Neonatal Development

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Educational Use Only - Embryology is an educational resource for learning concepts in embryological development, no clinical information is provided and content should not be used for any other purpose.

Introduction

A newborn infant (perinatal period)

For information on parturition see birth.

The neonatal period (birth to 1 month) is a time of extensive and ongoing system transition from uterine environment to external world, this includes the initial period after birth which is referred to as the perinatal period.

It would seem obvious to say that development does not stop at birth. In fact many systems (cardiovascular, respiratory, gastrointestinal, homeostasis) undergo significant changes at birth, and many others (neural) have not yet completed their development. Note this current project focuses on prenatal development, so postnatal content is not as detailed.

Postnatal development can be broadly divided into the age categories of: Neonatal (birth to 1 month), Infancy (1 month to 2 years), Childhood (2 years to puberty), Puberty (12 years to mid-teens) and Young Adult which is a new category (late teens to early twenties).


Postnatal Links: birth | neonatal | neonatal diagnosis | milk | Nutrition | growth charts | Disease School Exclusion | vaccination | puberty | genital


Birth Links: birth | Lecture - Birth | caesarean | preterm birth | birth weight | macrosomia | Birth Statistics | Australian Birth Data | Developmental Origins of Health and Disease (DOHAD) | Neonatal Diagnosis | Apgar test | Guthrie test | neonatal | stillbirth and perinatal death | ICD-10 Perinatal Period | Category:Birth
Historic Birth links  
1921 USA Birth Mortality

Some Recent Findings

NSW Pertussis Notification Graph (2012-16)
NSW Pertussis Notification Graph (2012-16)
  • Metrics of early childhood growth in recent epidemiological research: A scoping review[1] "In 122 studies, we found 40 unique metrics of childhood growth. The most common approach to quantifying growth in length, weight or BMI was the calculation of each child's change in z-score. Label-to-content discordance was common due to distinct content signatures carrying the same label, and because of instances in which the same content signature was assigned multiple different labels. In conclusion, the numerous distinct growth metrics and the lack of specificity in the application of metric labels challenge the integration of data and inferences from studies investigating the determinants or consequences of variations in childhood growth."
    • There has been a recent significant increase in the total number of pertussis (whooping cough) notifications in NSW, Australia.
More recent papers  
Mark Hill.jpg
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This table shows an automated computer PubMed search using the listed sub-heading term.

  • Therefore the list of references do not reflect any editorial selection of material based on content or relevance.
  • References appear in this list based upon the date of the actual page viewing.

References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.

Links: References | Discussion Page | Pubmed Most Recent | Journal Searches


Search term: Neonatal Development

Afaf A Korraa, Maha Youssef, Eman A Almorsy, Hoad A Dosoqui, Amany M ElSaied The Effect of Breast Feeding on T-Lymphocyte Subpopulation. Egypt J Immunol: 2018, 25(1);105-111 PubMed 30243002

Annemarie Stroustrup, Jennifer B Bragg, Stefanie A Busgang, Syam S Andra, Paul Curtin, Emily A Spear, Allan C Just, Manish Arora, Chris Gennings Sources of clinically significant neonatal intensive care unit phthalate exposure. J Expo Sci Environ Epidemiol: 2018; PubMed 30242269

Manuel Blesa, Gemma Sullivan, Devasuda Anblagan, Emma J Telford, Alan J Quigley, Sarah A Sparrow, Ahmed Serag, Scott I Semple, Mark E Bastin, James P Boardman Early breast milk exposure modifies brain connectivity in preterm infants. Neuroimage: 2018; PubMed 30240903

R Douglas Wilson, Aaron B Caughey, Stephen L Wood, George A Macones, Ian J Wrench, Jeffrey Huang, Mikael Norman, Karin Pettersson, William J Fawcett, Medhat M Shalabi, Amy Metcalfe, Leah Gramlich, Gregg Nelson Guidelines for Antenatal and Pre-operative care in Cesarean Delivery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations (Part 1). Am. J. Obstet. Gynecol.: 2018; PubMed 30240657

Nina Makretskaya, Olga Bezlepkina, Anna Kolodkina, Alexey Kiyaev, Evgeny V Vasilyev, Vasily Petrov, Svetlana Kalinenkova, Oleg Malievsky, Ivan I Dedov, Anatoly Tiulpakov High frequency of mutations in 'dyshormonogenesis genes' in severe congenital hypothyroidism. PLoS ONE: 2018, 13(9);e0204323 PubMed 30240412

Head Circumference

Along with weight, Guthrie test, and other diagnostic measurements of the neonate are a number of size measurements including head circumference (OFC, occipital-frontal circumference).


