MINISTRY OF HEALTH OF UKRAINE

Ukrainian Medical Stomatological Academy

”Approved”
at the meeting of the Department of Pediatrics №1
with Propaedeutics and Neonatology
“ ___” ___________ 20__ year
Protocol No._____ from________
Chief of the department, assoc. prof.
______________ S.M. Tsvirenko

Methodical instructions for independent work of

students during preparation to practical (seminar) сlasses
and on the classes

Education discipline Propaedeutics of Pediatrics

Module № 1 Development and feeding of children.
Topic of the class Features of the neonatal period. Physiological
and transition states in the neonatal period. To
сoncept of maturity of the newborn. Care of the
newborn.
Year of education ІІІ
Faculty Foreign students training faculty

Poltava – 2019
I. Actuality of the theme: One of characteristic features of children's organism is
continuous growth, development, imperfection of structure and functions of organs
and systems. Neonates have their specific features. Knowledge of these features
helps to diagnose and to treat various pathology of new-born child, to conduct the
concrete measures of prophylaxis and rehabilitation.
II. The training aims of the classes: to collect anamnesis of disease and life,
to estimate the features of current of periods of children's age, to estimate the general
condition of child, to make a conclusion about condition of neonate, to interpret the
revealing changes in a child on the basis of knowledge of anatomic and physiologic
features.
1. Student has to know:
1. Definition of the terms “new-born child”, “mature new-born”, “premature
new-born”.
2. Concept about maturity and immaturity of newborn child.
3. Concept about prematurity, basic anatomic, morphological and functional
signs of prematurity.
4. Classification of prematurity.
5. Physiological and transitional states in neonatal period:
a) transitory loss of mass of body
b) transitory infringements of thermal balance
c) physiologic hyperbilirubinemia of new-born
d) hormonal crisis
e) physiology changes of skin
f) transitory changes of urinary system
g) transitory changes of the system of blood
h) transitory dyspepsia.
1. Student has to be able:
 To use the knowledge about factors influence growth and development
of newborn.
  To master to measure body weight, body length, head circumference,
chest circumference of newborn .
III. Interdisciplinary integration processes:
Disciplines To know To be able
 The main principles  Students should be able
to use the main
of Medical etiquettes and
principles of Medical
deontology
etiquettes and
1. Previous disciplines  The main rules of
deontology
- Medical ethics and communication between
deontology the doctor and patient,  Students should be able
to use the knowledge
- Human Anatomy doctor and parents
about the peculiarity of
- Medical Biology  Anatomical structure
anatomical structure of
- Physiology of body
body in different age.
- - Medical Histology  Peculiarity of
and Embriology  Students should be able
children metabolism in
to use the knowledge
different age periods
about the genetic
 Genetics factors
apparatus of cells
which impacts to complexes hereditary
physical development of properties
children
 Students should be
able to interrogate of
the children of
different age and their
 The main rules of parents
communication  Students should be able
between the doctor to use the knowledge
and patient, doctor about intrauterine
and parents development of child
2. Following disciplines
 The intrauterine  Students should be
- Pediatrics;
development of child able to measure body
- Nutriciology
 Peculiarity of of the healthy and sick
nutrition, diet balance children in different
and feeding of age periods
different age children  Students should be
able to estimate results
of measurements for
proper diagnostics of
the physical
development
variability .
  Students should be
 Principe of
able to use the of
pediatrics etiquettes and
3. Inside discipline etiquettes and
deontology.
- topics: deontology in pediatric
 Peculiarity of
 Pediatrics etiquettes and practic
district pediatric doctor’s
deontology.  Students should be
work. Medical
 Structure of children's able to use the
documents of district
medical and preventive knowledge about
pediatric doctor (History
establishments, features of the medical documents of
of Children
organization of their work. district pediatric doctor
Development).
 The organization of the  Students should be
 The organization of
balanced diet for the healthy able to use the
the balanced diet and
infants and toddlers knowledge about
feeding of the healthy
balanced diet and
children
feeding of the healthy
children

