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Flashcards in 2. Newborn Deck (111):
1

What is a neonate?

A baby up to 28 days old

2

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

3

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

4

1st period of reactivity
• Duration
• What happens? (2)

• Lasts 30 minutes to 2 hours
• Increased HR and RR

5

Period of decreased responsiveness
• Duration
• What happens? (2)

• Lasts from 2-4 hours
• HR & RR are back to normal

6

2nd period of reactivity
• Duration
• What happens? (4)

• Lasts 10 minutes to several hours

• Increased HR, RR
• Increased muscle tone, mucus production (bulb syringe)

7

Six types of activity for babies:

• Active alert
• Quiet alert
• Drowsy
• Light sleeping
• Crying
• Deep sleep

8

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.

9

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)

10

Vessels in umbilical cord

2 Arteries, 1 vein

11

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

12

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

13

Four mechanisms of heat loss in the neonate

• Convection
• Radiation
• Evaporation
• Conduction

14

Convection

• Heat loss due to air current or flow or people walking by creating a cool breeze

15

Radiation

• Loss to cooler environment that might be NEAR a cold surface. Like the warmed incubator to the window or cold wall

16

Evaporation

• Can occur during birth or anytime the infant is wet from insensible water loss.

17

Conduction

• Loss to cooler object in direct contact
• Example: Scale or providers hand actually touching baby

18

3 mechanisms newborns use to increase body temp

• Increasing BMR
• Increased muscular activity
• Non-shivering thermogenesis (NST)

19

What is Non-Shivering Thermogenesis (NST)?

BROWN FAT METABOLISM

20

When in the lifespan does brown fat metabolism occur?

• Developed at 26-30 weeks gestation
• Continues to 2-5 weeks old

21

What triggers the body to start metabolizing brown fat when needed?

SNS

22

Burning brown fat requires the use of what?

• Glucose
• ATP
• Oxygen

23

What is the risk of brown fat metabolism?

Hypoglycemia

24

Oxygen consumption in a newborn doubles with...

a 2 degree ambient temperature drop

25

Baby has capacity to suck, swallow, breathe at what age?

32 weeks gestation

26

How big is the baby's stomach when leaving the hospital?

30cc

27

Characteristics of Meconium

Thick, Sticky, Dark (Almost black)
Odorless
First 1-2 days

28

Characteristics of milk stool

SYS: Seedy Yellow Stool. No odor, doesn't stain clothing.

29

3 types of baby stools:

1) Meconium
2) Transitional Stool
3) Milk stool

30

How many stools by 34d day of life?

1-3 stools per day

31

When do you want the baby to pass first stool?

Within 24 hours of life

32

Characteristics of normal urine

Usually straw colored and odorless

33

Characteristics of urate crystals

Look like brick dust, means baby is dehydrated

34

Characteristic of pseudomenstruation

Normally occurs on the 3rd day after birth 2/2 mom's drop in hormones

35

When should urine output be 6-8 voids per day

4th day of life

36

What is acrocyanosis?
When does it resolve?

- Peripheral cyanosis
- Resolves in 24-48 hours

37

How can you tell the difference between facial brusing and acrocyanosis?

If pressed, acrocyanosis will blanch -- facial bruising will not blanch.

38

Mongolian spots

Bluish black spots that resemble bruises

39

Stork bite

Little red area sometimes on back of neck

40

Erythema Toxicum

Benign rash of unknown cause in newborn. Transient.

41

Millia

White crystals 1-2 mm in size, 2/2 distended sebacious glands. Over the nose.

42

Vernix

Thick, white substance. Protects skin of fetus.

43

Lanugo

- In term infant
- Fine hair

44

Caput Succadaneum
• What is it
• What causes it

• Pitting edema in skull that Crosses the Suture line
• Occurs with vaginal births or vacuum extractions

45

Cephalohematoma

- Swelling with clear edges that end at the suture line -- bleeding is held between the bone and the periosteum

46

Normal newborn temp (F)

97-99.5

47

Normal newborn respirations

30-60 rpm

48

How often to check respirations

ea 30 minutes until infant has been stable for 2 hours after birth (more often if there are abnormalities)

49

Normal newborn heart rate

120-160 bpm

50

Normal Newborn BP

• Systolic: 65-95 mm/Hg
• Diastolic: 30-60 mmHg

51

Normal Newborn Length

19-21" (48-53cm)

52

Normal newborn head circumfrence

13-15" (33-35cm)

53

Normal newborn Chest circumfrence

12-13" (30.5-33cm)

54

Normal newborn weight

5.3-8.5lbs (2500-4000g)

55

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)

56

What is administered during initial physical assessment - LDR (2)

Vitamin K
Opthalmic ointment (prophylactic ABX)

57

Term infant

37-42 weeks

58

What defines Postmature (Syndrome)

>42 weeks with s&s of placental insufficiency (placenta shuts down at 42 weeks)

59

LGA

Large for gestational age.
>4000 or >90th percentile

60

AGA

Average for gestational age.
Between 10th and 90th percentile.

