This document provides an overview of key concepts in neonatology and care of newborn infants. It discusses physiological states in newborns including maturity assessments, bordering states, and transitional conditions. Premature and immature newborns are specifically addressed, outlining challenges they face and degrees of prematurity. The lecture covers periods of perinatal development, signs of maturity, and common transitional processes and conditions experienced by newborns as they adapt to extrauterine life.

1. Theme of the lecture:
A Newborn Child
Physiological and Transition
States in the Newborn Period.
Premature and Immature
Newborn Children.

2. PLAN OF THE LECTURE:
Neonatology as a speciality.
Notion about maturity of a newborn.
Bordering states in the newborn period.
Assessment of viability of newborn children.
- Reasons of the birth of premature children.
A scale of assessment of RDS.
Primary toilet of newborns.
Every day toilet of newborns.
Sanitary-hygienic demands to maternity
departments.

3. Neonatology – a science which studies physiological and
pathological states in newborn children
The birth of a child leads to destruction of the whole
system of mother-placenta-fetus and the changes of
the conditions of the outer surroundings, which leads
in its turn to the activation of the system of adaptation
mechanisms of a newborn. Thanks to this the
newborns adapt to the new conditions of the
environments.
From the moment of tying the umbilical cord and
disconnecting the fetus from the mother an
extrauterine life begins. In the first hours and days
rebuilding of the functions of separate organs and
systems with deep changes in exchange of
substances.

4. SOME STAGES OF CARE-
FREE ANTENATAL LIFE OF
A CHILD IS
DEMONSTRATED IN THE
FOLLOWING SLIDES

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6. 18 weeks. Almost 14 cm. The fetus now can percieve
sounds from the surrounding world. Be careful in talking.

7. I hear everything. Speak and behave yourself friendly and
humane as good people. Life is given only once !
24 weeks

8. 6 months. There 8-10 care-free weeks, but a little man is too
restricted in the womb of the mother, and he is going to leave it.
He turns down with his head- this way it is easier to go out and
get freedom…

9. 36 weeks. In 4 weeks this child will see the outer
space.

10. Wait for me ! Soon I will be a new worthy Resident
of the Earth.

11. Processes going on in the organism of a
newborn child after the birth
Pulmonary type of respiration is established,
the lesser blood circle begins functioning ,
the child starts selfdependently take food,
proper thermoregulation appears,
properties of the blood are changed,
metabolism is increased, etc.

12. The main terms of in neonatology
Neonatal period- the period of life of a child from
the moment of tying up the umbilical cord to 28
days of life (1 month).
- Gestational age or the term of gestation (GT-the
number of full weeks between the last day of
menstruation (but not conception) and the date of
delivery.

13. The Main Terms in Neonatology
Mature baby - born in GT from 37 to 41 weeks of
gestation (between 260 and 294 days of gestation).
Premature baby - a baby born on the 36 and earlier
weeks.
Overmature baby - a baby born on the 42nd
week of
gestation or later.
Delay of intrauterine development (DIUD) - the
mass of body at the time of the birth does not
correspond to gestation age.

14. Indications of Physical
Development of a Mature Baby:
• the length of the body – more than
45 cm (average 55-52 cm);
• body mass –more than 2500g
(medium 3200-3500g);
• medium head circumference -34-36
cm;
• medium circumference of chest 32-
34cm.

15. Signs of Maturity of
Newborn Babies
• Mature, in-time born baby - a baby, born between
37-41 weeks of gestation, the length of the body is
more than 45 cm (medium 50-52cdm), the body
mass more than 2500g (medium 3200-3500g), the
middle head circumference 34-36cm, middle chest
circumference 32-34 cm. Such child is crying loudly,
he actively sucks, holds warmness well, there are
marked physical reflexes, enough muscular tone,
marked moving activity, reaction of pupils on light is
preserved (under the action of light the pupils are
widened). The child reacts on bad smell and taste.

