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You are watching: Which statement best describes normal transitional physiology at the time of birth

StatPearls . Sweetheart Island (FL): StatPearls Publishing; 2021 Jan-.



The first four main of life that an child are considered the neonatal period. During this duration many facility physiologic transforms occur, and also the infant interacts v the various stimuli. Treatment during this duration should be continuous and effective. Child care consists of testimonial for the need of resuscitation, a complete physical exam, management of prophylactic medications and vaccines, sufficient feedings, safe sleep, hygiene of the newborn, and other important locations for baby wellbeing.

Issues the Concern

Initial Examination

Growth parameters and also behavior space assessed in ~ the minute of birth. In the setting of a normal spontaneous vaginal delivery or a Cesarean ar with no complications, the examination is deferred until one hour of age after skin to skin call with mommy is established and also breastfeeding is began if appropriate and desired. A pediatrician or nurse practitioner examines the newborn in the an initial twenty-four hours of life. A team with expertise of the equipment, training, and also resources is in fee of assessing and also attending any kind of resuscitation efforts needed by the child at the moment of birth. The Neonatal Resuscitation Guidelines are advantageous to guide resuscitation if necessary.<1>

The Apgar score at 1 and also 5 minutes of life is provided to assess for the need for resuscitation. This scoring device takes into factor to consider five materials with values from 0 to 2, and it includes respiratory effort, color, heart rate, and also reflex irritability and also muscle tone.

Physical Examination

Growth parameters are thought about at the moment of examination: weight, length, head circumference, and abdominal muscle and chest circumference. The worths vary relying on sex, socioeconomic status, and also race. Boys space usually heavier than girls, however the average weight is about 3500 grams, length, and head circumference room an average of 50cm or 20 inches and also 35cm or 14 inch +/- 2 inches, respectively. These measurements deserve to be plotted ~ above a growth curve, and also patient outcomes fall into 3 categories:

1) small for gestational period (SGA) which is additionally <10 percentile,

2) sufficient for gestational period (AGA) 

3) huge for gestational period (LGA) which is >90 percentile, based upon weight and also gestational age.

If the gestational age or due day is unknown, Dubowitz/Ballard maturational assessments have the right to be supplied to take it into factor to consider the infant"s neuromuscular tone and also reflexes as well as physical maturation.

A full physical exam is excellent to evaluate for any type of abnormalities. A head to toe approach is the preferred method. Beginning with the head, look for the existence of hematomas, subcutaneous swelling, overriding of sutures, and also patency of anterior and also posterior fontanelles. For the eyes, symmetry and size must be assessed as well as any subconjunctival hemorrhage, and the red reflexes should be elicited prior to discharging the infant home. Check of the sleep looks for patency and also symmetry of nares. In the mouth, the hard and soft palate are palpated and examined to preeminence out cleft palate or any type of other abnormalities, and also an evaluate of the suck reflex. The ears room examined for size, patency that ear canals, malformations, skin tags or pits. Neck palpation checks because that masses and range of motion. The clavicles should likewise undergo palpation to assure continuity and to preeminence out fractures. While assessing the chest, evaluate because that symmetry and location the nipples in relationship to the clavicular midline.

Auscultation that the love identifies rhythm and the presence of murmurs if any. Lung fields are then auscultated because that identification the adventitious sounds and also air entry. While analyzing the abdomen evaluate because that asymmetry or malformations, auscultate to evaluate peristalsis and also palpate for the existence of masses or organomegaly (the liver edge is generally at 1cm listed below the costal margin). Study the umbilical stump for typical vessels and hernias. The femoral pulses are palpated for intensity and symmetry and examination the the hips using the Ortolani and Barlow maneuvers come assess for the presence of clicks arguing developmental dysplasia of the hip should follow. Every extremities are examined because that symmetry, pulses, the range of motion and any deformities. As soon as it comes to inspecting the back, centralization of the spine is assessed to identify any type of abnormal deviations and the existence of sacral dimples or hair tuff.

Skin result in the newborn room prevalent. Check of the skin looks because that color, macules, spots, birthmarks or trauma that could have developed at bear or caused by medical devices like scalp monitors, ensuring documentation of every finding. Neurologic advance is evaluate by eliciting reflexes and also assessing tone. The most typical are primitive reflexes favor the Moro, sucking, rooting, palmar and also plantar grasp. It is essential to communicate with the newborn and to observe the responses come light and also touch.

