C.

PHYSICAL EXAMINATION TECHNIQUE ◆ Vigorously crying w/ accompanying

activity of arms & legs
➔ Initial examination of newborn infant:
➔ Active & passive tone & any unusual posture
performed as soon as possible after delivery
should be noted
➔ Temp, pulse, RR, color, signs of respiratory
➔ Coarse, tremulous movements w/ ankle or jaw
distress, tone, activity, & level of consciousness:
myoclonus: more common & less significant in
monitored frequently until stabilization
newborn infants than at any other age; occur
➔ High-risk deliveries: examine in delivery room;
when infant is active
focus on congenital anomalies(3-5%),
➔ Convulsive twitching: quiet state
maturation & growth, & pathophysiologic
➔ Edema: produce superficial appearance of good
problems that may interfere w/ normal
nutrition
cardiopulmonary & metabolic adaptation to
➔ Pitting after applied pressure may or may not be
extrauterine life
noted, but the skin of the fingers & toes lacks
➔ After a stable delivery room course, a 2nd &
the normal fine wrinkles when filled with fluid
more detailed examination should be
➔ Edema of eyelids: commonly results from
performed w/in 24 hr of birth
irritation caused by silver nitrate
➔ Infant remains in the hosp >48 hrs: repeat
➔ Generalized edema: prematurity,
assessments performed throughout the hospital
hypoporoteinemia secondary to severe
stay including discharge examination w/in 24 hr
erythroblastosis fetalis, nonimmune hydrops,
discharge
congenital nephrosis, Hurler syndrome,
➔ Healthy infant: mother should be present during
unknown causes
examination; minor insignificant anatomic
➔ Localized edema: suggests congenital
variations may worry the parents & should be
malformation of the lymphatic system
explained carefully & skillfully
◆ When confined to >1 extremities of
➔ Infants should NOT be discharged w/o final
female infant: initial sign of Turner
examination because:
Syndrome
◆ Cyanosis & heart murmurs often
appear/disappear in the immediate
Skin
neonatal period
➔ Vasomotor instability & peripheral sluggishness:
◆ Evidence of disease that has just been
◆ deep redness or purple lividity in a
acquired may be noted
crying infant, whose color may darken
➔ Examine:
profoundly w/ closure of the glottis
◆ Pulse (N: 120-60 beats/min)
preceding a vigorous cry
◆ Respiratory rate (N: 30-60 breaths/min)
◆ harmless cyanosis (acrocyanosis) of the
◆ Temperature
hands & feet, especially when they are
◆ Weight
cool.
◆ Length
➔ Mottling: general circulatory instability;
◆ Head circumference
associated w/ serious illness or related to
➔ Dimensions of any visible/palpable structural
transient fluctuation in skin temperature
abnormality should be assessed
➔ Harlequin color change: extraordinary division
➔ Blood pressure: determined if neonate appears
of the body from forehead to the pubis into red
ill or has a heart murmur
& pale halves; transient & harmless
➔ Pulse oximetry: screen for critical congenital
➔ Significant cyanosis: masked by pallor of
heart disease; part of the routine screening of
circulatory failure or anemia
newborn infants
➔ High hemoglobin content of the 1st few days &
➔ If infant is quiet & relaxed at the beginning of
thin skin: appearance of cyanosis at a higher
the examination: palpation of abdomen or
partial pressure of arterial oxygen (PaO2) than in
auscultation of heart should be performed first
older children
➔ Localized cyanosis differentiated from
General Appearance
ecchymosis: momentary blanching pallor (w/