16. Periods of Perinatal
Development
Late antenatal period – from 22 to 40 weeks of
i/uterine development;
Intranatal period - from the beginning of delivery activity
up to the birth;
Perinatal period - from 22nd
week of i/uterine
development to 7 days of extra-uterine life;
Neonatal period - from the moment of tying up the
umbilical cord to 28 days (1 month) of life;
Early neonatal period – from the moment of tying up
the umbilical cord to the 7th
day of life;
Late neonatal period – from the 8 to 28th
days of life.

17. Signs of Maturity of Newborn
Babies
The skin is smooth, elastic, some how inflamed,
covered with lubricant, reach of blood vessels,
well developed sebaceous glands. The skin can
be the entrance gate to infection.
Subcutaneous fatty layer is laid down in the last
2 months of intrauterine development.
Characteristic is greyish-brown fat, which takes
the main part in the process of permanent
thermogenesis.

18. Signs of Maturity of Newborn Babies
Muscular system – characteristic is high muscular tone of
bending muscles.
The nervous system is characterized by a number of
physiological reflexes.
Sense organs are underdeveloped, but there is reaction on
light, sound, taste, smell.
Hair covering and its accessories. Hair on the head is well
marked, the nails go up to the end of the phalanxes of the
fingers, on the shoulders there is bloom of hair.
External ears are formed, the cartilages are compact and
elastic.
Sex organs –ovaries are go down in the boys, in girls – the
large sex lips close the little ones. Diameter of breast
gland is more than 10 mm.

19. The Aphar Scale
PointsPoints 00 11 22
Colour of skin paleness or
general cyanosis
cyanotic
extremities
pink color
Muscle tone decreased weak movement
of
extremities
active
Reflectory
activity
-- weak cry, cough
Respiratory rate -- bradypnea 40-60-min.
Heart beat rate -- less than 100 in
1 min
more than 100 in
1 min.

20. The Aphar Scale
The condition of the child is assessed as satisfactory,
if the child is born with a mark on Aphar scale 8-10
balls.
4-7 balls -noticeable asphyxia,
0-3 balls - grave asphyxia.
Assessment on Aphar scale is performed on the 1-th
and 5-th min. after the child is born.

21. Bordering States in the Newborn
Period
In the process of adaptation with truly physiological can
arise reactions, which stand on the border between the normal
and pathological. These are bordering states, which are
accompanied with changes in the child’s organism and
connected with adaptation to the new conditions of life.
There are the following bordering states:
Physiological (transitory) loss of body weight.
Transitory violation of heat balance. These disturbances
develop due to insufficiency of thermoregulation processes,
unadequate care of a newborn baby (increase or decrease of
the environmental temperature ):
- transitory hypothermia;
- transitory hyperthermia.

22. Bordering States in the
Newborn Period
3.Transitory changes of skin coverings.
Develop in all newborn babies.
- simple erythema;
- Physiological shell of skin coverings;
- Toxic erythema;
4. Transitory (physiological)
hyperbilirubinemia.

23. Bordering States in the
Newborn Period
5. Hormonal crisis.
- Thickening of breast glands (physiological
mastopathy);
- Metrorrhagia (bleeding from the groin);
- Desquamative vulvovaginitis;
- Miliaria.
6. Transitory peculiarities of kidney functions.
- Transitory oliguria;
- Proteinuria;
- Urate infarction.

24. Bordering States in the
Newborn Period
7. Transitory changes on the side of GIT.
- Physiological dyspepsia;
- Transitory dysbacteriosis.
8. Transitory changes in blood circulation.

25. Physiological (transitory) loss of body
mass.
Loosing of weight begins from the 2nd
day of life.
Maximal - on the 3-4th
day, in rare cases- on the 5th
day.
Loss of weight is connected with:
Insufficient coming of liquid and relative hunger of a
child;
With loss of liquid through the skin;
With discharge of meconium and primary urine;
With drying and falling out the umbilical remnant.

26. Physiological (transitory) loss of body
mass.
Loss of the primary body weight more than
by 10% is supposed to be pathological.
Renovation of primary body weight under
correct care and regime takes place at
the 1st
or 2nd
week of postnatal life.

