The normal newborn

Question 1

Define:

• extremely preterm
• very preterm
• preterm
• term
• post term

Due date and time an c sec is offered

Answer 1

extremely preterm: 23+0 - 28+0
very preterm: 23+0 - 32+0
preterm: 23+0 - 37+0
term: 37+0 -42+0
post term: 42+0 - 44+7
Due date : 40 weeks
Offered c-sec 41weeks

Question 2

Describe the weight of an average male at 28 weeks, what is an average male at term?
-what is the daily weight gain in the third trimester?

Answer 2

¥ Average male at 28 weeks = 1150g, 3.5% fat
¥ Average male at term = 3550g, 15% fat
¥ Daily weight gain = 24 g
¥ Approximately 7g of fat per day in last 4 weeks

Question 3

What is a normal weight for a newborn? what is small for gestation age, what is large for gestational age?

Answer 3

¥ Term after 37 weeks completed gestation
¥ Post term after 41 weeks completed gestation (after 41+6)

¥ Normal weight 2.5 kg – 4 kg
¥ Over 4 Kg, large for gestational age, LGA
¥ Under 2.5 kg, small for gestational age, SGA

Question 4

Describe what happens in the first breath/cry?

Answer 4

¥ First breath/cry
¥ Alveolar expansion – as soon as this happens pulmonary arterial pressure decreases which increases circulation to lungs
¥ Decreased pulmonary arterial pressure
¥ Change from fetal to newborn circulation
¥ Increased PaO2
¥ Apgar score – score of 9 is good

Question 5

What temperature is a newborn baby kept at? why is this?

Answer 5

A newborn baby is kept between 36.5-37 degrees – if temp drops lower than this surfactant doesn’t work and = resp. distress

Question 6

Feeding:

• how many feeds in the first 24hours
• why will the baby be hypoglycaemic in the first few days of life?
• what is important for establishing breast feeding?

Answer 6

¥ Well grown term infants have little calorific intake in the first 24 hours – 3 feeds
¥ Dramatic change from continuous glucose infusion to intermittent bolus enteral feeds – baby will be hypoglycaemic in 1st few days of life
¥ Skin to skin contact important for establishing breast feeding

Question 7

What is haemorrhagic disease of the newborn? how is this prevented?

Answer 7

This is due to deficiency of clotting factors as a result of vitamin K deficiency.

• given vitamin K to prevent
• formula fed babies are more protect as this has vit K

Question 8

What screening tests are carried out in all babies?

Answer 8

¥	Universal hearing screening
¥	Hip screening, clinical and USS (DDH – needs a harness)
¥	Metabolic
Thyroid – hypothyroidism by day 5 to get result by day 16 in time to treat and not let IQ drop (cretinism)
MCCAD
PKU
Haemoglobinopathies
CF