Neonatal Development

Embryology - 1 Dec 2023        Expand to Translate
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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).

Some Recent Findings

NSW Pertussis Notification Graph (2012-16)

Distinct locomotor precursors in newborn babies "It is commonly thought that human locomotor development stems from a single precursor behavior, consisting of alternating flexor–extensor movements, such as kicking or stepping on ground. According to this view, kicking and stepping are identical movement patterns generated by the same neural mechanisms. Here we show that the neuromuscular modules of neonatal kicking and stepping are different, presumably related to different neural mechanisms. Kicking involves an adult-like number of temporal activation patterns, whose association with specific sets of muscles varies across movements. Ground-stepping involves a limited number of activation patterns, each associated with a stable muscle synergy. Since neonatal kicking and ground-stepping seem to anticipate subsequent developmental changes of locomotion in human babies, they might represent distinct locomotor antecedents." Perinatal Risk Factors Associated With Gastroenteritis Hospitalizations in Aboriginal and Non-Aboriginal Children in Western Australia (2000-2012): A Record Linkage Cohort Study "Gastroenteritis is a leading cause of childhood morbidity worldwide. We aimed to assess the maternal and infant characteristics and population attributable fractions associated with childhood gastroenteritis-related hospitalizations. METHODS: We conducted a whole-of-population retrospective birth cohort study of 367,476 children live-born in Western Australia 2000-2012. We identified hospital admissions up to <15 years of age pertaining to these children, with a principal diagnosis code for infectious gastroenteritis. Cox regression was used to obtain the adjusted hazard ratios with 95% confidence intervals and the population attributable fractions associated with each risk factor in Aboriginal and non-Aboriginal children for their first gastroenteritis-related hospital admission. ...Given the beneficial effect of infant rotavirus vaccination in preventing all-cause gastroenteritis hospitalization, efforts should be taken to optimize rotavirus vaccine coverage in those at highest risk." Metrics of early childhood growth in recent epidemiological research: A scoping review "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

This table allows an automated computer search of the external PubMed database using the listed "Search term" text link. This search now requires a manual link as the original PubMed extension has been disabled. The displayed list of references do not reflect any editorial selection of material based on content or relevance. References also appear on 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. More? References | Discussion Page | Journal Searches | 2019 References | 2020 References Search term: Neonatal Development | Newborn Development | Postnatal Development

Older papers
These papers originally appeared in the Some Recent Findings table, but as that list grew in length have now been shuffled down to this collapsible table. See also the Discussion Page for other references listed by year and References on this current page.

Head Circumference

<html5media height="400" width="500">File:Newborn n 28.mp4</html5media>

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.

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.

Unmanaged jaundice can lead to neural (brain), and sensory (vision and hearing) damage. 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.

• P00-P04 - Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery.
• P05-P08 - Disorders related to length of gestation and fatal growth.
• P10-P15 - Birth trauma.
• P20-P29 - Respiratory and cardiovascular disorders specific to the perinatal period.
• P35-P39 - Infections specific to the perinatal period.
• P50-P61 - Haemorrhagic and haematological disorders of fetus and newborn.
• P70-P74 - Transitory endocrine and metabolic disorders specific to fetus and newborn.
• P75-P78 - Digestive system disorders of fetus and newborn.
• P80-P83 - Conditions involving the integument and temperature regulation of fetus and newborn.
• P90-P96 - Other disorders originating in the perinatal period.

• O00-O08 - Pregnancy with abortive outcome.
• O10-O16 - Oedema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium.
• O20-O29 - Other maternal disorders predominantly related to pregnancy.
• O30-O48 - Maternal care related to the fetus and amniotic cavity and possible delivery problems.
• O60-O75 - Complications of labour and delivery.
• O80-O84 - Delivery.
• O85-O92 - Complications predominantly related to the puerperium.
• O94-O99 - Other obstetric conditions, not elsewhere classified.

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.

