Care of the Newborn and Family Flashcards
When are the two assessments for the APGAR score?
Immediately following birth and again 5 minutes later
List the SEVEN points in the APGAR score procedure
- Ensure adequate lighting
- Note time of delivery (first score at 1 minute)
- Act promptly and appropriately to the score
- Repeat score at 5 minutes
- Repeat again at 10 minutes and 15 minutes if active resuscitation is in progress
- Document findings
- Discuss with parents
List the FOUR aspects of the midwife’s examination of the newborn head
- Look for signs of caput and moulding / Does the head appear asymmetrical?
- Observe for visible signs if trauma
- Feel along suture lines and fontanelles. Are they normal size and appearance?
- Measure head circumference
List the FIVE aspects of the midwife’s examination of the newborn face
- Eyes - 2, general shape and size, cloudy may be cataracts, discharge may be infection
- Nose - shape and size, note if flaring and react
- Mouth - symmetrical? Inside should be viewed
- Ears - 2, formed and in correct position, skin tags noted
- Milia - pin head sized whited spots
List the FIVE aspects of the midwife’s examination of the newborn neck
- Examine for symmetry
- Feel to detect presence of swelling
- Head should be able to move from side to side
- Webbing can be unusual - react
- Feel both clavicles to ensure they are intact
List the FIVE aspects of the midwife’s examination of the newborn arms and hands
- Arms should be the same length
- Arms should both move freely, lack of movement may denote underlying trauma
- The number of digits should be counted. Polydactyly (extra digits) or syndactyly (webbing) should be noted
- Palm should be straightened and creases examined
- Look at the nails
List the SIX aspects of the midwife’s examination of the newborn chest
- Examine for symmetry
- Sternal recession should be reported immediately
- Nipples and areola should be well formed, accessory nipples noted
- Breasts may appear enlarged, not a concern if no signs of infection
- Heart rate should be 110 - 160 bpm
- Respiration rate should be 40 - 60 breaths per minute
List the THREE aspects of the midwife’s examination of the newborn abdomen
- Should be rounded and move in synchrony with the chest
- Inspect and gently palpate for swelling
- Umbilical cord should be securely clamped with no signs of haemorhage
List the TWO aspects of the midwife’s examination of the newborn genitalia
- BOYS, length of penis should be around 3 cm, position of urethral meatus confirmed, do not retract foreskin, palpate scrotum for presence of two testes
- GIRLS, examine for presence of clitoris, urethral and vaginal orifices, Mucoid discharge may be present
List the FIVE aspects of the midwife’s examination of the newborn legs
- Assess symmetry, length
- Both legs should move freely
- Shape of feet noted
- Count toes
- Look for polydactyly and syndacyly
List the TWO aspects of the midwife’s examination of the newborn feet
- Positional talipes - contraction of muscles and tendons related to positioning in utero
- Ankles should move freely
List the THREE aspects of the midwife’s examination of the newborn spine
- Look for obvious signs of swelling or dimpling or hairy patches (could indicate abnormality of the spine)
- Assess curvature by running fingers lightly over the spine
- Gently part cleft of buttocks to look for any dimples, sinuses and to confirm the presence of the anal sphincter
List the THREE aspects of the midwife’s examination of the newborn skin
- General condition should be observed
- Obvious swelling or spots should be recorded
- Mongolian blue spot may be present and should be differentiated from bruising
What THREE things should be measured following the birth?
- Weight in kilograms
- Length in centimetres
- Occipital Frontal Circumference (OFC) - normal range 32-37cm
List EIGHT danger signs in newborns
- Poor feeding
- Lethargy
- Convulsions (staring and lip twitching or limb twitches)
- Cold body temperature (less than 35.5 degrees)
- Hot body temperature (more than 37.5 degrees)
- Chest indrawing
- Fast breathing (more than 60 is too fast)
- Jaundice
Which vessel carries oxygenated blood from the placenta to the fetus?
Umbilical vein
What is the foramen ovale?
The hole in the neonate’s heart between the right and left atria
What is the ductus arteriosus?
The vessel which allows the blood to bypass the pulmonary arteries and flow in to the aorta
What is the ductus venosus?
The vein which allows most of the oxygenated blood to enter directly in to the inferior vena cava, bypassing the liver
What is surfactant?
A substance produced in the lungs, which encourages the alveoli to stay open in the newborn
What is non-shivering thermogenesis?
The generation of heat in the newborn, by increasing the cellular metabolic rate in skeletal muscle and the breakdown of brown fat
What are the TWO types of urinary incontinence and describe each
Stress incontinence
Pelvic floor is weakened, sudden increase in abdominal pressure occurs and external urinary sphincter fails to contract
Urge incontinence
Sudden and uncontrollable urge to urinate
What can be used as a preventative strategy for incontinence?
