Postnatal Baby

Question 1

What is the golden hour?

Answer 1

A unique time for mother and baby
Uninterrupted skin to skin
Calm environment
At least one hour or until after the first feed whichever comes first
Encourages feeding behaviours
Described as giving the best start in life

Question 2

Benefits of skin to skin for both the mother and baby?

Answer 2

Calms and relaxes
Regulates breathing and heart rate
Stimulates digestion and supports feeding behaviours
Thermoregulation
Skin colonisation of maternal bacteria
Hormonal response in the mother - oxytocin and prolactin

Question 3

Why will babies do during initial skin to skin contact?

Answer 3

Cry a distinctive cry
Recover from delivery
Start to awaken
Mouthing and sucking movements begin
Small motor movements begins to move towards the breast
Often rest at the breast
Familiarise with the breast
Self latch and begin to feed
Come off the breast and fall asleep

Question 4

Benefits of delayed cord clamping?

Answer 4

Increases volume of RBC’s transferred from the placenta by up to 30%
increases iron transfer to the baby
Reduces anaemia in the 1st few months
Reduces need for blood transfusion, risk of death and risk of brain bleeds
Small increased risk of jaundice in babies who have delayed cord clamping

Question 5

What is apgar scoring?

Answer 5

A score of 0-2 in each criteria: appearance - blue all over, blue only at extremities, no blue colouration.
Pulse - no pulse, <100bpm, >100bpm
Grimace - no response to stimulation, grimace or feeble cry when stimulated, sneezing, coughing or pulling away when stimulated.
Activity - no movement, some movement, active movement.
Respiration - no breathing, weak slow or irregular breathing, strong cry

At 1,5, 10 minutes.

Question 6

What is included in the initial midwife check of the neonate?

Answer 6

Head circumference
Body temperature
Birth weight
Initial examination
1st feed
Skin to skin

Question 7

Why are neonates predisposed to heat loss?

Answer 7

They have less subcutaneous fat than adults - subcutaneous adipose tissue froms an insulating barrier around the shell of the body and prevents heat loss.

Question 8

What type of tissue do neonates have?

Answer 8

Brown adipose tissue
Forms from 30wks - 4wks PN
Well vascularised, cells densely packed with mitochondria and generates heat by non shivering thermogenesis
Breaks down blood glucose and fat molecules to creat heat and maintain body temperature.

Question 9

Why do pre term infants lose heat more rapidly than a term infant?

Answer 9

They have a large surface area to body mass ratio and decreased subcutaneous fat.
Pre term infants at increased risk of trans epidermal water loss through evaporation

Question 10

How do neonates lose there heat?

Answer 10

Conduction
Convection
Evaporation
Radiation

Question 11

What is vitamin K and what does it do? Why do we give it?

Answer 11

Vitamin K helps the body to make certain proteins required for blood clotting for example prothrombin
Prothrombin - vitamin K dependent protein involved in blood clotting
It reduces vitamin k deficiency bleeding
In utero transfer of vit k is poor
Little transfer is breast milk

Question 12

What are the hormones involved in BF?

Answer 12

Prolactin - stimulation - nervous response sent to hypothalamus - stimulates anterior pituitary - secrete prolactin - stimulates lactocytes - causes milk production

Oxytocin - stimulation - nervous response sent to hypothalamus - stimulates posterior pituitary - secretes oxytocin - stimulates contraction of myoepithelial cells - milk ejection/ let down reflex.

Question 13

How do we assess infant feeding?

Answer 13

Meaningful conversations as per BFI guidelines
Effective positioning and attachment
Signs of effective milk transfer - happy and content after feeds
Comfort of both mother and infant
BFI feeding checklist
Infant behaviour and appearance

Question 14

What is lactogenesis 1?

Answer 14

Initiation of milk secretion
Mid pregnancy to early PN - included colostrum
progesterone inhibits prolactin, fall post birth.

Question 15

What is lactogenesis 2?

Answer 15

Onset of copious production
‘Milk comes in’ around 48hrs post birth when prolactin levels have stimulated milk production

Question 16

What is lactogenesis 3?

Answer 16

Maintenance of established supply
Local autocrine control - production is mantianed on ‘supply and demand’ basis.
7-10 days post birth.

Question 17

What does early frequent feeding do?

Answer 17

Primes receptor sites to improve and maintain milk production for ongoing feeds.

Question 18

What are the differences in the gut of a BF baby and AF baby?

Answer 18

Different types of bacteria are found in gut of breastfed to artificial fed babies - different gut flora and less pathogenic bacteria.
PH level is more acidic in BF babies which is preferred
The neonatal gut is immature and immunonaive

Question 19

What are the benefits of colostrum?

Answer 19

Antibodies and immunoglobulins are proteins
Vitamin K and E are fat soluble - lower fats = energy
Secretory IgA levels - protect the gut lining against pathogenic bacteria
anti - infective properties - macrophages, lymphocytes, lactogerrin, lysosomes etc.