61

SGA

Small for gestational age.
<10th percentile

62

LBW

<2500 g

63

VLBW

<1500g

64

IUGR

Doesn't meet expected nroms

65

What does the Apgar score mean?

• 0-3 serious distress
• 1-4 moderate difficulty
• 7-10 no difficulty adjusting to extrauterine life

66

5 components of the apgar score

• Heart Rate
• Respiratory Effort
• Muscle tone
• Reflex irritability
• Color

67

Apgar: Heart Rate
0
1
2

0: Absent
1: 100

68

Apgar: Respiratory Effort
0
1
2

0 Absent
1 Slow weak cry
2 Good cry

69

Apgar: Muscle tone
0
1
2

0 Flaccid
1 Some flexion
2 Well flexed

70

Apgar: Reflex irritability
0
1
2

0 No response
1 Grimace
2 Good cry

71

Apgar: Color
0
1
2

0 Pale / blue
1 Acrocyanosis
2 Pink / uniform

72

What is the glabellar reflex

Tap the forehead, the baby will blink 4-5x

73

Normal babinski response - newborn

toes flare with dorsiflexion of big toe

74

New Ballard's Scale: 3 characteristics
• Age
• 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

75

Four physical / muscular tests for newborns:

• Heel to ear
• Popliteal angle
• Scarf sign
• Square window

76

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)

77

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.

78

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)

79

How to perform the square window test

Flex the wrist and measure the angle.

(Pre-term infant wrist ill bend more)

80

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

81

When is bilirubin visible

In jaundice -- unconjugated bilirubin binds to albumin, then can leave the vascular system and permeate other extravascular tissue

82

Two types of jaundice:

• Physiologic
• Pathologic

83

Characteristics of physiologic jaundice

• 50% prevalence
• Onset > 24 hours

84

Onset of pathologic jaundice

Onset: within 24 hours of life

85

Possible causes of pathologic jaundice (3)

• Result of ABO disease
• Result of Rh incompatibility
• Physiologic hyperbilirumia that is more severe

86

Unconjugated serum bilirubin levels: Physiologic versus pathologic

Unconjugated serum bilirubin:
Physiologic: < or = to 12 mg / dL
Pathologic: Peaks >13mg/dL

87

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

88

3 characteristics of kernicterus

• Bilirubin encephalopathy
• Results in acute symptoms and long term neurologic damage
• 50% of infants survive

89

Early signs of a cold infant:

Crying, restlessness, increased activity

90

What could result from a cold infant (NST, crying)?

- Hypoglycemia
- Acidosis

91

Signs of respiratory distress (5)

o Nasal Flaring
o Retractions:
o Grunting
o Altered respiratory Rate
o Apnea > 20 seconds

92

Where do retractions in babies occur (early)

• Babies retract in the lower lungs first, when an older person would be using accessory muscles

93

Sign of respiratory distress in infants: Early / late

• Early: >60 at rest
• Late: <30 at rest

(RR)

94

Newborn weight loss
• Early
• Later
• 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

95

3 signs of newborn dehydration

o Fewer wet diapers (early)
o Sunken fontanel
o Lethargy

96

Most notable sign of hypoglycemia
- Symptom
- Blood clucose concentration

o “Jittery” infant
o Blood glucose concentration <35 mg / dL

97

Other sx of hypoglycemia (9)

• Irregular respiration / apnea
• Cyanosis
• Weak, high-pitched cry
• Feeding difficulty
• Hunger
• Lethargy
• Twitching
• Eye rolling
• Seizures

98

Neonatal sepsis: Definition

Infection in blood or tissues. Wide range of symptoms

99

Respiratory sepsis in neonate -- sx (6)

• Apnea, tachypnea, grunting, nasal flaring, retractions
• Decreased O2 sat is a late sign

100

CV sepsis in neonate -- sx (5)

• Bradycardia, tachycardia, hypotension, decreased perfusion, decreased cardiac output

101

CNS sepsis in neonate -- sx (5)

• Temperature instability
• Lethargy
• Hypotonia
• Irritability
• Seizures

102

GI sepsis in neonate -- sx (4)

• Feeding intolerance, abdominal distention, vomiting, diarrhea

103

Integumentary sepsis in neonate -- sx (3)

• Jaundice, pallor, petechiae

104

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

105

When to contact the HCP after discharge (6)

• Fever (100.4 or higher)
• Lethargy
• Decreased appetite
• Decreased urine / stool
• Color night right (pale, yellow, blue)
• Baby “just doesn’t seem well”

106

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)

107

NB Care instructions at discharge: Feeding guidelines

• Breastfeed approximately every 2-3 hours
• Bottlefeeding approximately up to 2 oz every 3-4 hours

108

NB Care instructions at discharge: Expected activity

• 4-5 wakeful periods a day, responds to sounds / voices
• “Back to sleep”

109

NB Care instructions at discharge: Bathing

Sponge bath until cord falls off, 2-3x per week or less

110

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

111

NB Care instructions at discharge: Circumcision care (3)

• Wash with warm water only
• May put Vaseline on diaper or glands
• Watch for signs and symptoms of infection