IV. The argument of the topic:

The newborn child is a child from the moment of a cutting of an
umbilical cord till 28 days of life. Early neonatal period is the first 7 days of life; late
neonatal period is from 8th to 28th days
Depending of term of pregnancy the child may be born
in term (full-term pregnancy),
preterm (partial pregnancy),
post term (prolonged pregnancy).
The mature newborn child is born at 37-42 weeks, premature – between 22 and
37 weeks, postmature – after 42 weeks. Usually mass of body of full-term neonate is
2500 and more g; length is 45 and more cm
Viable newborn has duration of pregnancy 22 and more weeks, mass not less
than 500 g according to WHO criteria.
Dead Birth is viable child who don’t has any attribute of life
Abortion is a birth of fetus before 22 weeks, with mass less then 500 g. If such
newborn will go through 168 hours (7 day), he may be concern to birth alive but
extremely immature.
 Born in time newborn usually is mature, but not always. Premature neonate
may be born in time. Mature child may be born from partial pregnancy.
Generally, maturity is ability of neonate for extrauterine existence.
You should know external and functional attributes of maturity
External attributes of maturity
Skin is pink.
Lanugo (the first-born down) is kept only on the upper part of back and on the
shoulders.
Length of head hair is 2-3 cm.
Nasal and ear cartilages and nails are dense.
Nails reach up to end of fingers.
Umbilical cord is in the middle of the body.
Testicles are lowered in a scrotum; in girls major lips are cover the minor one.
Functional attributes of maturity
Ability to keeping constant body temperature.
Rather right rhythm of respiration and cardiac tones without cases of apnea
and cyanosis.
Active suction, absence of the expressed regurgitation.
Sufficient mobility (uncoordinated movements).
Physiological hypertensions of bend muscles (an embryo pose).
Loud emotional cry, presence of reaction to bright light, sounds,
manipulations.
Presents (expressiveness) of instinctive reflexes.
Permanent reflexes are swallowing, papillary, conjunctival, tendon and corneal
reflexes.
Transitory reflexes of oral automatism are: sucking, trunk (lip), search,
Babkin’s palmary- and-mouth.
The basic spinal reflexes are: grasping, a Robinson’s tonic reflex of hands,
Moro’s reflex, reflex of support, crawling Bauer’s reflex, reflex of stepping
automatism, Kerning’s, Babinski’s, Perez’s, Gallant’s.
 After a birth process of adaptation to new conditions of existence begins. The
most acute changes occur within the first 2-6 hours, restoration of morphological and
functional infringements usually occurs by the end of 7th day (early neonatal the
period comes to end).
Main Features of newborn’s systems
Respiratory system. Right after birth transition to pulmonary respiration is
carried out. Because of delicacy of respiratory muscles respiration is superficial,
arrhythmic, it’s character his weakened vesicular. It is observed tachypnea 40-60 in
minute, type of respiration is diaphragmatic. The ribs are located almost horizontally.
A chest is wide, short.
Cardiovascular system. The pulmonary circulation begins; umbilical vessels,
venous and arterial ducts, and the oval window have closed. The sizes of newborn’s
heart are relatively bigger, than in adult. Frequency of cardiac tones is 140-160 per
one minute; arterial pressure is lower, 60-76 mm of hg.
Alimentary system. In the first day there is a Meconium – a first-born feces
like the dark green mass, consisting of an epithelium, cholic pigments, slime and
swallowing amniotic fluid. The digestive tract right after burning is sterile, then
colonization by bacteria begins. The liver is relatively bigger; it is palpated 2-3 cm
lower the right hypochondria
Urinary system. It is observed physiological oliguria or anuria in the first day.
The quantity of urine is 5-50 ml a day, relative density of urine is 1008-1013, later,
approximately about 5 days quantity of urine is enlarged, and the relative density is
reduced up to 1002-1004.
Since the period of newborn is the period of adaptation to new condition of
existence, only for this period series of the conditions between norm and pathology
are characteristic. These are physiological (transitional) and borderline conditions.
Physiological conditions take place in most neonates. It is the norm.
Borderline cases meet not at all newborns and they are much closer to
