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NU314 OB > Newborn Transitioning > Flashcards

Newborn Transitioning Flashcards

1
Q

Neonatal Period

A

the first 28 days of life

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2
Q

What must occur immediately at birth to sustain extrauterine life?

A

Respiratory gas exchange along with circulatory modifications

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3
Q

What 4 areas do the newborn’s most dramatic and most rapid extrauterine transitions occur in?

A

Respiratory
Circulatory
Thermoregulation
Ability to stabilize blood glucose levels

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4
Q

What are the 4 primary challenges faced by the newborn?

A
  • System-wide changes
  • Neutral thermal environment
  • Prevent cold stress
  • Problems bilirubin conjugation and jaundice
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5
Q

When do the enzymatic pathways become fully active in the newborn?

A

3 months

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6
Q

Hepatic System Functions

A

Blood coagulation
Iron storage
Carbohydrate metabolism
Conjugation of bilirubin

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7
Q

Newborn iron stores are determined by what?

A

total body hemoglobin content and length of gestations

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8
Q

If the mother’s iron intake was adequate during pregnancy what does that mean for the newborn?

A

Sufficient iron has been stored in the newborn’s liver for 6 months

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9
Q

How long will the newborn have a sufficient iron supply if the mother had an adequate intake during pregnancy?

A

6 months

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10
Q

Glucose is an essential fuel for what?

A

Brain metabolism

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11
Q

What is one of the most frequent fetal-to-newborn problems?

A

Hypoglycemia

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12
Q

What is the main source of energy for the first several hours after birth?

A

Glucose

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13
Q

What will help to stabilize the newborn’s blood glucose levels?

A

initiating early breast or bottle feedings

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14
Q

Bilirubin

A

yellow/orange bile pigment produced by the breakdown of red blood cells

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15
Q

What is responsible for bilirubin elimination in utero?

A

the placenta and mother’s liver

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16
Q

Where is the principle source of bilirubin in the newborn?

A

Hemolysis and erythrocytes

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17
Q

What is the rate of bilirubin production in the newborns?

A

6-8 mg/kg/day

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18
Q

When will bilirubin decline to the adult level?

A

10-14 days after birth

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19
Q

Jaundice

A

increased amount of bilirubin in the bloodstream

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20
Q

Jaundice causes what?

A

yellowing of the skin, sclera, and mucous membranes

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21
Q

Extremely elevated levels of bilirubin in the first week of life can cause what?

A

Bilirubin encephalopathy

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22
Q

Bilirubin Encephalopathy

A

a permanent and devastating form of brain damage from extremely elevated levels of bilirubin in the first week of life

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23
Q

Common risk factors for Jaundice

A
  • fetal-maternal blood group incompatibility
  • prematurity
  • asphyxia at birth
  • insufficient intake of milk during breastfeeding
  • drugs
  • maternal gestational diabetes
  • infrequent feedings
  • male gender
  • birth trauma
  • previous siblings
  • intrauterine infections
  • Asians or Native American
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24
Q

TORCH Infections that can cause Jaundice

A 
T-toxoplasmosis
O-other viruses 
R-rubella
C-cytomegalovirus
H-herpes simplex virus
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25
Q

What are the 3 groups of jaundice based on?

A

Mechanism of accumulation

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26
Q

What are the 3 groups of Jaundice?

A
  • Overproduction
  • Decreased conjugation
  • Impaired excretion
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27
Q

Overproduction of Bilirubin

A 
Blood incompatibilities
Drugs
Trauma at birth
Polycythemia 
Delayed cord clamping
Breast milk jaundice
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28
Q

Decreased Bilirubin Conjugations

A

Physiologic Jaundice
Hypothyroidism
Breast-feeding

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29
Q

Impaired Bilirubin Excretion

A 
Biliary obstruction
Sepsis
Hepatitis 
Chromosomal abnormality
Drugs
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30
Q

Biliary obstructions associated with jaundice?

A

Biliary atresia
Gallstones
Neoplasm

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31
Q

Chromosomal abnormalities associated with Jaundice?

A

Turner syndrome

Trisomies 18 and 21

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32
Q

What is the most important adaptation to the gastrointestinal system?

A

Development of a mucosal barrier

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33
Q

What does the gastrointestinal mucosal barrier do?

A

Prevent the penetration of harmful substances present w/in the intestinal lumen

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34
Q

Colonization in the gut depends on what?

A

oral intake

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35
Q

What will harmful substances that penetrate the mucosal epithelial barrier under pathologic conditions cause?

A

inflammatory and allergic reactions

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36
Q

Colonization

A

occurs w/in 24 hours of age

required for the production of vitamin K

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37
Q

What microbes will be mechanically transferred from mom to baby after birth?

