ch 23 newborn adaptations Flashcards
baby’s first 28 days of life
neonatal period
baby’s first year of life
infancy
biological tasks during neonatal period (6)
-establish and maintain respirations
-adjust to circulatory changes (close shunts)
-*regulate temp
-ingest, retain and digest nutrients
-eliminate waste
-regulate weight
phases of instability during first 6-8 hours after birth; from intra-uterine to extra-uterine life
transition
what happens in first period of reactivity in transition (up to 30 min after birth)
-tachycardia
-tachypnea, irregular
-possible resp crackles
-possible brief periods apnea
-alert, eyes open
-decreased body temp
-increased motor activity and muscle tone
-GI (variable bowel sounds, meconium, saliva)
-strong suck reflex
3 phases in transition
-first period reactivity
-period of decreased responsiveness
-second period of reactivity
what happens during period of decreased responsiveness in transition (60-100 mins after birth)
-unresponsiveness, deep sleep
-color is pink
-resps are rapid and shallow, but unlabored
-bowel sounds audible
what happens during second period of reactivity in transition (from 2-8 hrs after birth, lasts 10 mins to several hours)
-tachycardia, tachypnea
-increased muscle tone
-changes in skin color
-lots of mucus production
-meconium
(preterm infants don’t experience this phase)
respiratory adaptations of neonate
-breathing becomes coordinated and regular
-lungs are mature (surfactant - keeps alveoli dilated on expiration)
-pulmonary vascular bed
-CNS responsiveness to blood gases
how to measure adequate surfactant in lungs
amniocentesis:
-L/S ratio 2:1
-PG positive
4 types of stimuli that initiate respiration after birth
-chemical stimuli (blood gases)
-sensory stimuli
-thermal stimuli
-mechanical stimuli
characteristics of normal respirations in neonate
-nose breathing without flaring
-quiet, shallow, irregular resps with brief periods apnea
-rate 30-60 breaths/min
-resp movements are abdominal (abdomen rises with chest)
characteristics of abnormal respirations in neonate
-nasal flaring
-chest retractions (intercostal retractions)
-grunting
-see-saw respirations (abdomen and chest rise at opposite times)
-crackles
-tachypnea
-central cyanosis
what can tachypnea in neonate indicate
-resp problem
-cardiac problem
-metabolic problem; cold stress
-infectious illness
cardiovascular adaptations in neonate
-closure of foramen ovale (because of increased LH pressure)
-closure of ductus arteriosus (because of increased oxygen)
-closure of ductus venosus
-heart rate variations, irregular is ok for first few hours
-murmurs might be normal (shunts are closing)
HR sleeping neonate
100 bpm
HR awake neonate
110-160 bpm
HR crying neonate
up to 180 bpm
where is apical pulse on neonate
3rd to 4th intercostal space to left of midclavicular line
approximate blood pressure for neonate
60-80/40-50
*MAP = EGA
*check upper and lower extremities
cardiovascular signs of problems in neonate
-abnormal rate (persistent tachycardia/bradycardia)
-murmurs (maybe)
-alterations and differentials in pulses
-changes in perfusion and skin color (jaundice, cyanosis, pallor)
-tachypnea
normal Hgb and Hct for neonate
Hgb: 15-24
Hct: 44-70%
normal RBC for neonate
4.8-7.1
normal WBC for neonate
9K-30K
*elevated WBC is very late sign of infection in newborn
normal platelets for neonate
<1 week: 85-500K
>1 week: 150-300K
what vitamin is needed for clotting factors to activate in neonate
vitamin K
factors contributing to heat loss
-higher surface area to body weight ratio
-thin adipose tissue, thin skin, blood vessels close to surface
-wet skin at birth
-extra-uterine environment (colder, less humid, air currents)
4 mechanisms of heat loss
-convection (to cooler air or air currents)
-radiation (to colder substance without touching it)
-evaporation (skin is wet)
-conduction (to colder substance by touch)
how to prevent heat loss by convection in neonate
-delivery room is warm
-warmers
-tall walls on basinets
-two blankets wrapped around baby
-cap on head
how to prevent heat loss by radiation in neonate
-keep them away from outside doors and windows
how to prevent heat loss by evaporation in neonate
-dry newborn
-remove wet linens
how to prevent heat loss by conduction in neonate
-warm everything before it comes into contact with baby
-warm hands
