Anatomical and physiological features of the newborn system. Anatomical and physiological characteristics of the newborn. Daily newborn care
Primary care of a newborn
Target - monitoring the health of the newborn and his mother. Tasks: Identifying newborn problems related to basic life needs (breathing, eating, sleeping, excreting, being clean and protected); identifying mother's problems related to the child. Determination of assistance in solving these problems.
A telephone message is sent from the maternity hospital to the children's clinic about the newborn's discharge. The local pediatrician and the local nurse should visit him the next day after discharge - primary patronage of the newborn. They examine the newborn, get acquainted with the “extract from the history of the newborn,” give advice on care and feeding, and organizing walks. A nurse teaches a mother how to give a hygienic bath to a newborn, care for the umbilical wound, and teaches swaddling.
When conducting primary care of a healthy newborn, the following most common problems may arise. In a child: regurgitation associated with violation of feeding rules; transition states; anxiety associated with underfeeding, overheating, flatulence. Mom has: on the side of the mammary glands, compaction, cracks, abrasions of the nipples; excitement, anxiety associated with a lack of knowledge and information about the anatomical and physiological characteristics of the child, his condition, the rules of care, and a lack of child care skills.
Nervous system.– the brain of a newborn is relatively large (1/8 of body weight, in an adult 1/40); - cerebral convolutions and grooves are underdeveloped; - there are the same number of nerve cells as in adults, but they are poorly connected to each other, because they have few processes; - brain tissue is rich in water, low in protein substances; - the brain is rich in blood supply; - increased permeability of the blood-brain barrier; - the child’s spinal cord is more formed; - the spinal cord in a newborn is relatively longer (reaches 3-4 lumbar vertebrae). The spinal tap is performed lower than in an adult. – from the moment of birth, the child has a number of unconditioned reflexes that adapt the child’s body to the environment (sucking, blinking, blinking eyes, etc.); - a newborn has a number of primitive reflexes, which are called physiological; the presence of these reflexes and their disappearance after a certain period of time is a sign of normal development; their persistence after a certain period or their reappearance is a pathological sign; - on the basis of unconditioned reflexes, the child develops conditioned reflexes (i.e. 1 signal system is formed), then the 2 signal system begins to form; - imperfection of thermoregulation (its lability). The air temperature in the room should be 22-23 degrees. Unconditioned reflexes
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the simplest “automatic” actions controlled by more primitive centers of the brain and spinal cord. Proboscis reflex- protrusion of the baby’s lips in the form of a kind of “proboscis” in response to a quick, abrupt touch of an adult’s fingers on them. Typically, the proboscis reflex persists for the first 2-3 months of life, then fades away.
Kussmaul search reflex. Careful, gentle stroking of the area of the corner of the baby's mouth with an adult's finger, the latter begins to actively "search" for the mother's breast: at the same time, the lower lip lowers, "stretches" towards the stimulus, and the baby's tongue also deviates there. Babkin's palmo-oral reflex. Moderate pressure on the baby's palms with the fingertips of an adult causes the child's mouth to open and his head to move towards the stimulus. Sucking reflex - If you put a pacifier in a child’s mouth, he begins to make active sucking movements.
Bauer crawling reflex- Being laid out on his stomach and feeling the adult’s palms placed on his soles, the baby will try to push off from them as if from a support. And it will move forward.
Support and automatic walking reflexes If you give the newborn’s body a vertical position and ensure that the soles of his feet are in contact with a horizontal hard surface, the baby will straighten his legs and “stand.” If the newborn “standing” in this way is slightly tilted forward, shifting the center of gravity of the body, then the baby immediately begins to “step over” with his legs - this is automatic walking.
Grasp reflex and Robinson reflex– the child grabs the adult’s inserted fingers into his palm. Sometimes such a grip is so strong that a baby who grabs the offered fingers of an adult can be lifted into the air (Robinson reflex).
Galant reflex is expressed in the bending of the newborn's back in response to tactile irritation of his skin in the paravertebral region in the direction from the neck to the buttocks. At the same time, the baby arches his back, forming an arc open towards the stimulus.
Revf ex Perez. Checking this reflex, the doctor, with light pressure, runs the pad of his finger over the skin directly above the spinous processes of the baby’s spine. From the tailbone to the neck. Usually, in response to such irritation, the child straightens his torso, bends his arms and legs, raises his head and... cries.
Moro reflex- clap with palms on the surface on which the child is lying, made simultaneously at a distance of 15 cm to the right and left of his head; sudden passive extension of the legs of a lying child; by lifting the lower half of his body by straightened legs. The baby's reaction to these irritations occurs in two phases: first, the child sharply moves his arms to the sides, simultaneously opening his fists, then, as if wrapping his arms around himself. Babinski reflex - streak irritations of the sole along the outer edge of the foot in the direction from the heel to the toes causes dorsal extension of the big toe and plantar flexion of the remaining toes, which sometimes fan out.
The development of the 1st signaling system is closely related to the development of sensory organs. Taste - quite developed. The child distinguishes between bitter and sweet mixtures (prefers sweet ones).
Smell – less developed. Distinguishes only strong odors.
Hearing – hears. Already during the newborn period, the child stops moving and freezes at the sound of a bell. Reacts to strong sounds by shuddering. Vision - sees from the neonatal period. Strabismus and nystagmus often occur (disappears by ½-1 month).
Skin and subcutaneous fat. – the epidermis is loose, easily wounded; - the basement membrane is underdeveloped, does not have “spikes”, so the connection between the epidermis and the dermis is very weak, and epidermal detachment easily occurs. This causes frequent skin diseases in the newborn, in many cases associated with the formation of blisters. – The dermis is the skin itself: richly vascularized, the sebaceous glands are well developed, secrete a lot of secretion, the sweat glands are formed at birth, but their excretory ducts are poorly developed. – The hair does not have a core, so it is soft - vellus, and is replaced with new ones from 1.5 months. - The subcutaneous fat layer is abundantly developed, which explains the roundness of the shape and deep folds. The subcutaneous fat layer is weakest on the abdomen. - The protective function of the skin is imperfect, the surface layers are thin, delicate, and easily wounded. - Thermoregulatory function is insufficient. The child cools down quickly. – The respiratory function of the skin is well developed (the stratum corneum of the epidermis is thin, the skin has a rich blood supply, the skin surface is large, the child’s pulmonary apparatus is not yet perfect). – The excretory function is well developed (the stratum corneum of the epidermis is thin, rich blood supply to the skin, large surface of the skin). – Vitamin-forming function plays an important role. Vitamin D is formed under the influence of UV rays.
Muscular system. In children in the first months of life, the flexor tone prevails over the extensor tone - the posture of a newborn child (lying with bent arms and legs). The child's muscle strength is weak.
Skeletal system.– fibrous structure; - rich in water, poor in mineral salts; - the bones are soft, fragile, and therefore easily bent, so it is necessary to ensure proper swaddling, there should be no oppressive clothing, and correctly place the baby in the crib (head deformation). – richly vascularized – development of hematogenous osteomyelitis. - between the epiphysis and diaphysis of the tubular bones there is a cartilaginous plate - a growth zone (metaphysis). – the head is relatively large (a quarter of the body length, in an adult – 1/8). Head circumference at birth is 34-36 cm. – The sutures of the skull are open, so the bones are easily displaced. – There are fontanelles (these are connective tissue membranes at the junction of bones). There are: Great fontanel– anterior – located between the parietal and frontal bones, diamond-shaped. The normal size in diameter is up to 3 by 3 cm. It closes by 12-15 months. Small fontanel- rear. Located between the parietal and occipital bones. Triangular shape. After birth, it is open in only 25% of babies. Closes by 3 months. Lateral fontanelles can only be opened in premature infants. – The spine of a newborn has no bends. Cervical lordosis forms at 2 months (the child begins to hold his head up); thoracic kyphosis develops at 6 months (the child begins to sit); lumbar lordosis - at 11-12 months (the child begins to walk). – The chest is cylindrical (up to 6 months) or truncated cone. At birth, the chest circumference is 32-34 cm. The ribs are almost horizontal, the intercostal spaces are wide. – The pelvis is mainly represented by cartilaginous tissue, has a small capacity, and there are no gender differences (in size). – Teeth – a child is born with the rudiments of milk and permanent teeth. – The limbs are bent in a newborn child, this is due to hypertonicity of the flexor muscles (up to 3-4 months).