pathology. They do not demand treatment, but orient the doctor on carrying out some
preventive actions.
 The borderline conditions are transitional hyperthermia, toxic erythema, urate
infarct of kidneys and the loss of initial mass of a body more than 6 %.
Transitional conditions of newborns
Transitional loss of initial mass of body.
It is usually observed for 3-4, less often for 5 day of life. Loss of initial mass is
caused by separating of Meconium, taking out of a vernix caseosa, dehydratation by
respiration and perspiration, deficiency of milk in the first days of life.
The 1st degree is loss of mass less than 6 %. Clinical attributes of a
dehydratation are absent.
The 2nd degree is loss 6-10 % of initial mass. Paleness of a skin, brightness
mucous, increasing of skin turgor, irritability, a tachycardia, a dyspnea are observed.
The 3rd degree is loss more than 10 % of mass. Thirst, dryness of mucous, a
retraction of a fontanels, quiet heart sounds, tremor, hyporeflexia are observed.
Restoration of mass occurs more often for 7-10th day, but for 14th day in all
children. Preventive actions consist in early applying to a breast, a rational water
regimen.
Transitional infringements of thermal balance.
The transitional hypothermia is caused by decrease of an external temperature
after a birth on 12-15 degrees. Thus the body temperature in one hour is reduced up
to 35,5-35,8 degrees, paradoxical reaction of vessels of a skin (spasm) on decrease of
temperature is observed. The temperature is restored to the middle of 1 day after a
birth. Prophylaxis consists in placing the child under a source of radiant heat right
after birth, and also on a mother’s abdomen.
The transitional hyperthermia arises usually on 3-5 day. The body temperature
rises up to 38-39 degrees. The reasons are a dehydratation, a catabolic orientation of
metabolism, occurrence of endotoxins of an intestinal bacteria and overheating. The
child is restless, thirsty, the xeroderma and mucous drying are observed.
Transitional changes of skin
Simple erythema – a reactive inflammation of a skin after erosion of a vernix
caseosa. The brightest hyperemia is observed for the second day after a birth. By 3-5
day - to the end of 1 week the simple erythema disappears, being replaced by a
macrolaminar peeling of the skin more often on abdomen, and a chest. Disappears
without treatment.
The toxic erythema is observed at 20-30 % of newborns, reaction is regarded
as allergic. For 2-5 day of life there is a papular or vesicular eruption on the
hyperemic basis, settles down on unbending surfaces, around of joints, on buttocks,
on a chest. In 2-3 days the eruption completely disappears.
Transitional hyperbilirubinemia. Develops at all newborns, but the jaundice of
newborns appears only at 60-70 %. The reason of this condition is the increased
formation of bilirubin from an erythrocytolysis. During the intrauterine period the
fetus has a hypoxia since any organ of a fetus do not receive a pure arterial blood.
That is why the quantity of erythrocytes increases. After a birth with transition to
pulmonary respiration some erythrocytes is exposed to disintegration. Fetal
hemoglobin has the bigger affinity to Oxygenium, but the erythrocytes with fetal
hemoglobin have shorter period of life. The second reason of a hyperbilirubinemia is
the reduced functional ability of a liver in newborn. The increased entering of a
bilirubin from an intestine in a blood is observed also. The jaundice of a skin and
sclera is observed for 2-3 day of life and proceeds up to 8-12 days. More long
jaundice causes doubts in its physiological character
Hormonal crisis. This condition is observed in 2/3 newborns, more often in
girls. It is connected with entering of mother’s sexual Hormones through a placenta
and during breast-feeding.
The induration of mammary glands (a physiological mastopathy) is observed
both in girls, and in boys, occurs for 3-4 day, it much expressed by the end of 1 week.
Treatments it is not required. The squeezing out of colostrum is forbidden
Desquamattive vulvovaginitis. Plentiful mucous discharge of gray-and-white
color in 60-70% of girls within the first 3 days of life is observed. The bleeding from
a vagina – metrorrhagia arises for 5-8 day approximately in 10 % of girls, duration no
more than 2-3 days.
 White comedons – milia. White-and-yellow nodules in the field of a forehead