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  ‎‎Behaviour Page | Play  ‎‎Cranial Nerves Page | Play normal behaviour cranial nerves 3 Month Tone  ‎‎Control Page | Play  ‎‎Tone Upper Limb Page | Play  ‎‎Hand Movements Page | Play  ‎‎Lower Limb Page | Play 3 Month Positions  ‎‎Supine Position Page | Play  ‎‎Prone Position Page | Play  ‎‎Ventral Suspension Page | Play  ‎‎Vertical Suspension Page | Play 3 Month Reflexes  ‎‎Deep Tendon Page | Play  ‎‎Plantar Reflex Page | Play  ‎‎Suck-Root Page | Play  ‎‎Moro Reflex Page | Play  ‎‎Galant Reflex Page | Play  ‎‎Grasp Reflex Page | Play  ‎‎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 (TSH) levels PubmedParser error: The PubmedParser extension received invalid XML data. ()

Thyroid

Postnatal freeT4 (fT4) levels PubmedParser error: The PubmedParser extension received invalid XML data. ()

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. 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:

• 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

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.

• Criteria for Determining Disability in Infants and Children: Low Birth Weight
• Effects of Omega-3 Fatty Acids on Child and Maternal Health

Old Links (search book shelf with text)

• Management of Neonatal Hyperbilirubinemia
• Criteria for Determining Disability in Infants and Children: Failure to Thrive
• Newborn Screening for Sickle Cell Disease and Other Hemoglobinopathies
• Early Identification of Hearing Impairment in Infants and Young Children
• Critical Care Medicine
• The Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes
• Improving Treatment for Drug-Exposed Infants
• Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States
• Management of Preterm Labor
• Management of Prolonged Pregnancy
• Cesarean Childbirth
• Vaginal Birth After Cesarean (VBAC) Volume 1 and Volume 2

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)

• etiology of schizophrenia may involve pathological processes during brain development
• steroid hormone receptors become evident in target neurons of the brain
• Biochemistry of Thyroid Hormone Actions on Brain

"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."

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

• NHMRC - Staying Healthy in Child Care - Preventing infectious diseases in child care | 2006 Recommended minimum exclusion periods for infectious conditions for schools, pre-schools PDF
• NSW Information Mark Hill 08:04, 7 June 2012 (EST) These links no longer function and require updating.
  • The following are links to PDF documents prepared by NSW Health designed for clinical care (not patient information). Clinical Practice Guidelines for Paediatric Care
  • Acute Management of Infants and Children with: Bacterial Meningitis | Otitis Media | Fever | Asthma | Croup |
• WA Information Institute for Child Health Research (WA) | http://www.ichr.uwa.edu.au/about/intro.html | meningitis centre
• Victorian Department of Health Neonatal ehandbook - structured approach to the clinical management of conditions regularly encountered by health professionals caring for newborns.

American Information

• American Academy of Family Physicians
  • The Newborn Examination Part I. Emergencies and Common Abnormalities Involving the Skin, Head, Neck, Chest, and Respiratory and Cardiovascular Systems | Part II. Emergencies and Common Abnormalities Involving the Abdomen, Pelvis, Extremities, Genitalia, and Spine
  • Common Issues in the Care of Sick Neonates
• American Medical Association "Kids Health" (these are easy to read general public pages American not Australian Information )
  • Baby Development by Age
  • Baby Development by Topic
  • Childhood Infections
  • Childhood Immunizations

Terms

Neonatal Terms
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. Video - plantar reflex 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, Maple syrup urine disease, and cystic fibrosis). Maple syrup urine disease - (MSUD) metabolic disorder, clinical features include mental and physical retardation, feeding problems, and a maple syrup odour 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).  ICD-11 5C50.D0 Maple-syrup-urine disease 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 | Genital | Genetic | Head | Hearing | Heart | Immune | Integumentary | Neonatal | Neural | Oocyte | Palate | Placenta | Radiation | Renal | Respiratory | Spermatozoa | Statistics | Tooth | Ultrasound | Vision | Historic | Drugs | Glossary

Glossary Links

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Cite this page: Hill, M.A. (2023, December 1) Embryology Neonatal Development. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Neonatal_Development

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© Dr Mark Hill 2023, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G