Chapter 17 and 18: Newborn Flashcards
1
Q
Phases of physiologic transitioning
A
- first period of reactivity - approx 30 minutes after birth
- period of decreased responsiveness or inactivity (30 min - 2hrs)
- second period of reactivity (lasting 2 - 8 hrs)
2
Q
Normal RR:
A
30 - 60
Over 60 in first 2 hours is ok
3
Q
Normal newborn breathing characteristics
A
irregular shallow unlabored short periods of apnea (<15 sec) symmetrical chest movements
4
Q
3 cardiovascular adaptations and timing
A
- closure of foramen ovale (
functional: 1-2 hours after birth, permanent: by 6 months) - Closure of ductus arteriosus (functional: w/n first 72 hours, permanent closure 3-4 weeks)
- Closure of the ductus venosus
(closure 1 week after birth)
5
Q
Infant heart rate after birth
first few minutes:
after:
A
first few minutes: 120-180
after: 120-140
6
Q
are cardiac murmurs ok?
A
yes
7
Q
Newborn normal temp range
A
97.9 (36.5) – 99.7 (37.5)
8
Q
reasons for poor thermoregulation in infants
A
thin skin (vessels close to surface) lack of shivering ability limited energy stores limited voluntary muscle activity large SA relative to weight lack of SQ fat
9
Q
Primary heat production mechanism of newborn
A
Nonshivering thermogenesis
10
Q
Cold stress leads to…
A
- depleted brown fat stores
- increased oxygen needs
- respiratory distress
- increased glucose
- consumption leading to hypoglycemia
- metabolic acidosis
- jaundice, hypoxia
- decreased surfactant production
11
Q
When does hepatic system become fully active
A
3 months old
12
Q
3 types of jaundice based on mechanism of accumulation of bilirubin
A
overproduction
decreased conjugation
impaired excretion
13
Q
Causes of overproduction bilirubin
A
blood incompatibility Rh or ABO drugs trauma at birth polycythemia delayed cord clamping breast milk jaundice
14
Q
Decreased bilirubin conjugation
A
physiologic jaundice
hypothyroidism
breast-feeding
15
Q
Impaired bilirubin excretion causes
A
biliary obstruction sepsis hepatitis chromosomal abnormality drugs
16
Q
What organ is responsible for bilirubin conjugation
A
liver
17
Q
When does bilirubin production decline to adult level
A
10-14 days after birth
18
Q
danger of extremely high bilirubin in the first week of newborn
A
bilirubin encephalopathy
19
Q
Risk factors for juandice
A
- Maternal blood group incompatibility
- Prematurity
- breast-feeding
- drugs (diazepam)
- maternal gestational diabetes
- infrequent feedings
- male gender
- cephalohematoma
- TORCH infection
20
Q
TORCH
A
toxoplasmosis other viruses rubella cytomegalovirus herpes simplex virus
21
Q
phsyiologic jaundice timeing
A
24 hr - 3 days
22
Q
When is phototherapy indicated (bilirubin level)
A
12-15 mg/dl in the first 48 hours
23
Q
how many kcal/kg/day for first 6 months
A
108 kcal/kg/day
24
Q
Normal amount of daily voids for newborn
A
6-8
up until day 7 the voids and stools match the day
25
pink orange material in diaper in first week
urate cyrstals - may indicate dehydration
26
least mature sense at birth
vision (limit of 8-10")
27
What does serum glucose decline of 40-50 after birth mean?
normal
28
Newborn assessment
1. general appearance
2. head/neck
3. chest/abd.
