4500 Class 9 — NEONATAL Flashcards by M. B.

Health assessment techniques and diagnostic tests r/t to the neinate

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MAIN physiological processesof neonatal transition to extra-uterine life

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Jaundice — neonate

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Signs of integumentary problems in neonates

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Name important newborn reflexes

Sucking and rooting

Swallowing

Palmar grasp

Plantar grasp

Moro (or startle)

Stepping or “walking”

Crawling

Babinski (plantar)

Pull to sit postural tone

Add

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What is the therapy for hyperbilirubinemia

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Newborn Nursing Interventions related to the postpartum period

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MAIN physiological processes of neonatal transition to extra-uterine life

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What ARE IMPORTANT changes/adaptation in the first 2 hours of life

ESTABLISH RESPIRATIONS

Adjust to circulatory changes

Regulate temp

Eliminate waste

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What indicates poor sdaptation in fetal heart monitoring?

Minimal variability. Heart rate not in range, LATE DECELERATIONS

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What does late deceleration indicate?

POOR OXYGENATION

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WHAT DO WE ASSESS IN THE FIRST STAGE OF LABOUR

Fetal positioning/presentation

Internal electronic fetal monitoring

Length

Rupture of membranes — time of ROM (length of ROM), note presence of Scalp

Scalp sampling?
Any sign of fetal distress?

Any complication in labour? Bleeding, eclampsia, tx with magnesium sulphate)

Birther analgesia/anesthesia (fentanyl, morphine)

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When GBS pos? How to treat?

1 initial dose of 5M units of PENICILLIN

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What is a meconium?
Color? When does it usually pass?
Where does it pass?

What can cause it

First stool

Green-black in colour, viscous and sticky!

Usually passes within 12-24 hours after birth

May pass in utero — chnages of passing meconium increases in utero after 38 weeks gestation. It is common in breech presentation. Common in anything after 40 weeks — postdates.

It can be caused by hypoxia (induced peristalsis), and spihincter relaxation

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Fetal Circulation?

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Top CHANGES in the heart FROM FETAL TO NEWBORN CIRCULATION

DUCTUS VENOSUS

FORAMEN OVALE

Shuts

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Why are preterm infants at higher risk of ineffective osygen supply

Has immature alveoli

Decrease elasticity, recoil

Less surfactant

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How can meconium present itself? (Meconuim Aspirarion Syndrome) MAS

How do we manage

Abnormal / atypical FHR patterns

Complications include terminal airway obstruction, respiratory distress, inflammation, and infection

Persistent pulmonary hypertension of newborn!

EFM in labour!!! ⭐️

When during birth, not breathing or crying, has a flat tone
- may intubate to suction below the cords, may need ventilate! ⭐️

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What are three things we look for before starting a NEONATAL RESUSCITATION?

Term gestation? ~over 37 weeks?
Crying or breathing>
Good tone?

If mo, STAR RESUS

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What’s the routine care for neonatal transition?

A. Prone on birther’s chest (skini to skin) — maintain warmth/normal temp
B. Clear secretions as needed
C. Dry and stimulate to breathe
D. Delayed cord clamping
E. Newborn stays w parents
F. Ongoing observations

ESTABLISH EFFECTIVE RESPIRATIONS

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What are potential benefits of delayed cord clamping in preterm newborns?

Decreased mortality

Higher bp and blood volume

Less need for blood transfusion after birth

FEWER brain hemorrhages and

Lower risk of necrotizing enterocolitis

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Potential benefits of cord clamping in term newborns

Decrease chance of developing iron-deficiency anemia

Maybimprove neurodevelopmental outcomes

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Potential adverse effects of DELAYED CORD CLAMPING

Delaying resuscitation for compromised newborns

Increased risk of POLYCYTHEMIA (high red blood cell concentration)

Jaundice

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CONTRAINDICATIONS of delayed cord clamping (DCC)

those who require immediate resus

For infants less than 37 weeks gestational age, DCC only for at least 1 minute

For infants 37 weeks or more. DCC for 1-2 minutes!

COMTRAINDICATIONS OTHERS:

Known or suspected placental abruption

Uncontrolled maternal hemorrhage

Vasa previa

Fetuses with pre-existing volume overload such as hydrops fetalis

Multiple gestation deliverieswhere the second twin is in distress

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When do we expect an o2 of 10p%

10 mins after birth

Body pink, extremities blue

Acrocyanosis

Apgar score that means newborn is on severe distress

0-3

Apgar score that means normal transition, little difficulty

7-10

What physiological mechanisms happen when a newborn is cold (hypothermia)

1. Thermogenesis - newborns attempt to generate heat by increasing muscle activity, could appear restless and cry, could feel cool due to vasocontriction 2. Increase in cellular metabolic activity — which increases consumption of oxygen and glucose 3. Flexiom to reduce exposure 4. Constriction of blood vessels 5. Shovering mechanism is not operable in new born — in turn brown fat metabolism — these are higher in preterm infants (increases metabolic activity in the brain, heart, and liver)

What can cold stress lead to? Adverse effect

1. RESPIRATORY DISTRESS /metabolic distress 2. HYPOGLYCEMIA!! They would need more glucose

WEIGHT Average finding? Normal VARIATION?

Average finding: *3400-3500 grams Normal bariation: *2500-4000 grams

Average finding for LENGTH of newborn

45-55 cm

What is the method of assessment of *head circumference of a newborn

OCCIPITOFRONTAL CIRCUMFERENCE

What is the headcircumference of a newborn AVERAGE FINDING NORMAL VARIATION

AVERAGE FINDING: 33-35 cm NORMAL VARIATION: 32-36.8 cm

TEMPERATURE IN NEWBORN Average finding Normal Variation

Average: 37 Normal variation: 36.5 - 37.5

HEART RATE IN NEWBORNS Average finding Normal variations

Average findings: 110-160 bpm Variations: as low as 80-100 when asleep Up tp 18- bpm if actively crying

RESP RATE IN NEWBORNS Average finding Normal Variations

Average findings: 30-60 bpm Normal variation: >20 s , Stabilization occurs by day 1-2 days

SKIN ASSESSMENT (normal findings or variation?)