A

Environmental
Oral
Cutaneous

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38
Q

How are these microbes transmitted from mom to baby?

A

suckling, kissing, and caressing

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39
Q

What are effective methods of ensuring transmission of microbes from one generation to the next?

A

Proximity of birth canal to anus

Parental expression of neonatal care

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40
Q

What leads to regurgitation and uncoordinated peristaltic activity in newborn?

A

Cardiac sphincter and nervous control of stomach are immature

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41
Q

What can minimize regurgitation?

A

Avoiding overfeeding and stimulating frequent burps

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42
Q

Excreting fair amounts of lipids results in?

A

fatty stools

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43
Q

How many calories a day does the newborn need to gain weight?

A

110-120 kcal/kg/day from birth to 6 months

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44
Q

What is the newborn’s first stool?

A

Meconium

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45
Q

Meconium

A

greenish, black w/ tarry consistency

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46
Q

What is meconium made of?

A

amniotic fluid, shed mucosal cells, intestinal secretions, and blood

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47
Q

When is meconium usually passed?

A

w/in 12-24 hours of birth

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48
Q

Breastfed stools

A

yellow-gold, loose, stringy to pasty, sour smelling, seedy

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49
Q

Bottle-fed stools

A

yellow, yellow-green, loose, pasty, or formed, unpleasant odor

50
Q

The glomeruli and nephrons are immature at birth resulting in what?

A

Reduced glomerular filtration rate and limited concentrating ability

51
Q

What can make the newborn susceptible to dehydration and fluid overload?

A

Limited ability to concentrate urine and the reduced GFR

52
Q

How many voidings per day are considered normal?

A

6-8

53
Q

What will become stimuli for initiating respirations from a normal labor?

A

Hypercapnia
Hypoxia
Acidosis

54
Q

Surfactant

A

surface-tension reducing lipoprotein found in the newborn’s lungs

55
Q

What will surfactant prevent?

A

Alveolar collapse at the end of expiration
Loss of lung volume
Atelectasis

56
Q

What is one of the most crucial adaptations the newborn makes at birth?

A

Adjusting from fluid-filled intrauterine environment to a gaseous extrauterine environment

57
Q

How does the birth canal help eliminate fluid in the lungs?

A

intermittent compression of the thorax

58
Q

After passing through the birth canal what will remove the rest of the fluid?

A

Pulmonary capillaries and the lymphatics

59
Q

What happens if the fluid is removed to slowly or incompletely?

A

Transient tachypnea

60
Q

What events have to happen before the newborn’s lungs can maintain respiratory function?

A
  • Initiation of respiratory movement
  • Expansion of the lungs
  • Establishment of functional residual capacity
  • Increased pulmonary blood flow
  • Redistribution of cardiac output
61
Q

Newborn Respiration Characteristics

A
  • 30-60 breaths per minute
  • irregular and shallow
  • short periods of apnea
62
Q

Signs of Respiratory Distress

A 
cyanosis
tachypnea
grunting 
sternal retraction
nasal flaring
63
Q

Chest movements of the newborn should be?

A

symmetrical

64
Q

Periodic Breathing

A

cessation of breathing that lasts 5-10 seconds w/o changes in color or HR

65
Q

Average Newborn HR

A

110-160 bpm

66
Q

The blood volume of the newborn depends on what?

A

The amount of blood transferred from the placenta at birth

67
Q

Benefits of delayed cord clamping?

A
  • improving cardiopulmonary adaptations
  • preventing iron-deficient anemia
  • increased iron stores
  • increased BP
  • improve oxygen transport
  • increasing RBC flow
68
Q

Fetus RBC vs Adult RBC

A

Fetus has more RBC’s per cubic millimeter than adults and have a higher affinity for oxygen at a lower oxygen pressure

69
Q

Newborn RBC Lifespan

A

80-100 days

70
Q

What is the initial method recommended for maintaining newborn body temp?

A

Skin to skin contact

71
Q

Skin to skin should be the first line of treatment for what?

A

Hypothermia

Measure to reduce discomfort from painful procedure

72
Q

Thermoregulation

A

process of maintaining the balance b/t heat loss and heat production in order to maintain core temp

73
Q

Characteristics Predisposing Newborns to Heat Loss

A
  • thin skin
  • lack of shivering ability/voluntary muscle activity
  • limited stores of fat=large body surface area
  • No ability to adjust own clothes/blankets
  • Cannot communicate if to hot or cold
74
Q

Conduction

A

transfer of heat from object to object when the 2 objects are in direct contact w/ each other

75
Q

Convection

A

flow of heat from body surface to cooler surrounding air or to air circulating over a body surface

76
Q

Evaporations

A

loss of heat when liquid is converted to vapor

77
Q

Radiation

A

loss of body heat to cooler, solid surfaces in close proximity but NOT direct contact

78
Q

How do newborns produce heat?