and a nose arise in 60 % of children. These are the corked channels of sebaceous
glands. Disappear without treatment in 1-2 weeks.
It may be other displays of a sexual crisis, such as a hyperpegmentation of
nipples area and scrotums, an edema of external genitals, which also pass without
treatment
Transitional features of function of kidneys.
The transitional oliguria is observed in all healthy newborns in the first days of
life
Transitory proteinuria also are observed practically in all newborns, it is
caused by a hyper penetration of glomerulus’s epithelium and kidneys canaliculus
Urate infarct of kidneys – deposition of a uric acid as crystals in ducts of
connective tubules. The ending product of an aluminous metabolism in newborns is
the urinary acid, while in adults is the urea. The transitional oliguria causes formation
of a urate infarct. After physiological increasing of a diuresis the urinary acid is
washed away from connective tubules, and appears red-and-brown stain on napkins.
Hyaline and granular cylinders, an epithelium, leucocytes are presents in the urine.
The reason of a urate infarct of kidneys is the catabolic orientation of metabolism in
the first days of life, disintegration of cells. All displays pass independently by the
end of the first week
The transitional dysbacteriosis and physiological dyspepsia arises in all
newborns as a result of settling a sterile newborn’s intestine by normal microflora.
The first-born feces (Meconium) is replaced in 3-4 day to transitive feces. Frequency
of defecations is increased, the feces becomes watery, not homogeneous, during a
microscopy a plenty of leucocytes, fat acids and slime is defined.
Premature child. Premature count the child who has been born between 22 and
38 weeks of pregnancy with mass of a body less then 2500 g and length less then 45
cm. 5-10 % of all newborns are premature.
The reasons of premature infectious diseases during pregnancy: a rubella, a
cytomegaly, a HIV – infection, other infections transmitted in the sexual way the
burdened current of pregnancy: toxicoses, a wrong position of a fetus, a multiple
pregnancy endocrine and somatopathies of mother chronic inflammatory diseases of
mother’s pelvic organs anomalies of a structure of genitals, traumas and cicatrices on
a uterus immune incompatibility of mother and fetus, for example, on a Rh factor
social and economic, and also physical (radiation), chemical (medicinal substances,
narcotics, alcohol), the nutritional reasons stressful situations
Classification of a prematurity
А. Depending the term of gestation
1 degree 37-35 weeks
2 degree 34-32 weeks
3 degree 31-29 weeks
4 degree less than 29 weeks
В. Depending the mass of a body
1 degree 2500-2000 g
2 degree 1999-1500 g
3 degree 1499-1000 g
4 degree less than 1000 g
Therefore, the WHO Expert Committee recommended applying the definition
of “low birth weight” for term infants, weighing less than 2500 g.
Infants with low birth weight are regarded as newborns with intrauterine
growth retardation (IUGR) due to certain pathogenic factors.
During the neonatal period, the condition of organs and systems, as well as
their physiological functions in infants are decreased and have a number of features
related to their gradual development.
Morphological (external) attributes of a immaturity disproportional body build,
a head rather big, a cerebral skull sharply prevails above facial, extremities and a
neck are short, the umbilical ring is displaced to a pubic area skull is spherical, its
bones are soft, pliable, seams and a small fontanel are open auricles are soft and close
adjoin to a head skin is thin lanugo is not only on a back and brachium, but also on a
forehead, cheeks and hips the subcutaneous fatty layer is thin, it is kept only in the
field of cheeks (Beesh’s fatty lumps) nail plates are soft, nails do not reach up to end
of fingers labia major in girls do not cover labia minor, in boys testicles are not
lowered in a scrotum.
Functional attributes of a immaturity flaccidity, sleepiness, weak cry,
hypomyotonia, lower sucking, swallowing reflexes, infringement of
thermoregulation superficial, spasmodic respiration, pathological types of respiration,
attacks of apnea are defined tachycardia at anxiety up to 200 in one minute,
embriocardia (equal intervals between 1 and 2 tone), low arterial pressure pathologic
vascular tone: a underlying part of a trunk is pink, and top part is white –