Acrocyanosis Skin pigmentation begins to deepen after birth General p\plump appearance Vernix caseosa (soft cheeselike/whiteish substance —protective) Lanugo hair

SKIN ASSESSMENT (normal variation or normal finding??) — superficial cracking/peeling of hands and feet — mottling extremities due to instability of the newborn circulation — congenital dermal melancytosis—common to back and buttocks, fade over months — Nevi / telangiectases / stork bites —flat, pink capillary hemangioma—easily blanched, most fade in fist and second years of life — erythema toxicum — transient rash (appeards 24-72 hours; can last up to 3 weeks), no clinical significance, no tx required — petechiae — MILIA (sweat glands on the face, normal)

Normal variation

Erythema Toxicum What is it? When do we see it? How long does it last? Tx?

It is a transient rash; erythematous macules, papules, and small vesicles Appears around w4-72 hours after birth / can last up to 3 weeks No clinical significance, no tx reauired

What is vernix caseosa? Is it a normal finding or normal variation?

It is sof cheeselike/whitetish substance, protective It is a normal finding

What is a milia? Is it a normal finding or normal variation?

It is a small sweat-gland spots, usually found on the face It if a normal variation

What is a telangiectatic nevi? On a newborn? Is it a normal finding or a normal variation?

It is a stork bite It is a normal variation

What would be a potential concern on SKIN ASSESSMENT

1. Bruising 2. Jaundice 3. Central cyanosis 4. Pallor

Moulding in the head/face normal?

Yes. May or may not be present

Head a _______ (size) as compared to body length

A fourth

Fontanels and sutures should be? Should not be/

Suture lines should be palpable Both should not be bulging, swollen or sunken

Discharge in the eyes on newborn?

Should be none

What is caput succedaneum? Is it normal finding? Or normal variation? Unexpected?

It is generalized edematous areas of the scalp. Can be accompanied by exxhymosis. Crosses suture lines. It is a normal c]variation.

It is the collection of blood between a skull bone and its periosteneum. (common in forcept birth) (can result in jaundice) Does not cross suture lines. Does mot pulsate or bulge when baby cried Appears several hours or the day after birth — usually largest on the 2nd or 3rd day Fullness evolved in 3-6 weeks

CEPHALHEMATOMA

It is the bleeding into the subgaleal compartment. Dangerous! Crosses suture lined Potential space — loosely arranged connective tissue — blood lss in this space can be severe (*do head circumference assessments!)

SUBGALEAL HEMORRHAGE

EDEMA AT THE BACK OF THE NECK MASSES FOR NEWBORNS DELIVERED BY VACUUM EXTRACTION Potential: BOGGY SCALP TACHYCARDIA INCREASING HEAD CIRCUMFERENCE FORWARD POSITION IN OF THE NEWBORN’S EARS CHANGES IN NEWBORN LOC What does these assessment findings suggest? What might the the order?

SUBGALEAL HEMORRHAGE May require blood transfusion

Thyroid in newborn Palpable or not?

NOT

Webbing, masses in neck??

No expected

Prominent tip of sternum Normal? Or not

Normal

Breast nodule in a newborn What is a normal findong What is a normal variation

Normal finding: ~6mm Normal variation: 3-10 mm/ potential for discharge

Where can fluid retention lead to?

TTNB (transient tachypnea of the newborn)

Abd breathing

Normal variation

What is the normal interuterine o2

60%

After 10 mins (newborn), what should o2 be

95%

What are signs of respiratory distress

Nasal flaring Intercoastal or substernal retractions Stridor Grinting Gasping Apnea lasting 20nseconds or longer

Mottling

Not expected

Tachypnea is its most common feature. It is a parenchymal lung disorder from delayed resorption and clearance of fetal alveolar fluod 1-2 hours: RR up to 100 breaths/min along with some grunting, nasal flaring, mild retractions *usually resolves within 24 hours

Transient tachypnea of the newborn (TTN)

Ttnb care?

Support on feeding Promote thermal emvironment Maintain o2 at 90-95%

Nb blood vol

80-100 ml/kg

Heart murmur on nb?

Does not signify pathological defect >50% disappear by 6 months It should be assessed in conjunction with overall status(color, appearance, behaviour, feeding) Note to provider

Irregular HR in the first few hourd

Not uncommon

CVS assessment on a newborn

Inspect for visible pulsation in midclavicular line (4th intercoastal space) Palpate apical pulse (4th intercoastal sapce) Auscultation of apical pulse for FULL MINUTE for rate (4th intercoastal space) Auscultate heart sounds (S1 and S2)— should be sharp and clear

What does greenish umbilical cord imdicate

Meconium staining

Important fo synthesis of blood coagulation factors

VIT K

When do we expect the first stool? Of a newborn

24-48 hours

How does a newborn’s ABDOMEN look like

Round and prominent — like a dome Soft Cold be a few visible veins Movement with resp should be noted

When to expect bowel sounds in a newborn

After a few minutes

How does the umbilical cord look like on assessment

Has two arteries, one vein Clamp should not be bleeding Usually white\ish grey Should be odourless

What is vernix caseosa? Normal Finding or variation?

It is a sof cheeselike/whitish substance It is a NORMAL FINDING

What is lanugo hair Is it a NORMAL FINDING ORRR VARIATION

It is fine hairs over favc3, shoulders, and back It is a N FINDING