growth and development: newborn assessment and reflexes/postural reactions

APGAR score

assesses the status of the newborn to show if immediate care is needed

1 and 5 minutes after birth

when is the APGAR score reported

reported again at 10, 15, and 20 minutes

if an APGAR score of 7 or greater is not achieved at 1 or 5 minutes, what happens

grimace response, appearance/color, respiration, pulse, activity/muscle tone

what are the APGAR score signs

4-6

what is a moderately abnormal APGAR score

0-3

what is a critically low APGAR score

greater than 4000g/ 8.8lbs

what is classified as high birth weight

less than 2500g/ 5.5lbs

what is classified as low birth rate

less than 1500g/ 3.3lb

what is classified as very low birth rate

less than 1000g/ 2.2lb

what is classified as extremely low birth rate

weight, length, and head circumference

what are the growth measures based on

10th to 90th percentile

what is the normal growth measure appropriate for gestational age

smoking, malnutrition, drug use

what typically causes small for gestational age (SGA)

gestational diabetes and post-term infants

what typically causes large for gestational age (LGA)

before 37 weeks

what is classified as GA preterm

37 weeks through 38 weeks and 6 days

what is classified as GA early term

39 weeks through 40 weeks and 6 days

what is classified as GA full term

41 weeks through 41 weeks and 6 days

what is classified as GA late term

42 weeks and beyond

what is classified as GA post-term

gestational age

time between the first day of the last menstrual period and the day of delivery

chronological age

time since birth

postmenstrual age

gestational age + chronological age

corrected age

age of the child from the expected date of delivery

if the baby is not past their predicted due date yet

when is corrected age not appropriate

day of assessment- birthdate

how do you calculate chronological age

2 years old

how long do you typically correct the age regardless of the amount of prematurity

chronological age- weeks preterm

how do you calculate corrected age

48

how many weeks are in 12 months

posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear

what does the neuromuscular maturity of the New Ballard Score measure

skin, lanugo, ear, breast, genital development

what does the physical maturity of the New Ballard Score measure

primitive reflexes

reflexes that help the fetus to survive and promotes human development

postural reactions

reflexes that are more mature than primitive; include righting, protective, and equilibrium reactions

righting reactions

keeps head upright and in a vertical position

protective reactions

prevent injury

equilibrium reactions

most mature reactions and help maintain balance

brainstem and spinal cord

where do the primitive reflexes come from

midbrain and cortex

where do the postural reactions come from

plantar grasp and STNR

which two primitive reflexes are integrated after 6 months

9 months

when is plantar grasp integrated

8-12 months

when is STNR integrated

abnormal functioning of the nervous system

if there is a failure to appear of a reflex at the appropriate age or persistance beyond a certain age, what does it imply

primitive

what type of reflex is the rooting reflex

infant turns head toward the side that is being stimulated and opens mouth

what is a positive sign for the rooting reflex

place child in supine with head in midling and gently stroke infant from lips to cheek

how do you stimulate the rooting reflex

infant in supine with head in midline and place a finger into the infant’s mouth

how do you stimulate the suck-swallow reflex

infant begins to suck on the finger and try to swallow

what is a positive sign for the suck-swallow reflex

infant is supine with head supported in midline, halfway between supine and sitting, and allow the neck to drop to quickly stretch neck muscles before catching again

how do you stimulate the moro reflex

arm abduction and extension in elbows, wrists, and fingers

what is the positive sign for the moro reflex

place child in supine with head un midline and the legs relaxed before applying firm pressure to the plantar surface of the foot

how do you stimulate the plantar grasp reflex

toe flexion

what is the positive sign for plantar grasp

infant lies prone and gently stimulate along the paravertebral area from C7 area to buttocks (or backwards)

how do you stimulate the galant reflex

pelvic tilt to the side of stimulation

what is the positive response for the galant reflex

infant placed in supine with head in midline and turn the infant’s head to one side

how do you stimulate the neonatal neck righting (NOB)

whole body moves in the direction of the neck at once (log rolling)

what is the positive response for the primitive/immature portion of neonatal neck righting (NOB)

twisting starts at arms and then the legs follow- segmental rolling

what is the mature response to neonatal neck righting (NOB) that makes it a righting reaction

supine with head in midline and flex one limb over the chest and rotate limb across the body

how do you stimulate the neonatal body righting (BOB)

support infant in vertical position and allow feet to make firm contact with the floor or table

how do you stimulate the positive support reflex

co-contraction of flexors and extensors in the legs to attempt support

what is the positive response for the positive support reflex

support infant in vertical position and have feet touch a hard surface while inclining the infant and gently moving it forward

how do you stimulate the stepping (walking) reflex

step forward

what is the positive response to the stepping/walking reflex

position infant in supine and gently turn the infants head to one side

how do you stimulate the asymmetrical tonic neck reflex (ATNR)

extension of limbs on face side and flexion on skull side

what is the positive response to the asymmetrical tonic neck response (ATNR)

interferes with hands to midline

if the asymmetrical tonic neck reflex persists, what happens

in supine with head in midline, place a finger in infant’s hand from ulnar to palmar surface

how do you stimulate the palmar grasp reflex

finger flexion

what is the positive response to the palmar grasp reflex

have infant in prone or supine with head in midline and evaluate the muscle tone in extremities

how do you stimulate the tonic labyrinthine reflex (TLR)

increased flexor tone in prone and extensor in supine

what is the positive response for the tonic labyrinthine reflex (TLR)

on hands and knees passively flex the head forward and then extend it backwards

how do you stimulate the symmetrical tonic neck reflex *STNR)

the arms follow the head: arms extend and legs flex when head is extended and arms flex and legs extend when head is flexed

what is the positive response for the symmetrical neck reflex (STNR)

righting reaction

secures the head in space by aligning the head and trunk, and trunk and limbs; brings head in upright orientation in space in opposite direction of gravity

equilibrium reactions

maintain balance when center of gravity is disturbed and is more mature than righting reactions; head and trunk counter away from the direction of displacement and there is a use of extremities

moving surface vs steady

how is tilting reactions different from equilibrium reactions

protective reactions

required if equilibrium reactions cannot restore balance to prevent injury and emerge first downward then front, side, and back

when infant is in prone or supine with the chest or shoulders touching the support surface, the head moves in vertical

what is the body righting acting on the head

support the infant in the air by its stomach

how do you test for the landau righting reaction

head extends at the same time as back and the hips

what is the positive reaction for the landau righting reaction