If both the mother and the father actively involved in the birthing process, both can easily get used to the new tasks of parenting.
To avoid cross-infection, hand-washing for hospital staff is imperative. If both the mother and the father actively involved in the birthing process, both can easily get used to the new tasks of parenting. First hours of life immediately after birth should be investigated respiration, heart rate, skin color, muscle tone and reflexes of the newborn. From these it is the so-called. APGAR number after 1 and 5 min after the birth is determined result. (.. Editor’s note .: In Germany, the APGAR number after 1, 5 and 10 rated ‘is the APGAR numbers at 5 and 10 min correlated most closely with the prognosis of the child after birth complications) (see Table : Apgar number). A APGAR number of 8 to 10 reflects an unobtrusive transition to extrauterine life, a value of ? 7 after 5 min (v. A., If it continues up to the 10th minute) is associated with increased neonatal morbidity and mortality. Many normal newborns show after one minute even cyanosis, but which then lost to the 5th minute. A continuing cyanosis may indicate a congenital heart defect or caused by the central nervous system, respiratory depression. In addition to APGAR number newborns need for external abnormalities (eg. As clubfoot, Polydactyly), and other disorders such as heart sounds are examined. Ideally, the study should be carried out under a radiant heat source close to the family. As prevention of gonococcal and chlamydial infections of the eye antimicrobial substances (for example: 0.5% 1 cm Erythromycinsalbe, 1 cm 1% Tetracyclinsalbe, 2 drops of 1% Silbernitlösung; in some Lländern 2.5% povidone iodine. drops) are used. In addition, the administration of 1 mg of vitamin K occurs i.m. to prevent hemorrhagic complications of the newborn. (N. D. Talk .: In Germany eyes prophylaxis with antimicrobials usually in newborns whose mothers have gone regularly for prenatal care, no longer carried out. Vitamin K is in Germany usually at a dose of 2 mg po for U1, U2 and U3 screening administered.) the mixture is then bathed the newborn, wrapped and taken to his family. The head should be covered with a cap to prevent heat loss. In order for the family to know how to deal with the infant and can get good advice and guidance from midwives and nurses, we recommend a rooming-in and especially early breastfeeding. The likelihood that breastfeeding can be successfully carried out, the larger, more regular family assistance offered. First days of life Physical Examination A thorough physical examination should be performed within 24 hours. It is advantageous to carry out this investigation in the presence of the mother and other family members because so questions can be asked and the doctor can explain the examination findings and give valuable advice. The basic measurements include the body length, body weight and head circumference (Physical growth of infants and children). The body length is measured from top to bottom; The values ??should be entered on a percentile curve and compared with the standard values ??that depend on the gestational age. If the gestational age is not safe or the newborn seems too large or too small for the presumed age, gestational age can be precisely determined on the basis of physical and neuromuscular findings (assessment of the duration of pregnancy – new Ballard score). This method is accurate to ± 2 weeks. Assessment of the duration of pregnancy – To obtain the total value of new Ballard score values ??from the neuromuscular and physical areas are added. (Adapted from Ballard JL, Khoury JC, Wedig K, et al: New Ballard score, expanded to include extremely premature infants The Journal of Pediatrics 119 (3): 417-423, 1991; with permission of CV Mosby Company.). Many doctors start with an examination of the heart and lungs, followed by a systematic examination from head to toe, with special attention to signs of birth trauma and congenital malformations wird.Kardiorespiratorisches System The heart and lungs are then judged if the child is calm , First, it is identified at which the heart sounds are loudest (a Dextrokardie excluded). Heart rate (normal: 100-160 beats / min) and rhythm are examined. The rhythm should be regular, although are not rare by premature atrial or ventricular excitations outgoing arrhythmias. A auskultierbares within the first 24 h systolic is generally obtained through the still open ductus arteriosus (PDA, patent ductus arteriosus) gives. The disappearance of the PDA noise can be confirmed usually within the first three days of life through daily auscultation. The strips pulses (femoral pulses) are examined and compared with the pulses of the brachial artery. A weak or delayed femoral pulse leaves a coarctation of the aorta (coarctation) or stenosis of the left ventricular outflow tract suspect. Is a central cyanosis before, the suspected heart failure, pulmonary disease or sepsis. The assessment of the respiratory system by counting the respiratory rate over a full minute, as the breathing of newborns is irregular; the normal breathing rate is between 40-60 breaths / min. On examination of the chest is taken of the symmetry, the sound of breathing should be uniform everywhere. Groans, fluttering nostrils and