POST MATURE

NEWBORN

Gervacio, Jonah Micah N.

Past term, the placenta involutes, and

multiple infarcts and villous degeneration
cause placental insufficiency syndrome. In
this syndrome, the fetus receives
inadequate nutrients from the mother,
resulting in soft-tissue wasting.

During labor, postmature infants are prone to

develop asphyxia; meconium aspiration
syndrome, which may be unusually severe
because post-term amniotic fluid volume is
decreased and the aspirated meconium is less
diluted; and neonatal hypoglycemia caused by
insufficient glycogen stores at birth. Because
anaerobic metabolism rapidly uses the remaining
glycogen stores, hypoglycemia is exaggerated if
perinatal asphyxia has occurred.

ASSESSMENT OF POSTMATURE
Each newborn baby is carefully checked at
birth for signs of problems or complications. A
complete physical assessment will be done that
includes every body system. Throughout the
hospital stay, doctors, nurses, and other health
care providers continually assess the health of
the baby, observing for signs of problems or
illness.

The Apgar score is one of the first checks of

your new baby's health. The Apgar score is
assigned in the first few minutes after birth to
help identify babies that have difficulty breathing
or have a problem that needs further care. The
baby is checked at 1 minute and 5 minutes after
birth for heart and respiratory rates, muscle tone,
reflexes, and color.

Each area can have a score of 0, 1, or 2, with 10

points as the maximum. A total score of 10 means a

baby is in the best possible condition. Nearly all
babies score between 8 and 10, with 1 or 2 points
taken off for blue hands and feet because of
immature circulation. If a baby has a difficult time
during delivery, this can lower the oxygen levels in
the blood, which can lower the Apgar score. Apgar
scores of 3 or less often mean a baby needs
immediate attention and care.

EXAMPLE:
Sign

Heart rate
Respiratory
effort

Score = 0

Color

Score = 2

Absent

Below 100 per

minute

Above 100 per

minute

Absent

Weak, irregular,
or gasping

Good, crying

Flaccid

Some flexion of
arms and legs

Well-flexed, or
active
movements of
extremities

No response

Grimace or weak Good cry

cry

Blue all over, or

pale

Body pink,
hands and feet
blue

Muscle tone

Reflex or
irritability

Score = 1

Pink all over

Measurements

Other measurements are also taken of each

baby. These include the following:
Head circumference. The distance around the
baby's head.
Abdominal circumference. The distance
around the abdomen.
Length. The measurement from crown of head
to the heel.

Vital signs:
Temperature (able to maintain stable body

temperature in normal room environment)

Pulse (normally 120 to 160 beats per minute
in the newborn period)
Breathing rate (normally 40 to 60 breaths per
minute in the newborn period

PHYSICAL EXAM
A complete physical exam is an important part of
newborn care. Each body system is carefully
examined for signs of health and normal
function. The doctor also looks for any signs of
illness or birth defects. Physical exam of a
newborn often includes the assessment of the
following:

General appearance. Physical activity, tone,

posture, and level of consciousness

Skin. Color, texture, nails, presence of rashes
Head and neck:
Appearance, shape, presence of molding
(shaping of the head from passage through
the birth canal
Fontanels (the open "soft spots" between the
bones of the baby's skull
Clavicles (bones across the upper chest

Predisposing factors
A postmature infant is infants born of a gestation that extends beyond 42weeks as calculated from the mothers last menstrual period

Pregnancy between the age of 15-19 yrs

Elderly women
Wrong dates
Multiple pregnancy
Fetal anomalies
Hereditary

Clinical manifestation
Absence of vernix caseosa
Loose skin and little subcutaneous fat
Absence of lanugo
Abundent hair on the head and long nails
Skin is wrinkles, cracked and peeling
Umbilical cord is thin

Care of post mature

newborn

135 million newborns and 15

million premature babies-health
system needs and human capital
outcomes around the year 2010.

Methods Of Respiratory Assistance (Depends On The

Premature Newborns Individual Needs)

Endotracheal tube This is a tube that is placed

down the newborns windpipe in order to deliver

warm, humidified air and oxygen.
Ventilator This machine is sometimes referred to

as a respirator. It is the breathing machine connected

to the endotracheal tube that can monitor the amount
of oxygen, air pressure and number of breaths.
Continuous Positive Airway Pressure (C-PAP)

This method is used for babies who can breathe on

their own but need help getting air to their lungs.
Oxygen hood This a clear plastic box that is placed

over the babys head and is attached to a tube that

pumps oxygen to the baby.

Methods Of Feeding (Depends On The Premature Newborns

Individual Needs)
Intravenous lines These lines carry nutrition directly into

the babys blood stream. They are used for premature babies
who have immature digestive systems and are unable to suck,
swallow and breathe normally. This method is sometimes used
when treatment for other health complications is being
implemented. This approach utilizes an IV that may be placed
in the scalp, arm or leg.
Umbilical catheter This painless method involves a tube

that is surgically placed into a vessel of the umbilical cord.

However, there are risks associated with this method that
include infection andblood clots. Therefore, the method is
normally used only in the most critical cases and where the
baby might need this type of feeding for several weeks. For
these babies, it is the safest and most effective way to receive
nutrients.

Oral and nasal feeding This method utilizes a narrow

flexible tube that is threaded through their nose

(nasogastric tube) or mouth (orogastric tube). It is a
solution for babies who are ready to digestbreast milkor
formula but not yet able to suck, swallow and breathe in
a coordinated manner.
Central line (sometimes referred to as a PICC

line) This is an intravenous line that is inserted into a

vein, often in the arm, that allows the use of a larger
vein. This is a method of delivering nutrients and
medicines that might otherwise irritate smaller veins.

Other Equipment
Incubator Incubators are clear plastic cribs that keep babies

warm and help protect them from germs and noise.

Bili lights A bright blue fluorescent light located over the babys

incubator used to treat jaundice (yellowing of skin and eyes).

Kangaroo care

is a technique where the premature baby is placed in an upright

position on its mothers bare chest allowing tummy to tummy contact
and positioning the baby between the mothers breasts. The babys head
is turned so that its ear is positioned above the mothers heart.

Kangaroo care has been shown to help premature newborns with:

Body temperature Studies have shown that a mother has thermal

synchrony with her baby and that if her baby was cold, her body
temperature would increase to warm up the baby and visa versa.
Breastfeeding Kangaroo care allows easy access to the breast, and

skin-to-skin contact increasing milk let-down.

Increase weight gain Kangaroo care allows the baby to fall into a

deeper sleep allowing it to direct more energy to other bodily functions.

Increased weight gain also means shorter hospital stay.
Increased intimacy and bonding

How YOU Can Participate In The Neonatal Intensive Care Unit (NICU)
There are additional ways to provide care for a baby in the NICU.
Both the mother and father are encouraged by the NICU staff to interact with

their baby.
As a mother or father you might not be aware of all the ways that you can
interact with your baby.
Here are some suggestions:
1. Touch your baby as much as possible. You can do this by using a gentle

touch and stroking motions.

.2. Talk to your baby. Your baby can recognize your voice(s) and be comforted

by hearing you. In addition to talking, you can read or sing to your baby.
.3. Change your babys diaper.
.4. Participate in your babys first bath. Depending on your babys progress,

you may choose washcloths or sponges.

.5. Take your babys temperature.