The newborn child Flashcards
Fontanels
Soft spots on the skull between loosely joined pieces of the skull that shift during the birth process to assist passage through the birth canal.
It will take about 18 months before the pieces of the skull are firmly joined and the fontanels have disappeared.
Neonate
Newborn up to four weeks old. The typical newborn child, or neonate, is about 50 centimetres long and weighs about 3.4 kilograms. Lose 10% of weight in the first few days then start to gain weight again by the fifth day.
Neonatal jaundice
About half of all neonates have a yellowish look to their skin and eyeballs in the first few days of life. This condition is due to the immaturity of the liver. In most cases, neonatal jaundice disappears after a few days as the liver begins to function normally, but if it lasts more than a few days it should be treated, or it can result in brain damage.
Anoxia
Deprivation of oxygen during the birth process and soon after that can result in serious neurological damage within minutes.
Apgar scale
Appearance (colour)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration (breathing)
Rated on each scale a zero, one or two. Total score is 0-10. Rated twice, about a minute after birth then 5 minutes after.
A score of 7–10 means good to excellent condition. Scores in this range are received by over 98% of Australian and American babies. If the score is from 4 to 6, anoxia is likely and the neonate is in need of assistance to begin breathing. If the score is 3 or below, the neonate is in life-threatening danger and immediate medical assistance is required.
Low birth weight
Born weighing less than 2500 grams.
Preterm
Born 3 or more weeks earlier than the optimal 40 weeks after conception.
Small for date
Weigh less than 90% of the average for other neonates who were born at the same gestational age (number of weeks since conception).
Small-for-date neonates are especially at risk, with an infant death rate four times higher than that of preterm infants.
Rates of low birth weight around the world
The overall rate worldwide is 15%. Asia and Africa have the highest rates, and Europe the lowest.
The current rates in New Zealand (5.7%) and Australia (6.5%) are lower than in developing regions of the world but higher than in Europe.
Within Australia, rates of low birth weight are nearly twice as high among Indigenous babies.
Consequences of low birth weight
Low-birth-weight babies are at high risk of death in their first year of life. Even in developed countries with advanced medical care, low birth weight is the second most common cause of death in infancy, next to genetic birth defects.
Very low-birth-weight neonates, who weigh 1,000–1,500 grams at birth, and extremely low-birth-weight neonates, who weigh less than 1,000 grams at birth, are at especially high risk for early death.
In Australia, 6.8 out of 10 extremely low-birth-weight babies die within the first 4 weeks; this figure includes preterm babies. 1 in 10 for very low birth weight.
Why low-weight neonates are at high risk
Have not properly developed immune system, central nervous system, low fat for insulation, and lungs are underdeveloped.
Surfactant
Substance in lungs that promote breathing and keeps the air sacs in the lungs from collapsing.
Kangaroo care
Mothers or fathers are advised to place their preterm newborns skin-to-skin on their chests for 2–3 hours a day during the early weeks of life.
It helps newborns stabilise and regulate bodily functions such as heart rate, breathing, body temperature and sleep–wake cycles.
Preterm infants who receive kangaroo care have reduced mortality, fewer infections, shorter hospital stays, increased breastfeeding and better infant growth.
Infant massage
Helpful for low-birth-weight babies but used in Asia and Africa on all babies.
In the West, infant massage developed because low-birth-weight babies are often placed in an isolette, a covered, sterile chamber that provides oxygen and a controlled temperature. The isolette protects neonates from infection but also cuts them off from sensory and social stimulation.
Preterm neonates who receive three 15-minute massages a day in their first days of life gain weight faster than other preterm babies, and they are more active and alert. The massages work by triggering the release of hormones that promote weight gain, muscle development and neurological development.
Effects of low birth weight
In childhood, low birth weight predicts physical problems such as asthma and cognitive problems that include language delays and poor school performance.
In adolescence, low birth weight predicts relatively low intelligence-test scores and greater likelihood of repeating a grade.
In adulthood, low birth weight predicts brain abnormalities, attention deficits and low educational attainment, as well as obesity and diabetes.
Neonatal sleeping patterns
Even in the womb there are cycles of waking and sleeping, beginning at about 28 weeks gestation. Once born, most neonates spend more time asleep than awake. The average for neonates is 16–17 hours of sleep a day, although there is great variation, from about 10 hours to about 21.