This measurement is generally used an indirect measure of neural development, brain growth, and neural abnormalities, such as hydrocephalus.


The measurement is also an initial indicator of skull size to be compared with later measurements.


Prenatally this measurement can be calculated by ultrasound.


Links: measuring neonatal head circumference

Neonatal - Very Low Birth Weight (VLBW)

VLBW neonates are between 401 to 1500 grams. The table below shows USA (NICHD) data for VLBW infants who survived beyond 3 days and had one or more episodes of blood culture-proven sepsis, the common cause of infection by gram-positive organisms, and the percentage of these resulting from coagulase-negative staphylococci.[2][3]


Years Blood culture-proven sepsis Gram-positive organisms Staphylococci
1991 - 1993 25% 73% 55%
1998 - 2000 21% 70% 48%

Neonatal Jaundice

Neonatal jaundice refers to the yellow colouration of the skin and the sclera (whites of the eyes) that results from accumulation of bilirubin in the skin and mucous membranes. This is associated with a raised level of bilirubin in the circulation, a condition known as hyperbilirubinaemia. About 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breastfed babies are still jaundiced at 1 month of age.[4]

Unmanaged jaundice can lead to neural (brain), and sensory (vision and hearing) damage.[5] Treatment involves frequent feeding, phototherapy, and in severe cases exchange transfusion.


Links: Medline Plus - Newborn jaundice | Neonatal Jaundice, NICE Clinical Guidelines, No. 98

Abnormalities

There are many birth associated abnormalities, only a few examples are listed below. In particular the perinatal period is a time when fetal systems that have either not yet been functional (respiratory, gastrointestinal, neural) or are extensively remodelled (cardiovascular, placental). There are also a number of maternal issues.

The International Classification of Diseases (ICD) has two entire chapters committed to the childbirth and the perinatal period, the major sub-headings are shown below. More detail is available on the chapter pages, Chapter XV Pregnancy Childbirth and Chapter XVI Perinatal Period. The World Health Organization's ICD classification used worldwide as the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems.

Chapter XVI Certain conditions originating in the perinatal period (P00-P96)

Includes conditions that have their origin in the perinatal period even though death or morbidity occurs later.

Excludes congenital malformations, deformations and chromosomal abnormalities (Q00-Q99); endocrine, nutritional and metabolic diseases (E00-E90); injury, poisoning and certain other consequences of external causes (S00-T98); neoplasms (C00-D48); tetanus neonatorum (A33)

Major sub-headings are shown below, select the sub-heading link to see details.


Links: ICD - XVI Perinatal Period | ICD - XV Pregnancy Childbirth | International Classification of Diseases | Human Abnormal Development

Australian Statistics

Australian Perinatal Deaths
Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Rate 10.1 10.4 9.8 9.8 9.9 10.6 9.2 8.8 8.4 9.0
Number 2,534 2,571 2,475 2,480 2,541 2,769 2,459 2,532 2,501 2,671
  • Perinatal deaths are all fetal deaths (at least 20 weeks gestation or at least 400 grams birth weight) plus all neonatal deaths (death of a live born baby within 28 completed days of birth).
  • Perinatal death rates are calculated per 1,000 all births for the calendar year.
  • Source: ABS Births, Australia, 2009 (cat. no. 3301.0); ABS Perinatal Deaths, Australia, 2009 (cat. no. 3304.0).


Links: Stillbirth Perinatal Death | Australian Statistics

Newborn Neural Exam

Neural - The collapsed tables below link to a number of short videos that demonstrate simple assessments of the postnatal developing nervous system.

3 Months Normal Neural Exam Movies

Normal 3 Month Neural Exam Movies
Normal 3 Month Neural Exam Movies

The neuromuscular system can be initially assessed by 6 quick tests (posture, square window, arm recoil, popliteal angle, scarf sign and heel to ear). The following short videos show clinical examination of these assessments and a number of reflexes.

Later developmental assessment includes behaviour, reflexes (primitive and postural), muscular tone, and motor (gross, fine, co-ordination).


