Healthy Term Infant

Terminology

  • Preterm: a birth that occurs before 37 completed weeks of gestation
  • Term: a birth between 37 weeks and 42 weeks of gestation
  • Post term: a birth that occurs after 42 weeks of gestation
  • 'Normal' weight 2.5kg-4.0kg
    • Over 4.0kg - large for gestational age (LGA)
    • Under 2.5kg - small for gestational age (SGA)

Events in the 3rd trimester

  • Daily weight gain of 24g during 3rd trimester
  • Approx. 7g of fat per day in last 4 weeks
  • Transplacental transfer - iron, vitamins, calcium, phosphate and antibodies

Challenges for baby during labour

  • During contractions, the baby is in a hypoxic environment
  • Foetal Hb helps release O2 to help with this
  • Prolonged labour reduces fetal reserves
  • Placental insufficiency can make it difficult for baby to cope with the hypoxia - many reasons including maternal smoking or drug use, pre-eclampsia
  • Growth restriction or excess can also make it difficult for baby
    • Growth restriction - lack of reserves to help during labour
    • Growth excess - large baby can be difficult to get out
  • The stress baby experiences increases cortisol and adrenaline, which enhances perinatal adaptation

Perinatal adaptation

  • First breath/cry causes alveolar expansion, prompting the change from foetal to newborn circulation
  • Decreased pulmonary arterial pressure, increased PaO2
  • Apgar score is an objective measure of perinatal adaptation
  • Early/immediate skin-to-skin and suckling

Normal care after birth

Immediately after birth

  • Keep baby warm
  • Skin-to-skin contact is important for establishing breast feeding
  • Well growth term infants have little calorific intake in the first 24 hours
  • Allow attachment
    • Babies often very alert immediately after delivery
    • Hormonal and emotional response to infant

Vitamin K

  • Vitamin K given in the newborn period given to prevent haemorrhagic disease of the newborn, which is a disorder of clotting (vitamin K dependent)
  • IM preferred by clinicians, some parents might prefer oral

Infection screen

  • Based on maternal history
  • Hep. B - consider immediate vaccination/immunoglobin
  • Hep. C
  • HIV
  • Syphilis
  • TB
  • Group B streptococcus

Early warning systems

  • Anticipatory methods used to monitor babies at risk e.g. newborn early warning score

Vaccination

  • Maternal pertussis and influenza vaccines
  • Routine vaccination schedule
  • Consider other vaccines - Hep. B at birth, BCG in first month - depending on risk factors

Screening tests

  • Newborn examination
  • Universal hearing screening
  • Hip screening - clinical exam, USS if risk factors present
  • Cystic fibrosis
  • Hypothyroid
  • Haemoglobiopathies
  • Metabolic disease e.g. PKU, MSUD