A neonate (from Latin, neonatus) is a baby who is 4 weeks old or younger also called a new born. The term applies to premature, mature and postmature infants. The neonatal period is the first 4 weeks of a child’s life and it is a time when changes are very rapid. During these first 4 weeks of life,the child is at highest risk of dying. It is therefore crucial that appropriate feeding and care are provided during this period, both to improve the child’s chances of survival and to lay foundations for a healthy life.
Many critical events can occur in this period:
After the first hour of life, newborns should receive eye care, vitamin K, and recommended immunizations (birth dose of OPV and Hepatitis B vaccine). They should be assessed for birth weight, gestational age, congenital defects and signs of newborn illness.
Special care should be provided for sick newborns, those who are preterm and/or low birth weight, and those who are exposed or infected by HIV or have congenital syphilis.
The Apgar score helps find breathing problems and other health issues. It is part of the special attention given to a baby in the first few minutes after birth. The baby is checked at 1 minute and 5 minutes after birth for heart and respiratory rates, muscle tone, reflexes, and color.
A baby who needs help with any of these issues is getting constant attention during those first 5 to 10 minutes. In this case, the actual Apgar score is given after the immediate issues have been taken care of.
Each area can have a score of 0, 1, or 2, with 10 points as the maximum. Most babies score 8 or 9, with 1 or 2 points taken off for blue hands and feet because of immature circulation. If a baby has a difficult time during delivery and needs extra help after birth, this will be shown in a lower Apgar score. Apgar scores of 6 or less usually mean a baby needed immediate attention and care.
Sign Score = 0 Score = 1 Score = 2
A baby’s birth weight is an important marker of health. Full-term babies are born between 37 and 41 weeks of pregnancy. The average weight for full-term babies is about 7 pounds (3.2 kg). In general, very small babies and very large babies are at greater risk for problems. Babies are weighed every day in the nursery to look at growth, and the baby’s need for fluids and nutrition. Newborn babies may often lose 5% to 7% of their birth weight. This means that a baby weighing 7 pounds 3 ounces at birth might lose as much as 8 ounces in the first few days. Babies will usually gain this weight back within the first 2 weeks after birth. Premature and sick babies may not begin to gain weight right away.
The hospital staff takes other measurements of each baby. These include:
The staff also checks these vital signs:
A complete physical exam is an important part of newborn care. The healthcare provider carefully checks each body system for health and normal function. The provider also looks for any signs of illness or birth defects. Physical exam of a newborn often includes:
The healthcare provider will check how mature the baby is. This is an important part of care. This check helps figure out the best care for the baby if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than he or she appears by size, and may need different care than a premature baby needs.
Healthcare providers often use an exam called the Dubowitz/Ballard Examination for Gestational Age. This exam can closely estimate a baby’s gestational age. The exam looks at a baby’s skin and other physical features, plus the baby’s movement and reflexes. The physical maturity part of the exam is done in the first 2 hours of birth. The movement and reflexes part of the exam is done within 24 hours after birth. The provider often uses the information from this exam to help with other maturity estimates.
The physical maturity part of the Dubowitz/Ballard exam looks at physical features that look different at different stages of a baby’s gestational age. Babies who are physically mature usually have higher scores than premature babies.
Points are given for each area of assessment. A low of -1 or -2 means that the baby is very immature. A score of 4 or 5 means that the baby is very mature (postmature). These are the areas looked at:
The healthcare provider does 6 checks of the baby’s nerves and muscles.
A score is given to each area looked at. Typically, the more mature the baby is, the higher the score. These are the areas checked:
When the physical assessment score and the nerves and muscles score are added together, the healthcare provider can estimate the baby’s gestational age. Scores range from very low for immature babies to very high scores for mature and postmature babies.
The normal fetus is sterile until shortly before birth, as long as the amniotic membrane remains intact. After birth, the neonate rapidly acquires commensal bacteria that colonise the skin and mucous membranes. The host defence mechanisms are not well developed at this stage and some commensals may become opportunist pathogens, particularly in compromised neonates who must remain in hospital for the treatment of congenital abnormalities. The gastrointestinal ‘tract is colonised soon after birth, mainly by facultative bacteria. Studies have shown that anaerobes colonise the neonatal gastrointestinal tract during the first week of life and are greater in number and variety than aerobes or facultative species. Subsequently, only micro-organisms that can adapt to live in this mixed population of facultative and anaerobic species will colonise the various parts of the tract and become part of the resident flora.
