Physiologic function/Systemic Evaluation

Cardiovascular system
1. Closure of the foramen ovale (fossa ovalis) by the 3rd
month of life to 1 year
2. Change of the ductus arteriosus into a mere ligament
(ligamentum arteriosum) when the infant is several
weeks to 4 months
3. Ductus venosus becomes a mere ligament
(ligamentum venosum) by 3rd month due to absence
of blood flow
4. Arteries and umbilical veins atrophied and degenerate
by 2-3 months since no more blood goes through
these vessels
Blood Values
a. Blood volume 80-110 ml./kg. of weight or about 300
ml
b. Erythrocytes count increase = around 6 million/mm3
c. Hgb level = 17-18 g/100 ml of blood
d. Hct level = 45% to 50%
e. White blood cells = 15,000 to 30,000/ml. (40,000/mm3 =
stressful birth)
f. Indirect bilirubin level = 1-4 mg/100 ml. Any increase
over this amount reflects that RBC are beginning to
breakdown
Respiratory System
a. The first breath of a neonate is initiated by a
combination of cold receptors, a lowered PO2 and an
increased PCO2
b. First breathe requires a tremendous amount of
pressure (about 40 to 70 cm H2O)
c. The presence of fluid in the lungs eases the surface
tension on alveolar walls and makes the first breathe
easier. This allows the alveoli to inflate more easily
than if the lung walls were dry
d. Once the alveoli have initially been inflated, breathing
becomes easier for the baby requiring only about 6-8
cm H2O pressure. Within 10 minutes of birth, the
newborn has established a good residual volume. By
10-12 hours of age, vital capacity is established at
newborn proportions
Gastrointestinal
a. GIT is sterile at birth
b. Most bacteria enter the tract through the newborns
mouth from airborne sources, vaginal secretions at
birth, from hospital bedding and from contact at the
breast
c. Newborns stomach holds about 60-90 ml
d. Pancreatic enzymes (lipase and amylase) are
deficient for the first few months.
e. Newborn has immature cardiac sphincter
regurgitation
f. Immature liver lowered glucose and protein serum
level
Stools
a. Meconium 1st stool of the newborn
- Usually passed within 24
hours
- A sticky, tarlike, blackish-
green, odorless material
formed from mucus, vernix,
lanugo, hormones and CHO
Meconium ileus, Imperforate anus or bowel obstruction newborn
who does not pass meconium stool by 24-48 hours after birth

b. Transitional stool occurs on the

2nd or third day of life
- becomes green and loose
-resembles diarrhea to the untrained
eye
By the fourth day of life, stool
changes depending on the
type of feeding:
a. Breast-fed babies light
yellow, mushy, more-frequent
and sweet smelling; 3-4/day

b. Bottle-fed babies bright

yellow, firm, less frequent
and foul-smelling; 2-3/day
Urinary system
-Average neonate voids within 24 hours after birth
-Urine is odorless and light in color because kidneys do
not concentrate well
-Daily urine output for the first 1-2 days of life is 30-60
ml and may increase to about 300 ml after 1 week
-Specific gravity is 1.008-1.010
-May have small amount of protein due to immature
glomeruli
-First voiding may be pink or dusky because of uric
acid crystals that were formed in the bladder in utero
Immune system
Passive natural immunity
IgA and IgG
Newborns have antibodies from mother against
poliomyelitis, diphtheria, tetanus, pertussis, rubella,
measles and chickenpox
 Neuromuscular System
- Demonstrates neuromuscular function
by moving their extremities and
attempting to control head movement,
exhibiting a strong cry, demonstrating
newborn reflexes
- Occasionally twitching movements of
extremities in the absence of stimulus
because of the immaturity of the
nervous system
 Testing newborn reflexes using simple maneuvers:

BLINK REFLEXES:
Purpose: serves to
protect eye from any
object coming near it.
Stimulus: shining a strong
light such as flashlight
or otoscope light on the
eye or sudden
movement toward the
eye
Reaction: rapid eye
closure
 ROOTING REFLEXES:

Purpose: serves to help the

baby find food.
Stimulus: stroke near the
corner of the mouth or
the cheek with a finger .
Reaction: .The infant will
open mouth and turn
toward the side
stimulated
Duration: Birth to six
weeks
 SUCKING REFLEXES:

Stimulus: Touch lips of

infant
Reaction: The infant has a
tendency to suck any
object touches the lips
Duration: From birth and
begins to diminish at 6
months. It disappears if
it is never stimulated
 SWALLOWING REFLEXES:
Stimulus: Food that reaches the posterior portion of the tongue
Reaction: automatically swallowed
Duration: This will never disappear

EXTRUSION REFLEX:
Purpose: It prevents the swallowing
of inedible substance.

Stimulus: Place any substance on the

anterior portion of the tongue

Reaction: extrudes any substance

that is placed.

Duration: Birth to 4 months of age.

