Module 6: The Neonate Flashcards
What 2 hormones plays an essential role in neonatal transition to extrauterine life?
- catecholamines
- cortisol
What role does hormone catecholamines (epinephrine, norepinephrine, and dopamine) play in neonatal transition?
- promote fluid clearance from lungs
Surge in response to the normal birth process:
- responsible for increased blood pressure after birth, - adaptation of energy metabolism,
- initiation of thermogenesis from brown fat
What 3 roles does hormone cortisol play in neonatal transition to extrauterine life?
- key regulatory hormone
- Clearance of lung fluid
- Lung maturation (anatomy and surfactant)
- Gut maturation
- cortisol level starts to increase around 30 weeks gestation
- Maturation of glucose metabolic pathways in the liver
- Maturation of the thyroid axis
The major adaptations associated with transition occur during the first 6-8 hours of life. What is the most critical adaptation required?
- establishment of effective respirations
What are the fetal physiological (cardiopulmonary) changes that occur during transition?
- initiation of gas exchange across alveolar membrane
- expansion of lungs with air
- rise in arterial pO2
- rapid decrease in pulmonary vascular resistance and increase in pulmonary blood flow
- pressure gradient changes (decreased right side pressure/increased left side pressure in heart)
- closure of circulatory shunts (foraman ovale, ductus arteriosus)
What is persistent pulmonary hypertension of newborn?
- During the stabilization period, which occurs over several hours, the pulmonary vessels remain very responsive to the effects of hypoxia.
- Hypo-expansion of the lungs, hypoxemia, –> persistent acidosis –> result in high pulmonary vascular resistance, delayed clearance of lung fluid, –> persistent right to left shunting
What are the initial steps of NRP (4)?
- dry
- warm
- stimulate the infant
- ensure there is an open airway
What 4 factors stimulate the newborn to take first breath?
- Chemical: factors in a newborn’s blood (low oxygen, high carbon dioxide, and low pH) which stimulate respiratory center in brain.
- Mechanical: release of pressure on a baby’s chest, as the chest is born, may stimulate breathing and chest expansion.
- Sensory: stimulation from drying, lights, sounds, smells all involved in stimulation of respiratory center
- Thermal: change from temperature from warm intrauterine environment to cool extrauterine environment stimulate skin receptors which stimulate respiratory center.
What are the major changes that take place in a newborns cardiopulmonary system during the transition to extrauterine life?
- the lungs become the primary organ of gas exchange (instead of the placenta); the lungs inflate, fluid is cleared from the alveoli, pulmonary vascular resistance decreases rapidly and there is increased pulmonary blood flow.
- The pressure gradient in the newborn’s heart shifts. Right sided pressure which was high in fetal circulation decreases, and left sided pressures which were low now increases. As a result the foramen ovale closes.
- Rising pO2 causes smooth muscle cells in the ductus arteriosus to constrict thereby closing the shunt.
- Removal of the low pressure placental system increases the pressure in a newborn’s circulation which increases circulation and pulmonary perfusion.
What is the role of lung surfactant?
- Surfactant lowers the surface tension of the alveoli thereby reducing the pressure required to keep the alveoli open.
- Decreased surface tension also results in increased lung compliance.
What is the rapid assessment of 5 parameters that is performed after completing the initial steps of NRP? When is it performed?
- Apgar score
- performed and scored at one and five minutes
What does APGAR score stand for?
- A: appearance (colour): generalized skin colour
- P: pulse (heart rate): based on observed movement of chest wall
- G: grimace (reflexes) “response to stimulation”: based on degree flexion and movement of extremities
- A: activity (muscle tone): based on presence of grimace, crying or active withdrawal
- R: respirations (breathing):
based on auscultation or palpation of umbilical cord
What does APGAR score (at one minute) of 7 or above mean? score of 4-6 mean? score of 3 or less?
- A score of 7 or above at one minute indicates that an infant is making a good adjustment to extrauterine life.
- A score of 4 to 6 at one minute indicates that an infant is having some difficulty
- A score of 3 or less at one minute indicates severe distress.
What APGAR score warrants another assessment at 10 minutes?
- Apgar of 7 or less at 5 minutes warrants another assessment of the five parameters at 10 minutes
What are the predictable phases of activity and rest during the transition period for full term healthy infant?
“What are the 3 stages of newborn transitions periods?”
