Newborn: Caring for Full-Term and Premature Infants

Newborn: Caring for Full-Term and Premature Infants

I. Full-Term Infants:

1. Physiology:

• Physical Examination:

• Length (CN):

• Head Circumference (CC):

• Skin:

• Subcutaneous Blood Vessels:

• Subcutaneous Fat:

• Vernix Caseosa:

• Lanugo Hair:

• Hair, Nails:

• Ears (Auricular cartilage):

• Skull: Head circumference, anterior fontanel, sutures

• Breasts: Areola, nipple

• Genitalia:

• Genital Changes:

• Nervous System: Crying, reflexes, primitive reflexes, muscle tone

• Reflexes:

• Sucking Reflex: Present at 28 weeks, well developed at 32-34 weeks, disappears after 12 months.

• Rooting Reflex: Present at 28 weeks, well developed at 32-34 weeks, disappears after 3-4 months.

• Grasping Reflex – Robinson: Present at 28 weeks, well developed at 32-34 weeks, disappears after 2 months.

• Moro Reflex: Present at 28-32 weeks, well developed at 37 weeks, disappears after 6 months.

• Stepping Reflex: Present at 35-36 weeks, well developed at 37 weeks, disappears after 3-4 months.

2. Care:

• Hygiene:

• Umbilical Cord: Clean with chlorhexidine or 1% iodine.

• Immunizations:

• Vitamin K: Administered intramuscularly or orally (2mg) to newborns. Breastfed infants: Supplement with 2mg/week for 6 weeks.

• Vitamin D: Administered orally (1000-2000 IU/day) for breastfed infants, 800-900 IU/day for formula-fed infants.

• Temperature: Maintain between 36.5-37°C.

II. Premature Infants:

1. Causes:

• Maternal Factors:

• Chronic diseases

• Infections: Viral (influenza, CMV, measles, rubella), bacterial (salmonella…), parasitic (toxoplasmosis, malaria)

• Local factors: Uterine rupture, placental abruption, postpartum hemorrhage, uterine malformations, polyhydramnios, premature rupture of membranes with or without infection

• Malnutrition

• History of preterm birth

• Maternal age <18 or >35

• Surgical, psychiatric, or uterine rupture interventions

• Obesity, alcohol or drug abuse

• Poor socioeconomic status

• Fetal Factors:

• Multiple births

• Stillbirth

• Chromosomal abnormalities

• Fetal growth restriction

• Intrauterine growth retardation

• Rh incompatibility

• Unknown cause (accounts for 30-50% of cases)

2. Development:

• Gestational Age:

• 24 weeks: Alveoli formation begins

• 26 weeks: Surfactant synthesis in the lungs starts

• 28 weeks: Survival rate >70%

• 30 weeks: Risk of brain hemorrhage decreases

• 32 weeks: Survival rate >90%

• 34 weeks: Active surfactant synthesis

• 36 weeks: Brain maturation, reduced risk of apnea

3. Pathology:

• Apnea of Prematurity:

• Occurs in preterm infants under 35 weeks, apnea lasting >20 seconds, or <20 seconds accompanied by cardiovascular abnormalities.

• Treatment: Xanthine group (caffeine) with a loading dose of 20mg/kg, followed by maintenance dose of 5mg/kg once daily until near term.

• Intraventricular Hemorrhage (IVH):

• Seen in infants aged 26-34 weeks due to the immature vascular network in the germinal matrix.

• Papile classification:

• Papile 1: Hemorrhage in the germinal matrix, resolves with few sequelae.

• Papile 2: Hemorrhage within the ventricles.

• Papile 3: Hemorrhage within the ventricles and dilation of the lateral ventricles, easily leaving sequelae of hydrocephalus.

• Papile 4: Hemorrhage within the ventricles and brain parenchyma.

• White Matter Injury (WMI):

• Caused by hypoxia, often occurring in the anterior and posterior horns.

• Symptoms: 1/2 cases have seizures, abnormal muscle tone.

• Retinopathy of Prematurity (ROP):

• Caused by prolonged exposure to high concentrations of oxygen.

• Late Complications:

• Bronchopulmonary dysplasia (BPD)

• Anemia of prematurity

• Rickets

4. Care:

• Antenatal Transfer: If there is a risk of preterm birth between 24-34 weeks, administer betamethasone 12mg/dose x2 doses 24 hours apart, 24 hours before birth.

• Effects of Prenatal Corticosteroids:

• Reduces the risk of hyaline membrane disease

• Reduces the incidence of persistent patent ductus arteriosus

• Reduces the risk of brain hemorrhage

• Reduces the risk of ROP

• Care of Preterm Infants:

• Temperature: 28-35°C.

• Oxygen saturation: 90-95%.

• Fluid requirements: 60-80ml/kg/day on the first day, increased by 20ml/kg/day to reach 150-160ml/kg/day by the end of the first week.

• Monitor fluid balance, fluid overload -> facilitates CODM and BPD.

• Energy Requirements:

• Premature infants: 130-140kcal/kg/day

• Full-term infants: 100-120kcal/kg/day

• Iron and Folic Acid Supplementation: After 4 weeks of age.

• Growth Assessment:

• Length (CN): 2cm/week

• Head Circumference (CC): 1cm/week

III. General Care Principles:

• Hygiene and Breast Milk:

• Caring for Full-Term Infants:

• Clean the umbilical cord with chlorhexidine or 1% iodine.

• Administer vitamin K 2mg to newborns.

• Administer vitamin D 1000-2000 IU/day for breastfed infants, 800-900 IU/day for formula-fed infants.

• Maintain temperature between 36.5-37°C.

• Caring for Premature Infants:

• Antenatal transfer if there is a risk of preterm birth between 24-34 weeks.

• Provide specialized care for preterm infants.

IV. Finstrom Score:

• The Finstrom score is used to assess the maturity of a newborn, including:

• Posture: 3 points

• Prone position on the hand: 3 points

• Nipple: 3 points

• Fingernails: 3 points

• Ears: 4 points

• Genitalia: 4 points

• Sole creases: 4 points

Note:

• This article is for informational purposes only. You should consult a healthcare professional for advice tailored to your child’s health condition.