Respiratory system - the mucous membranes of all parts of the respiratory system are vulnerable, richly vascularized, dry; - Nose – the nasal passages are small, narrow, short, the lower nasal passage is absent, so a minor disease causes blockage of the nasal passages. Accessory cavities are poorly developed or absent, so sinusitis is practically not observed in infants. - The throat is narrow. The Eustachian tube, which connects the pharynx to the middle ear, is short and wide, so secretions easily penetrate from the nasopharynx into the middle ear and otitis media develops. – Glottis – covers the entrance to the larynx. It is narrow and the vocal cords are short. The subglottic space is loose, so swelling quickly develops, which is why children often develop stenosing laryngitis. – The larynx is long, funnel-shaped, the cartilages are tender and pliable. – The trachea is narrow, the cartilage is soft, pliable, weakly fixed. – The bronchi are narrow. The right bronchus is a continuation of the trachea, wide, so foreign bodies must be looked for here. – Lungs – rich in connective tissue, low-elastic. The lungs are low in air and full of blood. Congestion in the lungs easily occurs, creating conditions for inflammation. As they grow, the volume of the alveoli increases, the amount of connective tissue decreases, and elastic fibers are formed. – The pleura is thin in infancy, the pleural cavity is easily extensible, which causes rapid displacement of the mediastinal organs. – The diaphragm is located relatively higher than in an adult, its contractions are weak, so the chest is in a state of inhalation. – Breathing is shallow (the ribs are located horizontally, the diaphragm is located high, its contractions are weak, the muscular system is poorly developed, and therefore the respiratory muscles are poorly developed, the lungs are inelastic, dense). – Respiratory rate in a newborn is 40-60 per minute. – The breathing rhythm is unstable, i.e. there are unequal pauses between breathing movements, so the child’s breathing must be counted strictly per minute. – The type of breathing up to one year is abdominal.
The cardiovascular system - At birth, separation of the systemic and pulmonary circulation occurs. – A newborn’s heart is relatively large. – The position of the heart is transverse (lies on the diaphragm). – The lumen of blood vessels in newborns and young children is wide. Arteries: veins = 1:1, and in an adult = 1:2. – Pulse is frequent, because the influence of the sympathetic nervous system prevails. The smaller the child, the faster the pulse (in a newborn it is 120-140 per minute), the child’s pulse is arrhythmic, so the pulse is counted strictly in 1 minute. – Blood pressure in a child is lower than in an adult; in newborns, the maximum pressure is 70-74 mmHg.
Digestive system- During the newborn period, the digestive apparatus is adapted only for the absorption of breast milk. – The mucous membrane of all parts of the digestive tract is vulnerable, richly vascularized, dry, because mucous glands are poorly developed. The activity of gastrointestinal enzymes is reduced. – Oral cavity – in the oral cavity of a young child there are devices for the act of sucking: roller-like thickenings on the gums, folding of the mucous lips, Bisha lumps (fat lumps in the thickness of the cheeks). – The salivary glands in a newborn are poorly developed, so there is little saliva. – The esophagus is relatively longer than in an adult, the muscle layer is poorly developed. – The stomach in children of the first year is located vertically, when the child begins to walk it assumes a horizontal position; the cardiac sphincter (entrance to the stomach) is poorly developed, the pyloric sphincter (exit from the stomach) is well developed, so the child may have frequent regurgitation after feeding (must be held upright for 5-10 minutes). – Intestines – length is relatively greater than that of an adult; We are well permeable to toxins and microbes (which is why toxicosis quickly develops in gastrointestinal diseases). The newborn's intestines are sterile until the first feeding. It is then populated by microbes. With natural feeding, mainly bifidobacteria, with artificial feeding - E. coli (non-pathogenic). – Stool – during the first days (12-72 hours) a thick dark green mass – meconium. Then a transition chair. From 4-5 days it is normal: breast-fed 4-5 times a day, mushy, yellow in color, with a sour odor; with artificial feeding, stool 2-3 times a day, a thick paste, yellow in color, with a putrid odor. – The liver is the largest organ of the child, occupies ½ of the volume of the abdominal cavity. In children under 7 years of age, the liver protrudes from the hypochondrium by 1-2 cm. The child’s liver is functionally immature.
Urinary system- Kidneys – have a lobular structure, i.e. embryonic structure (disappears by 2 years), their concentration function is reduced, therefore the specific density of urine is lower than that of an adult (before 2 years - 1003-1005, after 2 years - 1009-1016). – The ureters are relatively wide and more tortuous than in adults, their muscle layer is poorly developed, hence the hypotension of the ureters. – The bladder is located higher (in the suprapubic region), so it can be palpated; the muscle layer is poorly developed. – The urethra is shorter in girls (0.8-1 cm) than in boys (5-6 cm), the amount of urine up to 10 years is determined by the formula: D day = 600+100(P-1), where P – number of years, and the younger the child, the greater the number of urinations. A newborn has 20-25 r/day, an adult 4-7 r/day. The amount of urine in a newborn with each urination is 10-50 ml.
Hematopoietic system The hematopoietic system includes: red bone marrow, liver, spleen, lymph nodes and other lymphoid formations. Red bone marrow is found in all bones until the age of 4 years. Then it is stored only in flat bones: ribs, sternum, vertebral bodies.
Age indicators of general blood test (CBC)
After his birth, the child finds himself in a new environment. From a humid environment it enters the air. The air temperature is not comparable to the temperature at which the child developed in utero. Gravity, a lot of sound, tactile, visual and other stimuli - a newborn child will have to adapt to all this diversity of the world.
But nature took care of it. Getting used to new living conditions certainly leads to changes in all functional systems of the child’s body. The physiological characteristics of a newborn child allow it to successfully adapt to the environment.
Newborns(neopatus) is considered a child from birth to 28 days. This period is called neonatal.
IN neonatal period the child adapts to environmental conditions. Pulmonary breathing is established, blood circulation changes, and the digestive and excretory systems begin to function.
From the first days of a newborn’s life, thermoregulation improves and enzymatic processes are rearranged. All these processes are regulated by the central nervous system.
In full-term newborns, the adaptation mechanism is more advanced and functionally prepared than in premature and postterm infants.
Signs of a full-term baby
A newborn baby is considered full-term if its period of intrauterine development is a full 37 weeks. That is, the baby was born at 38, 39 or 40 weeks. A full-term newborn baby has the following anthropometric data:
- The body weight of a full-term newborn baby is equal to or greater than 2500 g.
- Height - at least 45 cm.
- The average body weight of a full-term boy is 3500-3600 g,
- The average body weight of a full-term girl is 3200-3300 g.
- The average body length is 49-52 cm.
After birth, a full-term baby screams loudly
The movements of the newborn's arms and legs are active. Muscle tone is well expressed. The sucking reflex and all other unconditioned reflexes are present (see section “Basic reflexes of newborns”).
The skin of a full-term newborn is pink and elastic. The subcutaneous fat layer is well developed. The bones of the skull are elastic, the lateral fontanels are closed, the auricles are elastic.
The umbilical ring is located midway between the pubis and the xiphoid process. Nails extend beyond fingertips. In girls, the labia majora cover the labia minora; in boys, the testicles are lowered into the scrotum.
Appearance of newborns
After birth, the child falls into the caring and professional hands of doctors. To determine the child's condition, an initial examination is carried out. The newborn is awarded points. The cry of a newborn baby a specific stimulus is always directed: pain, hunger, cold. Doctors may be concerned about a weak cry or the cry of a sick child.
In a newborn healthy child, the arms and legs are bent at the joints, the fists are clenched. This is a physiological increase in the tone of the flexor muscles, which causes fetal position of the child.
Basic reflexes of newborns
In a healthy newborn baby, you can observe basic reflexes of the newborn period:
Sucking reflex
If you touch the lips of a newborn, sucking movements appear. This reflex is vital for a child to feed independently. In its absence, the child is initially fed through a tube.
Sucking reflex Babkin's palmo-oral reflex
If you press on the middle of the newborn's palm with your thumbs, the baby opens his mouth and bends his head slightly.
Robinson's palmar grasp reflex
When placing a finger in the child's hand, the hand contracts and the child tightly grasps the finger.
Palmar grasp reflex When hitting the surface on which the child is lying or blowing in the face, the child’s arms are extended at the elbows and moved to the sides (Phase I), followed by “hugging” the body (Phase II).
Support and automatic walking reflex
Support reflex
In order to check the presence of the support reflex, the child is taken under the arms and placed vertically, supporting the back of the head with his fingers. In this case, its legs first bend, and then the legs and torso straighten. When leaning forward slightly, the child makes stepping movements (automatic walking).
Bauer crawling reflex
The Bauer reflex appears when the child is lying on his stomach. A palm is placed on his bent legs and the child begins to crawl, straightening his legs and pushing off.
Crawling reflex Newborn protective reflex
In the tummy position, the child turns his head to the side (protection).
Defense reflex Galant reflex
During the initial examination, the doctor runs his fingers along the spine from top to bottom using line movements. In response, the child bends his torso in the direction of irritation.