- first period of reactivity: within minutes after birth and lasting for 30-60 minutes
- sleep: generally go into a deep sleep, lasting for 60-100 minutes
- second period of reactivity: between two to six hours after birth and can last from 10 minutes to several hours
What is the “first period of reactivity” during the transition period (first hours of life) include for infant?
- Within minutes after birth and lasting for 30-60 minutes.
- In this period, infants are in a quiet alert state: eyes wide open and capable of responding to their environment.
- Healthy infants are in an optimal state for the important first meeting with their parents. Heart rate increases to 160-180 bpm, then settles to 100-120 bpm by 30 minutes of age.
- Respirations may be irregular and fine crackles may be audible on auscultation of lung fields.
- Transitory grunting, nasal flaring, and chest retractions may be evident.
What is the “sleep period” during the transition period (first hours of life) include for infant?
- Following this initial period of reactivity, infants generally go into a deep sleep, lasting for 60-100 minutes.
- During this deep sleep, many physiologic needs stabilize: temperature regulation and adequate oxygenation and circulation.
- Respirations may be rapid but not laboured.
What is the “second period of reactivity” during the transition period (first hours of life) include for infant?
- this takes place approximately between two to six hours after birth and can last from 10 minutes to several hours.
- brief periods of tachycardia and tachypnea, increased muscle tone, and skin colour changes.
- meconium is usually passed in this period.
What 2 physiological adaptation tasks are included for neonate to be maintaining respirations?
- adjusting to circulatory changes
- regulating temperature
-other additional tasks of ingesting, retaining, and digesting nutrients, eliminating wastes, and regulating weight
What is the most effective ways of supporting physiologic transition for infants to extrauterine life?
- skin to skin contact with mother
- kangaroo care
- involves placing the naked infant onto the naked chest of the woman
What are 4 benefits of neonatal skin to skin care?
- stabilizing respirations and oxygen saturation
- thermal regulation
- reduces stress and crying (lower salivary cortisol levels)
- increased incidence and duration of breastfeeding
- improves infant state organization and self-regulation
- reduces apnea and bradycardia
- facilitates neurodevelopment
- accelerated weight gain
- decreases pain response to painful procedures
What are 4 maternal benefits of skin to skin care?
- Increased self-confidence, competence, and self esteem
- Enhanced parent-infant attachment
- Increased incidence and duration of breastfeeding
- Positively affects maternal mood/behaviour
- increased milk supply
- Increased confidence in meeting infant’s needs
What behavioural tasks must a neonate accomplish to adapt to extrauterine life?
- establish regulated behavioural tempo independent of mother
- processing, snoring, organizing multiple stimuli
- establishing relationship with care givers and environment
- regulating physiologic functioning,
- motor organization,
- responding to stimuli and
- regulating states, and interacting with the environment
What are the 4 level of adaptations that Brazelton & Nugent (2011) describe infants progress as they adapt to their environment?
- First level: regulate their physiologic functions: heart rate, respiration, and temperature.
- Second level: motor organization; reduce excessive activity and improve muscle tone
- Third level: state regulation, predictable sleep/wake states and able to react to stress
- Fourth level: social interaction, able to attend to visual and auditory stimuli
What are the 4 necessary adaptations for neonate?
- regulating physiologic functioning
- motor organization
- responding to stimuli and regulating states
- interacting with the environment
What is the difference between an infant described as organized vs disorganzied?
Organized infant who is able to:
- regulate physiologic functioning,
- maintain good tone,
- modulate states, and
- interact with their environment
- disorganized: infant who is unable to manage these things due to gestational age or health status
What is sleep-wake states?
- Variations in the state of consciousness of infants
- affected by health status and gestational age
What is essential for neurodevelopment? What 2 factors affect it?
- ability to regulate sleep/wake states
- affected by health status and gestational age
What is state modulation?
- state modulation: ability to transition smoothly between states
- sleep-wake states: variations in the state of consciousness of infants
- Healthy term infants are able to transition smoothly through the six sleep/wake states
What are the 6 sleep-wake states?
(1) DEEP SLEEP (quiet): breathing regular, eyes closed, feed poorly
(2) LIGHT SLEEP (active): breathing irregular, rapid eye movements (REM), usually feed well
(3) DROWSY: breathing irregular, eyes open or closed, usually feed well
(4) QUIET ALERT: breathing regular, eyes open/bright, optimal state for feeding
(5) ACTIVE ALERT: breathing irregular, eyes open but not as bright,
(6) CRYING: breathing irregular, eyes tightly closed, difficult to feed
What 4 factors affect sleep-wake states?
