Chapter 23 - 2

Question 1

Newborn Response to Hyperthermia

Answer 1

Metabolic rate increases
Increased need of O2 and glucose
Vasodilation insensible water loss
Greater than 99.5-environmental factors, flushed, extension
(they try to cool themselves off and use all their glucose, babies should wear the same about of clothes as adults)

Question 2

Hematological Adaptation

Answer 2

Erythrocytes 
Fetal hemoglobin
Hematocrit 48-69%
Leukocytes
Possible clotting deficiency

Question 3

Erythrocytes

Answer 3

Shorter RBC life span than adult

Question 4

Fetal hemoglobin

Answer 4

Carries 20-50% more O2 than adult

Question 5

Leukocytes

Answer 5

Decreased levels or increased bands may indicate infection

Question 6

Possible clotting deficiency

Answer 6

Platelets 150-300thou/mm
Lack of Vitamin K
May decrease with infection

Question 7

jaundice -

Answer 7

when baby born they cannot process RBC that are dying and they have to build up

Question 8

if baby has clotting problems give

Answer 8

vitamin k

Question 9

Hematological Factors

Answer 9

Gestational age - Hgb rises during last weeks
Time of cord clamping-Delayed clamping > 2 minutes after birth can be beneficial in increasing Hct and iron stores-can last up to 6 months
Blood volume 80-85 ml/kg

Question 10

Gastrointestinal System

Answer 10

May have moderate to large amounts of mucous in mouth first few hours
Epstein pearls (white beash on gums)
Suck-swallow-breathe reflex
Natal teeth (don’t have good roots)
Capacity 30 ml-90 ml by day 3-dependent
Amylase and lipase enzymes not functional at birth
Can digest simple carbs but limited ability to digest fats

Question 11

when using a bulb syringe what do you suction first

Answer 11

mouth then nose

Question 12

Newborn Stooling

Answer 12

meconium, transitional, formula, breast

Question 13

Meconium stool -

Answer 13

greenish black/viscous-pass between 12-48 hours of age; hypertoxic if aspiration happens in utero

Question 14

Transitional stool -

Answer 14

greenish/yellowish brown thin-less sticky-usually by 3rd day

Question 15

formula stool -

Answer 15

usually by 4th day-pale yellow/light brown

Question 16

breast stool -

Answer 16

yellow/golden seedy

Question 17

Hepatic System

Answer 17

Blood glucose
Conjugation of bilirubin
Hyperbilirubinemia
Blood coagulation-Vitamin K
Iron storage
Drug metabolism

Question 18

Hyperbilirubinemia

Answer 18

Physiologic jaundice “Icterus Neonatorum”
Pathologic jaundice
Breast milk jaundice

Question 19

Newborn Blood Glucose

Answer 19

Low CHO reserves
Glucose stored in liver as glycogen last 1-2mos of gestation
Glucose falls rapidly and stabilizes at 40-60mg/dL, increases to 50-90mg/dL

Question 20

Risk Factors for Hypoglycemia

Answer 20

Prematurity
Postmaturity
Intrauterine growth restriction
Asphyxia
Cold stress
Large for gestational age (LGA)
Small for gestational age (SGA)
Maternal diabetes
Maternal intake of terbutaline

Question 21

Signs of Hypoglycemia

Answer 21

Jitteriness
Poor muscle tone
Sweating
Tachypnea
Dyspnea
Apnea
Cyanosis
Low temperature
Poor suck
High-pitched cry
Lethargy
Irritability
Seizures, coma

Question 22

Conjugation of Bilirubin:

Answer 22

RBC breakdown increased bilirubin load to liver low amount of liver enzymes slows metabolism of bilirubin

Question 23

Unconjugated bilirubin:

Answer 23

(bad) “indirect”
Fat soluble substance that binds with albumin
Absorbed into SQ when binding sites full
Can cross blood/brain barrier

Question 24

Conjugated bilirubin:

Answer 24

“direct”
Converts bilirubin into water soluble
Excreted by bile system into stool

Question 25

Lab Results that Indicate Jaundice (icterus)

Answer 25

Increase in total bili 5mg/dl/d
Total bili of 12.9mg/dL term or 15mg/dL preterm
Direct bili >1.5-2mg/dL
Clinical jaundice >1wk in duration for term or 2wks in preterm
Jaundice presents head to toe

Question 26

Physiologic Jaundice

Answer 26

60% of term and 80% of preterm
Occurs within first 2-4d at peak
Check forehead, sternum, sclera
Tx: Usually resolves without TX- or treat with phototherapy

Question 27

Pathologic Jaundice

Answer 27

Jaundice within first 24hrs
Etiology: excessive destruction of RBCs
ABO incompatability
Infection
Metabolic disorders

Question 28

Breast Milk Jaundice

Answer 28

1:3 infants at 2wks of age

Question 29

Breast feeding-related jaundice (early onset)

Answer 29

Caused by poor intake

10-25% BF babies

Question 30

Breast milk jaundice (late-onset)

Answer 30

Occurs after 4-6 d,2-3% BF babies

Exact cause unknown (might be hormonally mediated in the breast milk)

Question 31

Factors that Increase Hyperbilirubinemia

Answer 31

Hemolysis of excessive erythrocytes
Short life of erythrocytes
Liver immaturity
Lack of intestinal flora
Delayed feeding
Trauma resulting in bruising or cephalhematoma
Fatty acids from cold stress or asphyxia

Question 32

Common Risk Factors for Hyperbilirubinemia

Answer 32

Prematurity
Cephalhematoma
Bruising
Delayed or poor intake
Cold stress
Asphyxia
Rh incompatibility
ABO incompatibility
Sepsis
Sibling with jaundice
Breastfeeding

Question 33

Newborn Renal Functioning

Answer 33

92% void within first 24hrs, 1st void expected within 48hrs
Urine may appear cloudy
Uric acid crystal may cause diaper staining
may see orange ring in diaper

Question 34

First 2 days of life I&O for newborn

Answer 34

Intake: 40-60 ml/kg (18-27 ml/lb) a day
Output: 1 to 2 voids

Question 35

After the first 2 days of life I&O for newborn

Answer 35

Intake: 100 to 150 ml/kg (45 to 68 ml/lb) a day
Output: At least 6 voids by the 4th day

Question 36

breast fed

Answer 36

every 2 hours

Question 37

bottle fed

Answer 37

every 3-4 hours