents' love and care, a positive concept for his,
“self,” develops. It is also important for emotional, physical and mental development. Smell
and taste are as sensitive as touch sensation.

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This can be proved by observing the reaction of the baby to breast milk and to synthetic milk.
When his mother gives him the bottle after breast feeding he refuse it as he has become used
to the smell of his mother and the taste of breast milk.

So, as said before, the baby has major physiological functions that makes him able to react to
different external stimuli. The desired stimuli will enhance the growth of the baby. If there is
over stimulation, this will confuse and disturb the baby.

Deciduous teeth:
The first teeth start to develop between 5 to 8 months after birth. They may appear earlier or
later but this shouldn’t be a concern if the baby is in good health. If the baby develops some
symptoms, such as, excessive salivation, desire to bite anything in his hands, this may
indicate that his teeth are about to appear. You can feel his teeth if you touch his gum with
your finger. Give him something to bite, like a carrot, biscuit or a rubber biter. You should
acknowledge the strong association between teeth and fluoride. Regardless of the time these
teeth appear, the permanent teeth are hidden in gum tissues, so to keep your baby's teeth
healthy and free of cares, you should supply him with a fluoride treatment available through
your Dentist and some doctors.

Taking care of newborn skin:

The most important reason why parents like holding and touching their baby is his soft and
delicate skin. You should moisturize his skin with lotion around his heals and elbows and
folded areas, because these areas are prone to dryness.

After a bath, use the powder on the folded area to prevent skin lesions. Cut the nails while he
is sleeping to prevent scratches. Avoid harsh clothes as these will cause skin redness. Your
baby should wear a hat when going out. In addition to moisturizing lotion to protect his skin,
it is advised not to expose him to direct sunlight for long periods.

Sunbath:
Babies need a certain amount of sun light, and fresh air for healthy and good growth.

Sunlight is important as it produces Vitamin-D, which is important for bone, skin

development and blood circulation.

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At two months of age, it is preferred to expose your baby to fresh air and sunlight unless his
weight is less than 4.5kg. Pick a sunny, warm day to take time for a walk in his stroller. This
helps in adjusting his body temperature in a steady manner when he is exposed to different
temperatures outside. On your first day, do not take a long time, on average 20 minutes. You
can increase your time outside gradually up to an one hour if he is in good general condition.
If he is exposed to direct sunlight for long period, he may get sunburned. That is why you
should put some cream on exposed skin before going out, in addition to wearing a hat.

It is preferred to use a comfortable stroller that is bent a little bit backward. You should also
make sure that he is not wearing too many clothes. This is the best way to expose the baby to
sunlight. A nice sunbath can be given to the baby on the balcony, or close to the window. The
best time is between 10 AM and 3 PM during spring and autumn, or between 1 PM to 2 PM
during winter months and just before sunset in the Summer. It is appropriate to be done one
to two hours after a meal. The baby’s head should be covered or put under an umbrella to
avoid direct exposure to sunlight.

Taking care of the baby during summer:

Your baby will face difficult times during hot summer days. He may not have a desire to eat,
and his digestive functions may weaken. And he may become upset more often. The main
concern for his mother is how to protect him from summer diseases. First, you have to keep
him at home in the coolest room. You can give him several baths on hot days. Do not allow
him to lay naked. Instead, put some light clothes on him and change him continuously. Cover
him with light sheets when he sleeps and do not force him to eat. Give him good amounts of
fluids such as juice, vegetables and barley tea. Give him his milk or food cold, and mash his
food so that it will be easy to digest.

Keep his bottle and plates clean and keep them sterilized by boiling them. The baby should
be kept away from fans or air conditioners. Natural air is preferred but if the room
temperature is above 30c° (86f), you can switch on the AC.

If you have to use pesticides, your baby should stay outside for more than one hour after
refreshing the air in the room. It is preferred to use screening against mosquitoes instead of
pesticides. Do not forget to take him to the Doctor for his vaccinations, as scheduled.

