Flashcards in 2. Newborn Deck (111):
What is a neonate?
A baby up to 28 days old
Six biologic tasks of the neonate
o Establishing and maintaining respiration
o Adjusting to circulatory changes
o Regulating temperature
o Ingesting, retaining and digesting nutrients
o Eliminating waste
o Regulating waste
What are the 3 phases of transition period? What is the total duration?
• 1st period of reactivity
• Period of decreased responsiveness
• 2nd period of reactivity
TOTAL TOME: 6-8 hours
1st period of reactivity
• What happens? (2)
• Lasts 30 minutes to 2 hours
• Increased HR and RR
Period of decreased responsiveness
• What happens? (2)
• Lasts from 2-4 hours
• HR & RR are back to normal
2nd period of reactivity
• What happens? (4)
• Lasts 10 minutes to several hours
• Increased HR, RR
• Increased muscle tone, mucus production (bulb syringe)
Six types of activity for babies:
• Active alert
• Quiet alert
• Light sleeping
• Deep sleep
What must the first breath do?
Must force the fetal lung fluid into the interstitial spaces around the alveoli so that air can now enter the respiratory tract.
Initiation of breathing (3)
* Pressure (1st breath has the greatest negative pressure compared to subsequent breathing)
* Temperature (baby has sensors on skin to send impulses to brain to breathe)
* Chemical (Carotid arteries and the aorta respond to changes in blood chemistry brought on by hypoxia, which occurs with birth)
Vessels in umbilical cord
2 Arteries, 1 vein
What will the HCP do if a murmur is heard?
4- extremity BP
to ensure that there is no coarctation of the aorta, which would mean that there is higher BP on upper extremities than lower
What happens during the simultaneous CV / Respiratory shift? (5)
* Lung recoil causes a pressure shift
* Pressure shift causes closure / constriction of DA, DV, FO
* Circulatory shift
* Decreased pulmonary pressure
* Increased perfusion
Four mechanisms of heat loss in the neonate
• Heat loss due to air current or flow or people walking by creating a cool breeze
• Loss to cooler environment that might be NEAR a cold surface. Like the warmed incubator to the window or cold wall
• Can occur during birth or anytime the infant is wet from insensible water loss.
• Loss to cooler object in direct contact
• Example: Scale or providers hand actually touching baby
3 mechanisms newborns use to increase body temp
• Increasing BMR
• Increased muscular activity
• Non-shivering thermogenesis (NST)
What is Non-Shivering Thermogenesis (NST)?
BROWN FAT METABOLISM
When in the lifespan does brown fat metabolism occur?
• Developed at 26-30 weeks gestation
• Continues to 2-5 weeks old
What triggers the body to start metabolizing brown fat when needed?
Burning brown fat requires the use of what?
What is the risk of brown fat metabolism?
Oxygen consumption in a newborn doubles with...
a 2 degree ambient temperature drop
Baby has capacity to suck, swallow, breathe at what age?
32 weeks gestation
How big is the baby's stomach when leaving the hospital?
Characteristics of Meconium
Thick, Sticky, Dark (Almost black)
First 1-2 days
Characteristics of milk stool
SYS: Seedy Yellow Stool. No odor, doesn't stain clothing.
3 types of baby stools:
2) Transitional Stool
3) Milk stool
How many stools by 34d day of life?
1-3 stools per day
When do you want the baby to pass first stool?
Within 24 hours of life
Characteristics of normal urine
Usually straw colored and odorless
Characteristics of urate crystals
Look like brick dust, means baby is dehydrated
Characteristic of pseudomenstruation
Normally occurs on the 3rd day after birth 2/2 mom's drop in hormones
When should urine output be 6-8 voids per day
4th day of life
What is acrocyanosis?
When does it resolve?
- Peripheral cyanosis
- Resolves in 24-48 hours
How can you tell the difference between facial brusing and acrocyanosis?
If pressed, acrocyanosis will blanch -- facial bruising will not blanch.
Bluish black spots that resemble bruises
Little red area sometimes on back of neck
Benign rash of unknown cause in newborn. Transient.
White crystals 1-2 mm in size, 2/2 distended sebacious glands. Over the nose.
Thick, white substance. Protects skin of fetus.
- In term infant
- Fine hair
• What is it
• What causes it
• Pitting edema in skull that Crosses the Suture line
• Occurs with vaginal births or vacuum extractions
- Swelling with clear edges that end at the suture line -- bleeding is held between the bone and the periosteum
Normal newborn temp (F)
Normal newborn respirations
How often to check respirations
ea 30 minutes until infant has been stable for 2 hours after birth (more often if there are abnormalities)
Normal newborn heart rate
Normal Newborn BP
• Systolic: 65-95 mm/Hg
• Diastolic: 30-60 mmHg
Normal Newborn Length
Normal newborn head circumfrence
Normal newborn Chest circumfrence
Normal newborn weight
What is the APGAR score?
The immediate assessment of a newborn, to assess the transition to extrauterine life. Determines need for resuscitation
Assigned at 1 and 5 minutes (sometimes 10 also)
What is administered during initial physical assessment - LDR (2)
Opthalmic ointment (prophylactic ABX)
What defines Postmature (Syndrome)
>42 weeks with s&s of placental insufficiency (placenta shuts down at 42 weeks)
Large for gestational age.
>4000 or >90th percentile
Average for gestational age.
Between 10th and 90th percentile.
Small for gestational age.
Doesn't meet expected nroms
What does the Apgar score mean?