3 Months Neural Exam Movies: normal behaviour | cranial nerves | Tone - head and trunk control | upper extremity‎ | hand movements | lower extremity Positions - supine | prone | ventral suspension | vertical suspension | Reflexes - Deep tendon reflexes | Plantar reflex‎ | Root | Moro | Galant | Grasp | Asymmetric tonic neck‎ | Neural Exam Movies | Neonatal Diagnosis

3 Month Behaviour

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 ‎‎Behaviour
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 ‎‎Cranial Nerves
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normal behaviour cranial nerves

3 Month Tone

03mo 03.jpg
 ‎‎Control
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03mo 03.jpg
 ‎‎Tone Upper Limb
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 ‎‎Hand Movements
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 ‎‎Lower Limb
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3 Month Positions

03mo 04.jpg
 ‎‎Supine Position
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 ‎‎Prone Position
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03mo 04.jpg
 ‎‎Ventral Suspension
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03mo 04.jpg
 ‎‎Vertical Suspension
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3 Month Reflexes

03mo 04.jpg
 ‎‎Deep Tendon
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03mo 04.jpg
 ‎‎Plantar Reflex
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03mo 04.jpg
 ‎‎Suck-Root
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03mo 04.jpg
 ‎‎Moro Reflex
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03mo 04.jpg
 ‎‎Galant Reflex
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03mo 04.jpg
 ‎‎Grasp Reflex
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03mo 04.jpg
 ‎‎Neck Tone
Page | Play
3 Months Neural Exam Movies: normal behaviour | cranial nerves | Tone - head and trunk control | upper extremity‎ | hand movements | lower extremity Positions - supine | prone | ventral suspension | vertical suspension | Reflexes - Deep tendon reflexes | Plantar reflex‎ | Root | Moro | Galant | Grasp | Asymmetric tonic neck‎ | Neural Exam Movies | Neonatal Diagnosis
Normal 12 Month Neural Exam Movies  
Normal 12 Month Neural Exam Movies

The following short videos show clinical examination of neural development assessments and a number of reflexes.


12 Months Neural Exam Movies: Shy | Social and Language | Cranial Nerves | Tone - Tone | Reflexes - deep tendon reflexes | plantar reflex‎ | Parachute | Pincer Grasp | Beads in the Cup | Play Ball | Transition in and out of Sitting | Creeping | Stoop and Recover | Motor/Gait - Stand, Walks with Support | Toddler’s Gait | Head Circumference | Neural Exam Movies
Normal 18 Month Neural Exam Movies
Normal 18 Month Neural Exam Movies

The following short videos show clinical examination of neural development assessments and a number of reflexes.


Neural Exam Movies: Wants | Understanding | Points to Pictures | Points to Body Parts | Cranial Nerves Motor/Coordination - Blocks in Cup | Beads in Cup | Stacking Blocks | Pincer Grasp and Handedness | Drawing/Scribbling | Tone | Deep Tendon Reflex | Throwing Ball | Walking
Normal 30 Month Neural Exam Movies  
Normal 30 Month Neural Exam Movies

The following short videos show clinical examination of neural development assessments and a number of reflexes.


Neural Exam Movies: Establishing Relationship | Follows Commands | Points to Pictures | Names Pictures | Response to Questions | Pointing to and Naming Body Parts | Motor/Coordination - Using Puppets | Using Measuring Tape | Block Tower | Drawing | Tone | Deep Tendon Reflex | Kicking and Throwing a Ball | Walking, Running


Links: Neural Exam Movies

Postnatal Endocrine

Pituitary

Postnatal thyrotropin levels graph.jpg

Postnatal thyrotropin (TSH) levels[6]

Thyroid

Postnatal free T4 levels graph.jpg

Postnatal freeT4 (fT4) levels[6]

Childhood Disease

There are many different diseases that can impact on postnatal development, the most serious of which result in death. In developing countries the most common infectious diseases include acute otitis media, pharyngitis and gastroenteritis. Some postnatal diseases may also have different outcomes dependent upon availability of medical support, though even in developed countries other factors can also impact on outcomes.

For example, a recent British Medical Journal (BMJ 25 June 2005) article "Outcome of meningococcal disease in children" identified in this UK study (of 498 children) three independent factors associated with an increased risk of death: not being cared for by a paediatrician, junior staff working with not enough supervision, and failure of staff to administer adequate inotropes.

Gastroenteritis

Rotavirus (CDC)

(acute infectious enteritis) Occurs in children and is generally viral (rotavirus) rather than bacterial.[7] By 5 years of age, nearly every child worldwide will have had at least one episode of rotavirus gastroenteritis.

Rotavirus

  • Non-enveloped, icosahedral virus of the Reoviridae family containing a genome of 11 segments of double stranded RNA (dsRNA).
  • Divided into seven serotypes (Rotavirus A–G).
  • Replicates in mature enterocytes of the small intestine.

