Care of the Neonate Flashcards
Within minutes after birth…
-a newborn has to initiate respirations -adapt a circulatory system to extrauterine oxygenation
Within 24 hours…
-neurologic, renal, endocrine, and GI functions must be operating competently for life to be sustained
Fetal breathing starts…
11 weeks
Fetal breathing is characterized by…
minimal circulation to the pulmonary bed
intrauterine oxygenation occurs via..
placenta -no gas exchange in fetal lungs
Fetal lungs are…
fluid filled -some reduction in this prior to birth -there is still 100mL of fluid remaining in the respiratory passages at delivery
Intrauterine role of surfactant
-promotes lung maturity by overcoming surface tension inside and outside the alveolar sacs in the fetus -surfactant peaks at 35 weeks and remains high
How is blood shunted
-shunted away from the pulmonary (right side) circulation via the foramen ovale and ductus arterisus
Extra uterine circulation begins…
with the first breath
Respiratory gas exchange in conjunction with marked circulatory changes…
must occur immediately for the baby to begin life as a separate being
what 2 changes are needed to maintain life
-lungs must expand and allow for pulmonary ventilation -marked increase in pulmonary circulation
Initiation of Respirations
-thoracic squeeze decreases fluid further -chest wall recoil-small amount of air in, more fluid out -chemoreceptor response to decrease pO2, pH, and increase in CO2 -cold air means less resp effort -sensory stimuli including tactile, auditory, and visual that stimulate resp effort
What happens after umbilical cord is clamped and respirations are initiated
3 Anatomic Shunts that normally close after delivery
- Foramen Ovale
- Ductus Arteriosus
- Ductus Venosus
Why do the 3 shunts close after delivery?
due to the response to pressure gradient shifts following the first few breaths
What happens to pulmonary blood flow with first few breaths?
- lung fluid has been removed
- pulmonary vascular resistance decreases and pulmonary blood flow increases
- sometimes this doesn’t happen right away and the baby develops Transitory Tachypnea of the Newborn (TTN)
Tx for TTN
- support until the lungs clear
- O2
- hold PO feeds
- IVF with expected recovery in 24-72 hours
Initial steps for newborn
- drying
- warming
- stimulation
- positioning
- clear airway
- necessary for all newborns
Immediately after delivery, look at…
- general appearance
- color and cry
- ease of breathing
first exam begins as nurse is drying, stimulating and wrapping infant or when infant is placed on mothers abdomen after being born
Skin to skin
promotes bonding and breastfeeding
Immediate newborn care
- wear gloves
- maintain airway
- suction, O2 prn
- RR: 30-70’s
- Apgar score
- Neutral thermal environment
- warmer, maintain temp of 36.5-37.2 C
- Safety ID Bands
Convection
losses from circulating air
Radiation
body heat transferring to nearby objects
Evaporation
heat loss when moisture on baby vaporizes into air
Conduction
body heat lost when baby in direct contact with cold object
Increase in muscular activity
shown by crying and restlessness (increases BMR)
Non-shivering thermogenesis
unique to newborns
-uses the infants stores of brown fat
brown fat
found in the midscapular area, around the neck, axillas, trachea, kidneys, and adrenal glands
Cold Stress
- Hypothermia
- ↑ O2 consumption (to keep warm) that leads to ↑ RR
- Pulmonary vasoconstriction and Peripheral vasoconstriction
- ↓ O2 to tissues causing Anaerobic glycolysis OR metabolic acidosis
Metabolic acidosis
↓O2, ↑ CO2 leading to ↓ pH (acid)
Cord Clamping
- keep at level of uterus
- approx 45 second delay in clamping has benefits
- place clamp approx 1 inch from abdomen
- Assess for 2 arteries and 1 vein
- Remove plastic clamp in about 24 hours and offer save it for parents
Apgar Scoring System
Taken at 1 minute and 5 minutes
- 7-10 good condition
- 4-6 moderately depressed
- 0-3 severely depressed
Normal neonate axillary temp
36.5-37.2
Normal neonate respirations
30-60
Normal neonate apical pulse
120-160
Normal neonate BP
not generally done
80-60/45-40
Normal neonate weight
2500-4000g
Normal neonate length
46-56cm
Normal neonate head circumference
32-37cm
Immediate care
- vit k injection
- check cord clamp
- footprints and ID bands
- security tag
Vitamin K Injection
??
Protection from hypoglycemia
- closely monitor
- SGA, LGA, IUGR
- Stressed infants
- infants of DM
- Cold stress
- symptomatic
- feed as soon as possible
Hypoglycemia Heel Stick Procedure
- blood sugar norm: 45-60
- blood sugar <45
- requires feeding
- blood sugar <20-25
- requires parenteral glucose
- warm heel, select size and correct heel location
Newborn screening
- Development - orderly and predictable
- newborn screening
- Metabolic disorders
- phenylalanine/phenylketonuria PKU
- several genetic disorders
- F/U care home health after d/c home
- 2 weeks, then 2-4-6-9-12 months
SGA
small less than 2500
LGA
large over 4000g
IUGR
intrauterine growth restriction
Vernix Caseosa
??
Arocyanosis
??
Erythema Toxicum
??
Milia
??
Fontanels
Anterior:
Posterior:
Molding of head influenced by vaginal birth
??
Caput succedaneum
??
Cephalohematoma
??
Digits/Polydactyly
??
Palmar Crease - Simian Crease
??
Male Genitalia Exam
Determine meatus location: Hypospadias Epispadias
Warm hand when inspecting scrotum
Palpate testes separately
Assess for hydrocele
Female Genitalia Exam
- Examine
- Labia majora
- Labia minora
- clitoris
- Observe for pseudo-menstration
Reflexes
- Root
- Suck
- Swallow
- Moro
- Babinski
2 parts to Gestational Age Assessment
- External physical characteristics
- Neurological characteristics
Physical Maturity Charcteristics
- resting posture
- skin
- lanugo
- plantar creases
- breast tissue
- ear formation and cartilage development
- evaluation of genitals
Early assessment of neonatal distress
- parental teaching
- observe for:
- changes in color or activity
- grunting or sighing sounds
- rapid breathing
- chest retractions
- facial grimacing
Non Breastfed Feeding guidelines
- 1st feeding by 5 hours of age, 2nd period of reactivity
- enfamil, similac, good-start 20 kcal/oz
- various bottles and nipples available NUK nipple vs. standard and high flow versus normal. DR. brown bottles may help with reduction in gas
- no honey on pacificer - risk of botulism
General Feeding Guidelines
- establish a feeding routine after the first week or so
- incorporate baby’s cues into feeding routine
- initially feed q3-4 hours
- identify signs of intolerance including reflux, emesis, diarrhea
- burping q 1-2 ounces
- keep mixed formula in the fridge
- dilute correctly when using concentrate