- room temperature: the warmer the room, the longer an infant sleeps,
- amount of light: more active under minimal light versus moderate light,
- close contact with parents: (infants calm easier when in close contact with parents
- gestational age: preterm infants sleep longer and may have delayed responses to stimuli
What 4 factors about the infant should health care providers consider when interpreting what an infant is communicating?
- their health status
- their gestational age
- their environment
- their level of arousal
- knowledge of individual infant “knowing the infant”
What two key factors impact how an infant is able to communicate its needs?
- health status
- gestational age
What 2 factors make it difficult for NICU nurses to understanding the individual needs and behaviours of infant (knowing the infant)?
- First: newborn infants have very limited behavioural repertoires (the same behaviour may have different meanings in different situations)
- Second: they lack the energy to display characteristic behavioural responses (behaviour of critically ill infants is even more difficult to interpret)
What are 3 causes of apnea in infants?
Apnea: the cessation of breathing for longer than 20 seconds:
- blocked airway
- respiratory depression due to hypoxia
- immature central nervous system
Who are a great source of information when nurses need to know and understand the infants they care for?
- parents
- families
What are some infant behavours?
- alerting
- visual response
- auditory response
- habituation
- cuddliness
- consolability
- self-consoling
- consoling by caregivers
- motor behaviour and activity
- irritability
- readability
- smile
What are the 6 behavioural categories that the Neonatal Behavioural Assessment Scale (NBAS) uses to assess infant ability for social ineraction?
- habituation,
- auditory and visual stimuli,
- motor maturity,
- state regulation,
- self-consoling ability, and
- social behaviours
What is sensory threshold?
- the level of tolerance for stimuli within which the infant can respond appropriately
- when infant reach their threshold, they can become stressed
What are 4 stress cues of infant?
- irritable
- Disorganized sleep-wake states
- Gaze aversion
- Frowning
- Sneezing
- Yawning
- Hiccupping
- Irregular respirations
- Apnea
- Increased oxygen requirements
- Heart rate changes
- Finger splaying
- Arching/stiffening
What are 4 stability cues of infants?
- Smooth movements
- Regular respirations
- Regular heart rate
- Hand to mouth movements (self-consoling behaviour)
- Focused gaze
- Quiet alert state
- Clear sleep states
- Dilated pupils
- Rhythmic sucking
- Reaching or grasping
- Can be consoled easily
What is developmentally supportive care (DSC)?
- an approach that provides individualized care of infants to maximize neurological development and reduce long term cognitive and behavioural problems
- incorporates the ideas of normal neonatal development,
- assumes that infant behavioural cues can be interpreted to provide information about an infant’s needs and feelings, and
- recognizes the role that the environment plays in either nurturing an infant or adding to an infant’s vulnerability
What is the key concept of developmentally supportive care (DSC)?
individualized care with the intention of supporting the infant’s neurodevelopment according to:
- infant’s state,
- sensory threshold,
- physiologic homeostasis, and
- stability or stress cues
What is the basis for developmentally supportive care (DSC)?
- is based on the fact that infant behavioural cues communicate the infant’s needs, feelings, and overall neurologic status
- is based on the fact that infants continually interact with their environment
- involves altering the neonatal environment to nurture each of the infants’ sensory processes (tactile/kinesthetic, auditory, visual, and olfactory/gustatory)
- guides our decision making when providing care to infants
- creates an environment that nurtures brain growth and minimizes brain injury for optimal overall development
What are the 2 goals of developmentally supportive care (DSC)?
To create an environment that:
- nurtures brain growth and
- minimizes brain injury for optimal overall development.
What does habituation mean?
- infant is able to tune out and decrease their response to a stimuli.
What is the primary method used for communication by infants?
- Infants primarily use behaviours to communicate with their parents/care providers.
Can infant see?
- Infants can see objects as far away as 2 feet, but clearest visual distance is 8-12 inches.
- They prefer faces and can recognize their mother’s face.
What are 4 interventions or care practices by care giver to support developmentally supportive care (DSC)?
- skin to skin care
- decrease noise when feeding infant
- reading infant behavioural cues
- swaddling infant
- gentle touch to calm infants
- encouraging parents to talk to their infant
When is the first and second physical assessment of newborn done by primary care provider?