Worldwide each year it is estimated:[8]

  • 100 million episodes of gastroenteritis
  • results in 25 million clinic visits
  • 2 million hospitalizations
  • more than 611,000 deaths in children below 5 years of age.
  • children in developing countries account for 82% of rotavirus deaths.


Meningococcal disease

(meningitis) Is a viral or bacterial infection of cerebrospinal fluid of the spinal cord and brain. Treatment and outcomes differ for either viral (less severe, resolves without specific treatment) or bacterial (severe, may result in brain damage, hearing loss, or learning disability) infections. For bacterial meningitis, determining the type of bacteria is important because antibiotics can prevent some types from spreading and infecting other people. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis, but new vaccines being given to all children as part of their routine immunizations have reduced the occurrence of invasive disease due to H. influenzae. Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes of bacterial meningitis. (text modifed from CDC information - More? CDC - meningococcal disease | technical information)


Dysentry

Can be a substantial cause of death in newborn and young children in developing countries, it is a condition occurring sporadically in developed countries. Dysentery may be simply defined as diarrhoea containing blood. Although several organisms can cause dysentery, Shigella are the most important. Shigella dysenteriae type 1 (Sd1), also known as the Shiga bacillus, is the most virulent of the four serogroups of Shigella. Sd1 is the only cause of epidemic dysentery. In addition to bloody diarrhoea, the illness caused by Sd1 often includes abdominal cramps, fever and rectal pain. Less frequent complications of infection with Sd1 include sepsis, seizures, renal failure and the haemolytic uraemic syndrome. Approximately 5-15% of Sd1 cases are fatal. (from a WHO Factsheet on dysentry)


Links: vaccination | Rotavirus

References

  1. Leung M, Perumal N, Mesfin E, Krishna A, Yang S, Johnson W, Bassani DG & Roth DE. (2018). Metrics of early childhood growth in recent epidemiological research: A scoping review. PLoS ONE , 13, e0194565. PMID: 29558499 DOI.
  2. Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, Fanaroff AA, Lemons JA, Donovan EF, Oh W, Stevenson DK, Ehrenkranz RA, Papile LA, Verter J & Wright LL. (1996). Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J. Pediatr. , 129, 63-71. PMID: 8757564
  3. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, Lemons JA, Donovan EF, Stark AR, Tyson JE, Oh W, Bauer CR, Korones SB, Shankaran S, Laptook AR, Stevenson DK, Papile LA & Poole WK. (2002). Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics , 110, 285-91. PMID: 12165580
  4. National Collaborating Centre for Women's and Children's Health (UK). Neonatal Jaundice. London: RCOG Press; 2010 May. (NICE Clinical Guidelines, No. 98.) Bookshelf NBK65119
  5. Ip S, Chung M, Trikalinos T, et al. Screening for Bilirubin Encephalopathy [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2009 Oct. (Evidence Syntheses, No. 72.) Bookshelf NBK34036
  6. 6.0 6.1 . (). . , , . PMID: 219036169
  7. Koletzko S & Osterrieder S. (2009). Acute infectious diarrhea in children. Dtsch Arztebl Int , 106, 539-47; quiz 548. PMID: 19738921 DOI.
  8. Parashar UD, Gibson CJ, Bresee JS & Glass RI. (2006). Rotavirus and severe childhood diarrhea. Emerging Infect. Dis. , 12, 304-6. PMID: 16494759 DOI.

NCBI Bookshelf

The NCBI Bookshelf contains a number of complete online publications that relate to neonatal development. Of particular interest, is the new resource "Disease Control Priorities in Developing Countries", which talks to important neonatal health issues in these countries.

Health Services/Technology Assessment Text (HSTAT) Bethesda (MD): National Library of Medicine (US), 2003 Oct.

Old Links (search book shelf with text)

Disease Control Priorities in Developing Countries (2nd ed.) Dean T. Jamison, Joel G. Breman, Anthony R. Measham, George Alleyne, Mariam Claeson, David B. Evans, Prabhat Jha, Anne Mills, Philip Musgrove, editors Washington (DC): IBRD/The World Bank and Oxford University Press; 2006

  • Newborn Survival
  • Maternal and Perinatal Conditions
  • Vaccine-preventable Diseases
    • "Vaccines that prevent measles, tuberculosis, diphtheria, pertussis, Hib, and Neisseria meningitis prevent respiratory diseases.
    • Vaccines against measles and pertussis, prevent diseases that cause or contribute to malnutrition.
    • New vaccines, Streptococcus pneumoniae, influenza, typhoid fever, and rotavirus.
    • Vaccines to prevent mumps and varicella that are routinely used in some developed countries are not included in most vaccination programs in developing countries.
    • Clean umbilical cord care to reduce the incidence of neonatal tetanus, vitamin A therapy to reduce the case-fatality rate (CFR) from measles."

