Class 9: Uncomplicated Newborn Flashcards
birth thru the 1st 2 hrs of life is a time of…
- immense change and adaptability for newborn
what is included in changes for the newborn from birth thru the first 2 hrs of life (6)
- establish respirations
- adjust to circulatory changes
- regulate temp
- ingest, retain, and digest nutrients
- eliminate waste
- adjust to social enviro and new behaviors (sleep/stimuli/relationships)
prep of the neonatal transition includes assessment of… (5)
risk factors such as:
- fetal
- maternal
- intrapartum
- preconception
- prenatal
what are prenatal risk factors for neonatal transition to extrauterine life (7)
- prenatal care (when started, if attended regularly)
- nutrition
- health-compromising behaviors
- blood group or Rh sensitization
- meds
- history of infection (STBBIs, GBS)
- hx of antepartum bleeding, HTN, DM
what are prenatal risks for neonatal transition to extrauterine life r/t nutrition (4)
- weight gain
- diet
- obesity
- eating disorders
what are intrapartum risk factors for neonatal transition to extrauterine life (4)
- length of gestation
- first stage of labor
- GBS status (adequate treatment?)
- 2nd stage of labor
what are intrapartum risks for neonatal transition to extrauterine life r/t 1st stage of labor (6)
- fetal position/presentation
- length
- ROM (length of, meconium, S&S of infection)
- signs of fetal distress (scalp sampling done? FHR)
- complications in labor (bleeding, eclampsia, tx w magnesium)
- analgesia/anesthesia (fentanyl, morphine –> resp distress?)
what are intrapartum risks for neonatal transition to extrauterine life r/t 2nd stage of labor (3)
- length
- type of birth (c-section - planned/unplanned, vaginal - spontaneous, assisted)
- complications (shoulder dystocia, cord prolapse)
define: meconium
- first stool
describe meconium (2)
- green-black stool
- viscous and sticky (contains occult blood)
when does meconium usually occur?
- usually passes within 12-24 h after birth
meconium may occur when?
- in utero
the passage of meconium in utero can be due to (2)
- be a normal function that occurs with maturity of fetus (chances increased after 38 weeks gestation, more common w postdates)
- can be caused by hypoxia induced peristalsis & sphincter relaxation
what is the risk of meconium being passed in utero
- can be aspirated in fetal lung
what is the site of gas exchange for fetus?
- placenta
describe pulmonary circulation r/t fetal circulation
- high vascular resistance –> increased P in right ventricle and pulmonary arteries
describe systemic circulation r/t fetal circulation
- low P in left atrium, ventricle, aorta
describe umbilical arteries r/t fetal circulation
- carrying blood from hypogastric arteries to placenta
describe umbilical vein r/t fetal circulation
- carrying blood from placenta to ductus venosis
describe ductus venosis r/t fetal circulation
- connection of umbilical vein to IVC
describe ductus arteriosis r/t fetal circulation
- shunting of blood from pulmonary artery to descending aorta
describe foramen ovale r/t fetal circulation
- valve opening that allows blood to flow directly to left atrium –> shunting of blood from right to left atrium, due to low pressure in left atrium
what 4 things happen at birth r/t resp system
- baby breathes
- fluid in alveoli is absorbed
- the umbilical cord is clamped
- blood vessels in the lungs dilate
when the baby breathes for the first time, what impact does this have on gas exchange
- baby uses their lungs for gas exchange
what kind of breathing do we want the newborn to do at birth (3)
- big, deep breaths
- crying
- no gasping
when the baby breaths for the 1st time, what impact does this have on alveoli?
- fluid in alveoli is absorbed –> fluid is replaced w air
the replacement of fluid in alveoli w air has what impact on the pulmonary vessels? resistance and pressires? what does this allow for?
= relaxation of the pulmonary vessels
- low pulmonary vascular resistance
- decreased P in R atrium, ventricle, and pulmonary arteries
= allows for gas exchange and perfusion to lungs
shortly after birth, the umbilical cord is clamped. what impact does this have on gas exchange? pressures and resistance? what does this promote?
- placenta no longer used for gas exchange
- increased systemic vascular resistance
- increased pressure in L atrium, ventricle, and aorta
= promotes closure of foramen ovale
what impact does dilation of the blood vessels in the resp system have on pulmonary blood flow? this promotes gradual constriction of?
- pulmonary blood flow increases
- ductus arteriosus gradually constricts (may take hours/days)
describe newborn O2 sats PP?
- can take up to 10 min for neonatal O2>90%
define: meconium aspiration syndrome (MAS)
- resp distress in newborn infants born thru meconium stained amniotic fluid whose symptoms cannot be otherwise explained
MAS is more likely with situations of… (2)
- fetal distress (abnormal FHR patterns)
- postterm newborns
if meconium is present, and newborn is not vigorous at birth (not breathing or crying/flat tone), what is done?
- may intubate to suction below the cords
MAS requires close monitoring such as.. (2)
- electronic fetal monitoring in labor
- neonatal resus team likely at delivery
complications of MAS include? (4)
- terminal airway obstruction
- resp distress
- inflammation
- infection
what impact does MAS have on pressure in resp system
- can cause persistent pulmonary HTN of newborn
all births needs to be attended by?