• 0-3 serious distress
• 1-4 moderate difficulty
• 7-10 no difficulty adjusting to extrauterine life
5 components of the apgar score
• Heart Rate
• Respiratory Effort
• Muscle tone
• Reflex irritability
Apgar: Heart Rate
Apgar: Respiratory Effort
1 Slow weak cry
2 Good cry
Apgar: Muscle tone
1 Some flexion
2 Well flexed
Apgar: Reflex irritability
0 No response
2 Good cry
0 Pale / blue
2 Pink / uniform
What is the glabellar reflex
Tap the forehead, the baby will blink 4-5x
Normal babinski response - newborn
toes flare with dorsiflexion of big toe
New Ballard's Scale: 3 characteristics
• How accurate
• When most accurate
• From 20 to 44 weeks
• Provides accurate information within 2 weeks
• Most accurate if assessed within 12 hours of birth
Four physical / muscular tests for newborns:
• Heel to ear
• Popliteal angle
• Scarf sign
• Square window
How to perform the Heel-to-ear test
Grasp foot, bring it toward ear. Score is recorded when resistance is felt. (Pre-term infant = foot is closer to ear when resistance)
How to perform the popliteal angle test
The newborn's leg is folded against the thigh on the abdomen, and the lower leg is straightened until resistance is met.
Score is 0 if leg can be fully extended, 5 if the angle of the popliteal space is less than 90 degrees.
How to perform the scarf sign test
Move arm across chest; observe position of elbow when resistance is felt.
(Pre-term infant elbow can move past midline without resistance)
How to perform the square window test
Flex the wrist and measure the angle.
(Pre-term infant wrist ill bend more)
What is bilirubin?
What is it derived from (2)
• A yellow pigment
• Derived from the hemoglobin release with the breakdown of RBCs and myoglobin in muscle cells
When is bilirubin visible
In jaundice -- unconjugated bilirubin binds to albumin, then can leave the vascular system and permeate other extravascular tissue
Two types of jaundice:
Characteristics of physiologic jaundice
• 50% prevalence
• Onset > 24 hours
Onset of pathologic jaundice
Onset: within 24 hours of life
Possible causes of pathologic jaundice (3)
• Result of ABO disease
• Result of Rh incompatibility
• Physiologic hyperbilirumia that is more severe
Unconjugated serum bilirubin levels: Physiologic versus pathologic
Unconjugated serum bilirubin:
Physiologic: < or = to 12 mg / dL
Pathologic: Peaks >13mg/dL
Characteristics of physiologic hyperbilirubinemia that is classified as pathologic
- Unconjugated serum bilirubin levels
- Rate of increase
- 2 concurrent syndromes
• Peaks >13mg/dL
• Increases >0.5 mg/dL/hr
• a/w HSM (hepatosplenomegaly) or anemia
3 characteristics of kernicterus
• Bilirubin encephalopathy
• Results in acute symptoms and long term neurologic damage
• 50% of infants survive
Early signs of a cold infant:
Crying, restlessness, increased activity
What could result from a cold infant (NST, crying)?
Signs of respiratory distress (5)
o Nasal Flaring
o Altered respiratory Rate
o Apnea > 20 seconds
Where do retractions in babies occur (early)
• Babies retract in the lower lungs first, when an older person would be using accessory muscles
Sign of respiratory distress in infants: Early / late
• Early: >60 at rest
• Late: <30 at rest
Newborn weight loss
• When to see a HCP
By 3-5 DOL
• 5-10% of birth weight loss
By 14 DOL
• Regain to birth weight
o Any loss over 7-10% of body weight should be evaluated by HCP
3 signs of newborn dehydration
o Fewer wet diapers (early)
o Sunken fontanel
Most notable sign of hypoglycemia
- Blood clucose concentration
o “Jittery” infant
o Blood glucose concentration <35 mg / dL
Other sx of hypoglycemia (9)
• Irregular respiration / apnea
• Weak, high-pitched cry
• Feeding difficulty
• Eye rolling
Neonatal sepsis: Definition
Infection in blood or tissues. Wide range of symptoms
Respiratory sepsis in neonate -- sx (6)
• Apnea, tachypnea, grunting, nasal flaring, retractions
• Decreased O2 sat is a late sign
CV sepsis in neonate -- sx (5)
• Bradycardia, tachycardia, hypotension, decreased perfusion, decreased cardiac output
CNS sepsis in neonate -- sx (5)
• Temperature instability
GI sepsis in neonate -- sx (4)
• Feeding intolerance, abdominal distention, vomiting, diarrhea
Integumentary sepsis in neonate -- sx (3)
• Jaundice, pallor, petechiae
Seven components of postnatal nursing care
o Suction: Maintain patent airway
o Apply cord clamp: Check cord
o Vitamin K and eye ointment
o ID bands and footprints
o Wrap in pre-warmed blanket
o Encourage bonding, initiate breastfeeding
o APGAR score documented
When to contact the HCP after discharge (6)
• Fever (100.4 or higher)
• Decreased appetite
• Decreased urine / stool
• Color night right (pale, yellow, blue)
• Baby “just doesn’t seem well”
NB Care instructions at discharge: Urine and stool
o Urine: 6-10 wet diapers per day after about 4 days
o Stool: 1-3 per day (more if breastfed)
NB Care instructions at discharge: Feeding guidelines
• Breastfeed approximately every 2-3 hours
• Bottlefeeding approximately up to 2 oz every 3-4 hours
NB Care instructions at discharge: Expected activity
• 4-5 wakeful periods a day, responds to sounds / voices
• “Back to sleep”
NB Care instructions at discharge: Bathing
Sponge bath until cord falls off, 2-3x per week or less
NB Care instructions at discharge: Cord care (3)
• Keep clean and dry until falls off (2 weeks)
• Wharton’s jelly
• Clean with alcohol only if it looks infected