Galant reflex Anatomical and physiological characteristics of a full-term baby
Height and weight of a newborn baby
Newborn weight
After birth, during the first 3-5 days, the initial weight of the child in most cases decreases by 100-200 grams or more.
From the 4th-5th day of a child’s life, weight begins to increase and usually reaches its original value by the 9th-12th day.
A decrease in the weight of a newborn occurs for objective reasons: the umbilical cord dries out and falls off, the top layer of skin peels off, and original feces are released. Moreover, in the first days the newborn sucks only a small amount of milk from the mother’s breast.
During the first year of life, doctors monitor the baby’s weight very carefully. It is this indicator that primarily informs about the normal physical development of the child. Particularly important is the question of a sufficient amount of food he receives.
A normally developing child should double its weight by six months and triple its original weight by the end of the first year of life.
Newborn growth
The increase in the child’s body length follows the same patterns. The greatest increase in height occurs in the first year of life - 25 centimeters, in the second - 10 centimeters, in the third - 7-8 centimeters.
Table of height and weight of newborns by month
Head in newborns
Head in newborns characterized by the predominance of the cerebral skull over the facial one. Usually, after passing through the birth canal, the face of a newborn baby is swollen. Hematomas may form on the head. Sometimes you can observe tremor (visible shaking) in the area of the jaw joints. All these features will go away very quickly with proper care. The newborn's head is usually thrown back, which also determines the intrauterine position of the child.
Fontanas in newborns
Fontanas in newborns are anatomical formations of membranous tissue located on the baby’s head. Thanks to the presence of fontanelles, the head can easily pass through the birth canal, changing its shape (configuration).
Large fontanel in a newborn
The large fontanel in a newborn is the most noticeable of the fontanelles. It is located on the top of the head between the frontal and parietal bones. It got its name for a reason. Its size is quite large and averages 3 cm. The shape of a large fontanel is diamond-shaped, and upon careful examination you can see the pulsation.
Small fontanel in a newborn
A small fontanel in a newborn is located at the junction of the parietal and occipital bones. This fontanelle looks like a triangle about 5 mm in size. Children are often born with an already closed small fontanel; in others, it closes within one to two months.
Mastoid and wedge-shaped fontanelles
Two paired fontanelles can be found in the temporal regions. This wedge-shaped fontanelles. Another pair of fontanels, mastoid, found behind the ear. All of them close soon after the birth of the child and have no diagnostic significance.
Functions of the fontanelle in newborns
The fontanel plays an important role during childbirth. Thanks to the fontanelles, the baby's head contracts and passes through the birth canal more easily.
The child grows quickly, and so does the baby’s brain. The presence of the fontanelle and sutures of the skull creates favorable conditions for the growth and development of the brain. The fontanel helps the baby maintain normal body temperature, as it participates in thermoregulation. At high temperatures (over 38 degrees Celsius), fontanel helps cool the brain and meninges. Although the fontanelle seems very unreliable and fragile, it helps protect the brain if the baby falls.
Head size in newborns
In a healthy full-term baby, the head circumference is 32-38 cm. It is ¼ of the total body length. If we compare it with the proportions of an adult, then in an adult the head is 1/8 of the body length. The facial part of the skull in newborns is relatively small. Newborns have a short neck and therefore it seems that their head is located directly on their shoulders.
Newborn head shape
Depending on the characteristics of the birth, the shape of the head can be different: dolichocephalic (extended from front to back), brachycephalic (extended upward) or irregular (asymmetrical). The normal shape of the head is usually restored during the first week of life.
1-normal, 2-asymmetrical, 3-brachycephalic,
4 - dolichocephalic form
Features of the skin of a newborn baby
The baby's skin is covered at birth cheese lubricant secreted by the sebaceous glands of the skin. This lubricant in utero protects the skin from soaking the surface layer, protects against the action of amniotic fluid, and during childbirth it facilitates easier passage of the baby through the mother’s birth canal.
The skin of newborns is very delicate and thin, as a result of which it is extremely vulnerable. On the shoulders and upper back the skin is covered with fluff. In premature babies, this fluff is thicker and also covers the forehead and cheeks.
Fluff on the skin of a newborn After 2-3 days, the newborn’s skin begins to peel off. Therefore, careful care of the newborn’s skin is required: gentle bathing and treatment with baby oils and creams.
Newborn skin color
The skin of a newborn is bright pink. Its color depends on the fact that very close to the surface layer there is a dense network of blood vessels.
On the 2-3-4th day after birth, the bright pink color of the skin turns yellowish. The so-called physiological jaundice. It is observed in almost all children. This jaundice does not pose anything dangerous for the child, although it is sometimes very pronounced. After 3-4 days, the jaundice disappears and the skin gradually returns to its normal pale pink color.
Muscular and skeletal system of the newborn
Muscles in a child initially poorly developed. Despite this, the newborn’s muscles are in a tense, contracted state. As the child grows, this muscle tension weakens, movements become free, then the muscles increase in volume and become more elastic upon palpation.
Child's skeletal system, his skeleton, presents some features. His bones are softer and more elastic, since they contain a lot of cartilage tissue.
Body temperature in newborns
Body temperature in newborns unstable because his body cannot generate enough heat and retain it. Therefore, the child is quickly exposed to cooling, even at normal ambient temperatures, and also quickly overheats if he is overly wrapped up.
Gradually, the newborn adapts and gets used to new conditions. His body temperature is set at 36.6-37°.
Respiratory organs of a newborn
The respiratory organs of a newborn are still imperfect. The openings of the nostrils, nasal passages and other respiratory tracts (larynx, trachea and bronchi) are relatively narrow. With a runny nose, the mucous membranes swell, and if drops of milk get into the nose or larynx (when regurgitating), breathing becomes difficult and the child cannot suck normally.
Therefore, the correct position of the child during feeding and systematic care of the nose are essential to ensure that the newborn’s airways remain healthy.
Newborn breathing
The child's breathing is shallow. When breathing, he inhales relatively little air in one breath, and in order to provide the body with oxygen, the child breathes more often than an adult.
The air that the child breathes must always be clean, so you need to ventilate the room where the child is well, and spend more time with him in fresh, clean air. You should not tightly roll or swaddle a baby with arms, as this will compress the chest and make breathing difficult.
Heart of a newborn baby
The heart of a newborn child differs from the heart of an adult in that it does not work properly due to the imperfection of the nervous system, although the child may be completely healthy.
This abnormality of cardiac activity gradually disappears.
The heart of a young child is relatively larger than that of an adult. The vessels, especially large ones, are relatively wider than in an adult, which facilitates the work of the heart.
The contraction of the heart is determined by the pulse. The pulse of a newborn is up to 140 beats per minute, in the first year of life 130-110, at the age of 1-2 years - about 110 beats per minute; in an adult - 72-80 beats. Under the influence of minor reasons (movement, prolonged screaming, anxiety, etc.), the pulse may increase sharply.
Blood quantity relative to the body weight of an infant, it is almost twice as much as that of an adult. The composition of blood differs little from that of an adult. The composition of the blood changes quickly under the influence of diseases, but is quickly restored during recovery. The composition of the blood is affected by a lack of fresh air, nutrition, etc.
Newborn movements
A newborn baby does not hold his head up and only makes random movements with his arms and legs. His movements are usually sluggish and slow. Sometimes the child shudders and makes rapid movements with his arms and legs. This is normal. In the future, his movements become smoother.
In the first days after birth, the baby sleeps a lot and wakes up only to eat.
Newborns do not produce tears: the newborn screams, but does not cry. He can't blink.
Occasionally, a newborn may experience strabismus, which gradually disappears.
A newborn baby will only fuss and cry for a reason: usually if he is in wet diapers, if he is wrapped too tightly, if he is too hot or cold, or if his tummy is bothering him. In order for a child to stop crying, you need to find the reasons and eliminate them.
Normally, a child masters motor skills according to the following algorithm:
- at one month the baby can lift his head
- at two months, holds her tightly
- by 3 months the baby can grasp objects with his hands
- at 4 months it holds them for a long time
- By 6 months the baby is sitting
- by 8 months - standing, holding onto some object
- by 10 - free standing
- by 10-14 months begins to walk independently
- By the age of 3, the child overcomes obstacles and walks up stairs.
Caring for a newborn. Treatment of the umbilical wound. VIDEO
Bathing the baby. VIDEO
Educational film “Maternity Hospital on Furshtatskaya” on the topic “Bathing a baby.” Maria Konovalova, a pediatrician at the Pediatric Center, tells the story.
Anatomical and physiological characteristics of a premature baby
A child born before 38 weeks of pregnancy is considered premature. Newborn premature babies, regardless of the degree of underdevelopment, need special care, especially in the first weeks of life.
The weight of a premature newborn is from 500 to 2500 grams. The body length of a premature baby can be from 27 to 45 cm.