➔ Physical activity: decreased due to illness/drugs
cyanosis) that occurs after pressure; same
◆ Lying w/ extremities motionless:
maneuver demonstrates icterus
conserve energy for effort of difficult
➔ Pallor: due to anemia, asphyxia, shock, edema
breathing
➔ Early recognition of anemia → diagnosis of ➔ Pustular melanosis
fetomaternal blood transfusion, erythroblastosis ◆ benign lesion in black neonates
fetalis, subcapsular hematoma of liver or ◆ mainly neutrophils
spleen, subdural hemorrhage, fetal-maternal or ◆ present at birth as vesiculopustular
twin-twin transfusion eruption around chin, neck, back,
➔ Without being anemic, postmature infants tend extremities, & palms or soles
to have paler & thicker skin than term or ◆ lasts 2-3 days
preterm infants ➔ Erythema toxicum & pustular melanosis should
➔ Ruddy appearance of plethora: polycythemia be differentiated from: Herpes simplex &
➔ Vernix & common transitory macular capillary staphylococcal disease of the skin
hemangiomas of the eyelids & neck: ➔ Amniotic bands
➔ Cavernous hemangiomas: deeper, blue masses; ◆ disrupt the skin, extremities
if large, trap platelets and produce disseminated (amputation, ring constriction,
intravascular coagulation or interfere w/ local syndactyly), face (clefts), or trunk
organ function (abdominal or thoracic wall defects)
➔ Scattered petechiae: seen on presenting part ◆ due to amniotic membrane rupture or
(scalp or face) after a difficult delivery vascular compromise w/ fibrous band
➔ Mongolian spots formation
◆ slate-blue, well-demarcated areas of ➔ Excessive skin fragility & extensibility w/ joint
pigmentation hypermobility: Ehlers-Danlos Syndrome, Marfan
◆ seen over the buttocks, back, other part Syndrome, congenital contractural
of the body in >50% black, Native arachnodactyly, & other disorders of collagen
American, & Asian infants, occasionally synthesis
in white
◆ benign patches, no anthropologic Skull
significance ➔ Skull may be molded: first-born & head engaged
◆ disappear w/in the 1st year in pelvic canal for a considerable time
➔ Vernix, skin, cord: stained brownish yellow if ➔ Caput succedaneum: due to scalp pressure
amniotic fluid has been colored by the passage from the uterus, cervix, or pelvis; circular boggy
of meconium during or before birth area of edema w/ indistinct borders & often w/
➔ Skin of premature infant: thin & delicate, deep overlying ecchymosis
red ➔ Cephalohematoma: well-circumscribed
➔ Extremely premature infants: almost gelatinous fluid-filled mass that does NOT cross suture
& translucent skin lines
➔ Lanugo: fine, soft, immature hair; frequently ➔ Unlike caput succedaneum, cephalohematoma
covers scalp & brow & cover face of premature is often NOT present at delivery but develops
infants over the 1st few hr of life. Both conditions must
➔ Tufts of hair over the lumbosacral spine: be distinguished from subgaleal hemorrhage
suggest abnormality such as occult spina bifida, ➔ Subgaleal hemorrhage: NOT restricted by
a sinus tract, or a tumor boundaries of sutures; larger & more diffuse;
➔ Nails: rudimentary in very premature infants, requires prompt recognition because extensive
protrude beyond the fingertips in infants born bleeding may result in hypovolemic shock;
post term mortality 20%
➔ Postterm infants: peeling, parchment-like skin; ➔ Microcephaly: excessively small head
may mimic ichthyosis congenita ◆ Genetic disorders, congenital infection,
➔ Erythema toxicum intrauterine drug exposure