Pelvic floor exercises
List FOUR benefits of skin to skin contact
- Prolactin is released (stimulates milk production and bonding)
- Stimulation of oxytocin to calm the mother
- Baby is calmed
- Increased duration of exclusive breastfeeding
List the NINE stages of instinctive newborn behaviour
- Birth cry
- Relaxation
- Awakening
- Activity
- Crawling
- Resting
- Familiarisation
- Suckling
- Sleeping
How long should skin to skin contact last for?
Until after the first breastfeed
What is jaundice?
Yellow discolouration of the skin caused by a raised level of bilirubin in the circulation, a condition known as hyperbilirubinaemia
Why is most neonatal jaundice harmless?
The fetal circulation has a greater number of red blood cells with a shorter lifespan so the increased breakdown levels causes a build up of bilirubin
When is jaundice normal (physiological jaundice)?
Appears at day 2, peaking at 3-7 days of age with bilirubin levels up to 80 umol/l
List SIX possible causes of physiological jaundice
- Infection
- Concealed haemorrhages
- Dehydration
- Increased enterohepatic circulation
- Impaired liver function
- Metabolic disorders
List THREE possible causes for pathological jaundice
- Blood group incompatibility
- Infection
- Trauma and bruising
When is jaundice considered pathological (not normal)?
Appears at less than 24 hours old
Bilirubin levels rise more than 85 umol/l per day or 5mmol/l per hour
Sick infant
What treatment can be given for jaundice?
Phototherapy
How does phototherapy work?
Detoxifies bilirubin by converting it in to a water-soluble form which can be excreted by the kidney
What is the consequence of a vitamin k deficiency?
An impaired production of coagulation factors by the liver
What does VKDB mean?
Vitamin K Deficiency Bleeding
What are the THREE types of VKDB and when do they occur?
Early VKDB - within 24 hours of birth
Classic VKDB - between day 1 and 7 of life
Late VKDB - between week 2 and week 12 of life
List FIVE gastro intestinal tract problems of the newborn
- Cleft lip and or palate
- Oesphageal atresia
- Tracheal Oesphageal fistula
- Gastro-Oesphageal reflux
- Pyloric stenosis
- Intestinal obstruction
What is Oesphageal Atresia?
A congenital abnormality in which there is a blind ending oesophagus
What is pyloric stenosis?
The muscles of the pylorus are thickened which prevents the stomach from emptying into the small intestine
What are the signs of a bowel obstruction?
- Failure to pass meconium
- Progressive abdominal distention
- Poor feeding
- Bilious vomits
What is an imperforate anus? (4 abnormalities)
- The absence of an anal opening
- The anal opening in the wrong place
- A connection joining the intestine and the urinary system
- A connection joining the intestine and vagina
What is Hirschsprungs’s disease?
The nerves are missing from part of the bowel which then cannot push material through and causes a blockage
What is necrotising enterocolitis?
Portions of the bowel undergo necrosis (tissue death)
Which class of antibodies do neonate’s have at birth?
Immunoglobin G (IgG)
By how many weeks gestation are maternal and infant IgG levels equal and when are the infants IgG levels greater?
Equal at 33 weeks
Greater at 40 weeks
What FIVE types of antibodies are found in breast milk?
GAMED IgG IgA IgM IgE IgD
Describe passive immunity in relation to pregnancy and birth
Maternal antibodies passed to the fetus through the placenta and through breast milk
Describe natural acquired immunity
Immunity present at birth, which is exposed to different antigens in an environment
Describe induced active immunity
Immunity gained from deliberate antigen exposure such as vaccinations
Why does the newborn body require a higher demand for glucose than an adult?
The newborn has a higher brain-to-body weight ratio and the brain uses glucose almost exclusively for its energy needs
Describe the TWO changes to energy sources that occur in a neonate following birth
Changes from continuous supply to intermittent
Changes from high carb and low fat to low carb and high fat
What is hypoglycaemia?
A deficiency of glucose in the blood stream
What TWO reasons make detecting and treating neonatal hypoglycaemia very important?
- It deprives the brain of its primary source of metabolic fuel and can lead to brain damage and seizures
- It is a presenting feature of numerous endocrine disorders and inborn errors of metabolism
List FOUR things that may cause a neonate to be more at risk of developing hypoglycaemia
- Prematurity
- Hypothermia
- Perinatal asphyxia
- Sepsis
List SIX clinical features that would indicate that a neonate should have its blood glucose checked
- Jitteriness
- High-pitched cry
- Seizure activity
- Lethargy
- Poor feeding
- Apnoea
What FIVE things does the blood spot test screen for?
PKU - Phenylketonuria CHT - Congenital hypothyroidism CF - Cystic fibrosis SCD - Sickle cell diseases MCADD - Medium chain acetyl CoA dehydrogenase deficiency
What is the puerperium?
The time immediately following childbirth which lasts approximately 42 days during which anatomical and physiological changes brought about by childbirth resolve
How soon following birth should the mother have passed urine and opened her bowels?
Urine - 6 hours
Bowel - 3 days