Finkelstein’s sign.
Features of adaptation of premature transitional loss of mass of a body is more
expressive, 9-14 %,it is restored later, in 2-3 week hyperbilirubinemia is more
expressive, lasts till 3 weeks the physiological erythema is brighter and longer, but
peeling is absent the toxic erythema, transitional hyperthermia, hormonal crisis and
urate infarct of kidneys in premature meet seldom and have the erased clinic.
Table 1
Specific features of neonatal period (full-term infants)
# Morphological, functional and biochemical changes
1. Newborn’s body retains its intrauterine position (limbs are sharply bent and
pressed against the trunk). The length of the head is 1/4-1/5 of the infant’s
body length.
2. The nervous system is characterized by:
- predominance of inhibitory processes over the excitation processes in
the cerebral cortex (which is manifested by the fact that newborns sleep for
20-22 hours);
- incomplete structure of pyramidal tracts and striatal body, resulting
in increased tone of flexor muscles of the limbs and their uncoordinated,
continuous motion (presence of athetoid movements);
- incomplete myelination of nerve fibers;
- broad generalization of neural processes when exposed to
unconditioned stimuli;
- absence of conditioned reflexes.
3. Skin in full-term infants is thin, soft, pudgy, and therefore vulnerable.
4. Subcutaneous fat layer – there may be sclerema or scleredema.
5. Poorly developed muscular system.
6. Skeletal system:
- spine does not have physiological curves;
- ribs are attached to the spine at right angles;
- barrel-like shape of the chest;
- cranial bones in infants are balloting due to incomplete fusion of
sagittal, coronal and lambdoid sutures.
7. Respiratory organs – in newborns there is an immediate transition to
pulmonary respiration after birth, but:
- breathing is shallow, very labile, irregular in frequency, depth, shape
and rhythm; it resembles pathological types by its nature (Cheyne-Stokes or
Biot’s respiration);
- marked tachypnea (at an average of 40-60 respiratory movements per
1 min.); sometimes apnea (cessation of breathing) lasting for 3-4 seconds;
- diaphragmatic type of breathing regardless of sex.
The respiratory system in infants is also characterized by:
- narrow nasal passages;
- poor development of intercostal muscles;
- flexibility of bones of the chest;
- horizontal position of ribs;
- underdeveloped alveoli;
- immaturity of the surfactant system and respiratory center.
8. Cardiovascular system in newborns significantly changes in functional terms
as compared to intrauterine period:
- the placental circulation ceases;
- the functioning of pulmonary circulation starts;
- there is a desolation of fetal circulatory pathways – venous (Arantius’)
duct, arterial (Botallo’s) duct, foramen ovale, umbilical vessels;
- there is a switch of the left and right parts of the heart from operating in
parallel to the consistent operation;
- physiological tachycardia (heart rate within 140-160 beats per
minute);
- low blood pressure (about 60-76 mm Hg);
- oxygen demand, cardiac output and systemic vascular resistance
increase.
The closure of the foramen ovale begins during the second week after
birth. Anatomically, the foramen ovale closes at the end of the 5th-6th
months of life. In 50% of healthy infants, the right-left shunting
occasionally operates through the foramen ovale from 8 days to 1 year of
 life. In the remaining 50% of children, the functioning of the foramen ovale
lasts up to the age of 5 years, in 25% of them – it persists into adulthood and
can be interpreted as a congenital heart defect.
Arantius’ duct is emptied from the first moments of life, and its total
obliteration is completed at the end of the 8th week of life.
Spasm of Botallo’s duct begins with the first cry, but it continues to
operate for 8 hours. The obliteration is anatomically completed later (in
90% of infants – approximately by 2 months of postnatal period) under
the influence of increasing pO2 in neonate’s blood.
9. Digestive system. Since the moment of birth, the infant transfers to enteral
nutrition, however:
- the stomach is characterized by small volume;
- the stomach lies horizontally;
- the intestine is relatively long, with incomplete development of the
nervous apparatus; it is easily hurt
- small amount of saliva, the protective functions of the mucous
membrane are poorly developed (hence the presence of thrush);