◆ small, white papules on an ➔ Megalencephaly: excessively large head
erythematous base ◆ Hydrocephaly, storage disease,
◆ develop 1-3 days after birth achondroplasia, cerebral gigantism,
◆ benign rash neurocutaneous syndromes, inborn
◆ persist for 1 week errors of metabolism, familial disorder
◆ mainly eosinophils
◆ distributed the face, trunk, extremities
 ➔ Suture lines & size & fullness of anterior & ➔ When jaw has been held against a shoulder or
posterior fontanels: determined digitally by extremity during intrauterine period, mandible
palpation may deviate strikingly from the midline
➔ Parietal bones: override occipital & frontal ➔ Symmetric facial palsy: absence or hypoplasia of
bones 7th nerve nucleus (Mobius syndrome)
➔ Cranial synostosis: premature fusion of sutures;
hard non movable ridge over the suture & Eyes
abnormally shaped skull ➔ Open spontaneously if infant is held up & tipped
➔ Great variation in size of fontanels exists at gently forward & backward
birth; if small, anterior fontanel tends to enlarge ➔ This maneuver is a result of labyrinthine & neck
during the 1st few mo after birth reflexes: more successful for inspecting eyes
➔ Persistence of excessively large anterior than forcing the lids apart
(normal: 20 +10 mm) & posterior fontanels: ➔ Conjunctival & retinal hemorrhages: usually
associated w/ several disorders benign
➔ Persistently small fontanels: microcephaly, ➔ Retinal hemorrhages
craniosynostosis, congenital hyperthyroidism, ◆ more common w/ vacuum or
wormian bones forceps-assisted deliveries than
➔ Presence of 3rd fontanel: trisomy 21, preterm spontaneous vaginal delivery
infants ◆ least common after cesarean section
➔ Craniotabes: soft areas; occasionally found in ◆ bilateral, intraretinal, in posterior pole
parietal bones at the vertex near sagittal suture; ◆ Resolve in most infants by 2 wk (85%)
more common in preterm infants & infants ◆ Resolve in all infants by 4 wk
exposed to uterine compression ➔ Pupillary reflexes: present after 28-30 wk of
➔ Soft areas in occipital region: irregular gestation
calcification & wormian bone formation ➔ Iris: inspected for colobomas & heterochromia
associated w/ osteogenesis imperfecta, ➔ Cornea >1cm in diameter in term infant (w/
cleidocranial dysostosis, lacunar skull, cretinism, photophobia & tearing) or corneal clouding:
Down syndrome congenital glaucoma; requires prompt
➔ Atrophic or alopecic scalp areas: aplasia cutis ophthalmologic consultation
congenita; sporadic/autosomal dominant; ➔ Bilateral red reflexes: absence of cataracts &
associated w/ trisomy 13, chromosome 4 intraocular pathology
deletion, or Johanson-Blizzard syndrome ➔ Leukoria (white pupillary reflex): cataracts,
➔ Deformational plagiocephaly: result of in utero tumor, chorioretinitis, retinopathy of
positioning forces on skull; asymmetric skull & prematurity, or persistent hyperplastic primary
face w/ ear malalignment; associated w/ vitreous; warrants immediate ophthalmologic
torticollis & vertex positioning consultation
➔ Depression of skull (indentation, fracture,
Ping-Pong ball deformity): prenatal onset; result Ears
of prolonged focal pressure by maternal pelvic ➔ Deformities of pinnae: occasionally seen
bone ➔ Unilateral or bilateral preauricular skin tags:
occur frequently
Face ➔ If pedunculated skin tags: tightly ligated at base
➔ Dysmorphic features: epicanthal folds, widely → dry gangrene & sloughing
or narrowly spaced eyes, microphthalmos, ➔ Tympanic membrane: easily seen otoscopically