The main clinical external signs of an immature newborn:
- disproportionate physique
- open fontanelles (lateral and small)
- undeveloped fatty tissue or its complete absence
- hyperemia of the skin
- underdevelopment of the external and internal genital organs
- underdevelopment of physiological reflexes characteristic of full-term peers
- in severe cases, weakness or lack of muscle tone occurs.
Such children differ from full-term newborns in the incompetence and immaturity of almost all systems and organs of the body, as a result of which special care is required for premature infants.
Causes of prematurity
Premature birth can be triggered by many social factors, as well as the health status of the expectant mother and her obstetric history. Statistically, there are several groups of risk factors, in the presence of which women have a high risk of giving birth to a baby prematurely:
- if pregnancy is too early or late (parents' age is less than 16-18 or more than 40-45 years)
- presence of bad habits in a woman
- poor living conditions
- presence of occupational hazards
- high risks of preterm birth may occur in women whose interval between births is less than two years
- chronic maternal diseases
- pathological course of pregnancy
- history of abortions, miscarriages, multiple pregnancies, placental abruption
In addition, the risk of having a premature baby is higher for those girls who are not observed in the antenatal clinic during pregnancy.
Caring for a premature newborn baby
If a child was born prematurely, in any case (regardless of the degree of prematurity) additional medical therapy should be carried out.
- Firstly, additional heating is required newborn baby and rational oxygen therapy. To do this, in the delivery room the baby is immediately dried with sterile diapers and immediately placed in an incubator. Premature babies weighing less than 1800g at birth require supplemental heating for several weeks.
- When moving the child to the ward, the air temperature should be 24-25°C.
- Premature babies should be bathed no earlier than two weeks of age. Moreover, not every day, but every other day.
- To monitor the condition and development of a premature baby, Weighing is carried out daily. Once a week, height, head and chest circumference are measured.
- To normalize muscle tone, reduce the number of regurgitations, and also to increase the concentration of oxygen in the blood, a premature baby needs to be treated as early as possible spread on tummy.
If the premature baby is healthy, independently maintains a normal temperature, constantly gains weight and has reached 2000 g, the umbilical wound is healing well, tests and hemogram are normal, then he can be discharged home. As a rule, a healthy premature baby is discharged 7-9 days after birth.
Post-term baby, features
How long does it take to carry a baby to term? The countdown time begins from the 42nd obstetric week.
A late pregnancy can proceed normally, and as a result the child will be born completely healthy without any abnormalities.
In such situations, obstetricians call pregnancy “prolonged,” i.e., exceeding the term. They say that sometimes a child simply needs more time for its self-development, as a result of which the pregnancy period lasts longer than expected. This type of pregnancy is considered physiological and not pathological.
Post-term newborn baby But most often, a long delay in childbirth poses a danger to the health of both mother and child. Often there is a danger to life in post-term newborns if it was diagnosed after birth hypoxia (oxygen starvation).
If obstetricians determine that the child is overripe, this means that he tolerates oxygen starvation very poorly. As a result, the following complications arise:
- weight loss,
- dehydration in the first weeks of life;
- the presence of hormones in the blood changes (the amount of prolactin and cortisol decreases);
- The child’s brain functions may suffer (poor emotional and mental development).
Appearance of a post-term baby.
A post-term baby, lingering in the mother’s uterus, has a characteristic appearance. Since the cheese-like lubricant, which protects the baby’s skin from microbes and facilitates passage through the birth canal, is completely absent, The skin of a post-term baby is wrinkled and flaky, especially on the feet and palms. Skin color is greenish or yellowish, vellus hair is also absent, nails and hair are longer than those of a child born at term.
Due to the decrease in nutrients supplied to the baby in the womb, he is born thin. In post-term babies, the skull bones are a little denser and the fontanelle heals faster - but there is nothing to worry about, the main thing is to visit a neurologist in time.
In addition, post-term babies are often ahead of other babies in development; they are very active, easily excitable and restless, and cases of poor sleep are not uncommon.
Caring for post-term babies
The whole specificity of caring for post-term babies is a more thorough newborn skin care child. Adhere to the following rules:
- From birth, your baby's skin is drier, so it needs to be lubricated more often. To do this, you need to use special products for gentle care of baby skin: baby creams, oils for dry baby skin.
- Particular care must be taken when handling skin folds. To prevent diaper rash, skin irritations, rinse folds thoroughly, dry with a soft cloth. You only need to dry the folds of a small child using blotting movements. No friction! And after all, don’t forget to use special baby creams or self-prepared sterile vegetable oil.
- From time to time, give your child air baths, leaving him naked, without a diaper. Such procedures are very beneficial for the skin.
- Children with skin problems benefit from bathing in a bathtub. with decoctions of anti-inflammatory herbs(chamomile, string).
- And one more rule - using baby soap shouldn't be daily. For a newborn baby, bathing with soap should be no more than 1-2 times a week. Remember, soap dries out the skin, and in post-term newborns, the skin is already very dry and thin.
In general, caring for a newborn baby that has been transferred is no different from caring for any newborn baby. As for taking vitamin D, this issue should be discussed with your doctor. Everything will depend on the condition of the fontanel.
Nutritional features of a post-term baby
Taking into account all the characteristics of a newborn baby, two main rules should be followed in nutrition:
1 rule - the most useful and necessary for a post-term newborn will be breast milk;
Rule 2 – try to put your baby to your breast as often as possible. It is better if he eats more often, but in smaller portions.
28 days of a child’s life are usually called the newborn period (neonatal period). This is the most dangerous period in a child's life. Of all children who die before reaching one year of age, 70% die within the first four weeks after birth.
And the first week of life is included in the perinatal period.
At the moment of birth, the child comes from the mother's womb, whose temperature is about 37 ° C, into room conditions. The temperature in the delivery room is usually maintained on average within 20 (from 15 to 20°), and, therefore, the temperature difference in the first minutes of the child’s life is approximately 18°. This causes a protective reaction in the newborn - a reflex increase in muscle tone, raising body temperature to 36-37°. The lower the room temperature, the higher the newborn's body temperature turns out to be.
The degree of usefulness of the first extrauterine respirations depends on the intensity of muscle tone: inhalation, the volume of which in a physiologically mature newborn is 30-35 cubic meters. cm, and the subsequent exhalation - the “first cry”. This cry can serve as a criterion for the quality of breathing: the louder the cry, the more complete the exhalation and thus the inhalation preceding it. Complete expansion of a newborn’s lungs occurs within a minute to a minute and a half after leaving the mother’s womb.
In the first moments after birth, the child continues to receive nutrition (and blood) from the mother through the umbilical cord. Therefore, the umbilical cord should be tied no earlier than its pulsation stops - so that the newborn has time to receive the maximum of blood contained in it from the placenta.
An adult who finds himself without clothes, that is, naked at room temperature (18-20° C), can maintain a constant body temperature (36-37°) in two ways:
firstly, a decrease in heat transfer, i.e., a narrowing of the blood vessels of the skin (vasoconstriction), a decrease in sweating, or even a complete cessation of the action of the sweat glands;
secondly, by increasing the formation of heat, i.e., increasing the tone of the skeletal muscles, reaching the point of trembling.
An increase in muscle tone in newborns immediately after birth, with a sharp decrease in environmental temperature, causes, on the contrary, not a decrease, but an increase in heat transfer. At the same time, the blood vessels of the skin dilate (vasodilation), and the child does not turn pale, but turns pink. Higher heat transfer prevents the possibility of increased body temperature due to a reflexively caused increase in muscle tone.
Immediately after birth (more precisely, after ligation of the umbilical cord), the newborn, laid on a special table in the delivery room, acquires a specific position - flexion hypertension: the head bends in relation to the body, the elbows bend, the toes bend into a fist, the knees bend, the toes bend towards the sole .
Any additional irritation - slight tingling, light flux, sharp, even not very loud sounds - increases the degree of flexor hypertension.
The newborn does not yet turn his head towards the flash of light or sound source, but responds to such irritations with a flexion shudder. The severity of flexion hypertension (in children born physiologically mature) can be judged by the child’s resistance to the doctor’s (midwife’s) attempts to straighten the elbow or knee joint.
Such resistance is the first diagnostic sign of the physiological maturity of the newborn. This sign is combined with pink
skin color - despite the baby’s nakedness and the temperature in the delivery room, which is significantly lower than in the mother’s womb.
For a more accurate diagnosis of the condition of a newly born child, it is necessary to have a portable electrodermal thermometer and the same ohmometer to assess sweating.
