Caring For The Newborn Flashcards
How does the fetus transition into a newborn
As it begins to breathe, the lungs expand with air and pulmonary vascular resistance drops. Blood flows to the lungs for gas exchange. Anything that delays this can lead to delayed transition with hypoxia, possible brain damage and potentially death
What does APGAR stand for?
Appearance (skin colour)
Pulse rate
Grimace
Activity
Respiratory
Appearance scores
Completely pink -2
Body pink, extremities blue -1
Centrally blue, pale -0
Pulse scores
> 100 - 2
<100 - 1
Absent -0
Grimace scores
Cries- 2
-grimaces 1
No response 0
Activity scores
Active motion -2
Some flexion of extremities -1
Limp - 0
Respiratory scores
Strong cry -2
Slow and irregular - 1
Absent -0
When to use OPAs
-Bilateral choanal atresia
-Pierre Robin Sequence
What can cause Apnea
-prematurity
-GERD
-Drug-induced
How to treat apnea
Respiratory support to minimize hypoxic brain damage
What is a premature baby
Delivered before 37 weeks
What is a low birth weight
Less than 2,500g
Factors for prematurity
-genetic
-infection
Cervical incompetence
-uterine abnormalities
-abruption
Multiple gestations
Drug use by mother
Trauma
Factors for low birth weight
Chronic maternal hypertension
Smoking
Placental anomalies
Chromosomal abnormalities
What are the four types of seizures
-subtle seizure
-tonic seizure
-focal clonic seizure
-Myoclonic seizure
What is a subtle seizure
Eye movement, sucking
What is a tonic seizure
Constant contraction
What is a focal clonic seizure
Contraction and relaxation of muscle group
What is a myoclonic seizure
Jerking motion of extremities
What does multifocal mean?
Refers to asynchronous, different areas
What does generalized mean
Same presentation on both sides
What are some causes of seizures
-hypoxic ischemic encephalopathy
-hypoglycemia
-hypocalcemia
-meningitis
-epilepsy
What is hypoxic ischemic encephalopathy
Usually secondary to asphyxia just before or shortly after birth
The most common cause of seizures
Usually only occur in the first 24hrs as brain swelling usually goes down after this
What causes hypoglycemia in infants?
Small infants
Large infants
Mothers who were diabetic during pregnancy
What to do for Gastroschisis / omphalocele
Place newborn in a bag from the waist down, nurse infant on unaffected side, monitor colour of intestines
What is the average normal temperature of a newborn?
37.5C
What is non-shivering thermogenesis
Production of heat by metabolism of brown fat
Ways in which babies lose heat
Evaporation
Convection
Conduction
Radiation
Evaporation prevention
Dry baby well and keep dry. Use dry sheets to wrap them in, not the ones used to dry them off
Convection
The air passing over the baby
Conduction
Placing baby on cold surfaces
Radiation
Just being in a cold environment
What is considered a fever in a newborn
Temperature greater than 38C
What causes a fever
Overheating
Dehydration is an important consideration in breast feeding babies
They have a limited ability to control temperature
-do not sweat to allow cooling
-do not shiver to raise their temp
What to do when you suspect a seizure
Observe the newborn for the presence or rashes
Obtain a careful history
Obtain the newborns vitals
Remove additional layers of clothing and improve environmental ventilation
Symptoms of hypothermia
-cool to the touch
-Initially in the extremities
-may be pale and have acrocyanosis
May become lethargic
What is considered hypoglycemic for an infant
BGL less than 2.6
Symptoms of hypoglycemia
Cyanosis, apnea, irritability, poor sucking or feeding and hypothermia, tachycardia, tachypnea, vomiting
Management of hypoglycaemia
-check BGL
-direct medical control may order 10% dextrose solution
-maintain temperature
When is vomiting a concern
-if it is persistent or if it contains blood
What are some causes of vomiting
Pyloric stenosis
Esophageal atresia with or without distal fistula
GERD
Malrotation
Hirschprung disease
What is esophageal atresia
Congenital defect
Infants are excessively mucousy
May choke when attempting to feed
GERD presentation
Most commonly seen in infancy
May vomit immediately or a few hours after a feeding
What is pyloric stenosis
Narrowing of opening between stomach and intestine
Hypertrophy and hyperplasia of the pylorus
Stomach muscles contract forcibly causing vomiting
What is malrotation
Congenital anaomaly of the midgut
Small bowel is found on the right side of the abdomen
What is hirschsprung disease
Meconium plug syndrome
Last segment of colon fails to relax
Usually a history of not passing meconium in the first 24hrs of life
How many stools per day is normal for an infant
5-6
What causes acute diarrhea
-Viral infection
Gastroenteritis
Lactose intolerance
Neonatal abstinence syndrome (withdrawal)
Thyrotoxicosis (hyperthyroidism)
Cystic fibrosis
Symptoms of severe diarrhea
Generally look ill
Poor vitals
Delayed cap refill
Dry mucous membranes
Absent tears
Weight loss
Low urine output
Common injuries in the newborn
Caput succedaneum
Chephalhemtotoma
Linear fractures
Brachial plexus injuries
Spinal chord injury
Intrapleural-abdominal injury
What causes birth injuries
Big infant
Primigravida
Big head
Prolonged or rapid labour
Abnormal presentation
Prematurity
Low birth weight