asymmetry, long philtrum, low-set ears; often through the short & straight external auditory
associated w/ congenital syndromes canal; normally appears dull gray
➔ Face may be asymmetric due to:
◆ 7th nerve palsy Nose
◆ Hypoplasia of depressor muscle at the ➔ May be slightly obstructed my mucus
angle of the mouth accumulated in narrow nostrils
◆ Abnormal fetal posture ➔ Nares: should be symmetric & patent
➔ Dislocation of nasal cartilage from vomerian
groove → asymmetric nares
 ➔ Anatomic obstruction of nasal passages ➔ Throat: difficult to see due to low arch of palate;
secondary to unilateral or bilateral choanal should be clearly viewed because posterior
atresia → respiratory distress palatal or uvular clefts are easy to miss
➔ Tonsils: small
Mouth
➔ Normal mouth rarely have precocious dentition, Neck
w/ natal (present at birth) or neonatal (eruption ➔ Short
after birth) teeth in lower incisor position or ➔ Abnormalities NOT common but include:
aberrantly placed; these teeth are shed before ◆ Goiter
the deciduous ones erupt; extraction NOT ◆ Cystic hygroma
indicated ◆ Branchial cleft cysts
◆ Ellis-van Creveld ◆ Teratoma
◆ Hallermann-Streiff ◆ Hemangioma
➔ Premature eruption of deciduous teeth: more ◆ Lesions of sternocleidomastoid muscle:
unsual traumatic or caused by fixed positioning
➔ Soft & hard palate: inspected & palpated for in utero that produces either hematoma
complete or submucosal cleft; contour noted if or fibrosis
arch is excessively high or uvula is bifid ➔ Congenital torticollis: head turn toward & and
➔ Epstein pearls: temporary accumulations of the face turn away from the affected side
epithelial cells on the hard palate on either side ➔ Plagiocephaly, facial asymmetry, &
of the raphe hemihypoplasia: develop if congenital torticollis
➔ Retention cysts: seen on the gums; similar is untreated
appearance to epstein pearls ➔ Redundant skin or webbing in female infant:
➔ Epstein pearls & retention cysts: disappear intrauterine lymphedema & Turner Syndrome
spontaneously w/in a few weeks of birth ➔ Clavicles: both palpated for fractures
➔ Clusters of small, white, or yellow follicles or
ulcers on erythematous bases: Chest
◆ anterior tonsillar pillars ➔ Breast hypertrophy: common; milk may be
◆ most frequently on 2nd/3rd day of life present (should not be expressed)
◆ unknown cause ➔ Asymmetry, erythema, induration, &
◆ clear w/o treatment in 2-4 days tenderness: mastitis or breast abscess
➔ Neonates do NOT have active salivation ➔ Supernumerary nipples, inverted nipples, or
➔ Tongue: large widely spaced nipples w/ a shield-shaped chest:
➔ Frenulum: short, but its shortness (tongue-tie may be seen
or ankyloglossia) is rarely a reason for cutting it ➔ Widely spaced nipples w/ a shield-shaped chest:
➔ Problems w/ feedings (breast or bottle) & Turner Syndrome
frenulum is short → frenulectomy (frenotomy) Lungs
➔ Frenotomy: reduce maternal nipple pain & ➔ Much can be learned by observing breathing
improve breastfeeding scores more rapidly than ➔ Normal variations in rate & rhythm:
no treatment characteristic & fluctuate according to infant’s
➔ Neonates not treated w/ frenotomy: also have physical activity, state of wakefulness, or
successful feeding presence of crying
➔ Sublingual mucous membrane: occasionally ➔ Fluctuations are rapid; respiratory rate: counted
forms a prominent fold for a full minute w/ infant in resting state,
➔ Cheeks: fullness on both buccal & external preferably asleep.