In the forehead area of a newborn, the skin temperature is usually 34.5°; in the shoulder region - 33.8°, chest - 35°, abdomen - 35.2°, hips and upper legs - 34°, feet - 30.3°. This is much higher than the temperature of the corresponding areas of the skin of adults. A fairly significant difference in the temperature of the skin of the chest and foot (about 5°) shows good thermoregulation of the newborn, as well as a high level of heat transfer and, accordingly, a high level of heat production.
A child born physiologically mature immediately develops full thermoregulation reactions. However, until recently it was believed that the thermoregulatory reactions of a newborn were still imperfect, that only in the process of further development did the mechanisms of chemical thermoregulation mature in the child’s body, and only after that - physical ones. This is not true. In fact, the reactions of chemical (reflex stimulation of skeletal muscles) and physical thermoregulation in newborns are as perfect as thermoregulation in adults, but have their own distinctive characteristics.
It should be noted that a physiologically mature newborn should not remain naked on the table for more than 20-30 minutes - the time during which he can maintain a constant body temperature. After this period, the newborn's muscle tone decreases and his body temperature drops. To prevent this from happening, it is necessary to prevent further cooling - dress the child in the special clothing we offer (see Fig. 2)
So, within 20
It takes 30 minutes to toilet the newborn, make a diagnostic assessment of his physiological maturity - and immediately dress the child.
The newborn's clothing should ensure that the child maintains an orthotonic posture of flexion hypertension. This, in particular, makes it possible to reduce the surface of its body and reduce heat transfer. TIGHT swaddling, which is still recommended, in which the baby's arms and legs are forcibly stretched, not only disrupts chemical heat production, but also increases the heat transfer surface. In addition, tight swaddling to some extent interferes with normal blood circulation and can adversely affect the development of the neuromuscular system. Finally, tight swaddling immediately after birth muffles the natural “instinct of freedom” in the child (according to I.P. Pavlov - “freedom reflex”). This “eastern” custom unconsciously induces in the child the habit of submission, suppresses the will, makes it difficult to find his “I” and ultimately has a very harmful effect on the psyche of the developing individual.
Physiologically justified for a newborn can only be clothing that does not constrain the child’s natural (orthotonic) posture and does not interfere with his specific movements. This could be a blouse or vest made of paper or flannel with ribbons in the front; when tying the ribbons, one edge of the vest should overlap the other. A combination with pants sewn at the ends is also possible. Along with baby undershirts, it is possible to use a diaper, which (together with a diaper) should not distort the bent position of the legs. Therefore, you should not stretch the baby's legs.
Such clothing, which we proposed in 1950, was not accepted then. However, since 1954 it has been adopted in maternity hospitals in Czechoslovakia and only since 1956 in our country. Later, such clothing was adopted by the World Health Organization (WHO) and recommended to all countries that are members of WHO, including our country. However, to this day it is not used in all maternity hospitals; but even where they are used, only from the fourth to fifth day, and in the first days, tight swaddling is most often used.
Nevertheless, many young parents in our country, who follow the recommendations in the press, use the clothing described above after the child returns from the maternity hospital.
No later than 20-30 minutes later, the newborn should be given to the mother for the first breastfeeding.
During normal pregnancy, the mother's mammary glands produce colostrum by this time, and the newborn can receive 40-60 ml of it. As the stomach fills, the stretching of its walls reflexively causes a slowdown in sucking movements, the baby falls asleep on the mother's breast, and in a drowsy state he is carefully transferred to a crib placed next to the mother's bed.
Since the 30s, we have been conducting research into the characteristics of lactation (milk formation), first in animals, and then in humans. It turned out that the late start of feeding (a day or more after birth), which is practiced in some places to this day, is harmful both for the mother and, especially, for the child.
In the “Handbook of Children’s Diet” (1977), I.M. Vorontsov and A.V. Mazurin noted: “The question of the optimal time for the first breastfeeding continues to be debated. In many foreign countries, it is customary to carry out the first attachment in the delivery room, literally 15-20 minutes after the birth of the child.” The authors, unfortunately, did not indicate that the early start of breastfeeding, practiced in these countries, was first proposed in our country, although it follows: “Among Soviet scientists there are also supporters of early breastfeeding (I. A. Arshavsky) ... However, This technique is not yet widespread in the practice of domestic pediatrics, and this is due to clinical reasoning that requires a gentle attitude towards both mother and child in the first hours after birth.” This is a false understanding of humanity. In fact, true humanity involves contact between mother and child immediately after birth.
Late latching of the baby to the mother’s breast cannot be considered “gentle”; in this case, the natural physiology of both the mother and the baby is significantly disrupted. In fact, a child who received continuous nutrients from his mother before birth is doomed immediately after birth to prolonged starvation.
In 1980, WHO recognized the method of early breastfeeding 20-30 minutes after birth, which we proposed back in 1952, as mandatory for all countries. This method very soon began to be used in many countries around the world. Our country is also a member of WHO; in our country, the method was supposed to be used from the beginning of 1981. However, even if the corresponding order was issued by the Ministry of Health, it would be impossible to apply the method in practice in our country, because our accepted practice of narcotic anesthesia for childbirth ELIMINATES THE POSSIBILITY of early initiation of feeding: the so-called medicinal substances administered into the mother's blood during childbirth, penetrating through the placenta into the blood of the fetus, its nerve centers are narcotized and the newly born baby cannot realize the necessary sucking movements. But the mother cannot “attach the face” of the born child. Thus, due to hypogalactia occurring in the mother, the newborn is deprived of the most important thing - the colostrum period of breastfeeding.
Colostrum is very important not only due to its content of protein (casein), carbohydrate (lactose), fat (lipids), but also has a significant immunobiological effect. Colostrum contains complex proteins such as albumins, globulins (immunoglobulins - 1g), i.e. natural antibodies that bind foreign substances (antigens) with which the born organism can interact. In newborns, these proteins, unlike casein protein, are not yet broken down by digestive juices and pass unchanged into their blood. Finally, colostrum contains lysozyme, an enzyme with bactericidal properties and a natural physiological antibiotic. Through passive immunization, the mother provides high immunobiological resistance of the newborn to various infectious diseases (for example, sepsis, pneumonia, intestinal diseases). Later, the start of feeding inhibits lactation, and in the first days the mother develops a condition known as hypogalactia; the newborn is deprived of the most important thing that he needs after birth, not only nutrients, but also immunization with colostrum.
In conditions of a normal pregnancy, the fetus is born with pronounced indicators of natural immunity. This is manifested in cellular immunity (highly expressed phagocytic activity of leukocytes, which, figuratively speaking, “devour” bacteria). And also in humoral immunity. After feeding with colostrum milk, already 2-3 days after birth, the baby’s natural immunoprotective capabilities become four or more times higher than those of the mother. A child born physiologically mature, if his natural physiology is not disturbed, not only cannot die, but cannot even get sick.
Early initiation of feeding is essential not only for the baby, but also for the mother. Through the act of sucking, the anterior lobe of the pituitary gland is stimulated and the hormone prolactin is formed; with simultaneous stimulation of the posterior lobe of the pituitary gland, the hormone oxytocin is formed. Both hormones contribute to both the further development of breast cell function (lactogenesis) and full milk production. That is why a late start of feeding can lead to insufficient production of prolactin and oxytocin and the occurrence of hypogalactia.
Oxytocin, in addition, promotes uterine contractions, bloodless separation of the placenta and, more importantly, eliminates postpartum hemorrhage. Thus, early initiation of feeding promotes rapid involution (contraction) of the uterus and prevents the pathology that may occur when uterine contraction is delayed. And such a delay can occur precisely because of the late start of feeding. Finally, colostrum secreted in the first days of feeding, containing a large amount of lysozyme, contributes to abundant lubrication of the skin of the mother's breast and thereby prevents mastitis.
How do newborns pay for the late start of mother's breastfeeding - after a day, two or even three? They will experience a weight loss of 150 g or more; it is called “physiological.” Then - jaundice, due to the fact that due to fasting he develops acidosis, i.e. that acidification of the blood, which, by disrupting the function of the liver, excludes the ability for it to convert indirect bilirubin into direct bilirubin. Indirect bilirubin, entering the blood, causes jaundice, also called “physiological.” Subsequently, in the vast majority of cases this results in liver disease. In the blood of newborns, in addition to the fact that they are deprived of the opportunity to obtain from colostrum milk those proteins that increase their natural immunity, the content of their own is reduced. This is called “physiological” hypoproteinemia. Newborns lose water. Because of this, not only urine output is sharply reduced (“physiological” oliguria), but the blood also sharply thickens. This is also called “physiological” exicosis, i.e. a condition caused by loss of water. As a result, already within the first month of life, a further decrease in the content of red blood cells and hemoglobin in the blood occurs. And this severe deviation from normal development is characterized by modern pediatrics as a condition supposedly inevitable and even natural for newborn babies, and therefore called “physiological” anemia. From this we can understand blood diseases in newborns, in particular malignant ones and those known as leukemia. They occur in those children who, due to the late start of mother's breastfeeding, develop severe acidification of the blood (acidosis). We have not yet listed all the consequences. But from what has been said, one can understand why children who are born completely healthy and physiologically mature already in the maternity hospital acquire symptoms characteristic of babies born physiologically immature. So, the created state of sharp deviation from the norm and representing an undoubted pathology, is legitimized as a condition, supposedly “physiological”. All this can be avoided if the mother starts breastfeeding early (20-30 minutes after the baby is born).