-skin to skin contact
-warmers
can newborns shiver
no
what warms baby during non-shivering thermogenesis
brown fat
what is needed to metabolize brown fat to provide warming
-increased O2
-glucose
locations of brown fat in neonate
-superficial: interscapular, axillae
-deep: thoracic inlet, along vertebral column, around kidneys
physiological consequence of hypoxia in neonates
shunts reopen
how to prevent cold stress in neonate
-dry infant quickly
-remove wet linens
-maintain skin to skin
-radiant warmer
-double wrapped with blankets
-hat on head
physiological adaptations in renal system in neonate
-5-10% weight loss in first 3-5 days because of diuresis (regains by 10-14 days)
-infant should void within first 24 hours of life
-uric acid crystals ok for 1 week (“brick dust”)
-normal void: straw color, odorless, minimum 1 wet diaper/day of age (up to day 4, then 6-8/day)
stomach size of neonate day 1, day 3, and day 7
day 1: 10 mL
day 3: 30 mL
day 7: 60 mL
when does neonate usually pass meconium
within 12-24 hrs
signs of risk for GI problems
-no meconium
-diarrhea
-forceful vomiting
-meconium from vagina/urinary meatus
what does transitional stool look like, and when should it occur by
-greenish brown to yellow brown
-thin, less sticky than meconium
-may contain milk curds
-by day 3
what does breast milk stool look like
-yellow to golden
-pasty
-“cottage cheese with mustard”
-little to no odor
what does formula milk stool look like
-pale yellow to light brown
-firmer consistency
-odorous
3 functions of liver
-produce Hgb
-regulate glucose
-conjugation of bilirubin
how long does neonate iron storage from mother last
4 months
why are neonates at risk for hypoglycemia
-limited glycogen stores
-loss of maternal glucose supply
what increases risk of neonate hypoglycemia
-big baby
-maternal diabetes
-poor placental perfusion
-preterm/small baby
what is bilirubin
breakdown of dead RBCs
can unconjugated (indirect) bilirubin be excreted from body
no
why are neonates unable to conjugate bilirubin to be excreted
-shorter lifespan RBCs
-extra supply of RBCs
-immature liver
what increases risk of hyperbilirubinemia in neonate
not eating
4 causes physiologic jaundice (hyperbilirubinemia)
-increased bilirubin production due to increased RBCs
-decreased lifespan RBCs
-immature liver
-reabsorption bilirubin in intestines
when does physiologic jaundice occur
after 24 hours of life
when does pathologic jaundice occur
before 24 hours of life
causes pathologic jaundice
-hemolytic disease of newborn (Rh incompatibility, ABO incompatibility)
-trauma
2 types jaundice related to breastfeeding
-breastfeeding associated jaundice
-breast milk jaundice
characteristics of breastfeeding associated jaundice?
how to fix?
-begins 2-5 days
-lack of effective breastfeeding
Tx: feed baby, monitor wet diapers
characteristics of breast milk jaundice? how to fix?
-begins at 5-10 days, may last 3-12 weeks
-uncertain cause
Tx: none, educate mom to monitor and bring in baby
what levels of bilirubin are too high for neonate
> 20-25 mg/dL
term for bilirubin levels that are too high can cause bilirubin encephalopathy
kernicterus
early signs of infection in neonate
-temp instability/hyperthermia
-lethargy, irritability
-poor feeding, V/D
-decreased reflexes
-pale/mottled skin
-resp: apnea, tachypnea, grunting, retractions
-discharge from eyes, nose, mouth
-rashes
hierarchy of developmental challenges of neonate (most basic to advanced)
-regulate physiologic/autonomic system
-motor organization
-state (of consciousness) regulation
-attention and social interaction
6 states of neonate sleeping and wakefulness
-deep sleep
-light sleep
-drowsy
-quiet alert (*optimal for parent interaction)
-active alert
-crying
neonate purposeful behavior that communicates overstimulation and want to modulate state of wakefulness
-actively withdrawing by increasing physical distance
-rejecting by pushing away with hands/feet
-decreasing sensitivity by falling asleep/breaking eye contact
-fussing/crying
how far can babies see
8-12 inches away
when can babies see color
2 months
characteristics of neonate hearing
-attempts to locate sounds
-recognizes familiar voices
-prefers high pitched voices
-responds to rhythmic sounds
what sense is very strong in neonate
smell
what parts of baby is most sensitive
-face
-hands
-soles of feet