aspects due to accumulation of fat in the ➔ Usual rate for normal term infants: 30-60
sucking pads breaths/min
➔ Sucking pads & labial tubercle on the upper lip ➔ Premature infants: rate is higher & fluctuates
(sucking callus): disappear when suckling ceases more rapidly
➔ Marble-sized buccal mass: benign idiopathic fat ➔ Rate consistently >60 breaths/min during
necrosis periods of regular breathing that persists for >1
hr after birth: indication to rule out pulmonary,
cardiac, or metabolic (acidosis) etiologies
 ➔ Preterm infants: may breathe w/ Cheyne-Stokes neonatal examination have underlying
rhythm (periodic respiration) or w/ complete malformation
irregularity ➔ Routine screening for critical CHD using pulse
➔ Irregular grasping, sometimes accompanied by oximetry: performed between 24-48 hrs of life;
spasmodic movements of mouth & chin: sensitivity 80%; specificity >99%
strongly indicates serious impairment of ➔ Pulse oximetry screening w/ SO2 of >95% in the
respiratory centers right hand or either foot, & <3% difference
➔ Breathing of newborn infants at rest: between right hand & foot: NORMAL screening
diaphragmatic; during inspiration, soft front of test
thorax drawn inward while abdomen protrudes ➔ SO2 of <95%: referred for evaluation & possible
➔ If baby is quiet, relaxed, & w/ good color: echocardiogram
“paradoxical movement”; does not signify ➔ BP measurements: evaluate ill-appearing infants
insufficient ventilation & those suspected of CHD
➔ Labored respiration w/ retractions: respiratory ➔ Oscillometric method: easiest & most accurate
distress syndrome, pneumonia, anomalies, noninvasive method
mechanical disturbance of lungs ➔ Mean BP values: vary by gestational age
➔ Weak, persistent, or intermittent groaning, ➔ For all neonates: BP is expected to rise in the 1st
whining cry, or grunting during expiration: 72 hrs after birth
potentially serious cardiopulmonary disease or
sepsis; warrants immediate attention Abdomen
➔ When benign, grunting resolves 30-60 min after ➔ Liver: usually palpable as much as 2 cm below
birth rib margin
➔ Flaring of alae nasi & retraction of intercostal ➔ Tip of spleen: may be felt
muscles & sternum: common signs of ➔ Size & location of each kidney: determined by
pulmonary pathology deep palpation
➔ Normal breath sounds: bronchovesicular ➔ No other period in life does the amount of air in
➔ Diminished breath sounds, rhonchi, retractions, GI tract vary so much, nor is it usually as great
or cyanosis: always verified w/ chest radiograph; under normal circumstances
suspicion of pulmonary pathology ➔ Intestinal tract: gasless at birth
➔ Gas: swallowed soon after birth; normally
Heart present in the rectum on radiograph by 24 hrs
➔ Normal variation in size & shape of heart → ➔ Abdominal wall: normally weak (esp in
difficult to estimate size of heart premature infants)
➔ Location of heart: determined to detect ➔ Diastasis recti & umbilical hernias: common
dextrocardia among black infants
➔ Pulse: ➔ Unusual masses: investigated immediately with
◆ 110-140 beats/min at rest ultrasonography
◆ 90 beats/min in relaxed sleep ➔ Renal pathology: cause of most neonatal
◆ 180 beats/min during activity abdominal masses
➔ Supraventricular tachycardia: >220 beats/min; ➔ Cystic abdominal masses:
determined better w/ cardiac monitor or ECG ◆ Hydronephrosis
than by auscultation ◆ Multicystic-dysplastic kidneys
➔ Preterm infants: higher resting heart rate; 160 ◆ Adrenal hemorrhage
beats/min; may have sudden onset of sinus ◆ Hydrometrocolpos
bradycardia secondary to apnea ◆ Intestinal duplication
➔ Admission to & discharge from nursery: infant’s ◆ Choledochal, ovarian, omental, or
pulses palpated in upper & lower extremities to pancreatic cysts
detect coarctation of the aorta ➔ Solid masses:
➔ Transitory murmurs: closing ductus arteriosus ◆ Neuroblastoma
➔ Congenital Heart Disease (CHD): does NOT ◆ Congenital mesoblastic nephroma