- first physical assessment of the newborn is usually done in the first hour after birth
- second physical assessment including behavioural assessment is performed prior to discharge
What is the PWSOAC framework?
- organizes the goals of care for infants
Neonatal program has created:
- Pink
- Warm
- Sweet
- Organized
- Attached
- Clean
Are neonates primarily nasal or mouth breathers?
- neonates are primarily nasal breathers and the normal respiratory rate of the newborn is 30-60 breaths per minute
- respirations are initially shallow and irregular with occasional pauses lasting less than 20 seconds
- breathing should be effortless but the rate will vary with sleep-wake patterns and when the infant is crying
What should infants RR, colour, tone and HR be?
- colour: pink
- tone: flexed
- HR: 100-160bpm
- RR: 30-60bpm
Are heart murmurs normal in health newborn?
- irregular heart rate: heard for brief periods in the first few days after birth due to changes in activity or respiratory pattern of the newborn
- heart murmur: heard in the first few days of life; most are not pathological and disappear by 6 months once the ductus arteriosus is fully closed
When does hearing a heart murmur require urgent follow up?
- heart murmurs can also be heard in the first few days of life; most are not pathological and disappear by 6 months once the ductus arteriosus is fully closed
- presence of a murmur along with poor feedings, apnea, cyanosis or pallor may indicate significant cardiac defects
What are 3 factors during birth or labour can compromise respiratory function and oxygenation for neonates?
- medications administered during labour and birth,
- inadequate clearance of lung fluid which may result from caesarean birth,
- meconium aspiration,
- congenital defects, and
- absent or decreased surfactant
- respiratory distress or apnea: may be related to hypoglycemia, hypothermia, or sepsis
What are the 3 cardinal signs of respiratory distress in newborn?
- nasal flaring
- in-drawing or retractions
- grunting
Whats transient tachypnea of the newborn (TTNB)?
- mild TTN: result from tachypnea and signs of respiratory distress in first 1-2hours of life
- Consultation with the primary care provider is required as supplemental oxygen may be needed along with increased observation
What is the normal temperature for newborn?
- normal temperature for a newborn should be between 36.5 and 37.4 degrees Celsius axilla
- newborn are vulnerable to heat loss
- during the first 48hours: newborn still trying to achieve thermal balance or thermoregulation
What is thermoregulation?
- maintenance of constant internal body temperature independent of the environment temperature
What 3 characteristics of newborns that make them vulnerable to heat loss?
- thin layer of subcutaneous fat
- blood vessels are close to the surface of skin
- larger surface-to-body weight ratios
- changes in environment temperature alter blood temperature which impact temperature regulation centers in the hypothalamus
What are 4 ways to prevent heat loss at the beginning of birth?
- drying of infant immediately after birth
- placing infant skin to skin with mother
- putting cap/hat on infants head
- covering with warm blankets or towels
- keep infant off of cool surfaces and away from drafts
- delaying bath until newborn has minimum of 3 normal body temperature readings one hour apart
What are some behaviours that newborn are communicating they are hungry and ready to feed?
- turning toward breast and opening mouth
- making sucking motions with mouth and tongue
- bringing hands/fists towards mouth
In order to maintain normal blood sugar, what should infant be doing?
- in order to maintain a normal blood sugar, infant feeding should be established in the first few hours of life
- at birth when the umbilical cord is cut, the newborn no longer receives the maternal source of glucose.
- the first feed occurs during the infant’s first period of reactivity
Is it normal for healthy newborn to have blood sugar as low as 2.0mmol/L (or even 1.8mmol/L)?
- Canadian Pediatric Society (CPS) position statement on hypoglycemia states hypoglycemia cannot be defined by a single value of glucose
- blood glucose levels as low as 2.0 mmol/L (or even 1.8 mmol/L at 1 h of age) are not uncommon in healthy newborns
- blood sugar of less than 2.6mmol/l in at risk newborns is associated with adverse outcomes
What are 3 factors affect blood sugar of newborns?
- gestational age
- birth weight
- presence risk factors: maternal diabetes, stress during labour and birth and immediate care at delivery
What 3 type of infants are at risk for hypoglycemia? When should they have their blood sugar tested?