Question 20

What does BF reduce the risk of?

Answer 20

Gastroenteritis
Respiratory Illness
Ear infection
UTI
Allergies
Necrotising enterocolitis

Question 21

What do growth factors in breastmilk do?

Answer 21

Helps mature the gut.

Question 22

What does the NIPE consist of?

Answer 22

Eyes
Heart
Hips
Testes
Within 72 hours of birth
Again at 6-8 wks

Question 23

What are the key elements of safe sleeping?

Answer 23

On their back
Seperate cot or Moses basket in same room for at least 6 months
Keep baby in a smoke free environment
Use a firm flat waterproof mattress
breastfeed baby

Question 24

What increases the risk of SIDS?

Answer 24

Sleeping on the sofa increases it by 50X
Young babies may be at risk of breathing difficulties if they travel while sitting in an upright position for too long.
Low birth weight (under 2.5kg and prem babies) at an increased risk of SIDS

Question 25

What does the newborn blood spot screen for?

Answer 25

9 rare but serious condition
Sickle cell disease - inherited blood disease affecting the haemoglobin causing RBC to become hard and sticky like a C shape.
Cystic fibrosis - causes sticky mucus to build up in the lungs and digestive system.
Congenital hypothyroidism - thyroid hormone deficiency, low levels of thyroxine, results in growth problems, serious physical and learning disabilities.
6 inherited metabolic disorders - cannot process certain substances in their food but all can be treated by carefully managed diet and/or medication

Question 26

What is the role of the health visitor?

Answer 26

Healthy child programme recommends visit between 10-14 days PN.
Support families until child reaches 5 years old and starts school
Development assessment at 2 years
Support reduction in health inequalities
Feeding and nutrition
Safeguarding and social requirements
Passion for promotion of healthy lifestyles and prevention of illness.

Question 27

What are signs of a thriving neonate?

Answer 27

Feeding frequently 8-12x 24 hours
Waking for feeds
Alert and handling well
Settling after a feed
Good Urine and stool output
gaining weight
Good colour and perfusion
Safe sleeping practices
Opportunities for screening

Question 28

What common problems might you come across in the PN period?

Answer 28

Frequent crying
Weight loss
Slow weight gain
Infection - umbilical cord, eyes (sticky)
Nappy rash
Jaundice - bilirubin metabolism

Question 29

How do you promote evidence based care concerning promoting close and loving relationships?

Answer 29

Encourage parents to connect and develop a relationship with their unborn baby
Facilitate immediate and uninterrupted skin to skin after birth regardless of feeding intention
Ensure parents are supported in the early days and weeks to develop close and loving relationships with their babies and support to form these.
Provide skilled and sensitive support for BF mothers to allow them to effectively BF for as long as they wish.
encourage parents to keep their baby close so that they can pick up on feeding cues.
Encourage responsive feeding in bottle fed babies.
Explain that all will help with the development of their baby and help them to become happy and healthy children and adults.

Question 30

How do you provide evidence based care concerning early skin to skin promotion?

Answer 30

Educate families on important of skin to skin
Offer skin to skin to all for as long as they wish after birth
Encourage mums to offer first feed during that skin to skin contact when baby is ready to feed
Encourage skin to skin at the earliest opportunity whenever there has been a delay
Maternal and neonatal wellbeing

Question 31

How do you explain the anatomy and physiology involved in breastmilk production and ejection in the human breast?

Answer 31

Lactogenesis 1 - initiation of milk production, priming receptor sites for prolactin
Lactogenesis 2 - copious amounts of milk production.
Lactogenesis 3 - maintenance of milk production
Hormone pathways
Prolactin - stimulated for next feed by the anterior pituitary, lactocytes produce the milk.
Oxytocin - stimulated beforehand by the posterior pituitary and is ejected via the myoepithelial cells.
Frequent feeding - reduces FIL which is a prolactin antagonist.

Question 32

What are key elements of the BFI on close and loving relationships?

Answer 32

Security releases oxytocin in both the mother and fetus
Oxytocin release can become conditioned and easily triggered in the newborn by sight smell or voice of its mother
Reduces cortisol levels - higher levels may delay lactogenesis, negative effect on newborn growth and brain development.
High levels of oxytocin - affect receptor sites in the brain, encouraging development of the right brain.

Question 33

What are the key elements of the hearing screening?

Answer 33

Hearing loss may affect language, speech and communication skills
Automated Otoacoustic emission (AOAE) - first line
Soft earpiece placed into the baby’s ear and clicking nose played - cochlea responds to this which is detected by the screening equipment.
Automated auditory brain steam response (AABR)
3x small sensor placed on forehead, back of neck and shoulder
Soft headphones used and clicking noise played.
Referral to audiology may be required