When a mother sees her newly born child for the first time, when she begins to feed him, the mother’s face and, especially, her eyes acquire features of incomparable spiritual beauty. And her pleasure is incomparable to any other emotion in her entire life. The mother seems to awaken an all-consuming tenderness for the child she has just born. All the hardships of life seem insignificant to the mother and fade into the background, the entire inner spiritual world of the mother seems to be ennobled. This is a maternal instinct that awakens even in those women who initially did not want to have a child. This feeling of pleasure is repeated with each subsequent breastfeeding.
The baby's sucking movements reflexively stimulate in the nursing mother the formation of those hormones and, in particular, neuropeptides, including endorphin, which neutralizes pain and causes positive emotions (“joyful sensations”). The child also receives these hormones with mother’s milk, which thereby evokes positive emotions in response. It’s as if kindness is “poured into him,” which children who are artificially fed “don’t receive enough.”
At the birth of a physiologically mature child and the early start of breastfeeding, only positive emotions are usually evoked in the baby. Negative emotions can arise (in a physiologically mature infant) only when hygienic conditions are not observed or the parents and other people around them behave incorrectly. The indications accepted in the literature that children are supposedly born with negative emotions and only later positive ones arise do not correspond to reality.
In many maternity hospitals, it is customary to deliver the baby to the mother once a day. We consider such a “routine”, convenient for service personnel, to be unreasonable.
After the first feeding directly in the delivery room (no more than half an hour after birth!) the next feeding should be in the ward, where the baby’s crib should be placed next to the mother’s bed. The time of the second and subsequent feedings should be determined by the child himself.
In a physiologically mature newborn, milk is absorbed (i.e., removed from the stomach) on average after 2.5-3 hours, for each child at a DIFFERENT TIME. An empty stomach causes another stimulation of the food center - this is most often manifested by a cry, the child seems to demand another feeding, and the mother willingly (with pleasure!) feeds her child. Physiological processes in a child’s body in the first days after birth occur WITHOUT a night break, so the child should be fed as many times a day as he “asks”, sometimes up to 8 times.
Our recommendations NOT to SEPARATE a child from its mother aroused strong objections back in the 50s. In pediatric guidelines, the main rule for caring for newborns was considered “mandatory.” separation of newborns and women in labor. As we have established, such separation, as well as a late start of breastfeeding, is HARMFUL for development. Thus, the incidence of early birth in newborns is 34 times lower than in late birth.
As our research has shown, even physiologically mature newborns, if they find themselves in the fundamentally incorrect hygienic conditions adopted in our maternity hospitals, which do not correspond to the characteristics of their physiology, can become physiologically immature and, therefore, be susceptible to many diseases, especially before the age of one year. Hence the high infant mortality rate in our country (56th place in the world!).
And if hygienic conditions are observed that correspond to the specific features of the physiology of newborns, children born physiologically mature, we emphasize once again, not only cannot die, but cannot even get sick!
Initial examination of the newborn carried out immediately after his birth in the children's ward of the maternity ward in order to identify possible pathology and assess the condition as a whole. The room temperature should be 24–26°C, the changing table should be heated, the child should be dry. An examination in the neonatal ward of the department is carried out at a temperature of at least 22°C on a changing table or in an incubator. Examination of a newborn requires patience, caution and gentle handling.
Appearance. A healthy full-term newborn is characterized by a calm facial expression. The beginning of the examination is often accompanied by a loud emotional cry. The duration of a healthy child’s cry is adequate to the action of the stimulus (hunger, tactile or painful stimulation); soon after its elimination, the cry stops. Scream the sick child is assessed both in strength and duration. A weak or absent cry in a very premature baby does not cause concern to the neonatologist. An aphonic cry may be due to resuscitation measures (tracheal trauma) or damage to the central nervous system. Features of a newborn's cry can help diagnose metabolic disorders and some hereditary diseases (Down's disease, "cry of the cat" syndrome).
The movements of a newborn child are excessive and uncoordinated. Characteristic is a physiological increase in the tone of the flexor muscles, which determines the child’s posture (flexion posture, fetal posture): the head is slightly brought to the chest, the arms are bent at the elbow joints and pressed to the side surface of the chest, the hands are clenched into fists. The lower limbs are bent at the knee and hip joints; when the child is positioned on his side, the head is sometimes thrown back. Tremors in the ankle and jaw joints are common in a healthy child. The facial expression and posture of a healthy newborn depend on the position of the fetus during labor. With extension insertions (frontal, facial), the face is swollen, abundant petechiae are possible, the head is usually thrown back. With breech presentation, the legs can be sharply bent at the hip joints and straightened at the knees.
Normally, in healthy newborns the following are caused: basic reflexes of the newborn period:
Sucking- the child responds to irritation of the lips by touch with sucking movements.
Babkin's palmo-oral reflex- when pressing on the child’s palms with his thumbs, he opens his mouth and bends his head slightly.
Robinson's palmar grasp reflex- when placing a finger in the child’s hand, the hand contracts and the child tightly grasps the finger.
Moro reflex- when hitting the surface on which the child is lying or blowing in the face, the child’s arms are extended at the elbows and moved to the sides (Phase I), followed by “hugging” the body (Phase II).
Support and automatic walking reflex- the child is taken under the arms and placed vertically, supporting the back of the head with his fingers. In this case, its legs first bend, and then the legs and torso straighten. When leaning forward slightly, the child makes stepping movements (automatic walking).
Bauer crawling reflex- in the position of the child on his stomach, a palm is placed on his bent legs and the child begins to crawl, straightening his legs and pushing off.
Protective reflex of a newborn - in the tummy position, the child turns his head to the side (protection).
Galant reflex- with line movements of the finger, the skin along the spine is irritated from top to bottom. In response, the child bends his torso in the direction of irritation.
Facial expression. Dissatisfied “painful” is characteristic of many diseases of newborns. A restless facial expression, a “frightened” look or a hypomimic, sometimes mask-like face often accompanies subarachnoid hemorrhages, cerebral hypoxia, and bilirubin encephalopathy. The face of a newborn may be asymmetrical due to the peculiarities of the position of the fetus during childbirth, paralysis of the VII pair of cranial nerves.
Head in newborns it is distinguished by the predominance of the cerebral skull over the facial skull. Premature newborns have a skull shape similar to hydrocephalus, as they are characterized by intensive brain growth. The bones of the skull in the vast majority are not fused, a large fontanel is open (its dimensions are 1–2 cm), the sutures can be closed, slightly diverge, or overlap each other (disjointed), which is due to the process of childbirth and is typical for a protracted course. Depending on the characteristics of the birth, the shape of the head can be different: dolichocephalic (extended from front to back), brachycephalic (extended upward) or irregular (asymmetrical). The normal shape of the head is usually restored during the first week of life. A bulging fontanel may be caused by increased intracranial pressure, meningitis or hydrocephalus. When dehydrated, the fontanelles collapse. A healthy full-term baby has a head circumference of 33(32)–37(38) cm.
Eyes in the first days of life they are closed almost all the time. They spontaneously open and close when rocked, which serves as a manifestation of labyrinthine reflexes. The pupils become symmetrical a few weeks after birth. The diameter of the pupils does not exceed 3 mm. The sclera is usually white. Premature babies may have blue sclera because they are thin. If the sclera is dark blue, osteogenesis imperfecta must be excluded. Brushfield spots on the iris, which appear as if the iris is sprinkled with salt and pepper, are often observed in Down syndrome. Subconjunctival hemorrhage - rupture of small capillaries of the conjunctiva can also occur in healthy newborns, but is more often the result of a traumatic birth. For the first days of life, spontaneous horizontal nystagmus (small-amplitude involuntary twitching of the eyeballs), a symptom of the “setting sun,” may be observed.
Use a nasogastric tube to check patency nasal passages to exclude choanal atresia. Flaring of the wings of the nose indicates respiratory distress syndrome.
Oral cavity. The hard and soft palate is examined to exclude clefts. At the bottom of the mouth you can find a cystic tumor (ranula), which in most cases disappears on its own without requiring treatment. There may be cysts on the hard and soft palates (Epstein's pearls), which are not a deviation from the norm and disappear spontaneously. Extra teeth (natal) occur in 1:4000 newborns and usually require removal. Foamy discharge from the nose or mouth can usually indicate esophageal atresia.