Their sleep–wake patterns are governed by when they get hungry, not whether it is light or dark outside. Also spend higher amounts of time in REM sleep (50%). By about 3 months of age, time spent in REM sleep has fallen to 40%, and infants no longer begin their sleep cycle with it. Unlikely to be dreaming because brain-wave patterns are different.
By about 4 months of age, most infants have begun to sleep for longer periods, usually about 6 hours in a row at night, and their total sleep has declined to about 14 hours a day.
Neonatal refelxes
A total of 27 reflexes are present at birth or shortly after. Examples include and when they disappear:
Stepping - Hold baby under arms with feet touching floor - Makes stepping motions - 2 months
Moro - Dip downwards suddenly, or a loud sound - Arches back, extends arms and legs outwards, brings arms together swiftly - 3 months
Babkin - Press and stroke both palms - Opens mouth, closes eyes, tilts head forwards - 3 months
Sucking - Place object or substance in mouth - Sucking - 4 months
Rooting - Touch on cheek or mouth - Turns towards touch - 4 months
Grasping - Place object in palm - Holds object tightly - 4 months
Swimming - Immerse baby in water - Holds breath, swims with arms and legs - 4 months
Babinski - Stroke sole of foot - Foot twists in, toes fan out - 8 months
Neonate sense of touch
Touch is the earliest sense to develop. Even as early as 2 months gestation, the rooting reflex is present. By 7 months gestation, 2 months before a full-term birth, all the fetus’s body parts respond to touch. Most neonatal reflexes involve responses to touch.
Neonate sense of taste and smell
Like touch, taste is well developed even in the womb. The amniotic fluid that the fetus floats in has the flavour of whatever the mother has recently eaten, and neonates show a preference for the tastes and smells that were distinctive in the mother’s diet in the days before birth.
Neonates find the smell of their mother’s amniotic fluid soothing, and cry less when it is present. Same for sweet tastes.
At 2 days after birth, breastfeeding neonates show no difference in response between their mother’s breast smell and the breast smell of another lactating mother, but by 4 days they orient more towards their mother’s smell.
Neonate sense of hearing
Hearing is another sense that is quite well developed before birth. After birth, they recognise distinctive sounds they heard in the womb.
Neonates have an innate sensitivity to human speech that is apparent from birth. Neonates prefer their mother’s voice to other women’s voices, and their mother’s language to foreign languages. However, they show no preference for their father’s voice over other male voices.
Neonates can distinguish small changes in speech sounds. Neonates also detect differences in the emotional tone of speech and prefer positive (happy) voices over negative (angry or fearful) ones.
One reason for these limitations is that it takes a while after birth for the amniotic fluid to drain out of their ears. Another reason is that their hearing system is not physiologically mature until they are about 2 years old. Their abilities for sound localisation actually become worse for the first 2 months of life, but then improve rapidly and reach adult levels by 1 year of age.
Neonate sense of sight
Least developed of the senses. Several key structures of the eye are still immature at birth, specifically:
(1) the muscles of the lens, which adjust the eyes’ focus depending on the distance from the object;
(2) the cells of the retina, the membrane in the back of the eye that collects visual information and converts it into a form that can be sent to the brain;
(3) cones, which identify colours; and
(4) the optic nerve, which transmits visual information from the retina to the brain.
At birth, neonates’ vision is estimated to range from 6/60 to 6/180. Their visual acuity is best at a distance of 20–35 centimetres. Vision improves steadily as their eyes mature and reaches 20/20 sometime in the second half of the first year.
Their capacity for binocular vision, combining information from both eyes for perceiving depth and motion, is also limited at birth but matures quickly, by about 3–4 months old. Colour vision at the same pace.
Neonates can distinguish between red and white but not between white and other colours, probably because the cones are immature (Kellman & Arterberry, 2006474). By 4 months of age, infants are similar to adults in their perception of colours.
Even shortly after birth they prefer patterns to random designs, curved to straight lines, three-dimensional to two-dimensional objects and coloured to grey patterns. Above all, they prefer human faces to any other pattern. This indicates that they are born with cells that are specialised to detect and prefer certain kinds of visual patterns.
Let down reflex
Causes milk to be released to the tip of her nipples whenever she hears the sound of her infant’s cry, sees its open mouth or even thinks about breastfeeding.
By 4 months gestation, the breasts are ready to produce milk.
Benefits of breast feeding
Disease protection
Cognitive development
Reduced obesity and better nutrition
Better health in childhood
Results of Kramer’s study
Mothers with breastfeeding advice and instruction resulted in children with IQs of 6 points higher at age 6.