Taking care of the baby during winter:

Winter is a difficult time as is the case in summer. As said before, temperature regulation

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centers in the baby as he still immature. He can easily get cold and flu, which may lead to
serious diseases, if not treated properly. Keep your baby in a warmer area at home. Usually, it
is the room and / or window toward the Southern area. Keep the room temperature around
20C°. If it is less than 10C°, he will be at a risk of having a cold and if it is less than 5C° he
will suffer from frail frost. This is not good care.

The best method for warming the room is an electrical heater. If you choose gas or kerosene,
you should pay attention to the potential of poisonous gases and make sure that there is good
ventilation. Put a protective barrier around the heater, to protect the baby from burns. Do not
over dress him, as this will impede his movement.

When the weather gets better and it becomes warm, open the windows to refresh the air and
try to let him enjoy the warm sunlight.

It is difficult to keep the baby warm during a bath. It is better to bathe during the daytime
when the weather is relatively warm.

The baby’s appetite does not change during the winter. Give him good amounts of warm
food, rich with vitamins.
WARM CHAIN:-
The “warm chain” is a set of interlinked procedures to be performed at birth and during the
next few hours and days after birth in order to minimize heat loss in all newborns (WHO,
1997). Failure to implement any one of these procedures will break the chain and put the
newborn at risk of getting cold. Ideally, hospitals that care for sick and low birth weight
newborns should have additional equipment such as overhead heaters, heated mattresses,
incubators and low-reading thermometers that read temperatures down to 25°C. These
should be used with caution and following manufacturer’s directions.
A newborn’s temperature should be monitored closely under the following conditions:
• Difficulty maintaining the “warm chain” or providing an optimal thermal
environment
• Low birth weight and/or ill newborn
• Resuscitation required at birth
• Suspicion of hypothermia or hyperthermia
• With rewarming or cooling down
• If the newborn has been re-admitted to hospital for any reason

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Ten steps of the “warm chain” (adapted from WHO, 1997)
STEPS PROCEDURE
1. Warm delivery room  The temperature of the delivery room should be at
least 25°C, free from the drafts from open
windows, doors, or fans.
 Supplies needed to keep the newborn warm
should be prepared ahead of time.
 Adults should never determine the temperature of
the delivery room according to their comfort

2. Immediate drying  Immediately dry the newborn after birth with a

warm towel or cloth to prevent heat loss from
evaporation (For newborns <29 wks GA refer to
the NRP guidelines).

3. Skin-to-skin contact  While the newborn is being dried, place on the

mother’s chest or abdomen (skinto-skin contact)
to prevent heat loss.
-If mother is unable the cold newborn may go
skin-to-skin with the partner
 Cover the newborn with a second towel and put a
cap on the head to prevent heat loss from
convection.
 Leave the newborn skin-to-skin on the mother
and keep covered.
 Newborns should be uncovered as little as
possible during assessments and interventions.
 Newborns can be maintained in skin-to-skin
contact with the mother:
-while she is being attended to (placenta delivery,
suturing)
-during transfer to the postnatal unit, recovery
room
-during assessments and initial interventions
- for the first hours after birth

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4. Breast feeding Initiate as soon as possible, preferably within one hour of
birth.
5. Postpone weighing and  Weighing can be done following the period of
bathing uninterrupted skin-to-skin contact and the first
feed. Place a warm blanket on the scale.
 Bathing the newborn soon after birth causes a
drop in the body temperature and may propagate
hypothermia and hypoglycaemia.
 Following the transition period (6-8 hours)
newborns may be assessed for bathing readiness.
Bathing may be considered when vital signs are
stable.
 If a hypothermic newborn has thick wet hair,
consider washing the hair only, drying the hair
thoroughly and then place a cap on the head.
 Bathing should be done quickly in a warm room,
using warm water. Tub bathing is the preferred
method of bathing to prevent heat loss for all
stable newborns both term and preterm. The water
should be deep enough to cover the newborn’s
shoulders.
 Note: Newborns with an umbilical catheter
should not be tub bathed
 Immediately after the bath dry thoroughly,
immediately diaper and place skin-toskin. If skin-
to-skin is not possible double wrap the newborn
with warm blankets ensuring the head is covered.
 After skin-to-skin, dress the newborn, apply a dry
cap and wrap in dry warm blankets.

