THE NEONATE

What the neonate is like. (A neonate is a baby less than four weeks old)

The average mass of white Anglo-Saxon babies is between 2,7 kg and 3,8 kg, with boys being slightly heavier. African and Asian babies tend to be lighter on average. Factors such as the nutrition and age of the mother, as well as her size and the fathers, affect birth mass. Your smoking more than 10 cigarettes a day and prematurity result in a lighter baby, while certain conditions like pre-diabetes or uncontrolled diabetes usually mean a very heavy baby [over 4,5 kg). Infants that are born at term (a full 40 weeks) but are much smaller than average are known as small-for-dates babies.

During the first three days of life babies usually lose mass. This is due to the passing of meconium (dark sticky stools which contain waste matter accumulated before birth) and the fact that they do not take sufficient feeds to meet their full requirements. From the fourth day there is usually a gradual increase and the child should regain her birth mass between the end of the first week and the beginning of the third week. Breast fed babies lose more mass because the flow of milk is inadequate in the first few days, but they usually catch up by the sixth day, unless they have not been demand fed.

The newborn baby is not always attractive, especially if forceps have been used or labour has been difficult. Babies born by Caesarean section are usually better looking as there is no moulding of the head or bruising in the birth process, however, in a week or two there should be little difference.

Cord. The umbilical cord by which the baby has been joined to the placenta is clamped and cut at birth. Eventually the stump dries and falls off, leaving the navel. By the time the mother leaves the nursing home after seven days, the stump has usually come away. If not, dab the base with a piece of sterile cotton wool or cotton bud dipped in surgical or methylated spirits. If the area is damp, red, discharging, or has a bad smell, a doctor must be seen immediately as it could be infected.

Eyes. At birth all babies have slate blue eyes until they gradually change to their permanent colour between three and six months. After about four weeks of life she should be able to follow a bright light with her eyes, and watch a patterned object that is not too big or too small and contrasts well with the background. More specifically, a brightly patterned disc between 18 cm and 36 cm wide, held between 20 cm and 35 cm away from her face moving from left to right at a speed of 30 cm per second should attract her attention. The human face fits these specifications perfectly, thus your baby is genetically primed to respond to you from the earliest weeks. It is important that the child practises focusing, and a mobile hung over the cot can provide entertainment as well as visual stimulation. See p. 140 for sketch and instructions.

Young babies cannot tolerate bright light, so dont put her where she will be staring into a light source like a window, or she will close her eyes. In the first few months babies are inclined to squint when focusing because they have not perfected the ability to co-ordinate their eyes so-that they work simultaneously. If this tendency persists beyond the fourth month a specialist should be seen. Occasionally the epicanthic folds in the inner corner of the eyes make it seem as if the child is squinting, but it is nevertheless important that she be examined. In the first month babies do not cry tears, but a blocked tear duct can result in a discharge and excessive watering. Red spots may appear in the eye from pressure during birth but will disappear in time.

Fontanelles. These are four areas on a babys skull at the top, sides and back which are not covered by bone but by a tough membrane. The fontanelles at the temples and behind the ears disappear after 14 days, while the one at the back of the head should disappear at two to three months. The anterior fontanelle which is at the top of the head closes between the ages of six and 18 months. Most mothers notice the anterior fontanelle because the area is soft and the pulse can sometimes be seen beating through the skin. This can be frightening, but there is no danger of hurting the baby when washing her hair. A bulging fontanelle, however, is a danger sign and could mean that fluid is causing pressure inside the skull; while a sunken fontanelle after vomiting and diarrhoea is a sign of dehydration and should be regarded as an emergency. The fontanelle is normally slightly sunken, anyway, so it is only when it becomes more so, and is associated with the symptoms above, that it need cause alarm.

A babys Length The average length of the newborn baby is 52 cm and is doubled by the age of five years.