Newborn Care

Within 1 hour the birth, intramuscular vitamin K need to be administered. Prophylaxis with erythromycin ointment to both eyes and also injection of hepatitis B vaccine are recommendations, if the baby has skin-to-skin with the mother.<1>

Breastfeeding: early on skin-to-skin contact and also breastfeeding initiation are crucial to successful breastfeeding. Skin-to-skin contact improves the transition of the newborn, boosts the manufacturing of maternal milk and renders breastfeeding an ext effective. Reliable sucking and also latching need to be developed in the first 48 hours. If over there is a load loss of end 7% associated with a poor suckling reflex or feeding, supplementation with formula is an option. The volume that feedings can be raised each day during the an initial week beginning at 3 to 17 cc/kg/day on day one come 140-170cc/kg/day on work 7.<2>

Vitamin D supplementation need to initiate in ~ 2 months in breastfed just infants. Everyday requirements are 400 IU/day. Babies fed v formula and also breast milk the consume less than 32 ounces per day the formula should likewise be supplemented v vitamin D as well.<3> 

Skin Care: the is necessary to keep in mind that full-term newborn infant’s skin is covered by vernix caseosa i m sorry protects the epidermis in the uterus from water damage due come its high lipid content and hydrophobic properties. It is encourage to save it in contact with the skin because that at the very least 6 hours after birth.<4>

Bathing: till the umbilical stump falls, bathing need to be done with a sponge to keep the cord dry and also is not compelled frequently. Soaps usually contain surfactants to eliminate dirt, and also this can damages subcutaneous lipid and cause irritation.<4><5>

Diaper care: Diaper treatment is the ultimate score to reduce excessive skin moisture. Skin cleansing need to be v soft nonwoven wipes, water, and emollient cleansers; this wipes need to be complimentary of alcohol and also fragrance.<4>

Urine and also stool: Newborns pass very first meconium in ~ 24 to 48 hours after birth. Meconium is a black and also sticky substance and also is the first stool passed by the infant. The stools progressively change to a properties seedy, mustard yellow or eco-friendly stool with an increase in mother’s milk consumption. Infants have actually a gastro-colic reflex which provides them pass stools with almost every feeding. If meconium i delays more than 48 hours, the infant must undergo testimonial for pathologies choose imperforate anus or Hirschsprung disease. Urine usually is passed in the very first 24 hrs of life. The is crucial to remember the it is basic to miss out on urine as soon as it is combined with stools or is not witnessed or documented at the time of birth. If true anuria is suspected, the physical exam have to be repeated to evaluate genitals and also abdomen for any type of missed abnormalities. If there space valid concerns about voiding, catheterization and ultrasound together with a urology consultation need to take place. The parents need to receive counsel that vaginal discharge is normal at birth as result of maternal hormones and also that they can see the presence the urate crystals the look like brick dust, which have the right to be puzzled with blood.<1>.  The discharge should take place after voiding and happen stools.

Hyperbilirubinemia is typical in newborns, and most infants have some visible jaundice in the an initial week after birth. Jaundice during the first 24 hrs of life is pathologic and requires investigation. Jaundice may be because of an immature uridine diphosphate glucuronyltransferase enzyme in the liver, elevated hemoglobin level in newborns and increased destruction of RBCs. Bilirubin screening is done prior to hospital discharge one of two people transcutaneous or measure up serum levels.<1>

Umbilical cord: The umbilical cord is susceptible to bacterial colonization and can serve as a harbor of entry because that bacteria right into the systemic circulation. Dry cord care is the preferred method as every the people Health Organization. The umbilical cord must be retained exposed to the air, and if covered, it have to be loosely covered with a clean garment. If contaminated at any suggest with stool or urine, it have to be washed through soap and also sterile water and dried. The umbilical stump usually falls off normally in 10 come 14 days.

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Safety: native the moment of birth, parents must be provided education and guidance about sleep position, shaken baby syndrome, smoking roughly the baby, the effect on siblings and also pets. Babies must be put to sleep on their back in a crib with the goal of decreasing sudden infant death syndrome (SIDS), v fitted sheets, no blankets or stuffed animals, and also no co-bedding.<6>