The term

The exact term of a birth is 41.5 weeks after the 1st day of the last rules (41SA: Weeks of Amenorrhoea)

after 41.5 SA: newborn post-term
37 to 41,5 SA: newborn in the long term
from 24 to 37 SA: premature newborn

Adaptation to the extra-uterine life

Breathing

cerebral order:

physical stimuli: thoracic compression in the maternal urogenital die, handling of the Midwife, gravity, rhino-pharyngée removal of obstructions
sensory stimuli: reduction in the surrounding temperature
chemical stimuli: reduction in PaO2, reduction in the pH, increase in the PCO2 at the end of the childbirth. (attention: an intra-uterine anoxia can involve an intra-uterine inhalation méconiale)

> causes of failure: cerebral lesions, depressions of the respiratory centers by drugs, deterioration of the general state (infection…), paralysis of the respiratory muscles;

pulmonary order:

evacuation of the alveolar liquid : by compression, and lypmatic resorption (thanks to the cathécolamines)
creation and maintenance of a Functional Residual Capacity : good removal of obstructions, PaO2 X2 compared to the fetus
creation of respiratory cycles: by mechanical contact with the hands of the midwife, difference in temperature

> causes of failure: defect of resorption of the alveolar liquid, obstruction by inhalation of amniotic liquid, lung infection, absence of surfactant, malformation (compression of the air routes, lung)

Circulation

disappearance of placental circulation:

When the umbilical cord is cut, there is an increase in systemic resistances.

Creation of pulmonary circulation:

Lifting of the vasoconstriction on the level of the pulmonary artery: the Pressures between the Right Heart and the Left Heart are equalized, then are reversed, with Gauches pressures > with the Right Pressures

Closing of the shunts:

Left Pressure auricle > right auricle ==> closing of the Hole of Botal by the valvule of Vieussens
Increase in PaO2 and falls of the prostaglandin rate ==> vasoconstriction of the arterial channel

> Causes of failure: anoxia and acidosis maintain the vasoconstriction of the pulmonary artery, and the arterial channel and the open shunts (inter-auricular Communication,)

Kidney

filtration:

Emission of the 1st urines before H12 (J0-J2: 20mL/j, J6: 100mL/j, J10: 200-250mL/j)

power of concentration of the urines:

premature: 400mOsm/L (i.e. to eliminate 400mOsm, it must urinate water 1L) child in the long term: 600 mOsm/L

caution: milk of woman = 79mOsm/L whereas cow's milk = 221mOsm/L (X3 diuresis!)

balance acid-bases: there is a physiological metabolic acidosis of the newborn: pH > or = 7.35; then, there is a progressive maturation: pulmonary elimination of the acids and CO2, renal réabsorbtion of bicarbonates (HCO3-); The réabsorbtion of sodium (Na+) is immature at the newborn.

Metabolism

glycemic Regulation:

It is done by weak glycogen stocks; an early food as of the room of birth is necessary to fight against hypoglycemia.

thermal Regulation:

It is set up in the first hours of the life.

Immunizing

the immune system of the newborn is qualified, but naive (it spends time to react…)During the 3rd quarter of pregnancy, there is a transplacentaire transfer immunoglobulins G (IgG)

To the birth, the breast-feeding transmits have new-born of IgA nursery schools, directed specifically against the Antigens of the maternal vaginal bacteria!

Meticulous examination of the newborn

Measurements

for a normal child in the long term:

Weight of birth = 3250g + 500g
size = 50cm + 2cm
cranial Perimeter = 35cm + 1cm

There exist several curves of Croissance of the child making it possible to evaluate measurements of the newborn according to its age gestationnel: in France, one uses the curves of Leroy-Lefort, one finds also the curves of Pearse,…

A child " normal" is located between 3rd and the 97e percentile (or 10th and 90e according to the sources), i.e. its measurements are those of 94% (80%) of the population.

if it is beyond the 97e percentile, it is a macrosome

in lower part of the 3rd percentile, one speaks about baby hypotrophe. It is the sign of an intra-uterine delay of growth. the whole is to determine if this delay is harmonious or dysharmonieux :

- so harmonious: that means that the weight and the size and the cranial perimeter are in values lower than the normal. bad forecast compared to cerebral maturation

- so dysharmonieux: weights and/or size are lower than the standards, but the Cranial Perimeter remained in the standards: It is of good forecast for the child, since it is the proof of a good développemlent cerebral.

to see: Growth of the child.