- the digestive canal is sterile during the first 2 or 3 days of life.
10. The urinary system of infants is characterized by:
- during the first day after birth, the urinary system displays little
functional activity, therefore oliguria is observed (the volume of daily urine is
up to 50 ml);
- relative density of urine at birth is 1008-1013, but starting from the
5th-6th days it declines and gradually approaches the normal values of infants
(1002-1004);
- reaction of urine is strongly acidic (pH 5.4-5.9), then it becomes
slightly acidic, and at the end of neonatal period it reaches 6.9-7.0;
- urination during the first 1-3 days is 4-5 times a day, from the 4th
to 28th day – 15-20 times a day.
11. Hemopoietic organs:
- lability of hematopoiesis;
- susceptibility to a large number of immature blood elements.
12. Body temperature is labile due to the fact that the processes of heat
generation and output are poorly developed.
13. Water exchange:
- water constitutes 75-80% of the total body weight, weakly bound in
the tissues; its balance is easily disturbed;
- the need for liquid in neonates is on average 160-200 ml per day
per 1 kg of body weight.
 Initial toilet of newborn
Suction of slime from a nose and oral cavities right after births of the head for
prophylaxis of an aspiration and an asphyxia. Newborn is showed to his mother, and
placed on mother’s abdomen. The head and the body of newborn dried by warm and
sterile diaper cowered by napkin
The first stage of processing of an umbilical cord. After the discontinuance of
a pulsation of an umbilical cord the obstetrician imposes 2 clamps - on distance 10
cm from an umbilical ring and 2 cm externally from the first. The umbilical cord
between them is processed by 5 % solution of Iodum and dissected by sterile
scissors.
The newborn is placed on the mother’s chest. Than the search and sucking
reflexes appear and child reaches the breast and begins to suck.
Thermometry in 30 minutes after birth
Ophthalmic prophylaxis in 1 hour after birth with 0.5% Erythromycine cream.
The skin-to-skin contact between the mother and the child lasts not less then 2 hours
Then the child is placed on warm dressing table and the second stage of
processing of an umbilical cord begins. On the small distance from an umbilical ring
one imposes clamp or a silk sterile ligature. On distance of 2 cm an umbilical cord is
cut. The processing of an umbilical cord is not rational.
Anthropometrical measures. Obstetrician defines mass and length of a body, a
circle of a head and a breast with the help of a sterile centimeter tape.
Anthropometrical data, a surname of mother, date and time of a birth, a sex of the
child and number of a history of labors write down in a history of development of
newborn and on special sterile bracelets which put on newborn and mothers wrists
Transferring to ward together with mother.
Current views on the physiological nursing of newborns significantly differ
from the accepted and widespread ones throughout the 80’s and even early 90’s.
Nowadays, the early latching of the infant to the breast during the first thirty minutes
after birth (preferably immediately after gonoblennorrhea prophylaxis) is admitted as
physiological. This practice promotes:
 - microbial colonization of the newborn’s body with mother’s microflora;
- intake of a significant amount of immunoglobulins which secures a timely
“immune launching”;
- establishment of an adequate psycho-emotional relationships in the “mother –
infant” micro-environment;
- establishment of early lactation in mothers.
The beneficial effects of early latching of the infant to the breast are
complemented by the rooming-in practice. After the transfer from the delivery room,
the mother and neonate are housed in the same ward. In addition, the principle of
cyclic occupation of the ward is implemented, that is, the mothers (1-2) whose
infants were born within 1 or 2 days can be housed in one ward.
There are the following contraindications to the rooming-in practice:
a) on the part of the mother:
- severe late gestosis;
- extragenital diseases in decompensation stage;
- surgery with severely impaired homeostasis;
- acute infectious diseases;
- serious birth traumas;
- mental disorders;
- sexually transmitted diseases;
- TB.
b) on the part of the neonate:
- deep prematurity;
- intrauterine hypotrophy of the 3rd degree;
- severe asphyxia at birth;
