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What is normal

Newborn Care

Babies: A loud noise at one end and no sense
of responsibility at the other

The newborn baby weights 2500g to 4000g and measures 45 to 56 cm in length with head circumference of 33 to 36 cm. The average boy weight 250 g more than the average girl. The term or mature baby is one born between 37 and 42 weeks of gestation. During the first 3-5 days, the baby loses up to 10 per cent of the birth weight and regains it by the eighth of twelfth day. Although size at birth bears some correlation with future height and weight, exact prediction cannot be made.

The head at birth may have an oblong shape depending on the mode of delivery and consists of relatively soft tissue. These joints may be prominent, which is normal. There is a diamond-shaped soft depression at the centre of the head (anterior fontanelle) which closes completely by the age of 18 months. There is an unexplained tendency of some infants to prefer lying on one  side leading to flattening of that side. It increases to a maximum towards the ninth month, after which it becomes symmetrical in two years.

The mature newborn can see up to a distance of 25cm (10 inches) from the first day of life and can consistently follow moving objects by six weeks of age. Sub-Conjunctival hemorrhage is bright red ring around the black portion. It is not of serious significance and disappears in two to three weeks.

Round, thickened areas are often present at the midline of the upper lip and are known as sucking blisters. Epithelial pearls are small white areas present at the roof if the mouth. They are of no significance. True tongue tie is uncommon. If it leads to limitation of movement or sucking, it should be treated with minor surgical incision.  Eruption of one or more teeth before or soon after birth occurs once in 2000 births. If the tooth is loose or interferes with feeding it should be removed.

Skin colour varies widely and depends on the state of circulation of blood. It is pink while asleep and deep red when crying. In the first 48 hours, blueness of hands and feet is very common. It can be an indication that the baby has not been kept warm enough. At birth there can be protective cheesy covering over the skin called vernix caseosa. If not wiped away it comes off by itself within three to four days. Superficial peeling of skin is common in the first week especially in babies born beyond the due date. Oil massage helps. There can be fine facial and body hair called lanugo. They are gradually lost during the first month. Scalp hair is also gradually lost till five months of age after which a fresh crop appears.

Jaundice is the yellow coloration of skin and white of the eye. Normal (physiological) jaundice appears in 60 to 70 per cent of all newborns. It is first seen after 48 house and disappears within 10 to 14 days. However, if in doubt a bilirubin test should be done and values above 12 mg/dl should be taken seriously.

Milia are whitish pin-head-sized spots mainly on and around the nose. They disappear in a few weeks. A bluish black coloration of the skin is often present at the back and buttocks. They are called Mongolian patches and disappear by one year. Erythema toxicum is a common newborn red rash appearing after the second day. Although alarming in appearance, it is harmless and disappears in a few days. Breast engorgement in newborns due to hormonal imbalance is common after the third day. It should not be squeezed or massaged as it subsides by itself in 15 to 30 days.

The newborn shows a few reflex responses which are normal. Grasp reflex is the strong grip by which babies hold on to you when you offer your finger. The tight grip disappears after a few days although they can hold on to objects lightly. The newborn makes a stepping response when held upright on a flat surface. This also disappears after a few weeks. If the child is born around the due date, there is a good sucking reflex. Gently touch at the corner of the mouth and the baby moves the head in that direction and starts sucking.

For the first few days, the baby passes tarry black coloured stools called meconium. After the third day they become yellow and watery for a day (transitional stools) and then settle to a routine of two to eight semi-solid, pasty stools per day. The stools are usually during or soon after a feed. He will pass newborn’s urine 15 to 20 times in a day, indicate that he has diabetes. Newborn may commonly sneeze many times in a day. In case of a nasal block normal saline drops can instilled in the baby’s nostrils. The nails of a newborn grow very fast and have to be filed or cut every third or fourth day. Some newborn develop a protrusion at the umbilicus which is called umbilical hernia. This regresses by itself by one year of age, and it if does not, then a minor surgery may be required.

The baby arrives and the world
is turned upside down.
How utterly irrelevant are things that
Yesterday seemed vitally important.
This new life outweighs them all.

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