12. The newborn infant. Characteristics. Routine delivery room and initial care for the newbom. Flashcards
1
Q
Care of the Newborn
A
- Clear the Airway:
- Dry the Newborn and put warm towel around it
- Clamp the Cord
- ideal time 20 to 30 seconds after birth
- Ensure Onset of Respiration
- If respiration has not commenced at 30 seconds of life or the heart rate is less than 100, positive pressure ventilation with oxygen should be started.
- Correct Surfactant Deficiency
- Measurement of Apgar Score!
- Administer Vit. K & eye prophylaxis (silver nitrate drops to prevent gonococcal ophthalmia)
- Promote bonding between mother and newborn
2
Q
Assessment of the Newborn
Head
A
- bulging fontanelle may indicate increased intracranial pressure
- molding of the head can look like quite a strong deformation but is normal and is due to pressures that acted on the head during birth
- Cephalhematoma or caput succedaneum can occur, they resolve within weeks
- inspect face for symmetry of eyes, lips and ears (eyes are usually blue or gray, the real eye colour develops in the first 3-12 months of life)
- inspect mouth for wet mucosa and closed cleft palate
3
Q
Assessment of the Newborn
Neck
Chest
Abdomen
A
Neck: check lymph nodes, assess full range of motion
Chest:
- shape should be cylindrical
- bell sign could be a sign of underdeveloped lungs
- evaluate respiratory efforts and movements
- auscultate lungs
Abdomen:
- check the cut umbilical cord:
- should have 2 arteries and 1 veins
- auscultate for bowel sounds
- femoral pulses are palpated
- if absent: might be due to coarction of aorta
4
Q
Assessment of the Newborn
Genitalia
Female
Male
A
Female:
- labia majora cover labia minora and clitoris
- mucoid vaginal discharge and bleeding may be present
- maternal hormones
- hymen might still be intact
Male:
- rugae are present on scrotum
- check if testis are descended
- abnormal opening of the urethra might be present
5
Q
Assessment of the Newborn
Extremities
Spine
A
Extremities:
- Assess for full range of motion,
- check for symmetry and signs of trauma
- Spontaneous motion of all extremities should be present
- Assess muscle tone
- Hips need to be assessed for dislocation
- Nail beds pink- persistent cyanosis associated with hypoxia
- Simian crease (transverse palmer) suggests Down syndrome
Spine: Should be straight and flat
6
Q
Assessment of the Newborn
Skin
A
- Color… might be yellow (icterus), blue (cyanosis),…
- Lanugo is still present:
- check the skin turgor (elasticity)
- dehdydration decreases tugor
- common skin problems:
- petechial
- blisters
- milia (white bumps in face)
- Mongolian spots (blue/ grey spots which vansish in the first years of life)
7
Q
Assessment of the Newborn
Neurological Examination
A
- Reflexive behaviors are necessary for survival and safety
- Absence, weakness or asymmetry indicates abnormalities
- Reflexes that should be checked:
- The Moro reflex
- Grasp reflex
- Rooting reflex
- Stepping response
- Sucking reflex
- Galant reflex
8
Q
Large for gest. age
Small for gest. age
Normal birth weight
Still birth
A
- large for gestational age: newborn that is heavier than the 90th percentile
- small for gestational age: newborn that is lighter than the 10th percentile
- normal birth weight is usually 2500-4000g
- still birth: fetus that ways at least 500g but without any signs of life
9
Q
Physical Characteristics of the Newborn:
Lengths
Weight
Head and Chest Circumference
Temperature
Heart rate
Respiratory Rate
A
- normal size is 49-53 cm
- normal weight is between the 10th and the 90th percentile
- usually 2,5 - 4 kg
- newborns may lose up to 10% of their birth weight due to waterloss
- head circumference: usually 33-38 cm
- chest circumference: 31-36 cm
- temperature: axillary temperature is usually 36-37°C
- cardiovascular system: HR is usually 110-160 bpm
- respiratory rate is usually 30-60 breaths per minute, nose- breather