Color of the skin: plethora (dark red, erythematous), more common in newborns with polycythemia, but can be observed with hyperoxia (high oxygen concentration) and overheating of the child. Jaundice - when the level of bilirubin in the blood is above 85.5 µmol/l, this is a pathology for children under 24 hours of age and may indicate hemolytic disease of the newborn, sepsis or intrauterine infection; in children older than 24 hours of life, jaundice may be caused by the same diseases or physiological conditions. Pale skin is a consequence of anemia, asphyxia during childbirth, shock or the functioning of the ductus arteriosus. Cyanosis:
a) central (cyanotic color of the skin, tongue, lips) - may be associated with congenital heart disease or lung disease;
b) peripheral (cyanotic skin, and the tongue and lips are pink) - a symptom of methemoglobinemia;
c) acrocyanosis (cyanotic skin color only in the area of the hands and feet) - normally occurs in a newly born child or during hypothermia; if acrocyanosis persists at a later date, you should think about impaired peripheral circulation due to hypovolemia, a large number of ecchymosis, which is often the result of traumatic birth;
“cyanosis on a pink background” or “pink color on a cyanotic background” - inadequate oxygenation, ventilation or polycythemia;
Harlequin sign (a clear demarcation line between an area of redness and an area of normal skin color - as a result of persistent fetal blood flow, coarctation of the aorta or transient) - the line can extend from the head to the abdomen;
“marble pattern” (lacey red coloring of the skin) - as a consequence of hypothermia, hypovolemia, infection, leading to impaired peripheral circulation.
There may be rashes in the area of natural folds - miliaria, caused by blockage of the sweat glands, which can be in the form of: 1) superficial thin-walled vesicles; 2) small group erythematous papules; 3) non-erythematous pustules. The appearance in the first week of life or at birth of rashes on the forehead, chest, arms, legs is characteristic of transient neonatal pustular melanosis. Quite often at birth it occurs in the head area. acne newborns(neonatal scalp pustulosis).
The function should be studied with utmost care lungs. The chest of a newborn is barrel-shaped. Breathing is shallow, with a frequency of 40–60 per minute, almost completely diaphragmatic, accompanied by retraction of the pliable areas of the chest during inspiration and protrusion of the abdomen. When a child cries, feeds, or becomes restless, shortness of breath easily occurs due to narrow nasal passages and possible swelling of the nasal mucosa. Typically, newborns have bronchovesicular breathing. In a premature baby, breathing is more frequent and labile with irregular movements.
Heart. Determining the boundaries of the heart in newborns is difficult due to individual differences in the size and shape of the chest. The location of the heart should be determined to identify dextrocardia (right-sided location of the heart). Heart sounds are loud and clear. Normal heart rate in newborns is 140–160 beats/min. It is necessary to palpate the pulse in the femoral, radial, brachial arteries and arteries of the dorsum of the foot.
Stomach in a healthy newborn it is round in shape and actively participates in the act of breathing. With overfeeding, infectious diseases and surgical pathology, bloating occurs. On palpation, the abdomen of a healthy child is soft, accessible to deep palpation in a calm state. The liver in most newborns protrudes from under the edge of the costal arch no more than 2 cm (up to 5 years). The spleen in a healthy newborn child can be palpated at the edge of the costal arch. Palpation of the kidneys in healthy newborns indicates abnormalities in the development of the urinary system.
Inspection genitals. In healthy full-term boys, the testicles are lowered into the scrotum, the head of the penis is hidden under the foreskin. The size of the penis and scrotum is purely individual. In some newborns, the head of the penis is not covered by the foreskin - a variant of the norm, but it is necessary to make sure that there is no hypospadias. Enlargement of the penis and scrotum may indicate the manifestation of adrenogenital syndrome (salt-wasting form). Pigmentation of the scrotum should be regarded as ethnic.
In full-term girls, the labia majora cover the labia minora. Premature girls are characterized by a gaping genital slit and a predominance of the labia minora over the labia majora or they are equal in size. Significant enlargement of the clitoris makes it necessary to determine the sex of the child.
Thus, a scrupulously conducted clinical examination, along with a carefully collected anamnesis, contributes to the timely diagnosis of the disease and correct, timely treatment.
3. Anatomical and physiological characteristics of newborns. Newborn care.
Leather- tender, velvety to the touch, elastic, pink, there may be remnants of vellus hair on the back and shoulder girdle. Its richness in vessels and capillaries, poor development of sweat glands and active activity of the sebaceous glands lead to rapid overheating or hypothermia of the child.
He has easily vulnerable skin, which is also important to consider, because... With improper care, diaper rash appears, infection easily penetrates through the pores and pustules appear. On the back of the head, upper eyelids, between the eyebrows there may be bluish or reddish spots caused by vasodilation (telangiectasia), or pinpoint hemorrhages.
Sometimes there are yellowish-white nodules (milia) on the wings and dorsum of the nose. All these phenomena disappear in the first months of life. In the area of the sacrum there may also be an accumulation of skin pigment, the so-called. "Mongolian spot" It remains noticeable for a long time, sometimes throughout life, but is not a sign of any disorders. A newborn's hair is up to 2 cm long, eyebrows and eyelashes are almost invisible, nails reach the fingertips.
Subcutaneous fat- well developed, denser than it will become in the future - in terms of chemical composition, refractory fatty acids now predominate in it.
Skeletal system- contains few salts, which give it strength, so bones are easily bent if the child is not properly cared for. An infant feature is the presence of non-ossified areas in the skull - the so-called. fontanelles. The large one, in the shape of a diamond, is located in the area of the junction of the parietal and frontal bones, dimensions 1.8-2.6 × 2 - 3 cm. The small one, in the shape of a triangle, is located at the convergence of the parietal and occipital bones and is closed at birth in most children .
Such a soft connection of the skull bones is of practical importance when the head passes through the narrow birth canal. Its natural deformation into an elongated “pear” is not scary and should not cause “panic”. The correct outline is a matter of time. Parents should not be frightened by the conspicuous disproportion of the baby’s body parts. Indeed, the head looks too large, because it is 1-2 cm larger than the chest circumference, and the arms are much longer than the legs.
The existing imbalance is also a matter of time, which will correct everything. The chest is barrel-shaped: the ribs are located horizontally, and not obliquely, as in the future. They consist mainly of cartilage, just like the spine, which does not yet have physiological bends. They will form later, when the child begins to sit and stand.
Muscular system- their increased tone predominates - the arms are bent at the elbows, the legs are pressed to the stomach: the posture is uterine due to the preserved inertia. The neck does not support the head - its muscles are not strong. The child “knocks” his arms and legs continuously, but purposeful movements and motor skills will come with the maturity of the nervous system.
Respiratory system- the mucous membranes of the respiratory tract are delicate, contain a large number of blood vessels, therefore, during infections, often viral, swelling quickly develops, a large amount of mucus is released, which greatly complicates breathing. It is also hampered by the anatomical narrowness of the newborn’s nasal passages, as well as his trachea (windpipe) and bronchi.
The auditory, or Eustachian, tube is wider and shorter than in older children, which facilitates the penetration of infection and the development of otitis media (inflammation of the middle ear). But there is never inflammation of the frontal sinus (frontal sinusitis) and the maxillary or maxillary sinus (sinusitis), because they are not yet available. The lungs are underdeveloped, breathing is shallow and is mainly carried out by the diaphragm - a muscle located on the border of the chest and abdominal cavities.
Therefore, breathing is easily disrupted by the accumulation of gases in the stomach and intestines, constipation, tight swaddling, pushing the diaphragm upward. Hence the wish - to monitor regular bowel movements and not to swaddle the baby too tightly. Since the baby does not receive enough oxygen with his shallow breathing, he breathes quickly. The norm is 40-60 inhalations and exhalations per minute, but this frequency increases even with a slight load. Therefore, you need to pay attention first of all to shortness of breath, which is accompanied by a feeling of lack of air and may be a sign of illness.
The cardiovascular system- with the birth of a newborn, changes occur in the circulatory system, first the functional umbilical vessels and vein stop their activity, and then the anatomical ones - the intrauterine blood flow channels close.
With the first breath, the pulmonary circulation is activated, through which the blood is saturated with oxygen in the lung tissue. The pulse rate is 120-140 beats per minute; when feeding or crying, it increases to 160-200 beats. Blood pressure at the beginning of the first month is 66/36 mm. Hg, and by the end of it - 80/45 mmHg.
Digestive system- immature in functional terms, and since newborns have an increased metabolism, carries a large load - minor errors in the diet of a breastfeeding mother and the child’s diet can cause digestive upset (dyspepsia). The mucous membrane of the mouth is rich in blood vessels, thin, delicate, and easily vulnerable.