- birth trauma with disorders of vital functions;
- severe birth defects;
- severe hemolytic disease of newborns;
- respiratory distress syndrome of the II-III degrees.
Deeply premature neonates are fed through the enteral feeding tube.
 The rooming-in ward must be equipped with a sink (preferably with the
shower and toilet), person-weighing machine, swaddling table, bedside table for
diapers and baby care items, bedside table for mother’s personal things.
In the newborn department, the measures for preventing the purulent and
septic diseases must be implemented, and this requires an appropriate hygienic
regime.
After diapering, the neonates are put in cribs which are placed closer to natural
light. The mattresses must have oilcloth covers and sheets. Pillows are not needed.
For used diapers, a tank with a lid must be installed in the ward.
The temperature in the ward must be 22-24°C, humidity – 55-60%.
Preterm infants are placed in a special apparatus – incubator of various
modifications with automatic and manual control to create optimal conditions of
temperature, humidity, oxygen concentration and other parameters.
The temperature in the incubator is set depending on the degree of prematurity
(typically set within 34-36°C; the humidity during the first two days is up to 90-95%;
since the 3rd-4th day it is reduced to 40-60%). Every three days, incubators must be
changed and disinfected according to instructions.
The duration of stay in the incubator depends on the gestational age and
newborn’s health.
For preterm infants, the temperature in the ward must be 24-26°C, that is, by
2°C higher than in the ward for full-term newborns.
During the first day of life, the newborn care is performed by the nurse in the
presence of the mother.
All solutions and care items are designated only for one infant and preferably
in the disposable packing.
For each ward, there are gowns for the doctor and the nurse. The replacement
of gowns is conducted daily.
Bathing and weighing immediately after birth lead to heat loss; therefore, these
procedures must be postponed till the transfer to the rooming-in ward.
 The twenty-four-hour rooming-in practice (“skin to skin” contact) accustoms
the mother to proper neonatal care; she has the opportunity to observe the transient
states of the neonatal period; an appropriate rhythm of free feeding is established, and
the infant obtains enough breast milk. In addition, the minimal neonatal care by
medical staff reduces the risk of nosocomial infection.
During 5 days after birth, healthy infants stay in the hospital with their
mothers, and then they are discharged.
Preterm infants are transferred from the hospital (if indicated) to the 2nd stage
department for premature newborns after the 5th day after birth. In order to ensure
adequate neonatal care, the daily stock for one crib must be at least 20 cotton diapers,
9-10 flannel and 20-24 gauze or paper nappies. In addition, there must be 5 thin
flannel shirts, and 2 blankets. Only sterile clothes must be used.
Daily toilet in the neonatal ward is performed, as a rule, before the morning
feeding. At this time, newborns are weighed; body temperature is measured in the
armpit (every infant must have a separate thermometer). Thermometers are kept on a
tray in a sterile diaper after washing and soaking in 3% solution of hydrogen
peroxide.
Morning toilet is performed in a certain sequence. First, the face is washed
with warm boiled water. The eyes are washed with sterile cotton-wool balls towards
the outer corner of the eye to the nose. For each eye, separate sterile cotton-wool
balls in the disposable packing are used.
The nose is cleaned with cotton-wool filaments soaked in vegetable oil (from a
chemist’s, in the disposable packing), and external auditory passages – with a cotton-
wool wick.
Intimate washing is performed with running warm water and baby soap from
the front towards the back – for girls, and from the back towards the front – for boys.
Skin folds are treated with sterile vegetable oil.
One estimate the general condition of newborn by Apgar’s score at the
first and 5 minutes after a birth.
Apgar’s Score
Attributes / points 0 1 2
Body pink,
Skin color Cyanotic or pale Pink
extremities blue
Heart rate Absent Less then 100 More than 100
Respiration Absent Slow, irregular More than 20
Muscle tone Atony Hypotonia Normal
Hyporeflexia
Reflexes Absent well expressed
observed