Basic Neurochemistry, Molecular, Cellular, and Medical Aspects (6th ed.) Siegal, George J.; Agranoff, Bernard W.; Albers, R. Wayne; Fisher, Stephen K.; Uhler, Michael D., editors. Philadelphia: Lippincott, Williams & Wilkins; c1999.

Old Links (search book shelf with text)

"Hypothyroidism increases synaptic density, at least transiently. Interesting parallels with synapse formation are reported for learning behavior in rats; neonatal hypothyroidism impairs learning ability, whereas hyperthyroidism accelerates learning initially, followed by a decline later in life"

Type II glutaric aciduria

"The outlook is almost uniformly fatal, and the few babies who survive have severely compromised development and a cardiomyopathy that usually proves fatal. In rare cases, a patient stays asymptomatic until after the neonatal period, when hepatomegaly, vomiting, metabolic acidosis, hypoglycemia and a proximal myopathy become evident."

brain utilizes ketones in states of ketosis

"Significant utilization of ketone bodies by the brain is, however, normal in the neonatal period. The newborn infant tends to be hypoglycemic but becomes ketotic when it begins to nurse because of the high fat content of the mother's milk. When weaned onto the normal, relatively high-carbohydrate diet, the ketosis and cerebral ketone utilization disappear."

Reviews

Articles

Search Pubmed

April 2010

  • neonatal development - All (63838) Review (9418) Free Full Text (10937)

Search Pubmed Now: perinatal development | neonatal development

External Links

External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name. Links to any external commercial sites are provided for information purposes only and should never be considered an endorsement. UNSW Embryology is provided as an educational resource with no clinical information or commercial affiliation.

Australian Information

American Information

Terms

Neonatal Terms  
(draft list - notice removed when complete)
  • Apgar test - neonatal test used in nearly all maternity clinics to assess the newborn infants well being assigned scores for each of 5 indicators: Heart Rate, Respiratory Effort, Reflex Irritability, Muscle Tone, Colour.
  • Automated Auditory Brainstem Response - (AABR) neonatal hearing test that uses a trigger stimulus delivered through earphones and subsequent brain electrical activity then detected by scalp electrodes, averaging generates peaks reflecting signal passage activity through brain stem nuclei in the hearing central neural pathway.
  • Babinski reflex - (plantar reflex) The up going toes or “Babinski reflex” is a normal reflex in the infant and may be present for the first year of life because at that developmental stage the incomplete myelination of the corticospinal tracts. Also found in a number of developmental and adult neural disorders.
  • birth weight - (birth-weight) the weight of the neonate measured as soon as possible after birth. The measurement can be indicative of a number of developmental abnormalities. DOHAD
  • congenital hypothyroidism - (CH) Neonates born with this disorder typically have a normal appearance and no detectable physical signs. Thyroid hormone is required for normal postnatal neural (cognitive) development with newborn screening and thyroid therapy able to be begun within 2 weeks of birth. thyroid
  • Guthrie test - neonatal blood screening test detecting markers for a variety of known disorders (phenylketonuria (PKU), hypothyroidism and cystic fibrosis).
  • maple syrup urine disease - (MSUD) metabolic disorder, clinical features include mental and physical retardation, feeding problems, and a maple syrup odor to the urine. The urine effects are due to the presence of keto acids of the branched-chain amino acids (branched-chain keto acid dehydrogenase enzyme subunits).
  • Medium-Chain Acyl-CoA Dehydrogenase Deficiency - (MCAD) metabolic disorder, most common inherited disorder of mitochondrial fatty acid oxidation in people from northern Europe, intolerance to prolonged fasting and an inability to generate energy during periods of increased energy demand and can be severe to fatal in infants.
Other Terms Lists  
Terms Lists: ART | Birth | Bone | Cardiovascular | Cell Division | Endocrine | Gastrointestinal | Genetic | Head | Hearing | Heart | Immune | Integumentary | NeonatalNeural | Oocyte | Palate | Placenta | Radiation | Renal | Respiratory | Spermatozoa | Statistics | Ultrasound | Vision | Historic | Drugs | Glossary


Glossary Links

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Cite this page: Hill, M.A. (2018, September 24) Embryology Neonatal Development. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Neonatal_Development

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© Dr Mark Hill 2018, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G