initially produce a murmur; many infants w/ ◆ Hepatoblastoma
persistent murmurs detected during routine ◆ Teratoma
 ➔ Solid flank mass: renal vein thrombosis; ➔ Tests: in scrotum; palpable in canals in term
clinically apparent w/ hematuria, hypertension, infants
& thrombocytopenia ➔ Black male infants: dark pigmentation of
➔ Renal vein thrombosis in infants scrotum before rest of the skin assumes its
◆ Polycythemia permanent color
◆ Dehydration ➔ Scrotum: may be ecchymotic from breech
◆ Maternal diabetes presentation or retroperitoneal hemorrhage;
◆ Asphyxia may contain meconium particles associated w/
◆ Sepsis meconium peritonitis
◆ Nephrosis ➔ Prepuce or foreskin of newborn infant: normally
◆ Hypercoagulable states (antithrombin III tight & adherent to penile glans at birth; cannot
& protein C deficiency) be retracted
➔ Abdominal distention at birth or shortly ➔ Foreskin: separate naturally over several
afterward: months
◆ obstruction or perforation of GI tract ➔ Severe hypospadias or epispadias: abnormal
◆ result of meconium ileus sex chromosomes or infant is masculinized
◆ later distention → lower bowel dfemale w/ enlarged clitoris (may be the first
obstruction, sepsis, or peritonitis evidence of adrenogenital syndrome)
➔ Scaphoid abdomen: diaphragmatic hernia ➔ Erection of penis: common; no significance
➔ Abdominal wall defects: omphalocele ➔ Urine: usually passed during or immediately
(umbilicus); gastroschisis (lateral to midline) after birth; period w/o voiding normally follow
➔ Omphaloceles: Beckwith-Wiedemann, ➔ Most neonates void by 12 hrs
conjoined twins, trisomy 18, meningomyelocele, ➔ 95% of preterm & term infants void w/in 24 hrs
imperforate anus
➔ Omphalitis Anus
◆ Acute local inflammation of the ➔ Some passage of meconium: w/in 1st 12 hrs
periumbilical tissue after birth
◆ May extend to abdominal wall, ➔ 99% of term infants & 95% premature infants:
peritoneum, umbilical vein, or portal pass meconium w/in 48 hrs of birth
vessels or liver → portal hypertension ➔ Anal opening absent or incorrectly located:
➔ Umbilical cord: 2 arteries, 1 vein physical examination is sufficient for diagnosis
➔ Single umbilical artery: increased risk for occult of imperforate anus
renal anomaly ➔ Fistula to the skin, urethra, or vagina: newborn
can pass meconium; imperforate anus may not
Genitals be suspected unless a careful exam is done
➔ Genitals & mammary glands ➔ Abdominal radiographs
◆ normally respond to transplacentally ◆ Confirm distal obstruction
acquired maternal hormones ◆ Determine how low the rectum is
◆ Produce enlargement & secretion of ➔ Females w/ imperforate anus: careful
breasts in both sexes examination of vestibule to ensure separate
◆ Prominence of genitals in females, w/ openings of urethra & vagina
considerable nonpurulent discharge ➔ All newborns w/ anorectal malformations:
● These transitory manifestations evaluation for possible cardiac, renal, & spine
require no intervention. anomalies
➔ Imperforate hymen or other causes of vaginal ➔ Dimple or irregularity in skin fold: normally
obstruction → hydrometrocolpos & lower present in sacrococcygeal midline may be
abdominal mass mistaken for actual or potential neurocutaneous
➔ Normal scrotum at term: large; size increased by sinus
trauma of breech delivery or transitory
hydrocele Extremities
➔ Hydrocele: distinguished from hernia by ➔ Effects of fetal posture: noted so that their
palpation & transillumination cause & usual transitory nature can be
 explained to the mother; important after breech ➔ Most healthy infants in satisfactory condition:
presentations remain in skin-to-skin contact w/ their mothers
➔ Fracture or nerve injury associated w/ delivery: for immediate bonding & nursing
detected more frequently by observation of ➔ Placed in warmers for prompt resuscitation &
extremities in spontaneous or stimulated monitoring:
activity than by any other means ◆ Infants who fail to initiate or sustain