27. Pathogenesis of transitory jaundice in
newborn babies
Increase of bilirubin formation as a result of:
shortened life span of erythrocytes;
uneffective erythropoiesis;
increase of bilirubin formation from
nonerythrocytary sources of gem (myoglobin,
cytiochrome of the liver, etc.).
Decrease of ability of hepatocytes to catch indirect
bilirubin;
low activity of glucuroniltransferase and
uridindiphosphoglucoso-dehydrogenase;
decrease of ability of bilirubin excretion from
hepatocyte.

28. Transitory Violation of Heat Balance
• These violations develop because of unperfect processes
of thermoregulation , unadequate care of newborn babies
(increase or decrease of environmental temperature).
• Hypothermia – under the birth the environmental
temperature decreases by 12-15 C.* So, the body
temperature of a child becomes 35.5-35.8*C. So, measures
must be taken to keep warmth of a child (wrapping, heating
of the table while weighing the baby, etc).
- Hyperthermia develops, as a rule, on the 3-4th
day of life in
overheating the child or insufficient entering of liquid. Body
temperature can increase up to 38.5-39.5*C. The
measures taken are: giving more to drink, physical cooling,
etc.

29. Transitory changes in skin
integument
Simple erythema (physiological catarrh of
skin) appears from the first hours of life in
the form of skin hyperemia and lasts for 3-
7 days. It develops due to widening of
capillaries as a reaction on irritation of the
skin receptors with different external
irritants.

30. Transitory changes in skin
integument
Physiological shell of skin integument -
arises on the 3-5th
day of life (more often –
in overmature babies) with especially
bright physiological erythema during its
fading (more often on the head, chest). It
does not require treatment.

31. Transitory changes in skin
integument
Tocxic erythema (TE) is present in 40-50% of
children and is manifested with arising small dense
papules of whitish color, circled by red or pink
corolla.
TE arises around joints, buttocks, on the abdomen,
on face. Mostly it appears on the 2-5 days. The
condition of the baby’s health is not violated. It is a
kind of allergic reaction on cooling, proteins taken,
endotoxins, etc.

32. Hormonal crisis
Develops as a result of action of the mother’s
estrogens, discharged in large numbers at the end
of mature pregnancy and pass with the blood to the
baby. Due to physiological immaturity of the liver
these hormones in newborn babies do not
inactivate.
Manifestations of hormonal crisis:
physiological masteopathy;
metrorrhagia (hemorrhage from the groin);
desquamative vulvovaginitis.

33. Swelling of milk glands
(physiological mastopathy)
Arises on the 3-4 day of life independently of sex of
a baby, maximum of swelling is on the 7-8th
day,
enlargement is symmetrical, the skin is unchanged,
sometimes a whitish-grey contents is discharged.
No treatment is required. Do not stamp out the
contents !!!
It is necessary to remember - in entering
bacteriological infection mastitis can develop. If
hyperemia appears in the area of swelling and
temperature increases, the surgeon’s consultation is
necessary.

34. Pathogenesis of transitory jaundice in
newborn babies
Increase of entering of indirect bilirubin from the intestine
into the blood as a result of:
a) high activity of B-gluguronidase in the wall of intestine;
b) entering the part of blood out of the liver from the intestine
into the lower vein;
c) sterility of the intestine with weak reduction of biliary
pigments.
- Normal level of bilirubin in the blood serum of newborn
babies is - 26-34mcmol/L.

35. Transitory jaundice in
newborn babies
The main difference of TJ from
pathological jaundices is:
arises on the 3-4 day of life;
lasts less than 10 days;
there is no increasing the amount of
bilirubin.

36. Transitory changes in the functions
of the kidneys
Transitory olyguria is observed in all newborns in the first 3
days of life – discharge of urine less than 15-20 ml/kg/d.
Proteinuria is a consequence of increased permeability of
glomerular epithelium, canaliculi at a background of
hemodynamical peculiarities.
Urate infarction - laying of uric acid in the form of crystals in
the lumen of collecting tubules. “Infarction” urine is of
yellow-brick-red color. The reason of an increased amount
of uric acid is decomposition of a large number of cells in the
first days of the baby’s life, mostly decomposition of
leukocytes.