- preterm and late preterm infants
- SGA and LGA infants
- infants of diabetic mothers
- infants who have had difficult births
- infants who required resuscitation
- infants who experience hypothermia
-infants who are at risk of hypoglycemia usually have their blood sugar tested within 2 hours of age
What are 4 signs of hypoglycemia in newborns?
- tremors
- jitteriness
- irritability
- lethargy
- pallor
- temperature instability
- breathing difficulties
What are some characteristics of an “organized” infant?
- Stable heart rate, color
- Tolerance of feeding
- Smooth and synchronous movements
- Smooth transitions between sleep and wake cycles
- Uses self-consoling behaviours
- Ability to shut out (Habituation) noxious or repetitive stimuli
What are some characteristics of an “disorganized” infant?
- Fluctuations in heart rate and respiratory rate. May experience bradycardias and/or apnea
- Inability to tolerate feeds, increased stooling
- Hiccups, sneezing, gagging, yawning
- Frantic body movements and jitteriness, changes in muscle tone
- Inability to modulate state, sudden changes from sleep to wake
- Limited use of self-consoling behaviours
- Inability to be consoled
- Inability to habituate
What are 2 care practices that will promote organization (disorganize to organized infant)?
- skin to skin
- recognition and response to stress cues
What is parent-infant attachment?
- attachment is the process in the brain that motivates infants to seek proximity and communication with parents and other primary caregivers
- process of parent-infant attachment begins well before the birth of a baby, and continues on throughout the child’s life
- Attachment is developed and maintained by proximity and consistent responses to infant cues
Why is attachment crucial for in infants?
- crucial for the infant’s physical, psychological, and emotional health and survival
What is bonding vs attachmment?
Bonding:
- refers to earlier processes through which the parents becomes acquainted with infant, identifies the infant as an individual, and claims the infant as a member of the family
- Over time, positive interactions between the parent and the infant through social, verbal, and nonverbal responses (whether real or perceived) facilitates the development of secure parent-infant attachment
Attachment:
- is developed and maintained by proximity and consistent responses to infant cues
What 3 interventions can nurses do to encourage/support parent-infant attachment?
- rooming in
- skin to skin care
- parental involvement in care
- other helpful strategies to support bonding and attachment include pictures/videos of the infant, providing frequent updates on the condition and care of the infant
Is it possible to spoil infant by picking them up every time they cry?
- no
- parents need reassurance that responding to crying quickly is an important aspect of attachment.
What are the goals of clean related to infant care?
- keeping work surfaces clean
- preventing infections applies to all practice settings where infants are cared for
- hand washing
What makes all newborns at risk for infection in first few months of life?
- due to generalized hypo-functioning of immune response
What are 4 signs of infection?
- newborns do not typically respond with a fever but instead will show signs of hypothermia or temperature instability
- lethargy
- irritability
- poor feeding
- pale or mottled skin
- respiratory symptoms
- vomiting or diarrhea
- decreased reflexes
What are 3 factors increases risk of infection?
- preterm birth
- prolonged rupture of membranes
- maternal fever/infection
- asphyxia
- invasive procedures
- stress
- congenital anomalies
All babies are vulnerable, what heightened their vulnerabilities?
- when there are variations in gestational age, birth weight, challenges during labour and birth
What is preterm birth defined as?
- any birth after 20 weeks and before 37 weeks
What are 4 key concerns for preterm infants?
- respiration
- thermoregulation
- feeding (hypoglycemia)
- infection
What is mother/baby care?
- Some NICUs are now moving towards a new model of care where NICU nurses provide care to the vulnerable neonate and the healthy postpartum mother at the infant’s bedside. These units, often called Mother/Baby Care, are designed for stable infants requiring NICU care
- Both mother and neonate are cared for in the same room by the neonatal nurse. (Some units have perinatal and neonatal nurses working collaboratively to care for the mother/infant dyad).
What defines late preterm infants?
- infants born between 34 and 37 weeks (34 weeks and 0 days to 36 weeks and 6 days)
- these infants are often close to the size of term infants and often appear mature
- because of their gestational age they are at increased risk of problems related to respiratory function, thermoregulation, hypoglycemia, feeding issues, sepsis, and hyperbilirubinemia
What defines post term infants vs post mature infant?
