1. SEMINAR ON
GROWTH AND DEVELOPMENT OF NEONATE

2. INTRODUCTION

21. Principles of Growth and
Development
 Growth is an orderly process, occurring in systematic
fashion.
 Rates and patterns of growth are specific to certain
parts of the body.
 Wide individual differences exist in growth rates.
 Growth and development are influences by are
influences by a multiple factors
 Development proceeds from the simple to the complex
and from the general to the specific.
 Development occurs in a cephalocaudal and a
proximodistal progression.
 There are critical periods for growth and development.
 Rates in development vary.
 Development continues throughout the individual's life
span.

22. Growth Pattern

23. Stages of Growth and
Development

24. Terminologies

25. Adjustment to extra uterine life
of all systems
 Immediate adjustments

26. 1, Respiratory System
 Chemical stimuli
 Thermal stimuli

27. Circulatory system

28. Structure Before Birth After Birth
Umbilical
Vein
Brings arterial blood to
the heart
Obliterated; becomes
round
ligament of the liver
Umbilical
Arteries
Bring arteriovenous
blood to placenta
Obliterated; becomes
vesical ligaments
on anterior abdominal wall
Ductus
venousus
Shunts arterial blood
into inferior vena cava
Obliterated; becomes
ligamentum venosum
Ductus
Arteriosus
Shunts arterial and
some venous blood
from the pulmonary
artery to aorta
Obliterated; becomes
ligamentum arteriosum

29. Foramen
Ovale
Connects right and left
auricles
Obliterated usually;
at all times
Lungs Contain no air and very little
blood; filled with fluid
Filled with air and
well supplied with
blood
Pulmonary
arteries
Bring little blood to lungs Bring much blood to
lungs
Aorta Receive blood from both
ventricles
Receive blood only
from
left ventricle
Inferior vena
cava
Brings venous blood from
body and arterial blood from
placenta
Brings blood only to
right auricle

30. Physiologic status of other
systems
1, Thermoregulation
2, Hemopoetic Systems
3, Fluid And Electrolytes
4,Gastrointestinal System
5, Genito-Urinary System
6, Integumentary System

31. Birthmarks
Hemangiomas
- Are vascular tumors of the skin.
Three types of hemangiomas occur:
1. Nevus Flammeus
- Is a macular purple or dark-red lesion that is present at
birth
- Sometimes called a port-wine stain
- These lesion typically appear on the face, although they
often found on the face; it is less likely to fade.
- Can be covered by a cosmetic preparation later in life
or removed by laser therapy, although lesions may
reappear after treatment.

33. 2. Strawberry
Hemangioma
- Are elevated areas
formed by immature
capillaries and endothelial
cells.
- Most are present at birth
in term neonates,
although may appear up
to 2 weeks after birth.
- Application of
hydrocortisone ointment
may speed the
disappearance of the
lesions by interfering with
the binding of estrogen to
its receptor site.

34. 3. Cavernous Hemangioma
- Are dilated vascular spaces, they are usually raised and
resemble a strawberry hemangioma in appearance.
However they do not disappear with time as the
strawberry hemangioma.
- Suncutaneous infusions of interferon-alfa-2a can be
used to reduce these lesions in size, or they can be
removed surgically.
- Usually their hematocrit levels assed at health
maintenance to evaluate for possible internal blood loss

36. Mongolian Spot
- Are collections of
pigment cells that
appears as slate-
gray patches across
the sacrum or
buttocks and
possibly on the
arms and legs.
- They disappear by
school age without
treatment.

37. Vernix Caseosa
- Is a white, cream cheese-
like substance that serves
as a skin lubricant.
- It is noticeable in on a
term newborn’s skin, at
least in the skin folds, at
birth.

38. Lanugo
- Is the fine hair, downy hair
that covers a newborn’s
shoulder, back and upper
arm. It maybe found also on
the forehead and ears.
- A baby born after 37 to 39
weeks of gestation has
more lanugo than a
newborn of 40 weeks.
- Is rubbed away by the
friction of bedding and
clothes against the
newborn’s skin.
- By 2 weeks of age it
disappear

39. Desquamation
- Within 24 hours after
birth, the skin of most
newborns has become
extremely dry. The
dryness is particularly
evident on the palms of
the hands and soles of
the feet.
- This results in areas of
peeling similar to those
caused by sunburn.

40. Milia
- all newborn sebaceous
glanda are immature.
- At least one pinpoint white
papule can be found on
the cheek or across the
bridge of the nose of
every newborn.
- Disappear by 2 to 4
weeks of age, as
sebaceous glands mature
and drain.

41. Erythema Toxicum
- In most normal mature infants, a
newborn rash
- This usually appears in the first to
fourth day of life, but may appear up
to 2 weeks of age.
- It begins with papule, increases in
severity to become erythema by the
second day, and then disappears by
the third day
- Sometimes called flea-bite rash
- Caused by a newborn’s eosinophils
reacting to the environment as the
immune system matures.