37. Transitory changes of the gastro-
intestinal tract
Physiological dyspepsia – violation of the stool, observed
almost in all newborn babies in the 1st
week of life (transitory
stool). The basis - disturbances connected with increased
sensibility of secretory-motile apparatus of the intestine to
the fats, proteins, which earlier did not enter it.
Transitory dysbacteriosis - physiological phenomenon,
connected with settling in sterile intestine of a newborn
baby conditionally-pathogenic microflora. Maternal milk is a
deliverer of bifidoflora leading to force out pathogenic flora
or strict decreasing its amount.
Phase of sterility (the first 2 hours), the phase of settling (the
first 2-3 days of life) and the phase of transformation of
microflora – establishin prevailing of bifidum-flora in
condition of breast feeding.

38. Transitory changes in the
blood circulation
Are connected with:
tying up of umbilical cord;
starting the functioning of the lesser blood
circulation circuit;
closing fetal ways of communication in the
cardiovascular system.

39. A premature baby

40. A premature baby

41. Premature babies
Premature are very little babies, which compose very
extreme problems:
problems of morbidity;
problems of mortality;
problems of disability.
Premature babies are born dead in 8-13 times more
frequently than mature ones and 30 times more often
dye in the first week of life (M.S. Kramer et al., 2000).
Especially this concerns the babies with very little
body mass (less than 1500g).

42. Premature babies
Prematurity is an experiment made by the nature.
The result of the experiment depends on our
knowledge of the peculiarities of premature babies,
on our ability to compose for every such baby
proper conditions for existence. Only this can help
to solve the problems connected with prematurity.
The rate of premature deliveries is very variable,
but in the most of industrially developed countries
in recent years it stays enough stable and reaches
5-10%.

43. Premature babies
Assessment of the degree of immaturity is
performed on the basis of total indices: term of
gestation, body mass of a baby at birth and is taken
into consideration total combination of
morphological and functional signs.
Premature are supposed babies in the term of
gestation 36 and less weeks, body mass less than
2500g, body length less than 45 cm.

44. Premature baby
-- In the old textbooks there is division in degrees of
prematurity (there are 4 degrees). Now it is not
used.
- At present the babies with body weight at birth
less than 1500g and less are called premature
babies with very small body mass” (formerly – deep
premature).
- A baby with body mass less than 1000g at birth
is a baby with extreme low weight.

45. Reasons of prematurity
Social-economical conditions of life, absence or
insufficient medical service, poor nutrition, professional
harmful conditions of work, level of education.
Social-biological: the mother’s age less than 18 and
more than 30 for the 1st
delivery, the father’s age less
than 18 and more than 50, previous abortions,
spontaneous miscarriage,
Little interval between gestations.
Climatic factors.

46. Morpho-functional peculiarities of a
premature baby
The skull - the bones are soft, sutures and
small sinciput are open. External ears are
close to the head.
The skin is thin, wrinkled. Subcutaneous
fatty layer is very thin or absent, nails do
not reach the ends of the fingers.
Sex glottis in girls is open, ovaries in boys
are not put in place.
The baby is flaccid, weak, underdeveloped
or weak swallowing and sucking reflexes,
imperfect thermoregulation.

47. Morpho-functional peculiarities of a
premature baby
Respiratory organs: higher rate and less
deepness of respiratory movements,
respiratory movements are weak.
There are respiratory pauses.

48. Peculiarities of the nervous system of
premature babies
In deeply premature babies (up to 32 weeks of
gestation) is noticed absence or hindered
swallowing and sucking reflexes.
Loosing reflexes of inborn automatism (by Babkin,
Robinson, Moro, Halant).
Prevailing of subcortical activity appears a tendency
to chaotic movements and trembling.
Characteristic is slow development of orientation
reflex and producing conditioned reflexes.