The tongue is big. On the mucous membrane of the lips there are so-called. “pads” - small whitish elevations, separated by stripes, perpendicular to the length of the lip (Pfaundler-Luschka ridges); the mucous membrane forms a fold along the gums (Robin-Magitot fold); The elasticity of the cheeks is given by the so-called. Bisha's lumps are accumulations of fatty tissue located in the thickness of the cheeks.
They are present both in healthy people and in those born with malnutrition - a nutritional disorder accompanied by a decrease in body weight. With the transition of malnutrition to a severe form, the body loses almost all adipose tissue, except for Bisha's lumps. The digestive glands, including the salivary glands, have not yet developed: very little saliva is secreted in the first days.
The muscles that block the entrance from the esophagus to the stomach are also underdeveloped - this leads to frequent, light regurgitation. To prevent it after feeding, you need to hold the baby for 20 minutes in your arms, vertically, leaning against your chest. Initially, the stomach holds about 10 ml of liquid, by the end of the first month its capacity increases to 90-100 ml.
The intestinal muscles are still poorly trained and the movement of food through it is slow. That is why newborns are so tormented by accumulations of gases formed during the digestion of milk and bloating - flatulence. Constipation is common. Feces in the first 1-3 days of life (called “meconium”) have a characteristic viscous consistency of dark green color, there is practically no smell. Meconium is formed from amniotic fluid, mucus, and bile, which enter the stomach and intestines of the fetus.
By the presence of these secretions in the first hours after birth, it is judged that the child has no defects in the development of the esophagus, stomach, intestines, or anus. Organ obstruction requires immediate surgical intervention. During the first 10-20 hours of life, the child’s intestines are almost sterile, then they begin to colonize it with the bacterial flora necessary for digesting food.
The type of feces also changes - feces appears - a yellow mass consisting of 1/3 saliva, gastric and intestinal juices and 1/3 food debris. The work of the digestive glands is also noticeable in this. The largest of them, which is also the body’s protective barrier against toxic compounds, the liver, is relatively large in infants. But in healthy people, the edge of the liver can protrude from under the lowest rib (at the border of the chest and abdomen) by no more than 2 cm.
Genitourinary system- by the time of birth, the kidneys, ureters, and bladder are formed quite well. However, severe stress experienced by a child during childbirth short-term disrupts metabolism. In the areas where urine is formed, uric acid crystals are deposited and the kidney function is slightly reduced for the first few days.
The child urinates only 5-6 times a day. From the 2nd week, the metabolism gradually stabilizes, the number of urinations increases to 20-25 times per knock. This frequency is normal for the first months, given the relatively small volume and insufficient distensibility of the bladder walls. The external genitalia are formed. In boys, the testicles most often descend into the scrotum, but if they are in the lower abdomen, they can descend on their own in the first 3 years. In girls, the labia majora cover the labia minora.
Metabolism- increased need for carbohydrates, increased absorption of fats and their deposition in tissues. The water-salt balance is easily disturbed: the daily fluid requirement is 150-165 ml/kg.
Hematopoiesis- in newborns, the main focus of hematopoiesis is the red bone marrow of all bones, additional ones are the liver, spleen, and lymph nodes. The size of the spleen is approximately equal to the palm of the child himself, its lower edge is located in the projection of the left costal arch (the lowest protruding rib at the border of the chest and abdomen). Lymph nodes, as a rule, cannot be identified during examination; their protective function is reduced.
Endocrine system- the adrenal glands during childbirth bear the greatest load of all glands and some of their cells die, which determines the course of some borderline conditions. The thymus gland, which plays a protective role, is relatively large at birth and subsequently decreases in size.
The thyroid, parathyroid, and pituitary glands continue to develop after birth. The pancreas, which is involved in digestion and takes part in carbohydrate metabolism (produces the hormone insulin), functions well at the time of birth.
Nervous system- immature. The convolutions of the brain are barely outlined. They are more strongly developed in those sections where the vital centers responsible for breathing, heart function, digestion, etc. are located. In infancy, they sleep most of the day, waking up only from hunger and discomfort. Congenital reflexes, such as sucking, swallowing, grasping, blinking, etc., are well expressed, and by the 7-10th day of life the so-called reflexes begin to develop. conditioned reflexes, a reaction to the taste of food, a certain posture usually associated with feeding, by the time it is time for the child to soon begin to wake up on his own.
Normally, in healthy newborns the following basic reflexes of the newborn period are evoked:
1. Sucking - the child responds to irritation of the lips by touch with sucking movements.
2. Babkin's palm-oral reflex - when pressing on the baby's palms with his thumbs, he opens his mouth and bends his head slightly.
3. Robinson's palmar grasp reflex - when a finger is placed in a child's hand, the hand contracts and the child tightly grasps the finger.
4. Moro reflex - when hitting the surface on which the child is lying or blowing in the face, the child’s arms are extended at the elbows and retracted to the sides (Phase I), followed by “hugging” the body (Phase II).
5. Reflex of support and automatic walking - the child is taken under the arms and placed vertically, supporting the back of the head with his fingers. In this case, its legs first bend, and then the legs and torso straighten. When leaning forward slightly, the child makes stepping movements (automatic walking).
6. Bauer's crawling reflex - in the position of the child on his stomach, a palm is placed on his bent legs and the child begins to crawl, straightening his legs and pushing off.
7. Protective reflex of a newborn - in the position on the stomach, the child turns his head to the side (protection).
8. Galant reflex - streak movements of the finger irritate the skin along the spine from top to bottom. In response, the child bends his torso in the direction of irritation.
Sense organs- in the first weeks, the olfactory organs feel almost no smell; only an extremely loud sound can wake them up, and only too bright light can disturb them. The child's thoughtless gaze does not linger on anything; many experience physiological strabismus caused by weakness of the eye muscles, involuntary movements of the eyeballs - nystagmus.
Up to 2 months he cries without tears - the lacrimal glands do not produce fluid. So far, only the senses of taste, touch and temperature sensitivity help him to understand the world. But you can no longer say about a two-month-old that he is “blind and deaf.” A sure sign is that he persistently looks at the loud, bright rattle.
Immunity- some factors that play a protective role in the body are produced in utero. The child receives some of the immune substances from the mother with colostrum, in which their concentration is very high, and with breast milk, where their content is much lower, but in sufficient quantities. But in general, the immune system is imperfect, the child is vulnerable to infection.
Procedures for caring for a child up to one year old
Activities for caring for a newborn can be divided into daily and weekly. But if necessary, these procedures need to be performed more often so that the newborn baby feels comfortable.
Daily newborn care
Perform the following procedures sequentially:
Washing your face with warm boiled water. You can wipe your face with your hand, or you can use cotton balls. At the same time, the ears are wiped;
Eye treatment. It is carried out using cotton balls, which are moistened in boiled water. If you notice that your eye has become more dirty than usual, you can use a furacelin solution (1:5000 pharmaceutical preparation). There is an opinion that you can wipe your eyes with strong tea. If you decide to rinse with tea, be sure to make sure that there are no tea leaves on the cotton ball, as they can lead to eye irritation. Rinsing is carried out from the outer corner of the eye to the inner. Use a separate cotton ball for each eye;
Skin folds can be lubricated with sterile Vaseline or vegetable oil;
Treatment of the umbilical wound;
The smaller the child, the more often it is necessary to wash him, namely, this should be done after each urination and bowel movement. You need to wash with running water, and under no circumstances in a basin or bath, as this increases the risk of contamination and infection of the genitourinary tract. The rules for washing are as follows:
girls are washed from front to back;
washing is carried out with the hand, onto which a stream of warm water is directed (37-38 C);
Before you start washing your baby, be sure to check the water temperature (expose your hand first, and only then the baby).
After washing on the changing table, use a clean diaper to dry your baby's skin using a blotting motion. Then, lubricate the folds of the skin with a cotton swab moistened with sterile vegetable oil (you can also use baby cream for this).
Daily care must be done in the morning.
Weekly child care up to one year old
The nasal passages are cleaned with cotton wool. It is better to prepare them from sterile cotton wool. Technique: a cotton swab is moistened in sterile Vaseline or vegetable oil. Insert into the nasal passage to a depth of no more than 1-1.5 cm and clean with rotational movements from the inside out. The right and left nasal passages are cleaned with separate flagella. This procedure should not be carried out too long or often. Do not use dense objects for this, including matches and cotton swabs. This can lead to trauma to the mucous membrane;
The external auditory canals are cleaned with rotational movements using dry cotton wool;
The mucous membranes of the oral cavity should not be wiped, as they are very easily injured;
Nail cutting. It is more convenient to use scissors with rounded ends or nail clippers;
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