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

2. 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

3. 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

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. Our patients, newborn infants, who are ill or requiring special medical care due to:
prematurity, 
low birth weight, 
intrauterine growth retardation, 
congenital malformations (birth defects), 
sepsis, 
birth asphyxias

9. 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

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. 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

13. What for is neonatology Why neonatology 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. 

16. Breathing and circulation
The first challenge of a newborn is breathing independently instead of using placental oxygen delivered via the umbilical cord

17. 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 

18. What happens with lung liquid?
Question
What happens with lung liquid?

19. 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

20. 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

21. Circulation
The closure of:
the foramen ovale
the ductus arteriosus

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

23. 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)

24. 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

25. 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 for amylase and lipase

26. RENAL SYSTEM

27. RENAL SYSTEM not reach adult levels till 2nd year of life
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

28. 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.

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

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

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

34. Infantile menstruation

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

36. 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

37. 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

38. TERM 37-42

39. Premature infants
< 37 t.c.

40. Newborns are different…
23-27 EP
28-31 VP
32-33 MP LP
37-42
TERM

41. Born Too Soon %

42. Born Too Soon

43. Survival rate Poland 750 g - 1 000 g more than 90% 500 g -750 g 50-75%

44. Premature infants are very different…

45. Small for gestational age SGA Large for gestational age LGA
Newborns
Small for gestational age SGA
Large for gestational age LGA

46. Centile charts

47. tyg PCA

48. 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

49. How to assess newborn after delivery?
Question
How to assess newborn after delivery?

50. How to assess the newborn after delivery
Apgar Score

51. Apgar Score Virginia Apgar 1953
Appearance (Skin color)
Pulse puls/na min
Grimace (Reflex irritability)
Activity (Muscle tone)
Respiration

54. Apgar Score
0 - 3 – criticaly low
4 - 7 – fairly low
normal

55. 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

56. What is birth weight of term infant?
Question
What is birth weight of term infant?

57. Features of term infant
Birth weight 3-3,5 kg
Birth length 52 cm
Head circumference 33 cm
Chest circumference 32 cm
Proportions of body

61. Fontanelle of newborn

62. What is the normal size of anterior fontanelle?
Question
What is the normal size of anterior fontanelle?

63. The anterior fontanelle
is diamond in shape,
located at the junction of 2 parietal & frontal bones,
It is 2-3 cm in width & 3-4 cm in length,
It closes between months of age.

64. The posterior fontanelle
is triangular in shape,
located between the parietal & occipital bones
It closes by the 2nd month of age.

65. What is the normal heart rate and respiration rate of a newborn?
Question
What is the normal heart rate and respiration rate of a newborn?

66. Features of term infant
Heart rate
Respiration rate

67. After delivery.. What should we do?

68. After delivery Delay clamping cord Apgar Score
Warm control (protect body temperature)
Skin to skin contact (at least 2 hours)
Identification band
Identify high risk neonates
Prevention hemorrhage wit K …
documentation

69. Thank you