recoveries are signs of Dyspnoe.Kopf and neck For delivery from the apex position of the head is usually deformed. The skull bones overlap at the seams, also found mostly some swelling and ecchymosis of the scalp (caput succedaneum). When delivery from the breech deformation of the head is less pronounced; the swelling and ecchymosis occurs (buttocks, genitals or feet z. B.) at the preceding part of the body. The fontanels vary in diameter between a width of a fingertip to a few centimeters. A large anterior fontanelle may be a sign of hypothyroidism. Often there is a Cephalhematoma, a collection of blood between the periosteum and bone which can be occasionally occipital find both one and more than two parietal bones,. There may be a swelling occur, but does not exceed the cranial sutures. Kephalhämatome usually are not noticed before the soft tissue edema disappear and go back slowly over several months. Head size and shape are analyzed to detect a congenital hydrocephalus. Many genetic syndromes cause craniofacial abnormalities (congenital craniofacial malformations). The face is on symmetry and normal training, particularly of the lower jaw, palate, the ear cups and the external auditory canals were examined. The eyes can often the day after the birth to be better assessed, as the birth process can cause swelling around the eyelids. In examining the eyes of the red fundus reflex is examined; an absence may indicate glaucoma, cataract or retinoblastoma. A subconjunctival hemorrhage may have been caused by a forceps. A low base of the ear may indicate genetic abnormalities on a trisomy 21 (Down syndrome). Abnormalities of the ear, external auditory canals or both are given in many genetic syndromes. Care must be taken on ear tags and depressions also, as they may be related to deafness or kidney malformations sometimes. The physician should palpate the palate to exclude also malformations of the soft and hard palate. Facial clefts are among the most common congenital defects. Some newborns come with a gingival tumor (epulis) to the world, a benign hamartoma of the gums, which may result in a corresponding size to drinking or feeding difficulties and obstruct the airway. These lesions can be removed permanently. Some newborns come with primary and already visible teeth to the world. At birth, existing teeth do not have roots and may need to be removed because they fall out and can be aspirated. The hard palate can inclusion cysts, also called Epstein pearls are found. In the examination of the neck the chin must be raised in order to detect abnormalities such as cystic hygroma, a goiter or Kiemenbogen residues. A torticollis (torticollis), by a hematoma of the sternocleidomastoid as a result of birth trauma entstehen.Bauchraum and pelvis The abdomen should be round and symmetrical. A boat-shaped recovery of the abdominal wall may indicate a diaphragmatic hernia, through which can move in the chest in utero abdominal organs, which can lead to pulmonary hypoplasia and postnatal respiratory distress. An abdominal asymmetry may indicate a mass. Splenomegaly indicates a congenital infection or hemolytic anemia. The kidneys may be palpable, left rather than right at deep palpation. Large kidneys may be an indication of an obstruction, tumors or cysts in the urinary tract. The liver can normally be palpated 1-2 cm below the ribs. An umbilical hernia, caused by too weak training of umbilical ring muscles that often occurs but is rarely of clinical significance. A normal set, of exposed anus should be confirmed. In boys, the penis to a hypo- or epispadias needs to be investigated. In mature male newborn both testicles should be in the scrotum. A scrotal swelling may be caused by a torsion by a hydrocele, inguinal hernia (inguinal hernia) or, less commonly. A typical sign of the hydrocele is the positive diaphanoscopy. Sign a twist, which is a surgical emergency, are bruising and a firmer palpation. In mature female newborns, the labia are prominent. Mucous and bloody sero-vaginal secretions (Pseudo menses) are normal; they are caused by the child in utero exposure to maternal hormones and transferred the obstetric withdrawal. A small appendage hymenalen tissue at the posterior Fourchette, which is attributed to stimulation by maternal hormones is occasionally found, but disappears within a few weeks. Ambiguous genitalia (Intersexuality) may indicate a number of rare diseases (e.g., congenital adrenal hyperplasia;. 5?-reductase deficiency, Klinefelter’s, Turner’s or Swyer syndrome). A referral to an endocrinologist for evaluation and a discussion with the family about the benefits and risks of immediate or delayed gender assignment is angezeigt.Muskel-skeletal system, the extremities are examined for malformations, amputations (incomplete or missing limbs), contractures and aberrations , A brachial nerve paralysis due to a birth trauma can thus be noticeable that the arm movement is limited on the affected side or can not be performed spontaneously. Sometimes adduction and internal rotation of the shoulder and pronation of the forearm is added. The spine is examined for signs of spina bifida, and in particular, exposure of the meninges, spinal cord, or both (meningomyelocele). An orthopedic examination involves palpation of the long bones to birth trauma (particularly, a clavicle fracture), but is directed in the main to the detection of a dysplasia. Risk factors hierür are female gender, birth of breech presentation, twin pregnancy and a positive family history. The Barlow and Ortolani tests are used to rule out dysplasia. These tests must be performed when the baby is quiet. The position is the same for both: the newborn will be placed on the back, hips and knees turned 90 ° (the feet are not on the base). The feet are turned towards the doctor who puts his index finger on the greater trochanter and his thumb on the lesser trochanter. For the Barlow test, the doctor draws on the hip, the knee is pulled over the body while the thighs is pushed backwards. A clacking noise indicates that the head of the femur has moved out of the joint socket; the Ortolani test pushes it back then and confirms the diagnosis. For the Ortolani test the hip is moved back to the starting position. Then the tested hip is abducted. Here, the knee of the center line is moved away in the direction of the treatment table, so that there is a frog leg position. Now the hip is gently pulled forward. A palpable click the femoral head in abduction suggests a movement of the already dislocated femoral head in the acetabulum and is considered as a positive sign for the presence of hip dysplasia. (Ed. Note. D .: In Germany usually paid since the introduction of ultrasound screening for developmental disorders in the sixth week of life at baseline to a Abspreizhemmung and Pofaltenasymmetrien. The Ortolani test can result in improper conduct damage.) The maneuver may be false negative in children> 3 months because the hip muscles and belts tighter. Some experts recommend the hip sonography at this age for all children with risk factors. If the finding is unclear or even if a high risk (eg. As girls after birth from breech position), aged 4-6 weeks, a hip sonography erfolgen.Neurologisches system should the newborn the tone, the level of attention that are movement of the extremities, and the reflexes evaluated. Typically, the neonatal reflexes, including Moro, suction and rooting reflex, triggered. Moro reflex: The reaction of the newborn for a shock can be triggered by the support and sudden release by gently lifting the arms. The newborn stretched then arms and fingers, flexes the hips and starts to cry. Rooting reflex: causes a stroking the cheek or the lateral lips that the infant turns his head to the side of the contact and opens his mouth. Sucking reflex: A pacifier or a gloved finger is used to trigger this reflex. These reflexes are some months yet, and there are signs for a normal development of the peripheral Nervensystems.Haut The skin of the newborn is usually rosy; but cyanosis of fingers and toes in the first hours of life is not uncommon. The vernix caseosa (so-called. Vernix) covers most newborns with a gestational age of> 24 weeks. Dry and scaly skin often show up in the first few days, v. a. in the folds of skin on wrists and ankles. At the points that have been traumatized during childbirth, to petechiae can show as such. As the face, unless it was the previous body part; in generalized petechiae but thrombocytopenia must be excluded. Many newborns have erythema toxicum newborn, a benign erythema with whitish or yellowish papules. The skin symptoms usually appear within the first 24 h, can be found all over the body and can sein.Screening to see up to two weeks the recommendations for newborn screening vary depending on the clinical situation from the peer. Blood typing should be performed if the mother has blood group 0, Rh negative or minor antigens are present as a hemolytic anemia of the newborn is a risk (fetal erythroblastosis). All newborns must be investigated during the hospital stay and before discharge to a hyperbilirubinemia (jaundice). The risk of hyperbilirubinemia based on risk factors and the determination of the bilirubin, or both rated (neonatal hyperbilirubinemia). The bilirubin can both transcutaneous as determined in serum. In many hospitals all newborns be screened to assess the risk of extreme hyperbilirubinemia using a nomogram predictive. The check-ups depend on the time of discharge, the bilirubin level before discharge and the estimated risk of jaundice. In most countries, a newborn screening for certain genetic disorders (Inborn errors of metabolism) is carried out, incl. Phenylketonuria, the Tyrosinaemia, the Biotinidasemangels, homocystinuria, maple syrup disease, galactosemia, congenital adrenal hyperplasia (AGS, Adrenogenital syndrome), sickle cell anemia and hypothyroidism. In some countries (n. D. Talk .: in most federal states in Germany) also tests for cystic fibrosis, disorders of fatty acid oxidation and other organic Azidämien be performed. HIV screening is required only in some countries and is indicated in children whose mothers are HIV-positive or are at high risk for HIV infection beyond. Toxicological screening should be carried out with positive maternal history of drug abuse, unexplained placental abruption or unexplained preterm labor. Even with poor maternal compliance regarding pregnancy checkups or infantile withdrawal symptoms toxicological screening is indicated. Screening for critical congenital heart disease (CCHD) with pulse oximetry is now part of the routine assessment in newborns. So far newborns were screened by prenatal sonography and physical examination on CCHD, but this approach overlooked many cases of CCHD, leading to increased morbidity and mortality. The screening takes place when infants ? 