Neonatal Period (0-1 m)

- APGAR score – assessment of newborn based on Appearance, Pulse, Grimace, Activity & Respiration (0-10); taken at 1, 5 & 10 min

If summary score is…

0-2 NICU; Serious problems

3-6 Fair; needs help to maintain life

7-9 Good health

10 Excellent health

Apgar newborn scoring system

Score	0		1		2
Appearance	Color	Pale		Blue extremities		Pink
Pulse	Heart rate	Not detectable		Below 100		Above 100
Grimace	Reflex irritability	No response		Grimace		Vigorous cry
Activity	Muscle tone	Flaccid some		Flexion of extremities		Active motion
Respiration	Respiratory effort	absent		Slow, irregular		Good (crying)

Social interaction

Alertness – depends upon state of consciousness (when in deep regular sleep or when crying – can’t ‘reach’ them); #1 correlate to later intelligence

Preferred modalities- visual, some are tactile

Preferred stimulus- hopefully parentscue to something that is awry; if baby does not look at mom that is a problem

Irritability/innate temperament – consolability & self-quieting

- Sensory skills – can also show sensory deficits

Visual modality – need visual stimulation to develop full vision; dominent sense

Best focus = 8-10″; closer = double vision, farther = blur

Newborn vision = 20/150; due to flat lens that’s not good at focusing; don’t see pastels

Tracking – look at where baby’s looking; should be able to track a full field of vision

Auditory modality – should be able to localize sound; test different frequencies

Tactile – doesn’t determine temperate well (doesn’t know that s/he’s cold/hot); pricking feet for a response

Vestibular spin with the baby; baby’s head should turn with the spin (testing the cervical nerve)

Taste- baby’s love sweet things; don’t like sour

- Motor skills

o Neonatal reflexes

• Unlearned & automatic responses

• Adaptive behaviors

• Most disappear at 3-6 m- cortex begins dominating

• Reflexes:

• Babinski- stroking the foot results in the spreading out of the toes and upward extension of the big toe

• Galant- stroking the neonates back along the spine results in the trunk arching toward the side

• Moro – withdrawal of physical support & a sharp noise results in arms extending outward & returning to midline

• Palmer grasp – touching palm causes fingers to grasp object

• Plantar grasp – touching ball of foot results in inward flexion of toes

• Rooting – stroking cheek or corner of mouth causes head to turn toward object & mvmts that look as if infant’s searching for something to suck

• Sucking – placing object in mouth results in sucking (start at 35 wks gestation)

• Standing- holding the infant around the chest and bouncing it on the balls of its feet results in contractions of the legs so that the legs can support the baby’s weight

• Walking

• Swimming – infant will swim, head down & exhaling, from birth; disappears after several months; after that, swimming is a learned behavior

• Tonic neck – emerges several wks after birth; when infant’s head & neck turn in a direction, infant assumes a “fencing’ posture on that side

• Papillary – doesn’t go away

o Muscle tone & range of mvmt

Hypertonia- stiff baby; push babys arms one direction and they come back; esp in premature babies

Hypotonia – Down syndrome; decreased muscle tone

Both of these require physical therapy very early on

- Factors influencing newborn & early infant behaviors

o Teratogens

Aspirin – prolonged delay of labor onset; lethagic child; fetal bleeding?

Normal anesthesia – lethargic child; depresses breathing, et al

Caffeine – induces early labor; irritable (CNS disruption)

Barbiturates – vasoconstriction of intestine; decreased birth weight; brain damage to fetus (↓ [O₂]); tremoring

Nicotine – vasocontriction in maternal intestine; lower birth wt; hyperactivity; ↑ HR

EtOH – FAS (1^o microencephaly); lg eyes that are far apart; small jaw

• 1 drink/wk can cause problems

• Bottom line: NO drinking during pregnancy

Heroin or Methadone (Cocaine) – addicted baby (normal appearance at birth, but hrs later will develop withdrawal); increase prematurity

HIV (if left untreated) – giving mom AZT in 3^rd trimester, ↓ transmission to baby; infant progresses to point, then deteriorates

• 30-50%
  

  Tags: APGAR score, Auditory modality, Babinski, HIV infection, hypotonia, neonatal, Neonatal reflexes, Palmer grasp, plantar grasp, sensory skills, Tactile, teratogens, visual modality

  This entry was posted on Wednesday, September 2nd, 2009 at 5:00 am and is filed under Behavioral Science and Psychiatry. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.