6. Appropriate  Dress newborn in loose clothing and blanket.

clothing/blanket
7. Mother and newborn  Keep mother and newborn together 24 hours a
together day (rooming-in), in a warm room (at least 25°C).
 Newborn should be fed on demand.
 Skin-to-skin can be used to rewarm a newborn
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 experiencing mild to moderate hypothermia
8. Warm transportation  Keep newborn warm while waiting for
transportation.
 Dress the newborn and wrap in blankets if a
transport device is used.

9. Warm assessment (if  Lay on a warm surface in a warm room.

newborn not skin-to-skin  Put under an additional heat source as necessary
with mother) (i.e. radiant warmer).
 Utilize servocontrol if on radiant warmer for >10
minutes.

10. Training and raising  Alert health care providers and families to the
awareness risks of hypothermia and hyperthermia.
 Teach the principle of thermal protection of the
newborn.
 Provide on the job training and supervised
practice to ensure that the 10 steps of the warm
chain become part of the routine care of the
newborn.
 Demonstrate and provide supervised practice on
the appropriate use of equipment for low birth
weight/preterm newborns.

The usual physical examinations:

It is so important to visit the pediatrician on a regular basis to check on your baby and make
sure that his growth is appropriate to his age. The first visit should be 4 weeks after delivery,
then every 2 months until your baby is one year old. These regular visits are as important as
visiting the pediatrician when he is sick; you can talk with your baby’s doctor, take some
advices about unusual behaviors and about his growth and development. It is preferred to
choose the clinic that is close to your home in emergencies.

You can check your baby’s temperature. If it is between 37C° to 37.5C°, this is normal. Body
temperature may normally decrease a little in the morning and increase in the afternoon. The
best way to measure his temperature is rectally. Hold your baby while he is lying on his
abdomen, shake the thermometer till the red point drops below 37C°, put the thermometer
gently in the anus, for 1-3 minutes, and do not ever leave your baby with the thermometer
still in his anus. If you must leave him, remove the thermometer and start again later.

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Vomiting:
Newborn babies usually vomit what they had eaten last. His stomach is like a bottle in shape,
unlike the adult stomach, which is like a sac in shape. Babies can easily vomit if you bend his
back forward.
When you have to take your baby?
If he is vomiting for long time and if he vomits large amounts frequently, you should visit the
doctor to check if there is something abnormal, like asthma, meningitis or duodenal stenosis.
Diaper rash:
The genital area in the baby can be irritated and red from urine, stool or diapers. To avoid
these problems, change the diaper frequently. Use moisturizing cream or powder or special
ointments described by the doctor. When the area is red, try to expose it to the air, several
times a day.
Fever:
If the body temperature is above 38C°, use cold compresses on his forehead, or use skin
patches, or keep his feet warm when you use skin patches. Cover them with dry towels to
prevent direct contact with the skin. If the fever continues for hours, (< 37.8) you should
consult a doctor.
Constipation:
If the baby has difficulties in defecation, or his stool is hard, this does not mean he has
constipation. The most important factors causing constipation are inadequate nutritional
supplements, or frequent vomiting before giving any medication. You should try to realize
the precipitating factors. If it is not due to a certain disease, give your baby adequate amounts
of fluid. A warm sits bath can be helpful. You should keep in mind that some babies may
defecate twice weekly without having any medical problems so always check his stool
characteristics before becoming concerned.
Jaundice:
Most babies will have jaundice in the first few days after birth. That is due to incomplete
development of liver function. The liver is not capable of handling the yellow dye (bilirubin)
from dead red blood cells. Functional jaundice (hyperbilirubinemia) disappears usually
within two weeks. If the baby is not fully mature, if it persist for more than two weeks or if
the baby has a serious condition, his head and toes get yellowish in color. This will be a
pathological jaundice and the baby will need special care if the bilirubin level (yellow dye)
increases to 20%mg. This may lead to a serious condition in which the brain cells will be
affected and may be destroyed. Paralysis may occur so take care of this and do not wait too
long before taking your baby to the doctor.