49. Normative Documents of MPHU on
the Care of a Healthy Newborn Baby
Clinical Protocol of Medical Care of
Healthy Newborn Child - Order of MPH of
Ukraine, N 152, 04.04.2005.
Clinical Protocol of Medical Care of a
Healthy Child at the Age up to 3 Years –
Order of MPH of Ukraine, N 149,
20.03.2008.

50. Abstract from Order No 152 of MPH of
Ukraine
3.2 Weighing of a newborn baby.
3.7.1 The first weighing of a newborn is carried out in the maternity
room after performing the contact “skin-to-skin” and putting the baby to
the mother’s breast before removing the baby to the hospital ward for
mother and child.
3.7.2 During the weighing the principle of heat keeping chain is held
aimed at preventing the overcooling of a child.
3.7.3 A healthy newborn child does not need every day weighing.
3.7.4 Every day weighing is carried out if there is a medical indication.
3.7.5 Before discharging the baby from the maternity department
weighing is obligatory.

51. Medical care of a healthy newborn
baby in maternity room
Primary medical examination of a newborn,
Contact “skin-to-skin” is performed, it lasts not
les than 2 hours.
Tying up the umbilical cord at the end of the 1st
min after pulsation stopped.
Starting of breast feeding.
Taking the temperature in 30 min after the baby
is born.
Prophylaxis of ophthalmia Tobrex, but not later
than 1 hour.

52. Heat chain
- Warm maternity or operation room > 25*C.
- Urgent drying (take out moist wraps).
- Early contact “skin-to-skin” with the mother (not less than
2 hours).
- Early breast feeding (during an hour after the birth).
- Postponed bath, weighing and full examination of the
baby.
- Adequate dressing for the baby.
- Staying together of mother and a child.
- Heat defense of a newborn during reanimation and
transporting.
- Medical personnel must know every step of heat chain.

53. Routine medical procedures in the
maternity home
The majority of newborns do not require
Routine medical procedures.
Routine medical check ups by narrow
specialists.
Every medical examination must be:
evidential well-founded;
not harmful for the baby;
carried out with the mother’s consent

54. A V O I D ::
Routine aspiration of the contents of respiratory ways
If aspiration is yet needed, it is less harmful to use the pear
shaped ball
Routine checking of esophageal permeability.
Only in cases of:
Much water;
If before the deliver USE showed “small stomach” or
absence of the stomach;
If the baby has discharges from the mouth;
If the regurgitate milk;
If the baby has an attack of cough with episodes of apnoe
or cyanosis.

55. A V O I D::
Routine bacteriological examinations of gastric aspirate of a newborn
baby;
Bacteriological examination of feces, samples from the skin, umbilicus.
Routine laboratory tests (general blood analysis, determining of blood
group, serum bilirubin, etc.
Determining of blood group and Resus-factor, if :
a) The mother’s blood group is 0(1);
b) The mother’s Resus-factor is negative;
c) The mother’s blood group isn’t known.
If the mother has negative Resus-factor, determine bilirubin of
umbilical blood.
Routine Roentgenological and ultrasound research;
Routine medical interventions by doctors-specialists;
Every day weighing.
The baby must be weighed only after birth and before discharge from
the hospital

56. Common staying of the
mother and the baby
Common staying is when the baby and the
mother are in one hospital ward all the day
round from the moment, when the baby is born
and up to the discharge from the hospital.
Absolute contraindications for the common
staying of the baby and the mother are:
Open form of tuberculosis;
Acute psychological diseases of the mother.

57. “All day round staying together in one
ward with the mother from birth to the
moment of discharge”
Common staying includes the following:
Care of the mother her baby with introduction of family
members;
- The mother feeds the baby with breast milk;
- The interference of medical personnel is minimized;
- The baby’s temperature is taken and registered twice a
day;
- Wash and dress the baby;
- All administrations and manipulations are carried out in
the presence and agreement of the mother;
The hospital personnel must teach the mother to take care of
her baby, give her consultations in all questions.