Most infections in newborn babies are caused by bacteria, and some by viruses. A mother’s birth canal contains bacteria, especially if they have an active infection. During childbirth, the baby can swallow or breathe in the fluid in the birth canal, and bacteria or viruses can get into their lungs and blood. The baby can become sick during childbirth or within the first few days after birth. As the bacteria or viruses multiply, the newborn baby can become ill very quickly. The sooner the infection is discovered and treated, the better the outcomes will be for the newborn baby.
Infections are a major cause of neonatal mortality, responsible for approximately one third of the total neonatal deaths worldwide. Timely recognition of illness in sick neonates, appropriate care seeking and access to appropriate treatment is needed to reduce the neonatal mortality.
There are a number of bacteria and viruses that can be transmitted from mother to newborn baby during pregnancy or childbirth.
Common viral agents include herpes simplex viruses, HIV, CMV, and hepatitis B. Intrapartum infection with HIV or hepatitis B occurs from passage through an infected birth canal or by ascending infection if delivery is delayed after rupture of membranes; these viruses can less commonly be transmitted transplacentally. CMV is commonly transmitted transplacentally.
Bacterial agents include group B streptococci, enteric gram-negative organisms (primarily Escherichia coli), Listeria monocytogenes, gonococci, and chlamydiae.
In utero infection, which can occur any time before birth, results from overt or subclinical maternal infection. Consequences depend on the agent and timing of infection in gestation and include spontaneous abortion, intrauterine growth restriction, premature birth, stillbirth, congenital malformation (eg, rubella), and symptomatic (e.g., cytomegalovirus [CMV], toxoplasmosis, syphilis) or asymptomatic (e.g., CMV) neonatal infection.
Common infectious agents transmitted transplacentally include rubella, toxoplasma, CMV, and syphilis. HIV and hepatitis B are less commonly transmitted transplacentally.
Neonatal infections with herpes simplex viruses, HIV, hepatitis B, group B streptococci, enteric gram-negative organisms (primarily Escherichia coli), Listeria monocytogenes, gonococci, and chlamydiae usually occur from passage through an infected birth canal. Sometimes ascending infection can occur if delivery is delayed after rupture of membranes.
Postpartum infections are acquired from contact with an infected mother directly (e.g., TB, which also is sometimes transmitted in utero) or through breastfeeding (e.g., HIV, CMV) or from contact with family or visitors, health care practitioners, or the hospital environment.
The symptoms of a beginning infection are listed below. Determining if a new born has an infection may be difficult because healthy newborn babies can also have some of these symptoms even though there is no infection. In a newborn baby with an infection, these symptoms will continue and the baby needs to be checked by a doctor.
As the infection gets worse, the newborn baby may develop additional symptoms:
Several tests can be used to diagnose the infection. However, test results usually take two to three days to come back, so in the meantime, the doctor will prescribe antibiotics for the newborn baby while they are waiting for the test results to confirm the diagnosis. For example, rapid breathing could be caused by infection, and any delay in treatment could result in the newborn baby becoming much more ill.
The following tests may be needed to diagnose infection in newborn babies:
The consequences of infection in the newborn vary according to the gestational age, site of the infection, and micro-organism(s) involved. In general, due to the immaturity of the immune system in extremely premature babies, they have the worst incidence of mortality and significant morbidity. The site of infection is an important consideration:
Neonatal infections account for a significant proportion of neonatal deaths in the first week of life. In sub-Saharan Africa, south Asia, and Latin America where neonatal infections are most prevalent, the case fatality risk associated with possible severe bacterial infections in the first month of life is 9.8%. Infections are one of the three major causes of neonatal mortality and account for approximately a quarter of newborn deaths in the first month of CHlife. Neonatal infections are acquired horizontally (from the environment) or vertically (from mother).
👋 Hi! I’m your smart assistant Amy!
Don’t know where to start? Type your requirements and I’ll connect you to an academic expert within 3 minutes.get help with your assignment