 PALMAR GRASP REFLEX:
Stimulus: Place a finger or
object on the palms of the
newborn

Reaction: Automatically
grasp the finger or object
by closing her fingers on it

Duration: From birth and this

disappears at about 6
weeks to 3 months of age.
 STEP (WALK)-IN-
PLACE REFLEX:
Stimulus: Hold infant in
standing position with
feet touching a firm
surface

Reaction: Make stepping

motions

Duration: Birth to 3
months of age
PLACING REFLEX:
Stimulus: Touching
the anterior surface
of the newborns leg
against a hard
surface such as the
edge of the bassinet
or table.
Reaction: Makes a few
quick lifting
motions, as if to
step onto the table.
PLANTAR GRASP
REFLEX:
Stimulus: Touch the
soles of the foot at
the base of the toes
Reaction: Toes will
curl downward or
flex
Duration: Birth to 8 to
9 months of age in
preparation for
walking.
 TONIC NECK REFLEX:
Stimulus: Place in supine
position and turn head to
right and left side
Reaction: The arms and legs
on the side where the
head is turned will extend
and the arms and legs on
the opposite side will flex
Duration: From birth and
disappears between the
second and third month
of life.
MORO (STARTLE) REFLEX:
Stimulus: startling a newborn with a loud noise or by
jarring the bassinet.
Reaction: Arms and legs extend then drawn inward in
an embracing position. The arms and legs should
extend symmetrically
Duration: From birth. It is strong for the first 8 weeks of
life and then fades by the end of the fourth and fifth
month, at the same time an infant can roll away from
danger.
Abnormal reaction: Absence may indicate brain
damage; Assymetric arm movement paralysis of
the fractured clavicle, humerus or dislocated hip
MORO REFLEX
 BABINSKI REFLEX:
Stimulus: Stroke the
lateral aspect of the
soles of the foot in
inverted J- curve from
heel upward to the base
of the toes
Reaction: Fanning of toes
Duration: From birth and
it remains positive until
at least 3 months of
age.
MAGNET REFLEX:
Stimulus: pressure is applied to the soles of
the feet of a newborn lying in a supine
position

Reaction: he or she pushes back against the

pressure.

This reflex test spinal cord integrity

CROSSED EXTENSION REFLEX:
Stimulus: One leg of a newborn lying supine is
extended and the sole of the foot is irritated
by being rubbed with a sharp object, such as
thumbnail
Reaction: the infant raises the other leg and
extends it, as if it tries to push away the
hand irritating the first leg.

This reflex test spinal cord integrity

 TRUNK INCURVATION
REFLEX:
Stimulus: Place in prone
position and stroke one
side of the infants back
from shoulder to the
buttocks
Reaction: The infant
curves the body
towards the side
stroked
Duration: Birth to three
months

TEST OF SPINAL CORD

INTEGRITY
LANDAU REFLEX:
Stimulus: when held in a
prone position with a hand
underneath supporting the
trunk

Reaction: should
demonstrate some muscle
tone. Babies may not be
able to lift their head or
arch their back in this
position, but neither
should they sag into an
inverted U position.
 DEEP TENDON REFLEX:
Patellar reflex
STIMULUS: tapping the patellar tendon with the tip of
the finger.
REACTION: The lower leg will move perceptibly if the
infant has a mature reflex.
Test for spinal nerves L2 through L4.

Biceps reflex
STIMULUS: place the thumb of your left hand on the
tendon of the biceps muscle on the inner surface of
the elbow. Tap the thumb as it rests on the tendon
REACTION: you are mere likely to feel the tendon
contract than to observe movement.
This is a test for spinal nerves C 5 and C6
 SENSES
a. Hearing as soon as the amniotic fluid drains or is
absorbed from the middle ear by the way of
eustachian tube within hours after birth hearing
in newborns becomes acute although they appear
to have difficulty locating sound, not turning
toward it consistently. They recognized they
mothers voice immediately.
b. Vision a newborn can see at birth, although they
cannot see part of the midline of vision (not until 6-
8 weeks). They focus best on black and white
objects at a distance of 9-12 inches. They
demonstrate sight at birth by blinking at a strong
light or by following bright lights or toy a short
distance with their eyes. Pupillary reflex or ability
to contract the pupils is present at birth.
c. Touch most developed senses. It is demonstrated by
quieting at a soothing touch and by positive sucking and
rooting reflexes, which are elicited by touch. They also
react to pain stimuli.
d. Taste - a newborn has the ability to discriminate taste,
because taste buds are developed and functioning even
before birth. Ex. He turns away from a bitter taste but
readily accepts sweet taste.
e. Smell this is present as soon as the nose is clear of
mucus and amniotic fluid. Newborns turn towards their
mother breast partly out of recognition of the smell of
breast milk and as manifestation of rooting reflex. Their
ability to respond to odors can be used to document
alertness and possibly intelligence.
F. NEWBORN SCREENING TEST:
- to find out if the baby has a congenital metabolic disorder that
may lead to mental retardation and even death if left untreated
- ideally done on the 48th hour or at least 24 hour from birth. The
baby must be screened again after 2 weeks for more accurate
results
Disorder screened:
1. Congenital hypothyroidism (CH) results from lack or absence of
thyroid hormones (essential for growth of the brain and body)
2. Congenital adrenal hyperplasia (CAH) an endocrine disorder that
cause severe salt lose, DHN, and abnormally high levels of male
sex hormones in both boys and girls
3. G6PD deficiency the body lacks the enzyme G6PD. Baby may
have hemolytic anemia
4. Galactosemia (GAL) body is unable to process galactose, the
sugar present in milk
5. Phenylketonuria (PKU) metabolic disorder in which the body
cannot properly use one of the building blocks of protein called
phenylalanine.