Estimation on Aghar’s score

8-10 points - satisfactory general condition, an asphyxia is absent
6-4 points – moderate asphyxia
less then 4 – severe asphyxia
0 points – clinical death

Forms and methods of self-control

Tests

1. Anatomic attributes of a prematurity:

A. long extremities

B. short trunk

C. badly expressing of lanugo

D. long neck

E. low locating of a umbilical ring

2. Transitional conditions of the neonatal period:

A. hypotonia

B. regurgitation

C. hypothermia

D. hyporeflexia

E. hypertonia

3. Terms of the maximal expressiveness of transitional conditions of newborn:

 A. the first hours after a birth

B. the first week of life

C. the second week of life

D. the first month of life

E. the first day of life

4. What does not concern to transitive conditions of the neonatal period?

A. changes of skin

B. changes of thermal balance

C. sexual crisis

D. hyperbilirubinemia

E. hyperlipidemia

5. What does not concern to an estimation of a condition of newborn on

Apgar’s score?

A. color of a skin

B. hard beating

C. respiration

D. physical development

E. muscle tone

6. What does not concern to an initial toilet of newborn?

A. suction of contents of the upper respiratory ways

B. cutting of an umbilical cord

C. prophylaxis of ophtalmia

D. drying the child by sterile napkin

E. care about the umbilical wound

 Standards of answers:

1. E 2. C 3. B 4. E 5. D 6. E

Situational tasks

1. There are 5-6 times a day emictions in newborn, occurrence brown spots on
napkin after emictions. The child is mature, has cried at once after born, takes breast-
feeding 7 times a day. What kind of transitory condition takes a place?

A. acute cystitis

B. acute glomerulonephritis

C. acute pyelonephritis

D. uric acid infarct of kidneys

E. glucosuria

2. The newborn has a symmetric tumescence of mammary glands (the skin is

not changed). What kind of transitory conditions takes a place?

A. mastitis

B. endocrynopathy

C. tumor of mammary glands

D. infringement of function of an pituitary body (Hypophisis)

E. sexual crisis

3. A boy with mass of a body 3300 g, length 50 cm was born from 38-weeks
pregnancy. He got 4 points on Apgar score. What was general condition of the
newborn?

A. grave condition
 B. clinical death

C. healthy child

D. satisfactory condition

E. moderately grave condition

4. The child was born with mass of 3100 g, body length 50 cm, circle of the
thorax – 33 cm from the first pregnancy in a maternity home. Term of gestation was
39 weeks. How to name the child?

A. postmature newborn child

B. premature child

C. mature child

D. physiologically immature child

E. fetus

5. The newborn has the mass of body – 4100 g, the body length – 58 cm.
Vernix caseosa is absent, the skin is dry, the bones are dense, the cranial seams are
closed, the sizes of big fontanel is diminished. How to estimate a condition of
newborn?

A. mature child

B. premature child

C. fetus

D. postmature child

E. physiologically immature child

6. The newborn child, 5 days of life, was born with weight 3500 g, now has
weigh 3250 g. The general condition is satisfactory. What physiological condition of
newborn takes a place?

A. hormonal crisis

B. physiological dyspepsia
 C. physiological oliguria

D. physiological loss of weight (І degree)

E. physiological loss of weight (ІІ degree)

7. The newborn child has the І degree of transitional loss of initial mass of
body. How many % the mass of a body has decreased on?

A. Less than 6 %

B. 7-10 %

C. 11-12 %

D. 15-20 %

E. 13-14 %

Standards of answers:

1. D 2. E 3. E 4. C 5. D 6. E 7. A

Program of self-preparation of students to the theme:

1. 1. To study the theoretical questions of theme (see List of
information sources)
2. To be able to estimate the general condition of neonate.
3. To be able to determine maturity of newborn, physiological and
transitional conditions of neonatal period.
4. Pay attention to anatomical and physiological features of neonate.
5. Understand a difference between the signs of born in term and mature
newborn

VII. Materials for the methodical providing of the independent work of the
students:
 1. David Candy, Graham Davies, Euan Ross Clinical Paediatrics and
Child health. - Reprinted W.B. Saunders, 2006. – P. 207-238.
2. Tom Lissauer, Graham Clayden Illustrated textbook of Paediatrics. –
Mosby International Limited. – 2009. – P.169-188.

VIII. LITERATURE
A) The main literature:
1. Ghai O.P., Vinod [Link], Arvind Bagga Essential Pediatrics. Seventh
edition. – All India Institute of Medical Scences, New Delfi, 2009. – P. 1-3, 4-17.
2. Kapitan T. Propaedeutics of children’s diseases and nursing of the child:
Textbook for students of higher medical educational institutions. Fourth edition. –
Vinnitsa: The State Cartographical Factory, 2010. – P. 107-142.
3. Nelson Essential of Pediatrics. Fifth edition. Kliegman R.M. et all. –
Saunders: Imprint of Elsevier, 2016. – P. 15-22.

Methodical recommendations for practical lesson were prepared by the assistant of

the Department of Pediatrics №1 with propedeutics and neonatology
Soloviova H.O.