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PHYSIOLOGY AND EXAMINATION OF THE NEWBORN

PHYSIOLOGY AND EXAMINATION OF THE NEWBORN. Iwona Sadowska-Krawczenko MD, PhD. What are we going to talk about ?. What is neonatology What for is neonatology Who is newborn Who is premature infant How to assess newborn Examination of newborn. What are we going to talk about ?.

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PHYSIOLOGY AND EXAMINATION OF THE NEWBORN

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  1. PHYSIOLOGY AND EXAMINATION OF THE NEWBORN Iwona Sadowska-Krawczenko MD, PhD

  2. Whatare we going to talk about ? • What is neonatology • What for is neonatology • Who is newborn • Who is premature infant • How to assess newborn • Examination of newborn

  3. Whatare we going to talk about ? • Whatisneonatology • What for isneonatology • Whoisnewborn • Whoispremature infant • How to assessnewborn • Examination of newborn

  4. NEONATOLOGY • Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn infant.

  5. 3950g

  6. 950g

  7. NEONATOLOGY • It is a hospital-based specialty, • It is usually practiced in neonatal intensive care units(NICUs).

  8. Ourpatients, newborninfants, whoareillorrequiringspecialmedicalcaredue to: • prematurity,  • low birth weight,  • intrauterine growth retardation,  • congenital malformations (birth defects),  • sepsis,  • birth asphyxias

  9. Whatare we going to talk about ? • Whatisneonatology • What for isneonatology • Whoisnewborn • Whoispremature infant • How to assessnewborn • Examination of newborn

  10. Question Who is newborn?

  11. Newborn, neonate • In medical contexts, newborn or neonate refers to an infant in the first 28 days after birth neonatal period- a period from birth to 4 weeks postnatal

  12. Whatare we going to talk about ? • Whatisneonatology • What for isneonatology • Whoisnewborn • Whoispremature infant • How to assessnewborn • Examination of newborn

  13. What for isneonatologyWhyneonatology was distinguished from pediatrics? • Because it is very special period in human’s life • Transition from intrauterine to extrauterine life • Adaptation to extrauterine life

  14. The newborn must begin to adjust to life outside the uterus • entry into the air-breathing world, without the nutrition and oxygenation via the umbilical cord.

  15. Breathing and circulation • The first challenge of a newborn isbreathing independently instead of using placental oxygen delivered via the umbilical cord

  16. Breathing and circulation • At birth, the baby's lungs are filled with lung liquid. • When the newborn is expelled from the birth canal, its central nervous system reacts to the sudden change in temperature and environment.  • This triggers it to take the first breath, within about 10 seconds after delivery

  17. Question What happens with lung liquid?

  18. Breathing and circulation • At birth, the baby's lungs are filled with lung liquid. • When the newborn is expelled from the birth canal, its central nervous system reacts to the sudden change in temperature and environment.  • The first breath is taken within about 10 seconds after delivery 10 to 30 s

  19. Breathing and circulation • As the pulmonary circulation increases there is an equivalent reduction in the placental blood flow which normally ceases completely after about three minutes. 3 min

  20. Circulation • The closure of: • the foramen ovale • the ductus arteriosus

  21. CIRCULATORY SYSTEM FETAL CIRCULATION Presence of 3 shunts: Patent foramen ovale Patent ductus arteriosus Patent ductus venosus

  22. CIRCULATORY SYSTEM CHANGES AT BIRTH  ADULT TYPE OF CIRCULATION • Cessation of placental circulation • Physiologic closure of foramen ovale ( L atrial pressure) • Functional closure of patent ductus arteriosus (O2 content)

  23. GASTROINTESTINAL SYSTEM FETAL GI SYSTEM Swallowing as early as the 12th week of gestation Absence of excretion via the GIT unless with sphincter relaxation during hypoxic event. Accumulation of epithelial debris and conjugated bilirubin in small intestine

  24. GASTROINTESTINAL SYSTEM NEWBORN GI SYSTEM Passage of meconium (mixture of epithelial debris & mucopolysaccharide with conjugated bilirubin) within the 1st 24 hours  transitional stools (greenish soft stools) in the next 4 days  milk stools (normal pasty consistency and yellow color) Adequate levels of pancreatic enzymes except foramylase and lipase

  25. RENAL SYSTEM

  26. RENAL SYSTEM FETAL RENAL SYSTEM Production of urine as early as 4th month Renal function (GFR, tubular mass and RPF) not reach adult levels till 2nd year of life Glomerular filtration begins at about 9 weeks

  27. RENAL SYSTEM NEONATAL RENAL SYSTEM Passage of dilute urine due to inability to concentrate urine adequately Transient metabolic acidosis due to inadequate removal of acid ions, limited formation of NH3 for acid removal with minimum loss of base and overproduction of lactic and pyruvic acid.

  28. RENAL SYSTEM NEONATAL RENAL SYSTEM 6-10% physiologic weight loss (loss of body water) due to: Diuresis Expulsion of meconium Withholding of water and calories

  29. CENTRAL NERVOUS SYSTEM FETAL CNS Rapid growth of fetal brain during last half of fetal life with peak near time of birth

  30. ENDOCRINE SYSTEM MATERNAL ESTROGENIC EFFECTS breast enlargment Witch milk Mucoid to bloody vaginal discharge

  31. Infantile menstruation

  32. Changing the composition of hemoglobin before and after birth HbF α2 Ὑ2 produced by the fetus HbA α2 β2

  33. HEMATOLOGIC SYSTEM FETAL HEMATOPOIETIC SYSTEM Erythropoietin: hormone produced in the glomerular tuft responsible for the production of RBC Due to relative hypoxia of the fetus stimulating the bone marrow, the fetal hemoglobin is as high as 20g/dl

  34. Whatare we going to talk about ? • Whatisneonatology • What for isneonatology • Whoisnewborn • Whoispremature infant • How to assessnewborn • Examination of newborn

  35. TERM 37-42

  36. Prematureinfants < 37 t.c.

  37. Newborns are different…

  38. Born Too Soon 5-18%

  39. Born Too Soon

  40. Survival rate Poland • 750 g - 1 000 g more than 90% • 500 g -750 g 50-75% • <500 g 1-5%

  41. Premature infants are very different…

  42. Newborns • Small for gestational age SGA • Large for gestational age LGA

  43. Centile charts

  44. 22- 50 tyg PCA http://www.ucalgary.ca/fenton/

  45. Whatare we going to talk about ? • Whatisneonatology • What for isneonatology • Whoisnewborn • Whoispremature infant • How to assessnewborn • Examination of newborn

  46. Question How to assess newborn after delivery?

  47. How to assess the newborn after delivery • Apgar Score 1909 - 1974

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