NEO in the Matrix of Life

Who would ever forget “NEO”, the role reprised by Keanu Reeves in The Matrix Series? He signifies the birth of a new age. In the same manner, the term neonate was derived from the Greek word "neo" and Latin word "natus" which means “new” and “born”, respectively. Once a baby is born, he will face a lot of trials and complexities in life and will eventually create his own niche after coming out from the matrix or the mother’s womb.

What is a normal newborn? Pediatricians define a normal neonate as one who is term, about 37 to 42 weeks of age based on the Ballard’s scoring, with birth weight which is appropriate for gestational age, cephalic in presentation and born via spontaneous vaginal delivery with no history of maternal infection or disease.

The so-called Ballard's scoring or pediatric aging is a scoring system that sums up the physical and neuromuscular maturity rating of a newborn to determine whether the baby is term or mature.

We coined the phrase ”PLS BEG” for the physical maturity rating, i.e.: P for plantar crease, L for lanugo, S for skin, B for breast, E for ear and G for genitalia. The more lines there are on the sole, less fine hair and vernix on the back, the less transparent the skin on the abdomen, the bigger the breast bud, the firmer and well formed the ear lobe and the more rugae on the scrotal sac in the male or the less prominent the clitoris in the female, the more mature or term the baby is.

The neuromuscular maturity refers to certain maneuvers performed on the baby within 12 to 36 hours of life which will be added to the physical maturity score. The acronym to use is SHArP, S for square window and scarf sign, H for heel to ear, Ar for arm recoil, P for posture and popliteal angle. A mature newborn has a flexed posture, with good flexion of wrist joint, good muscle tone and with resistance to extension of the extremities while eliciting the heel to ear, popliteal angle, scarf sign and arm recoil.

The normal birth weight of a term neonate which is appropriate for age (AGA) is between 2500 grams to less than 4000 grams.

The presence of maternal infection or any disease, an abnormal presentation like face or breech, as well as a delivery that entails the use of forceps or caesarian section puts a neonate at risk to develop problems or other complications.

An infant from birth to 28 days is considered a newborn, although some authors extend the age to cover 2 months of life.

Lest I be accused of becoming technical in my definition of terms, I will introduce some acronyms or simple words to help parents or any caretaker understand a normal neonate. Regardless of the manner or place of delivery, everyone who attends to childbirth should be equipped with basic skills and knowledge on what to watch out for.

The APGAR score is a practical guide to assess the well being of a newborn immediately after birth. It was coined by Virginia Apgar in 1952 and stands for A – appearance, P – pulse, G – grimace , A – activity and R – respiration. It is taken at 1 minute and repeated after 5 minutes. The one minute APGAR reflects the need for immediate resuscitation, whereas, the five minute APGAR signifies the probable neurological outcome in one year. A pink baby, with a heart rate of more than 100 beats per minute, with good cry and activity and regular respiration is a normal baby with a perfect score of 10 at 2 points each for every parameter. A score of 7 and up means the baby is not asphyxiated or depressed.

Inspect the child from head to toe. Note for the color of the skin, nail beds, lips and tongue or the mucosal membranes. It should be pink, not pale, blue or red. Is the head round or irregular in shape due to molding, cephalhematoma or caput? Look at the eyes and check for asymmetry, extra folds, redness, and discharge or yellowish discoloration. Check the ear if it is low set and with intact hearing. Are the nostrils patent? Is there alar flaring? Look for cleft palate, high arch, and tongue-tie. Is the neck short or webbed? Are there symmetrical movements of the extremities? Is there chest lag? What is the shape of the thorax? Is the breathing deep, shallow, or absent? Does the baby grunt? Where is the heartbeat located? Is the abdomen globular? Do you feel any masses? Are the pulses full and supple? Count the fingers and the toes, hands, arms, legs and feet. Look at the palms and soles and check for a Simian crease, hypoplastic middle phalanx of the fifth digit and wide gapped toes. Check for the following reflexes: Moro, sucking, rooting and grasp reflex.

After the baby has been stabilized and checked, routine newborn care is provided. It entails giving prophylaxis like Vitamin K1 and eye ointment. The World Health Organization and the Department of Health recommend hepatitis vaccine and BCG at birth. The newborn screening is done after 24 hours of life once with adequate milk intake. Daily bath and cord care are also done in a sterile condition.

Breastfeeding is highly recommended and encouraged unless with contraindications. The benefits derived from it far outweigh the risk of using milk formula feeding. It is BEST for babies up to 2 years and beyond. BEST being B- Bonds the mother and the child; E – Economical in terms of time, money and convenience, S – Safe for it prevents diarrhea and other diseases, allergies and provides antibodies against infection and necessary nutrients in the proper quality and quantity and T – Tried and Tested for years with the right Temperature and contraceptive effect. However, the MRS CANT absolutely breastfeed in six maternal conditions like Mental disorders, Retardation and Seizure disorders, Cardiac diseases, Advanced Nephritis, open Tuberculosis and Thyrotoxicosis. Temporary contraindications to breastfeeding are intake of drugs like anticoagulants, antibiotics, toxic substances like mercury and benzene and mechanical problems like retracted and oversized nipples.

Taking care of a newborn is no easy task, especially for first time parents or caretakers. Babies put their absolute trust in whoever provides them their basic needs. A simple touch and a peek from their dads and moms on a daily basis may spell a difference so every neonate will not be deprived of TLC (Tender loving care).

Enjoy every single moment you spend with that cute little being who was temporarily loaned to you from up above. Don’t be afraid of the responsibility it entails to be a parent. Trust in your instincts and pray for guidance. If you were not sure of what you’re doing, it wouldn’t hurt to ask.