4. hip/genitals/anus
5. limb/spine/CNS
29
General appearance
```
muscle tone
LOC
color/size
cry
spine
```
30
head/neck
```
head circ
fontanels/sutures/molding
scalp
eyes/ears
nose
mouth
clavicles
neck/jaw
```
31
chest/abd
```
shape/symmetry pectus
heart sounds
apex
breath sounds
nipple
ABD
umbilicus
defects
liver hepatomegaly
```
32
hips/genitals/anus
femoral pulse
hip clicks
testes descended/hydrocele/hernia
33
limb/spine/CNS
```
digits
palmar creases
feet
pulses/perfusion
spine
reflexes (sucking, moro, grasp, babisnkin)
limbs
```
34
Physical maturity indicators in newborn
```
skin texture
lanugo
plantar creases
breast tissue
eyes
ears
genitals
```
35
Neuromuscular maturity indictors
```
posture
square window
arm recoil
popliteal angle
scarf sign
heel-to-ear
```
36
APGAR
```
appearance (color)
Pulse (HR)
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
```
37
APGAR HR
```
0= absent
1= <100
2= >100
```
38
Normal BP for newborn
50-75 / 30-45
39
How frequently are HR and RR assessed
1st 2hr: q 30min
| after: q 8hrs
40
Classifications by gestation age (3)
preterm or premature: <37
term: 38 to 42 weeks gestation
post-term or postdates: born after completion of week >42 gestation
41
Classifications by birth weight????
low birth weight: > 2500 g (>5.5 lb)
very low birth weight: > 1500 g (>3.5 lb)
extremely low birth weight: > 1000 g (>2.5 lb)
42
SGA vs AGA vs LGA
SGA: < 10th percentile, <5.5lbs
AGA: between 10th and 90th
LGA: >90th, >9lbs
43
Suction newborn order
1. mouth
| 2. nose
44
where is vitamin k injected
| what guage/length
vastus lateralis
| 25G, 5/8 inch
45
Expected length of newborn
44 - 55 cm
| 17 - 22 inches
46
what if newborn loses approximately 10% of their initial birth weight by 4 days?
this is normal
| -secondary to loss of meconium, extracellular fluid, limited food intake
47
collection ofo serous fluid that crosses suture line
caput cucedaneum
48
collection of blood that does not cross fluid line
cephalohematoma
49
what are large fontanels?
| what do they indicate
larger than 6cm in the anterior
larger than 1 cm in the posterior
- malnutrition
- hydrocephaly
- congenital hypothyroidism
- trisomys
- bone disoorders
50
telangiectatic nevi
stork bites
| angel kisses
51
Milia
dead skin cells get trapped within small pockets on teh skin's surface rather than falling off
52
Mongolian spots
disappear 3-5 years after birth
53
Erythema toxicum
harmless disappears in a few days
54
Nevus flammeus
port wine stain
55
Nevus vasculosus
overgrowth of capillary blood vessels
56
Factors associated with obstetric brachial plexus paralysis
large birth weight
breech delivery
shoulder dystocia
57
normal umbilical cord progression
drying within hours
shriveled and black by day 2 or 3
sloughs off by days 7-10
58
When to remove cord clamp
24 hours after birth
59
Circumcision care
assess for bleeding q30 for 2 hours
soapy water and pat dry
petroluem jelly with every diaper change
fasten diaper loosely
60
breastfeeding benefits mom
```
decreased postpartum bleeding
more rapid uterine involution
reduced risk of breast cancer, uterine cancer, and ovarian cancer
earlier return to prepregnancy weight
decreased risk of post menopausal oseto
```
61
breastfeeding benefits baby
decreased risk SIDS
decreased risk DM
decreased risk asthma and allergies
analgesic effect
62
LATCH
```
L - how well infant Latches
A- amount of audible swallowing
T - nipple type
C - level of comfort
H - amount of help mother needs
```
63
What conditions are screened for in newborn?
PKU - must be done 24 hours after feeding
hypothyroidism
Galactosemia
sickle cell
64
Infant hypoglycemia level
less than 40 mg/dL in first 72 hours
jitteriness, lethargy, cyanosis, apnea, seizures, highpitched or weak cry, hypothermia, poor feeding
65
risk factors hypoglycemia
preterm
SGA
maternal DM
LGA
