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: Introduction | Birth | Neonatal | Neonatal Diagnosis | Milk | Nutrition | Growth Charts | Disease School Exclusion | Vaccination | Puberty | Genital


Birth Links: Introduction | Lecture - Birth | Caesarean | Preterm | Birth Weight | Birth Statistics | Australian Birth Data | Developmental Origins of Health and Disease | Macrosomia | Neonatal Diagnosis | Apgar test | Guthrie test | Neonatal Development | Stillbirth and Perinatal Death | ICD-10 Perinatal Period | Category:Birth

Some Recent Findings

  • There has been a recent significant increase in the total number of pertussis (whooping cough) notifications in NSW, Australia.

NSW Pertussis Notification Graph (2012-16)

NSW Pertussis Notification Graph (2012-16)

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

Mikael Knip, Jarno Honkanen Modulation of Type 1 Diabetes Risk by the Intestinal Microbiome. Curr. Diab. Rep.: 2017, 17(11);105 PubMed 28942491

V Marugan-Hernandez Neospora caninum and Bovine Neosporosis: Current Vaccine Research. J. Comp. Pathol.: 2017, 157(2-3);193-200 PubMed 28942304

Jan Bures, Anna Jirkovska, Vit Sestak, Hana Jansova, Galina Karabanovich, Jaroslav Roh, Martin Sterba, Tomas Simunek, Petra Kovarikova Investigation of novel dexrazoxane analogue JR-311 shows significant cardioprotective effects through topoisomerase IIbeta but not its iron chelating metabolite. Toxicology: 2017; PubMed 28941780

Jintao Du, Xuemei Zhang, Hui Cao, Di Jiang, Xianren Wang, Wei Zhou, Kaitian Chen, Jiao Zhou, Hongyan Jiang, Luo Ba MiR-194 is involved in morphogenesis of spiral ganglion neurons in inner ear by rearranging actin cytoskeleton via targeting RhoB. Int. J. Dev. Neurosci.: 2017; PubMed 28941704

Jason H Peragallo Pediatric Myasthenia Gravis. Semin Pediatr Neurol: 2017, 24(2);116-121 PubMed 28941526

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.[1] [2]


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.[3]

Unmanaged jaundice can lead to neural (brain), and sensory (vision and hearing) damage.[4] 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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 ‎‎Tone Upper Limb
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 ‎‎Hand Movements
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 ‎‎Lower Limb
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3 Month Positions

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

03mo 04.jpg
 ‎‎Deep Tendon
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 ‎‎Plantar Reflex
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 ‎‎Suck-Root
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 ‎‎Moro Reflex
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 ‎‎Galant Reflex
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 ‎‎Grasp Reflex
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 ‎‎Neck Tone
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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[5]

Thyroid

Postnatal free T4 levels graph.jpg

Postnatal freeT4 (fT4) levels[5]

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.[6] 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:[7]

  • 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: Postnatal - Vaccination | Rotavirus

References

  1. B J Stoll, T Gordon, S B Korones, S Shankaran, J E Tyson, C R Bauer, A A Fanaroff, J A Lemons, E F Donovan, W Oh, D K Stevenson, R A Ehrenkranz, L A Papile, J Verter, L L Wright 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.: 1996, 129(1);63-71 PubMed 8757564
  2. Barbara J Stoll, Nellie Hansen, Avroy A Fanaroff, Linda L Wright, Waldemar A Carlo, Richard A Ehrenkranz, James A Lemons, Edward F Donovan, Ann R Stark, Jon E Tyson, William Oh, Charles R Bauer, Sheldon B Korones, Seetha Shankaran, Abbot R Laptook, David K Stevenson, Lu-Ann Papile, W Kenneth Poole Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics: 2002, 110(2 Pt 1);285-91 PubMed 12165580
  3. 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
  4. 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
  5. 5.0 5.1 | BMC Endocr Disord.
  6. Sibylle Koletzko, Stephanie Osterrieder Acute infectious diarrhea in children. Dtsch Arztebl Int: 2009, 106(33);539-47; quiz 548 PubMed 19738921 | PMC2737434
  7. Umesh D Parashar, Christopher J Gibson, Joseph S Bresee, Roger I Glass Rotavirus and severe childhood diarrhea. Emerging Infect. Dis.: 2006, 12(2);304-6 PubMed 16494759

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

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April 2010

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

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Cite this page: Hill, M.A. 2017 Embryology Neonatal Development. Retrieved September 25, 2017, from https://embryology.med.unsw.edu.au/embryology/index.php/Neonatal_Development

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© Dr Mark Hill 2017, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G