Chapter 23 - 2 Flashcards
Newborn Response to Hyperthermia
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)
Hematological Adaptation
Erythrocytes Fetal hemoglobin Hematocrit 48-69% Leukocytes Possible clotting deficiency
Erythrocytes
Shorter RBC life span than adult
Fetal hemoglobin
Carries 20-50% more O2 than adult
Leukocytes
Decreased levels or increased bands may indicate infection
Possible clotting deficiency
Platelets 150-300thou/mm
Lack of Vitamin K
May decrease with infection
jaundice -
when baby born they cannot process RBC that are dying and they have to build up
if baby has clotting problems give
vitamin k
Hematological Factors
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
Gastrointestinal System
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
when using a bulb syringe what do you suction first
mouth then nose
Newborn Stooling
meconium, transitional, formula, breast
Meconium stool -
greenish black/viscous-pass between 12-48 hours of age; hypertoxic if aspiration happens in utero
Transitional stool -
greenish/yellowish brown thin-less sticky-usually by 3rd day
formula stool -
usually by 4th day-pale yellow/light brown
breast stool -
yellow/golden seedy
Hepatic System
Blood glucose Conjugation of bilirubin Hyperbilirubinemia Blood coagulation-Vitamin K Iron storage Drug metabolism
Hyperbilirubinemia
Physiologic jaundice “Icterus Neonatorum”
Pathologic jaundice
Breast milk jaundice
Newborn Blood Glucose
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
Risk Factors for Hypoglycemia
Prematurity Postmaturity Intrauterine growth restriction Asphyxia Cold stress Large for gestational age (LGA) Small for gestational age (SGA) Maternal diabetes Maternal intake of terbutaline
Signs of Hypoglycemia
Jitteriness Poor muscle tone Sweating Tachypnea Dyspnea Apnea Cyanosis Low temperature Poor suck High-pitched cry Lethargy Irritability Seizures, coma
Conjugation of Bilirubin:
RBC breakdown increased bilirubin load to liver low amount of liver enzymes slows metabolism of bilirubin
Unconjugated bilirubin:
(bad) “indirect”
Fat soluble substance that binds with albumin
Absorbed into SQ when binding sites full
Can cross blood/brain barrier
Conjugated bilirubin:
“direct”
Converts bilirubin into water soluble
Excreted by bile system into stool