Cutaneous

child in good health:

the child is pink
It can present Grains of milium: or acne of the infant (of with the hormonal impregnation during the pregnancy).
In the same way, certain babies still have Lanugo, kind of sleeping bag which one finds on the back, shoulders. frequent at the premature one.
Certaines ethnos groups presents Taches mongoloïdes: spots bleuetées on the level of the sacrum or on the lower extremities, who grows blurred while growing (Mediterranean, Noirs)
In the same way one can find Angiomes plans, more specifically at the White.

pathological cutaneous signs:

Acrocyanose : cyanosite of the ends
toxi-allergic erythema: red cutaneous eruptions moving on all the body. neither poison nor allergic! benign. no the treatment
new-born erythrosic ==> Ictère
séro-blood Bump, Céphalhématome, hématome of the seat, face, marks Forceps
tuberous Angiome
expansive Naevus

Cardiologic

standards:

Heart rate: 120-160/mn
coloring
TRC: Time of Recoloration Cutaneous <3sec
MT: 7.5/4.5 average: 55
sounding (detects a diaphragmatic Hernie, a Situs inversus: Breath)
huméraux and femoral pulses (a aortic Coarctation detects)

cardiac signs of malformations:

obstacle in the middle right: cyanosite
obstacle in the middle Left: left Cardiac failure: collapse
shunts: cardiac failure, pulmonary edema, light secondary cyanosite
Transposition of the large vessels: baby " bleu" who is well!

Respiratory

standards:

respiratory Frequency: 30 with 40/mn
pauses? (<10 dry), apnea? (>10sec)
pulmonary sounding: free
coloring: acrocyanose? cyanosite?
not of signs of fight: Score of silverman

Abdominal

palpation:

flexible abdomen, gargouillant (light frequent distension post-prandial) the liver and the point of spleen can be palpated.

umbilical point:

umbilical Hernia frequent: benign; no the intervention before 2 years (can arrange itself with the acquisition of walk and the reinforcement of the abdominal musculature)
ignition? omphalite! risk septicaemia!
malformations: Omphalocèle (the intestinal handles are contained in the frost of Wharton; associated with a polymalformatif syndrome); Laparoschisis (; good forecast; bag with grèle)

External genitals

BOY:

position of the meatus? Hypospadias
genital crisis with mammite towards J3-J5
palpation of the testicles: Cryptorchidie? , Ectopia testiculaire? Hydrocèle? (liquid, firm, remittent), Hernia inguinale?

GIRL:

genital crisis: mammite, secretions blanchâtres, + métrorragies
hypertrophy of the small lips, prominent clitoris (Black)

Ostéo-articular

upper limb: traumatic lesion? (fracture declavicule, humerus, paralysis of the Plexus brachial) symmetry, tonicity
lower extremity: symmetry, tonicity, feet (Metatarsus varus), hips (LCH= congenital Luxation of the hip)
rachis: Spina bifida aperta (gives paraplegia, hydrocéphalie), spina bifida occulted; on the level sacro-coccygien: to check that there is no méningée dent (small cavity with seepage)
cranium: modelling by the genital die; séro-blood bump, céphalhématome; Crâniosténose; to check the Fontanelle S
face: choanes permeable; to check the palate: palatine Slit, Nozzle of hare; dysmorphie;

Neurological

basic tonicity: quadriflexion, sign of the scarf, angle poplité<90°, angle pied-jambe=0°, return in inflection of the front armlever when one draws above.
tonicity of the axis: test of rectification of the head in the axis of the body; freination of the fall of the head into drawn-sitted.
antiquated reflexes:

automatic suction

Grasping of the hands and the feet

automatic Walk

cardinal Points: Reflex of digging

Reflex of Moro

cross Extension: when the right leg is gripped, the left foot comes to push the hand

Reactivity

Vision

The newborn sees in black and white. It perceives contrasts well, and follows a from top to bottom target and from right to left 50cm of him; in the same way, it follows the faces

Hearing

reaction to the noise/oto-emissions acoustic = OAS, auditive evoked potentials =PEA, boxes of Moatti

See too

External bonds

Factbook of the CIA: Death rates perinatal in various countries and other indicators of health
Baby Milk Action (" aims to save lives and to end the avoidable suffering caused by inappropriate infant feeding")
Cord-Blood.org - information on the blood of cord - original cells of the Umbilical cord can be used to treat future diseases! =

Simple: Baby Zh-yue: 孲𤘅子

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