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ARCHAIC REFLEXES AND

MATURATION ASPECTS
OF NEWBORN INFANTS
MIHAI CRAIU MD PhD

ALFRED RUSESCU
CHILDRENS HOSPITAL
ARCHAIC REFLEXES 1
Reflexes are an involuntary reaction of
a muscle or a group of muscles to an
external stimulus.
Many parents are surprised when they
realize that their baby can do a lot of
movements during first days of his life

ARCHAIC REFLEXES 2
While some reflexes are kept for the
whole life (respiratory reflex), other
reflexes disappear, giving way to
voluntary, controlled motor habits and
skills.
Neonatology treats reflexes like a
peculiar temporary equipment for the
first period, as babys organism should
know how to
fulfill some vital functions right after
birth, as theres no time to learn.
ARCHAIC REFLEXES 3
All archaic reflexes are seen in infancy,
up until about one year of age.
Most frequent examined are :
Suckling reflex
Rooting reflex
Palmar and plantar grasp reflex
Moro reflex
Automatic walking reflex
SUCKLING REFLEX
During first nursing a
mother can notice that
suckling reflex is highly
developed in her baby.
A baby begins suckling
strongly, when he feels a
nipple or even a finger in
his mouth.
AUTOMATIC WALKING REFLEX
If you raise a newborn the way
that his feet would be in
contact with a hard surface, he
begins walking automatically
(running reflex).
This reaction disappears in 3-6
weeks.
GRASPING REFLEX
If you touch a baby`s palm with a
finger or some object, he will
grasp it in his fist so strong, that
you will be able to raise him a
little.
This reflex will disappear when a
baby learns
taking objects, on about 4th
month of life.
Feet also have grasping reflex.
When you press a babys feet, his
toes begin bending and remain
in this position until stimulation
stops.
When a baby learns standing this
reflex will disappear.
MORO REFLEX
Gripping reflex (also called
Moro`s reflex) is a protective
reaction of organism. Noise or
change of position induces this
reflex.
He tosses his arms and legs up
very fast, like he wants gripping
something.
On 4
th
month of life this
reaction disappears.

BREST CRAWLING REFLEX
Every newborn, when placed on her mothers
abdomen, soon after birth, has the ability
to find her mothers breast all on her own
and to decide when to take the first
breastfeed.
Was first described in 1987 at the
Karolinska Institute in Sweden (Widstrm
et al, 1987):

Immediately after birth the child was
dried and laid on the mothers chest. In the
control group a regular behavioural
sequence, previously not described in the
literature, was observed. After 15 minutes
of comparative inactivity, spontaneous
sucking and rooting movements occurred,
reaching maximal intensity at 45 minutes.
The first hand-to-mouth movement was
observed at a mean of 34 2 minutes after
birth and at 55+ minutes the infant
spontaneously found the nipple and started
to suckle.

CRONOLOGY OF REFLEXES
28 weeks all present at some extent
excepting automatic walking
32 weeks Moro reflex is complete
34 weeks grasping reflex is complete
37 weeks all present and complete,
excepting automatic walking
40 weeks automatic walking reflex
complete

MATURATION
Gestational age can be estimated
starting from firs day of the last
recorded menstrual cycle of the gravida
Probable birth day 270 +/- 10 days
Term gestation 38-42 weeks
Premature newborn < 38 weeks
Postmature newborn > 42 weeks
WEIGHT 1
Intrauterine growth is variable,
depending on maternal, placental and
fetal factors
Newborn weight should be concordant
with gestational age.
If weight is below the estimated value
the child will be diagnosed as SGA (small
for gestational age) or dismature.
WEIGHT 2
Small newborn weight, but concordant
with gestational age will be diagnosed as
prematurity.
At 30 weeks 1600 g birth weight
At 34 weeks 2600 g birth weight
At 38 weeks 3200 g birth weight
At 42 weeks 3800 g birth weight



WEIGHT 3
Small newborn weight, can be classified as
prematurity grade I - IV
Grade I prematurity 2000 - 2500 gBW
Grade II prematurity 1500 2000 gBW
Grade III prematurity 1000 1500 gBW
Grade IV prematurity < 1000 gBW


PREMATURITY
SGA (small for gestational age)
GESTATIONAL AGE
EVALUATION IN-UTERO
NEUROMATURATION
References
"New Ballard Score, expanded to include
extremely premature infants," by
Ballard, JL, et al, Journal of Pediatrics,
September 1991, page 417.

Scoring System for Clinical Assessment of
Klimeks maturation index in newborn infants.


What is the normal gestational
term for humans?
Naegeles Rule: The standard definition for
gestational term is 266 days from conception
to the date of the babys birth.
This is also defined as 280 days, or 40 weeks,
from the first day of the mothers last
menstrual period, a definition which assumes
that the mother ovulates on day 14 of a 28
day menstrual cycle.
What is the normal gestational
term for humans?
This definition is based on observations,
first reported by Franz Naegele in 1812,
who believed that pregnancy lasted ten
lunar months from the last menstrual
period.
The formula used to calculate due date
is:
(LMP + 7 days) 3 months = Due
Date

Mittendorfs Observations of
Gestational Term.
In the 1980s, Mittendorf noticed that birth
dates for women in his practice, primarily
second-generation Irish-Americans, averaged
seven days past their due dates.
He reviewed his records, then went on to
review records of 17,000 births, and
determined the average healthy, white,
private-care, primiparous woman averaged
288 days from LMP to birth:
8 days longer than Naegeles rule.
Mittendorfs Observations of
Gestational Term.
Mittendorf and others have determined several
factors that affect gestational term:
ethnicity,
parity,
nutrition,
substance use,
mothers age,
mothers size.
Based on Mittendorfs data, a more appropriate
formula might be:
(LMP 3 months) + 15* Days = Due Date

* Add 10, rather than 15, if mother is non-white, or
multiparous
Normal Variations in Gestational Term

From the wide range in birth dates, it is clear
that some variation is normal.
Some examples of known variations:
Multiparous women average 283 days, versus the
288 days of multiparous women.
Black women averaged 8.5 days fewer than white
women of similar socioeconomic status.
Other studies indicate that for multiple births,
each additional baby in the uterus shortens the
pregnancy by 4 weeks on average.
GESTATIONAL AGE
TERM vs PRETERM
GESTATIONAL AGE not BIRTH WEIGHT