- infants born after 42 weeks gestation may be referred to as post term or post mature
- infant who is born after 42 weeks gestation but does not show any signs of reduced placental functioning; meaning they continue to grow in utero, is considered a post term infant
- a post mature infant has experienced placental insufficiency which results in a loss of subcutaneous fat, dry cracked skin, and increased risk of meconium being present in the amniotic fluid
- post mature infant has experienced placental insufficiency resulting in increased risk of perinatal mortality/morbidity related to intrauterine hypoxia
Is the passage of meconium into the amniotic fluid normal function?
- passage of meconium into the amniotic fluid may be a normal physiologic function
- a result of hypoxia-induced peristalsis and sphincter relaxation,
- or the result of umbilical cord compression-induced vagal stimulation in mature fetuses
What is meconium aspiration syndrome (MAS)?
- fetus will aspirate this fluid in utero
What are 4 factors that can make pulmonary transition challenging for preterm infant?
- have decreased number of functioning alveoli
- deficient surfactant
- weak or absent gag reflex
- immature or friable capillaries in lungs
- smaller lumen in respiratory system
- greater collapsibility
- obstruction of respiratory passages
What are 4 factors increase vulnerability to heat loss in the preterm infant?
- Minimal subcutaneous fat,
- limited stores of brown fat,
- decreased or absent shiver response,
- inadequate muscle mass activity,
- poor muscle tone resulting in more body surface area being exposed to environment, and
- immature temperature regulation center in the brain
-muscle tone: Muscle tone is the amount of tension (or resistance to movement) in muscles
Why are preterm infants more susceptible to infection (2)?
- have a shortage of maternal immunoglobulins
- immature immune system.
- They are also exposed to more care providers, and more invasive procedures such as respiratory support and intravenous therapy.
What are 3 challenges to maintaining adequate nutrition in the preterm infant?
- weak or absent suck, swallow, and gag reflexes,
- difficulty coordinating sucking and swallowing,
- small stomach capacity, and immature digestive and enzyme systems
What are small for gestational age (SGA) vulnerable for (3)?
- Perinatal asphyxia
- Temperature instability
- Hypoglycemia
- Meconium aspiration
- Polycythemia (blood disorder)
What are large for gestational age (LGA) infants vulnerable to (3)?
- Birth injuries
- asphyxia
- Hypoglycemia
- Congenital anomalies
How many disorders are all newborns routinely screened for in BC?
- routinely screened for 24 different disorders
- all of these disorders are rare but treatable and when identified early can prevent and minimize serious complications
When is newborn screening done?
- between 24 to 48 hours of birth
- PKU and MCAD require collection after 24 hours for optimal test sensitivity
- Screening requires a newborn blood specimen, generally obtained by pricking the infant’s heel
How is newborn blood specimen collected for newborn screening?
- generally obtained by pricking the infant’s heel.
- The newborn blood is collected on a special blood dot card along with pertinent information - date of collection, date of birth, name of infant and primary physician or midwife.
- This card is sent to the newborn screening program in Vancouver for testing
Will newborn discharged prior to 24hrs of birth require another blood screening?
- Newborns discharged prior to 24 hours of birth can have a preliminary screen done prior to discharge.
- However, due to the time sensitivity with PKU and MCAD detection, this initial test must be followed up with another test within 14 days of discharge to ensure accuracy
What useful strategy can be used to reduce pain and crying when blood for newborn screening is drawn?
- skin to skin
- breastfeeding
What is acrocyanosis?
- bluish colouration of hands and feet which is normal finding in the first 24 hours after birth
What is central cyanosis?
- is abnormal and signifies hypoxemia (below-normal level of oxygen in your blood)
- lips and mucous membranes are bluish
What are some reasons for central cyanosis?
- result of inadequate delivery of oxygen to alveoli
- poor perfusion of lungs that inhibits gas exchange
- cardiac dysfunction
What are 4 signs of respiratory distress?
- RR > 120 bpm
- severe retraction
- grunting
- pallor
- central cyanosis
What are 4 common respiratory complications?
- respiratory distress syndrome (RDS)
- meconium aspiration
- pneumonia
- persistent pulmonary hypertension of the newborn (PPHN)
What are 4 common reflexes found in normal term newborn?
- rooting and sucking
- swallowing
- grasp: finger or toe curl around examiner finger
- extrusion: tongue force tongue outward
- tonic neck
- moro
- stepping
- crawling
- deep tendon
- crossed extension
- babinski: all toes hyperextend
- pull to sit
- truncal incurvation: trunk is flexed
- magnet: both lower limbs extend against examiner pressure