A

Through nonshivering thermogenesis

79
Q

Neutral Thermal Environment

A

body temp is maintained w/o an increase in metabolic rate or oxygen use

80
Q

What will a neutral thermal environment promote?

A
  • Growth and stability
  • Conserves energy for basic bodily functions
  • Minimizes heat and water loss
81
Q

Nonshivering Thermogenesis

A

process in which brown fat is oxidized in response to cold exposure

82
Q

Cold Stress

A

excessive heat loss

83
Q

What will a newborn do in response to cold stress?

A

Use compensatory mechanisms such as nonshivering thermogenesis and tachypnea to maintain core body temp

84
Q

Cold Stress can cause what?

A
  • Depleted brown fat stores
  • Increased oxygen needs
  • Respiratory distress
  • Hypoglycemia
  • Metabolic Acidosis
  • Jaundice
  • Hypoxia
  • Decreased surfactant production
85
Q

How ling will maternal antibodies protect the newborn from certain infections?

A

6 months

86
Q

What antibodies will the newborn receive from breast milk?

A

IgE, IgA, IgM, IgG

87
Q

When will healthy newborns begin producing their own antibodies?

A

2-3 months

88
Q

3 Purposes of Immune System Responses

A
  • Defense
  • Homeostasis
  • Surveillance
89
Q

All immune responses primarily involve what?

A

Leukocytes

90
Q

What are the 2 categories of immune system responses?

A

Natural and Acquired Immunity

91
Q

Natural Immunity

A

responses or mechanisms that do NOT require previous exposure to the microorganism or antigen to operate effectively

92
Q

Examples of Natural Immunity

A

Physical barriers
Chemical barriers
Resident nonpathologic organisms

93
Q

What are the 2 primary processes for Acquired Immunity?

A
  • development of circulating immunoglobins

- formation of activated lymphocytes

94
Q

Acquired immunity is absent until when?

A

Until after the first invasion by a foreign organism or toxin

95
Q

Newborn’s immunologic ability depends heavily on which 3 immunoglobulins?

A

IgG, IgA, IgM

96
Q

IgG

A
  • Major immunoglobulin and most abundant
  • Found in serum and interstitial fluid
  • produces antibodies against bacteria, bacterial toxins, and viral agents
97
Q

IgA

A
  • second most abundant
  • protects mucous membranes from viruses/bacteria
  • found in GI/Respiratory tract, tears, saliva, colostrum, and breast milk
98
Q

IgM

A
  • found in blood and lymph fluid
  • first to respond to infection
  • major source of protection from blood-borne infections
99
Q

What is the most important function of the skin?

A

provide a protective barrier b/t body and the environment

100
Q

Functions of the Skin

A
  • limits loss of water
  • prevents absorption of harmful agents
  • protects thermoregulation and fat storage
  • protects against physical trauma
101
Q

Neurologic development follows what patterns?

A

Cephalocaudal and proximal-distal patterns

102
Q

Cephalocaudal Pattern

A

head to toe

103
Q

Proximal-Distal Pattern

A

center to outside

104
Q

What acute senses will the newborn have from early myelin development?

A

Hearing, smell, and taste

105
Q

Hearing

A

well developed at birth; responds to noise by turning to sound

106
Q

Smell

A

ability to distinguish mother’s breast milk and breast milk from others

107
Q

Taste

A

ability to distinguish b/t sweet and sour by 72 hours old

108
Q

Touch

A

sensitivity to pain; responds to tactile stimuli

109
Q

Vision

A

incomplete at birth; maturation is dependent on nutrition and visual stimulation

110
Q

Reflex

A

an involuntary muscle response to a sensory stimulus

111
Q

What do reflexes indicate?

A

neurologic development and function

112
Q

First Period of Reactivity

A

Begins at birth and lasts for 30 minutes-2 hours

113
Q

How does the newborn act during the first period?

A

Alert, moving, and may appear hungry

114
Q

Period of Decreased Responsiveness

A

From 30 minutes-120 minutes of age

115
Q

How is the newborn during the period of decreased responsiveness?

A

“Sleep period”

Period of sleep or decreased activity

116
Q

Second Period of Reactivity

A

Begins as the newborn awakens and shows interest in environmental stimuli
Lasts 2-8 hours

117
Q

Neurobehavioral Response

A

how newborns react to the world around them

118
Q

Orientation

A

response of newborns to stimuli

119
Q

Habituation

A

ability to process and respond to auditory and visual stimuli ; ability to block out external stimuli

120
Q

Motor Maturity

A

ability to control movements

121
Q

Self-Quieting Ability

A

consolability

122
Q

Social Behaviors

A

snuggling and cuddling

NU314 OB (21 decks)

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