42. Epstein’s Pearls
- One or two small round, glistening, well circumscribed
cysts are present on the palate, as a result of the extra
load of calcium that was deposited in utero.

43.  7, Musculoskeletal System
 8, Immune Systems
 9, endocrine system
 10, Neurologic System
 11, Sensory Functions

44. Psychosexual development of
newborn

45. Cognitive development
 Personality type1: easy (about
40%of children)
 Personality type2: difficult child
(about 10% of children)
 Personality type3: slow to warm up
child (about 15% of children)

46. NURSING CARE OF THE
NORMAL NEWBORN INFANT
 GENERAL

48. CARE OF THE NEWBORN IN
THE DELIVERY ROOM

49. a. Establishing and
Maintaining the Newborn's
Airway

50. (1) Common characteristics of
newborn respirations

51. (2) Signs and symptoms of
newborn respiratory distress.

52. b. Maintaining Body
Temperature

53. c. Identify the Infant After
Delivery.

54. d. Establish Parent-Infant
Bonding Process

55. VIRGINIA APGAR SCORING
OF THE NEWBORN

56. Ballard Scoring

58. PROCEDURE FOR ADMISSION
TO THE NURSERY

62. Newborn Reflex
 Blink Reflex
- In a newborn serves the
same purpose as it does
in an adult-to protect the
eye from any object
coming near it by shining
a strong light such as a
flashlight or otoscope
light on an eye. A sudden
movement to ward the
eye sometimes can elicit
the blink reflex.

63.  Rooting reflex
- If the check is brushed or
stroke near the corner of the
mouth, a newborn infant will
turn the head in that direction.
This reflex serves to help a
newborn find food: when a
mother holds the child and
allows her breast to brush the
newborn’s cheek, the reflex
makes the baby turn toward
the breast.
- This reflex disappear at about
the sixth week of life. It about
time, newborn eyes focus

64.  Sucking reflex
- When a newborn lips are
touched, the baby makes a
sucking motion. This reflex
helps a newborn find food:
when the newborn lips touch
the mothers breast or
bottle, the baby sucks and
takes food.
- The sucking reflex begins to
diminish at about 6 months of
age.

65. • Swallowing reflex
- In a newborn is the
same as in adult.
Food that reaches the
posterior portion of
the tongue id
automatically
swallowed. Gag,
cough, and sneeze
reflexes are present
to maintain airway in
the event that normal
swallowing does not
keep the pharynx free
from obstructing
mucous.

66. Extrusion Reflex
- A newborn extrudes
any substance that is
placed on the anterior
portion of the tongue.
This protective reflex
prevents the
swallowing reflex of
inedible substance.
- It disappears at about
4 months of age

67. Palmar Grasp Reflex
- Newborn grasp an
object placed in their
palm by closing fingers
on it.
- Mature newborn grasp
so strongly that they
can be raised from a
supine position and
suspended
momentarily from an
examiner’s fingers.
- Reflex disappears at
about 6 weeks to 3
months of age.

68. Step-in-place reflex
- Newborn who are
held in a vertical
position with their feet
touching a hard
surface will take a few
quick, alternating
steps.
- This reflex disappears
by 3 months of age.
Placing reflex
- Is similar to the step-in-place
reflex, except that it is elicited
by touching the anterior
surface of the newborn’s leg
against a hard surface

69. Plantar Grasp Reflex
- When an object
touches the sole of a
newborn’s foot at the
base of the toes, the
toes grasp in the
same manner as the
finger do.
- Reflex disappears at
about 8 to 9 months.

70. Tonic neck reflex
- When newborn lie on
their backs, their head
usually turn to one side
or the other. The arm
and the legs on the side
toward which the head
turns extend, and the
opposite arm and leg
contract.
- This is also called the
boxer or fencing reflex
- The reflex disappears
between the second
and third months of life.

71. Moro Reflex
- Can be initiated by
startling a newborn with
a loud noise or by
jarring the bassinet.
The most accurate
method to eliciting the
reflex is to hold a
newborns in a supine
position and allow their
heads to drop
backward about 1 inch.
In response to this
sudden head
movement, they abduct
and extend their arms

72. Babinski Reflex
- When the side of the
sole of the foot is
stroked in an inverted
“J” curve from the
heel upward, a
newborn fans the
toes
- It remains positive
until at least 3 months
of age.