58. Care of umbilical cord remnant
Thorough washing the hands;
No need to cover with a wrap or dressing;
No need in treatment with any antiseptic;
in the condition of common staying in a separate room.
In the absence of the contact “skin-to-skin” and the
following separation of the baby from the mother with the
aim of prevention of colonization of hospital flora to treat
it with brilliant solution;
The child’s dresses must be clean;
If dirt entered the umbilical remnant (urine or feces),
wash it with clean boiled water with soup and thoroughly
dry it with clean wrap.

59. Care of the umbilical cord remnant
(umbilical wound) after discharge from the
hospital
The baby can be discharge from the hospital with umbilical wound, if
there are no signs of infection under the condition if the medical
personnel taught the mother all hygienic measures with this wound;
The umbilical remnant always must be clean and dry;
Do not cover the umbilical wound with wrap or dressing;
Up to the full healing of the umbilical wound bathe the baby only
with boiled water;
Strictly follow the possible signs of infection.

60. Care of the skin
Delivery oiling protects a delicate skin of the
baby, violation of its integrity can promote
entering infection;
It isn’t expedient without medical indication to
use different powders and ointments to care
about the umbilical wound;
Wash the child under warm running water;
The child’s dresses must be clean;
The first taking a bath is done after leaving the
hospital.

61. Life threatening conditions for
the newborn babies:
The mother must be informed about all conditions
which are dangerous for the baby’s life and urgent
medical assistance is required:
The child poorly sucks the breast;
Convulsions;
Violation of respiration (quick or difficult);
Hypo- or hyperthermia;
Umbilical wound is red or pus appeared;
Hypotension or increased excitability;
Vomiting or diarrhea.

62. Sanitary-hygienic requirements
to maternity departments
In the maternity homes the conditions of the
surrounding environment must correspond to the
peculiarities of the newborns and sanitary-hygienic
requirements. The wards must be light and warm
with good ventilation and with the rooming area for
every healthy baby baby -2,5m and for the
premature ones not less than 4,5 m. Obligatory is
the principle of cyclic settling of the wards.

63. Sanitary-hygienic requirements
to maternity departments
Every day wet cleaning of the wards is carried out not less
than 4 times with using disinfecting solutions. Then the
wards are radiated with bactericidal lamps. General
cleaning of the wards is done after the discharge of the
baby.
There are special instructions for choosing personnel for
the children’s out-patient departments. Once a year is
carried out a full medical check up of the medical
personnel working with newborn babies.

64. The baby can be discharged from
the maternity department, if:
Umbilical cord remnant is clean, dry, without signs of
infection.
The temperature of the baby is stabile , 36.5*C - 37.5 *C.
The baby sucks the breast well.
Performed all vaccinations and screening examinations.
Clinical state of the baby is good.
The mother can take care of the baby.
The mother got consultations about prevention children’s
diseases.
The mother got consultation about the cases when there is
urgent need in calling a doctor.

65. Terms of examination by the family
doctor he newborn baby
The primary check up is done at home, not later
than on the second day after discharge from the
hospital.
In a day after the doctor’s visit - a check up by
the district nurse.
At the age of two weeks - the doctor’s check up
at home.
At the age of 3 weeks - a nurse’s check up at
home.
At the age of 1 month - check up by the doctor
at the polyclinic.

66. The number of obligatory prophylactic
medical check ups of a child at the age up
to 3 years (13 check ups and 6 check ups
by the nurse) cannot be less. The doctor
can make more visits, if there is need on
the side of the baby.
There is no need in increasing the
number of check ups without any
serious reason. This does not lead to
making better the condition of a health of
the baby (A).

67. Obligatory medical prophylactic check ups
of the children at the age up to 3 years are
carried out in terms, determined by the
Order of MPH of Ukraine (in the 1st
month -
once a week, in the 1st
year of life - once a
month, in the 2nd
year of life - once in half a
year, in the 3rd
year of life - once at the age
of 3 years) (Appendix 2 to the Protocol N
149).