➔ Hands & feet: examined for polydactyly, respiratory effort after stimulation
syndactyly, abnormal dermatoglyphic patterns ◆ Heart rate <100 beats/min
(simian crease) ◆ Persistent central cyanosis
➔ Hips of all infants: examined w/ specific ➔ Apgar scores NOT used to determine need for
maneuvers to rule out congenital dislocation resuscitation or guide steps of resuscitation
➔ Changes in Apgar scores at sequential time
Neurologic Examination points after birth: reflect how well infant is
➔ In utero neuromuscular diseases associated w/ responding to resuscitation
limited fetal motion produce s & sx independent ➔ 5 min score <7: additional scores assigned every
of specific disease 5 min for up to 20 min
➔ Severe positional deformations & contractures ➔ Fetal distress, prematurity, drugs given to
→ arthrogryposis mother during labor: low Apgar score
➔ Other manifestations:
◆ Breech presentations
◆ Polyhydramnios
◆ Failure to breathe at birth
◆ Pulmonary hypoplasia
◆ Dislocated hips
◆ Undescended testes
◆ Thin ribs
◆ Clubfoot
➔ Congenital disorders: hypotonia, hypertonia,
seizures

ROUTINE NEWBORN CARE

➔ Initial steps after delivery: provide warmth,
drying, & tactile stimulation, while evaluating
respiratory effort, heart rate, & color
➔ Full-term, vigorous infants: initially placed on
mother’s abdomen after delivery
➔ Delayed clamping of umbilical cord: (30-60 sec)
recommended to improve transitional
circulation & increase neonatal RBC volume.
➔ Clearing of the mouth of secretions:
◆ gentle suction w/ bulb syringe or soft
catheter MAINTENANCE OF BODY HEAT
◆ indicated if there is excessive (copious)
➔ Newborn infants: at risk for heat loss &
amount of fluid in mouth or nares
hypothermia
➔ Resource-poor countries: gentle wiping of face,
➔ Body surface area (BSA): 3x adult relative to
nose, & mouth w/ soft cloth equally effective as
body weight
bulb syringe
➔ Generation of body heat: depends in large part
➔ Spontaneously breathing neonates w/o distress:
on body weight
require NO assisted method to clear airway
➔ Heat loss: depends on BSA
➔ Apgar score: practical method of systematically
➔ Low-birthweight & preterm infants: insulating
evaluating infants immediately after birth (1 & 5
layer of subcutaneous fat is thin
min of life)
➔ Estimated rate of heat loss in newborn: 4x adult
➔ Usual delivery room conditions (20-25C):
infant’s skin temperature falls 0.3C/min
➔ Deep body temperature: decreases 0.1C/min
during period immediately after delivery
➔ Cumulative loss: 2-3C in deep body temperature
(corresponding to heat loss of 200 kcal/kg)
➔ Heat loss occurs by 4 mechanisms:
◆ Convection of heat energy to cooler
surrounding air
◆ Conduction of heat to the colder
materials touching the infant
◆ Heat radiation from the infant to other
nearby cooler objects
◆ Evaporation from skin & lungs
➔ To compensate for heat loss in term infants
exposed to cold after birth, they develop:
◆ Metabolic acidosis
◆ Hypoxemia
◆ Hypoglycemia
◆ Increased renal excretion of water &
solutes
➔ Heat production: augmented by increasing
metabolic rate & oxygen consumption in part by
releasing norepinephrine → nonshivering
thermogenesis through oxidation of fat (brown
fat); muscular activity may increase
➔ Hypoglycemic or hypoxic infants: cannot
increase their oxygen consumption when
exposed to cold environment; central
temperature decreases
➔ After labor & vaginal delivery: many infants
have mild to moderate metabolic acidosis →
hyperventilating (response more difficult for
infants w/ CNS depression (asphyxia, drugs) &
infants exposed to cold stress in delivery room)
➔ Reduce heat loss: ensure infants are dried &
either wrapped in blankets or placed w/ mother
or under radiant warmers
➔ Skin-to-skin contact w/ mother: optimal
method of maintaining temperature in stable
newborn
➔ Resuscitative measures on covered infant or one
enclosed in incubator is difficult: radiant heat
source used to warm the baby during
resuscitation