73. Magnet Reflex
- If pressure is applied
to the soles of the
feet of a newborn
lying in a supine
position, he or she
pushes back against
the pressure.
Crossed Extension
Reflex
- If one leg of a
newborn lying supine
is extended and the
sole of that foot is
irritated by being
rubbed with a sharp
object, the infant
raises the other leg
and extends it, as if
trying to push away
the hand irritating the
first leg

74. Trunk Incurvation
Reflex
- When newborns lie in
a prone position and
are touched along the
paravertebral area by
a probing finger, their
trunk and swing their
pelvis toward the
touch.
Landau Reflex
- A newborn who is held
in a prone with a
hand underneath,
supporting the trunk,
should demonstrate
some muscle tone.
Babies may not be
able to lift their head
or arch their back in
this position

75. Deep Tendon Reflex
- A patellar reflex can
be elicited in a
newborn by tapping
the patellar tendon
with the top of the
finger.
- The lower leg moves
perceptibly if the
infant has an intact
reflex.
- Is a test for spinal
nerve L2 through L4

77. ADMINISTRATION OF VITAMIN
K
The vastus lateralis
muscle lies lateral to the
midline of the thigh and
wraps about 1/4 the
distance around the
thigh...from 12 o'clock to
3 o'clock

78. EYE PROPHYLAXIS FOR THE
NEWBORN

79. INITIAL BATH

80. CORD CARE FOR THE
NEWBORN INFANT

81. BONDING PROCESS

82. INFANT BAPTISM

83. COMPLETE INSPECTION OF
THE NEWBORN

84. GOALS OF NEWBORN
NURSING CARE
 a. To continue appraisal of the newborn
throughout his hospital stay.
 (1) Observe and record the infant's vital signs.
 (2) Monitor weight loss or gain (daily by some
local policy).
 (3) Monitor bowel and bladder function.
 (4) Monitor activity and sleep patterns.
 (5) Monitor interactions and bonding with
parents.
 b. To provide safeguards against infection (that
is, handwashing).
 c. To initiate feedings.
 d. To provide guidance and health instruction to
parents

85. DISCHARGE
CONSIDERATION FOR THE
NEWBORN AND FAMILY

86. Nursing Diagnosis
 Risk for ineffective thermoregulation
related to newborn’s transition to
extrauterine environment
 Risk for ineffective airway clearance
related to presence of mucus in mouth
and nose at birth
 Risk for infection related to newly
clamped umbilical cord and exposure
of eyes to vaginal secretions

87. Newborn Screening

88. Summary of
Recommendations
 • Universal newborn screening should be introduced in
phases in our country.
 • Screening should be done after 2 days and before 7
days of age . Infants screened before 24 hours of life
should be re-screened by 2 weeks of age to detect
possible missed cases. Sick and premature babies
should also have metabolic screening performed by 7
days of life.
 • The disorders to be screened our country have been
classified into three groups, depending on availability
of resources.
 • A positive screening test should always
be followed with parental counseling,
confirmatory test, genetic counseling and early dietary
or other interventions.
 • There is a need for comprehensive planning for NBS
at state and national levels

89. What disorders does the Newborn
Screening test for?
• Congenital Hypothyroidism - A lack or absence of
thyroid hormone, which is necessary for growth of
the brain and the body. Treatment is required within
the first four weeks to prevent stunted physical
growth and mental retardation.
• Congenital Adrenal Hyperplasia - An endocrine
disorder that causes severe salt loss, dehydration,
and abnormally high levels of male sex hormones.
Left undetected and untreated, a baby may die
within seven to 14 days.

90. • Galactosemia - A condition in which babies are
unable to process galactose. or the sugar present
in milk. Increased galactose levels in the body lead
to liver and brain damage, and to the development
of cataracts.
• Phenylketonuria - The inability to properly utilize
the enzyme phenylalanine, which may lead to brain
damage.
• Glucose-6-Phosphate Dehydrogenase (G6PD)
Deficiency - A condition where the body lacks
the enzyme called G6PD, which may cause
hemolytic anemia resulting from exposure to
oxidative substances present in certain drugs,
foods and chemicals. Parents of G6PD-positive
babies are given a list of these substances.

91. How is Newborn Screening
administered?
• Your baby will be pricked at the heel
and three drops of blood are taken.
This process is ideally done during
the 48th to 72nd hour of life.
A negative screen means that results
are normal. A positive screen will
require the newborn to be brought
back to her pediatrician for further
testing.

92. Puncture site (X) on sole of
infant's foot for heelstick sample.

93. Newborn assessment

94. Recent Research Study
 Neonatal Blue Light Phototherapy and
Melanocytic Nevi:
 OBJECTIVE: Our goal was to
conduct a twin study with the aim of
better understanding the role of NBLP
in melanocytic nevus development.
We also investigated the roles of other
environmental and constitutional
factors in nevus formation.

95.  CONCLUSIONS: Our data suggest
that NBLP could well be a risk factor
for melanocytic nevus development.
Phototherapy with blue-light lamps is a
standard and essential therapeutic
modality in neonatal care; therefore,
additional in vivo and in vitro studies
are necessary to establish its potential
long-term adverse effects.

96. CONCLUSION