- someone certified in neonatal resuscitation
what is included in routine care for neonatal transition? (6)
- prone on birther’s chest (skin to skin)
- clear secretions as needed
- dry & stimulate to breathe
- delayed cord clamping
- newborn stays w parents
- ongoing observations
what 3 things indicate routine care for neonatal transition
- term
- crying or breathing
- good tone (well flexed)
what is the most imp thing for neonatal transition
- establish effective respirations
what are potential benefits of delayed cord clamping for preterm newborns? (5)
- decreased mortality
- higher BP and blood volume
- less need for blood transfusion after birth
- fewer brain hemorrhages
- lower risk of necrotizing enterocolitis
what are potential benefits of delayed cord clamping for term newborns? (2)
- decrease change of developing iron-deficiency anemia
- may improve neurodevelopmental outcomes
what are potential adverse effects of delayed cord clamping (3)
- delaying resus for compromised newborns
- increased risk of polycythemia (high RBC conc.)
- jaundice
cord clamping is delayed for which types of newborns? (2)
- all vigorous (crying, deep breaths) infants regardless of gestational age
- who do not require immediate resus or other contraindications (= resus usually not delayed for cord clamping)
for infants born at less than 37 weeks gestational age, DCC for how long?
- at least 1 min
for infants born at 37 weeks or more, DCC for how long?
- 1-3 min
what are contraindications for DCC (5)
- known or suspected placental abruption
- uncontrolled maternal hemorrhage
- vasa previa
- fetuses w pre-existing volume overload such as hydrops fetalis
- multiple gestation deliveries where the 2nd twin is in distress
collection of cord blood can be done for? (2)
- Rh
- pH
cord blood sample for pH reflects??
- acid/base balance status of newborn at birth
umbilical artery values reflect?
- fetal condition –> fetal oxygenation
what are normal pH lvls for umbilical artery values
7.2-7.34
umbilical venous blood values reflect?
- placental function
what are normal pH values for umbilical venous blood values
7.28-7.4
what score is used for rapid assessment of newborn’s transition
- agpar
agpar includes what 5 aspects?
- Activity (muscle tone)
- Pulse
- Grimace (reflex irritability)
- Appearance (skin color)
- RR
when is agpar assessed?
- at 1 min and 5 min
what is meant by color with agpar assessment
- assessment of mucus membranes for central cyanosis
on agpar, what HR = score of 0? 1? 2?
0 = absent
1= slow <100 bpm
2 = >= 100
on agpar, what RR = score of 0? 1? 2?
0 = absent
1 = slow, hypoventilation, weak cry
2 = good, crying
on agpar, what muscle tone = score of 0? 1? 2?
0 = flaccid
1 = some flexion of extremities
2 = well flaxed
on agpar, what reflex irritability = score of 0? 1? 2?
0 = no response
1 = grimace
2 = cry or active withdrawal
on agpar, what color = score of 0? 1? 2?
0 = blue, pale
1 = body pink, extremities blue
2 = completely pink
define: acrocyanosis
- body pink/red undertone
- extremities blue
- considered normal at birth
what does agpar score of 0-3 mean? 4-6? 7-10?
- 0-3: severe distress
- 4-6: moderate difficulty
- 7-10: normal transition, little difficulty
if the APGAR score is <10, what is done?
- do at 10-20 min
APGAR is a tool for…. it’s not?
- tool for assessment of transition to extrauterine life
- not a predictor of neuro outcomes
describe thermoregulation of the newborn
- is the maintenance of balance between heat loss & heat production
what is common r/t temp in newborns?
- hypothermia –> dangerous in newborn
why is hypothermia common in newborn?
- thin layer of subcut fat/blood vessels close to skin’s surface / large body surface to mass ratio
what 4 terms describe the relationship of the newborn to the external enviro
- convection
- radiation
- evaporation
- conduction
define: convection
- loss of heat from the infant’s skin to the surrounding air
- infants lose a lot of heat by convection when exposed to cold air or draughts.
describe interventions to protect newborn from convection (3)
- keep ambient temp at 24*C
- newborns wrapped in open bassinets
- newborn cap
define: radiation
- loss of heat from an infant’s skin to distant cold objects
- not impacted by temp of surrounding air
describe interventions to protect newborn from radiation (2)
- keep newborns away from outside windows and air drafts
- radiant warmers
define: evaporation
- loss of heat from an infant’s wet skin to the surrounding air
describe interventions to protect newborn from evaporation (2)
- dry newborn immediately after birth & baths
- timely, efficient baths
define: conduction
- loss of heat when the infant lies on a cold surface
describe interventions to help prevent newborn from conduction (2)
- cover scales w blanket/pad when weighing newborn
- skin-to-skin contact
what is v imp with thermoregulation of newborn? why?
- maintaining a neutral thermal enviro for newborns is v important
- minimizes oxygen and glucose consumption
how does the newborn body respond to hypothermia? (5)
- thermogenesis
- increase in cellular metabolic activity
- position
- constriction of peripheral blood vessels
- shivering mechanism not generally operable in newborn
describe: thermogenosis
- newborn attempts to generate heat by increasing muscle activity
what are signs of thermogenesis (3)
could appear:
- restless
- cry
- skin feel cool due to vasoconstriction
what impact does increase in cellular metabolic activity with hypothermia have?
- increases consumption of oxygen and glucose
what position does the newborn assume in response to hypothermia
- flexion = reduces exposure
due to the lack of shivering mechanism in newborn, what occurs?
- non shivering thermogenesis
non-shivering thermogenesis leads to?
- metabolism of brown fat
- increase metabolic activity in brain, heart, liver
there are higher reserves of brown fat in…?
- term infants
cold stress can lead to.. (3)
- metabolic acidosis
- resp acidosis
- hypoglycemia
hyperthermia in the newborn is usually related to?
- sepsis
- inappropriate use of heat sources (ex. radiant warmers, excessive blankets)
describe skin-to-skin contact in newborn
- place naked, well, and DRIED newborn next to birther’s skin covered with blanket
what are the benefits of skin-to-skin contact (3)
- reduces heat loss
- enhances newborn temp control
- positive impact on maternal-infant interaction