24 days ago and is considered positive if any O2 saturation measurement is <90%. O2 saturation measurements in both the right hand and right foot, <95% are in 3 separate measurements taken at intervals of 1 hour. It in 3 separate measurements taken at intervals of 1 hour, are> 3% absolute difference between the O2 saturation in the right hand (präduktal) and the right foot (postduktal). Each infant with a positive screening should receive further testing, including chest x-ray, ECG and echocardiography. The pediatrician should be notified of the infant and the baby may need to be evaluated by a cardiologist. Checkups hearing vary by country. Hearing loss is one of the most common birth defects. About 3/1000 infants are born with moderate, severe to profound or severe hearing loss. Hearing loss in infants who are admitted at birth in intensive care units, even more common. Currently, some states screen only high-risk newborns (High risk factors for hearing loss in newborns), other screen all. The initial screening is done mostly with a hand-held device, which records the echoes that are submitted by a healthy ear in response to soft clicks (otoacoustic emissions). In an abnormal findings auditory evoked potentials (AEP, auditory brainstem response) can be derived. In some hospitals, this test is conducted primarily as a screening. Further investigation by a pediatric audiologist may be needed. High risk factors for hearing loss in newborns factor peculiarities birth weight <1500 g Apgar value ? 7 at 5 min serum bilirubin> 22 mg / dl (> 376 mol / l) in a newborn with a birth weight> 2000 g. > 17 mg / dl (> 290 .mu.mol / l) in a newborn infant with a birth weight <2000 g. Disorders Perinatal anoxia or hypoxia neonatal sepsis or meningitis Craniofacial Abnormalities seizures or apneic states Congenital Infections Rubella Syphilis Herpes simplex infection cytomegalovirus toxoplasmosis exposure of the mother aminoglycosides family history Early hearing loss of a parent or a close relative Regular care and observation newborns, once the body temperature about 2 h at 37 ° C has stabilized, are bathed (on request of the parents). The umbilical cord clamp can be removed when the umbilical cord appears dry, h mostly after about 24 hours. Umbilical Cord Care aims the risk of navel infection (omphalitis) to reduce. The umbilical cord rest should be kept dry and clean; further care depends on the particular circumstances of birth. In a maternity hospital (or properly managed home birth), in which is clamped off the cord and aseptically cut off, a dry cord care or cleaning with soap and water is sufficient; topical agents do not reduce the risk of infection. If the string does not aseptically disconnected and / or cut is (z. B. in some developing countries, not properly managed childbirth outside the hospital), the use of a topical antiseptic (eg. As chlorhexidine) on the cord reduces the risk of omphalitis and infant mortality. The umbilical cord should be examined daily for redness and secretions. Circumcision, if desired by the family, be performed safely under local anesthesia during the first days of life. Circumcision should be delayed if the mother anticoagulants or acetylsalicylic acid has taken if a family history of bleeding disorders is present or if the newborn has been a shift of the urethra, hypospadias or other damage to the penis or penis (because the foreskin later in the plastic- can be used surgical repair). Circumcision should not be performed when the baby is suffering from haemophilia or other bleeding disorders. Most newborns lose in the first days 5-7% of their birth weight, primarily due to urine and insensible, secondary to meconium, loss of vernix caseosa and drying the umbilical cord. The urine can, the diaper in the first days of life by urate crystals that are physiologically and due to the urine concentration, orange or pink color. Most newborns separate the first urine within 24 hours after birth of, usually after 7-9 h. In the second 24 hours is then excreted urine at least twice. A delayed onset of micturition is given to newborns frequent and possibly due to a tight foreskin; the inability to urination may indicate posterior urethral valves. A circumcision should be performed at the earliest after the first micturition; when no voiding occurs within the first 12 h after the circumcision, this may indicate a complication. If it is deposited within the first 24 h no meconium, a clarification other malformations such as anal atresia, megacolon congenitum (Hirschsprung's disease) and also to a cystic fibrosis, which can cause a meconium ileus, contemplated werden.Entlassung from the hospital newborns, the inside should be released for the first 48 h, should have a check-up, so that the drinking behavior (breast or bottle), the growth, the hydration and the degree of jaundice (especially at risk constellation) can be assessed after 2-3 days. The follow-ups for newborns depend on the presence of risk factors, incl. Those for jaundice and for breastfeeding problems and any identified problems.