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“The most dangerous time in an infant’s life is the neonatal period, the 28 days after birth. For those babies who survive, over seven decades of life may be anticipated.”

H.E. Evans

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Neonatology is a branch of pediatrics that studies the care, development, and diseases of newborn infants.

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Gestational age is measured from the first day of the mother's last normal menstruation. The average gestational age is 40 weeks (280 days). The majority of infants is born between 37 weeks (259 days) and 42 weeks (294 days) and is referred to as term infants.  Preterm infants are those born before 37 weeks while post-term infants are born on or after 42 weeks. 

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Embrional developmentbegins from the zygote formation ,

lasts up to the 8-th w eek of gestation .

Placental developmentbegins in the 8 w eeks of gestations.

Continue up to the end of pregnancy.

Intrauterine periods of developm ent

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Intranatal period begins from the first signs of

the delivery, extends until the birth of the baby.

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Perinatal period

begins from 28 weeks of gestation, extends until the 7 days after delivery, and includes:

a) late antenatal period (from 28 weeks of gestation to 40 weeks of gestation);

b) intranatal period (from the first signs of the delivery until the baby will born);

c) early neonatal period (from the birth of the baby until 7 days after birth)

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Neonatal period begins from the birth of the baby,

extends until 28 days after birth. Neonatal period divides on:

1.Early neonatal period – from the birth until 7 days after birth.

2.Late neonatal period - from 7 days until 28 days after birth.

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The functional status and grade of maturity of

the newborn are evaluated with:

Apgar score.Ability to maintain the stable

temperature.Presence of the newborns reflexes.Sufficient levels of movement

activity and emotional reactions.Newborns maturity signs according

clinical features and special tables.

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Care for newborn

immediately after birth.

Clearing the airway. Assessment by Apgar score.

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Apgar score

SIGN SCORE

0 1 2

Heart rate Absent Less than 100/min

Over 100/min

Respiratory effort

Absent Weak/irre-gular

Strong/re-gular

Muscle tone Atony Some flexion

Active movement

Reflex irritability

No response

Grimace Cough or sneeze

Color Universal cyanosis or pallor

Pink body, acrocyano-sis

Completely pink

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Care for newborn immediately after birth.

Warming. Umbilical cord care.

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After birth, the cord is clamped and cut. The recommended length of the stump after cutting is 2 or 3 cm. Solution of 0.5% chlorhexidine and 70% alcohol (brilliant green, iodine tincture) is used to clean the cord twice daily on admission and daily for the first three days. Eventually between 5-7 days the cord will become dry and will naturally fall off. During the time the cord is healing it should be kept as clean and as dry as possible. Daily care for umbilical wound include application of 3 % hydrogen peroxide or 5% KMnO4.

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Care for newborn immediately after birth.

Gonoblennorrhea prophylaxis (30 % solution of natrii sulfacyl, chloromycetin ointment)

First feeding

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The causes of neonatal transient (temporary,

physiological) states:

the environment becomes totally different

change of barometric pressure unstable temperature of

surroundings other tactile irritants microbic environment

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Transient weight loss of up to 10 % of birth weight

may occur during the first 3 to 5 days of life. Birth weight is usually regained by the seventh day.

Transient erythema usually appears in all

newborns during first 3-7 days of life because of capillary reaction for skin receptors stimulation with different external irritants. After erythema there is slight desquamation on the skin.

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Erythema toxicum neonatorumcan appear on the 2-5 day of life like

allergic reaction.  It looks like red blotchy rash, associated with whitish papules (which may look like pustules but without puss, contain eosinophiles) on the trunk, extremities, and the face. It disappears during 2-3 days usually. No treatment is indicated.

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Transient changes of heat

balance:

transient hypothermia

transient hyperthermia

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Neonatal transient nonhemolytic hyperbilirubinemia (physiological jaundice).

It occurs in approximately 50% of newborns on the 2-3-rd day of life and disappears up to the end of the second week. Total serum bilirubin concentration doesn’t exceed 205 mkmol/L (12 mg/dL).

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Sexual (hormonal) crisis In newborn on the 3-4-th day of life can

appear symmetrical breast engorgement, nipple discharge (white transparent fluid). Desquamative vulvovaginitis (mucous vaginal discharge during first 3 days of life) also can have place. In 5-10% of girls on the 5-8-th day of life can be present pseudomenstruation, lasts for 1 day

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Transient peculiarities of the renal function

In all newborns during first 3 days there is early neonatal oliguria, transient albuminuria. During the first week of life can be uric acid infarct which clinical features are rick-red or dark orange spots on the swaddling bands or newborns clothes, diapers after urination.

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The transient stool of the newborn is meconium- a sticky greenish substance that is excreted during the first few days after birth

Transient dysbacteriosis frequent watery greenish stool. The

causes of this disorder are bacterial contamination of sterile intestine and new milk food.

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Contraindications to “early” discharge (< 30

hours): 1. Birth asphyxia2. Diagnostic work-up in progress3. Presence of significant congenital

anomalies (i.e.cleft lip/palate, heart disease, chromosomal abnormalities, hydrocephalus, meningomyelocele...)

4.  Medical/surgical problems requiring further care (i.e. congenital infections, apnea episodes, drug withdrawal, poor feeding, anemia, paralysis, blindness, abnormal neurological function)

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5. Multiple birth6. Parental history of significant

medical/psycho-social problem (i.e. substance abuse, uncontrolled epilepsy, mental retardation, psychiatric problem)

7. Maternal age 16 or younger8. Maternal death9. High risk for child abuse (i.e. previous

child abuse family, poor social conditions, unwanted pregnancy, poor parental problems)

10. Severe family economic problems (i.e. inadequate housing)

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