Secret of Newborn infant

Introduction

The newborn infants normally born after 40weeks of gestation are around 2.8 kgs of body weight or more sometimes.

According to WHO, newborn babies weighing less than 2500 grams at birth are term as Low Birthweight (LBW), irrespective of the period of gestation. It includes preterm babies born before 37 weeks of gestation, as well full-term babies, who were small for a date or gestation due to intrauterine growth retardation (IUGR).

A normal full-term newborn infant

• Newborn baby at birth is about 52 cm long

• The head circumference is approx. 34 to  35 cm

• Chest circumference is 3 cm less

• The upper segment to lower segment ratio is between 1.7 and 1.9 to 1 relatively

• A full-term infant lies in an attitude of flexion

• Sclerae appears bluish

• The breast nodule is palpable usually more than 5 mm in diameter

• At least one testis is descended

• The scrotum appears deeply pigmented and has adequate rugate

• The heart rate ranges between 120 to  140 / minutes within a few hours after birth

• The respiratory rate stabilizes at about 30 to 40 / minutes but may rise to 60 / minutes during crying

• The peripheral cyanosis sometimes present for a short while after birth even in normal full-term infants

• The skull may show molding

• The parietal bones may slightly override the occipital and the frontal bones 

Neonatal reflexes

Sucking and rooting reflex

A full-term infant or baby sucks breast or nipple vigorously when the breast is brought into contact with the infant's cheek, it seeks the nipple. The stimulation of the upper and lower lips, influences movement of the lip and tongue in the direction of the stimulus (sucking reflex). The sucking reflex is feeble in sick and preterm infants.

Grasp reflex

Here when the baby's palms is stroked with the examiner's or physician's fingers, the baby's fingers close and grasp it. This grasp reflex usually disappears by the age of 12 to 13 weeks. If it persists beyond this age should arouse suspicion of brain damage or must examine the brain activity.

Moro's reflex

The supine infant's head is gently raised above the level of the bed and then released suddenly. A positive response consists of sudden abduction followed by the adduction of both arms. Hands open but fingers remain flexed. Reflex can be elicited at 28 weeks of gestation.

Glabellar tap

When the examiner gently taps the glabella, both eyelids of the neonate blink.

Crossed extension

There is flexion, abduction, and extension of the opposite leg when the foot is stroked with the leg held extended at the knee.

Automatic walking 

When the sole of the foot is pressed against the table, the opposite leg is flexed, as if there is alternate flexion and extension seen in attempted walking.

Tonic neck reflex

The recumbent baby's head is turned abruptly aside. The arm and leg on a similar side expand, while the opposite appendages go into flexion. Tirelessness of reflex past the age of 6 to 9 months is strange and typically demonstrates spastic cerebral paralysis.

Minor clinical problems

Milia

Distended sebaceous glands may appear as white dots on the face and nose. These disappear spontaneously.

Erythema toxicum

On the 2nd and 3rd day, discrete erythematous papules may appear on the trunk and face. It should be differentiated from impetigo. The rash disappears spontaneously.

Mongolian spots

These are bluish, well-demarcated spots on the buttocks and truck. Name is a misnomer because these are not related to Down Syndrome and usually disappear before the first birthday.

Stork bites

These are pinkish-grey capillary hemangiomata which are seen on the nape of the neck, upper eyelids, forehead, and root of the nose. These disappear after a few months.

Subconjunctival hemorrhages

These are not common but are absorbed within a few days without leaving any residue.

Vaginal bleeding

Menstrual-like bleeding may occur from the 3rd to the 7th day of life. As this is attributed to the transplacental passage of hormones, no therapy is required.

Breast engorgement

We sometimes seen, in a full-term baby, of both sexes may develop engorgement of breasts on the third or fourth day. This is also related to the transplacental passage of hormones.

Peeling of skin

This is frequent in post-term infants. It needs no treatment.

Epstein pearls

These appear as white spots in the place of the hard palate. No treatment is required

Physiological jaundice of the newborn.