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Colic:
It is not a disease. Instead, it is a physiological thing during growth. The baby may cry
without any symptoms such as fever, vomiting or diarrhea. Colic starts 3 weeks after delivery
and may continue until 3 months old. In this case, the baby doesn’t sleep at night and cries in
panicky way. Consequently his parents do not sleep and they may have difficulty tolerating
this situation.
The most important causative factors are psychological stresses, strong intestinal cramps,
intestinal dilatation due to environmental factors, or indigestion from over eating. If the colic
worsens in the evening, it is due mostly to pressure caused by several factors, such as, sound
of television, loud voices or changes in the environment of the house.
Sensitive babies are more prone to colic. If you face this problem with your baby, it will be
difficult to calm him. You should try as much as possible to make him comfortable with the
help of your family. If it is caused by the air, put the baby on your shoulder until he burps.
Patting on his back may help him along.
Sometimes, these symptoms might be due to other causes such as allergy, gastrointestinal
disorders, or peritonitis. If there is blood in his stool from the anus, take him immediately to
the hospital without changing his diaper to show it to the doctor.

Growth and development during childhood:

Most of the development in everyone’s life happens during this period.
During the first year, the baby has major developments in almost every area. He starts to
respond to his surrounding environment and adapt to it. He tries to regulate and change his
functional abilities and potentials to become a complete, small human being.
Parents can not determine certain goals for their baby, the desired length and weight, or the
potentials he should have. These things make every human unique from the others. Parents
should give much attention to these things. If their baby does not have these desired goals,
these important feelings will affect his emotions, making him over sensitive. Parents should
be relieved and give their baby the required attention and passion, in order for the baby to be
able to achieve the ideal development.

CONCLUSION:-
Newborn health is the key to child health and maintenance of normal physiological and
physical characteristics are very important.

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RESEARCH ARTICLES:-
TITLE:-
Association between newborn birth weight and the risk of postpartum maternal venous
thrombolism: a population based case- control study.
AUTHOR:-
Blondon M, Quon BS, Harrington LB, Boounameaux H, Smith NL
BACKGROUND:-
Post partum venous thrombosis is a potentially fatal and preventable event leading to
substantial short and long term morbidity. We sought to evaluate whether the delivery of term
newborn of low or high birth weight was associated with greater risk of VTE.
METHOD:-
The present case control study was conducted in Washington State from 1987-2011.
CONTROL GROUP;-
It was randomly selected postpartum mother without venous thromboembolism. They
compare the risk of VTE for mothers of newborn of low and high birth weights (<2500g and
>4000g, respectively) versus mothers of normal birth weight (2500-4000 g).
RESULT:-
Patients with VVTE (n=547) were older, had a higher body mass index, and experienced
more pregnancy- related complications than controls (n=9482). In comparison with mother of
newborns with normal birth weight, mother of newborn with low birth weight had a 3 fold
increased risk of VTE, which persisted after multivariable adjustment (odds ratio, 2.98; 95%
confidence interval, 1.80-4.93).
Mother of newborn with high birth weight had only a slightly increased risk of VTE, which
was attenuated after multivariable adjustment (odds ratio, 1.26; 95% confidence interval,
0.99-1.61).
CONCLUSION:-
The delivery of a newborn with low birth weight is associated with a 3 fold increased risk of
maternal postpartum VTE.
This should be considered when assessing VTE risk at delivery.
BIBLIOGRAPHY:-
1. Wong Donna L, Winkelstein Marilyn L, Et. al. Text book of nursing care and
infants and children,7th ed. New Delhi, Elsevier Publication.2006.
2. DuttaParul. Paediatric nursing , 2nd edition. New Delhi: Jaypee Brothers
Medical publishers(p). Page no 66-67.
3. https://www.nlm.nih.gov/medlineplus/ency/article/002395.htm

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4. http://www.ncbi.nlm.nih.gov/pubmed newborn relation with maternal
thromboembolism .

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