Healthy Term Infants Flashcards
After what point is an infant considered term?
After 37 weeks of completed gestation
When is an infant classified as being post-term?
After 41 weeks of completed gestation
What is the normal weight of a term infant?
Between 2.5-4kg
What would a birth weight of < 2.5kg be classed as?
Small for gestational age (SGA)
What would a birth weight of > 4kg be classed as?
Large for gestational age (LGA)
How much weight does a foetus gain in the third trimester?
Daily weight gain of 24g
About 7g of fat gained per day in the last 4 weeks
What materials are exchanged by transplacental transfer in the third trimester?
Iron, vitamins, calcium, phosphate, antibodies
How does term delivery usually take place?
Spontaneous or induced labour
Vaginal delivery or C-section
Cephalic (vertex) or breech position (or other)
What is the normal labour environment like?
Hypoxic during contractions
Placental insufficiency
Growth restriction or excess
What does foetal Hb help with during labour?
Release of oxygen
What does prolonged labour cause?
It reduced foetal reserves
What do increased cortisol and adrenaline levels during labour do?
Enhances adaptation of baby to new environment
What are the steps in perinatal adaptation?
First breath/cry, alveolar expansion, change from foetal to newborn circulation, decreased pulmonary arterial pressure, increased Pao2
What should be done immediately once a baby has been delivered?
Early/immediate skin to skin contact and suckling
What is the Apgar score?
Objective measure of perinatal adaptation = score out of ten (score of 0-2 in each category)
What are the components that make up the Apgar score?
Heart rate, respiratory rate, responsiveness, tone, colour
What is considered a normal Apgar score?
> = 8
What is skin to skin contact important in establishing?
Breast feeding
What is the change in control of glucose homeostasis in newborns?
Dramatic change from continuous glucose infusion ti intermittent bolus enteral feeds
What is the calorific intake like for well grown term infants in the first 24hrs?
They have very little intake
What is attachment?
Hormonal and emotional response to infant
What are some features of haemorrhagic disease of the newborn?
Rare
Potential mortality/morbidity (GI, lungs, CNS)
What causes haemorrhagic disease of the newborn?
Lack of vitamin K = deficiency impairs production of coagulation factors
Why is haemorrhagic disease of the newborn more common with formula feeding?
Vitamin K is transferred via breastmilk and can be inadequate in formulas
What is one way haemorrhagic disease of the newborn can be diagnosed?
By measuring PIVKA = not usually needed
What is infection risk of newborns based on?
Maternal history = mother testing positive for hep B and C, HIV, syphilis, TB or Group B strep
What are some vaccinations given to prevent infection?
Maternal pertussis and influenza vaccines, routine vaccination schedule, hep B at birth, BCG in first month
What are some screening tests done for newborns?
Newborn examination and universal hearing screening
Hip screening = clinical and USS
Cystic fibrosis and haemoglobinopathies
Metabolic diseases
What are some metabolic diseases screened for in newborns?
Phenylketonuria (PKU)
Medium-chain acyl-CoA dehydrogenase deficiency
Maple syrup urine disease
Isovaleric acidaemia
What is the newborn examination?
Top to toe examination is carried out by midwifery staff immediately after delivery
Formal neonatal examination carried out after 24hrs
What is being assessed in an examination of the new-born’s head?
OFC, overlapping sutures, fontanelles, ventouse/forceps marks, moulding, cephalhaematoma, caput succedaneum
What is being assessed when the ears are being examined?
Position, external auditory canal, tags/pits, folding, family history of hearing loss
How are the eyes assessed in an examination of the newborn?
Size, red reflex, conjunctival haemorrhage, frequent squints, iris abnormality
What is being looked at when the mouth is being examined?
Shape, philtrum, tongue tie, palate, neonatal teeth, Ebsteins pearls, sucking/rooting reflex
What are some abnormalities looked for on examination of the face?
Facial palsy, dysmorphism
How is respiratory function assessed on examination?
Chest shape, nasal flaring, grunting, tachypnoea, in-drawing, breath sounds
What is assessed on examination of the cardiovascular system?
Colour/O2 saturation, pulses (femoral, radial), apex, heart sounds, thrills and heaves
What is being looked for on examination of the abdomen?
Moves with respiration, distension, hernia, umbilicus, bile-stained vomiting, passage of meconium, anus
What are features of the examination of the GU system?
Normal passage of urine, normal genitalia, undescended testes, hypospadius
How is the MSK system assessed in an examination?
Movement, posture, limbs and digits, spine, hip examination
What is being assessed on examination of the neurological function of a newborn?
Alert and responsive, cry, muscle tone, posture, movement, primitive reflexes
What are the primitive reflexes of a newborn?
Sucking, rooting, Moro, ATNR
What are some features of health promotion in a newborn?
Foetal origin of adult disease
Parental habits = smoking, alcohol, drug use, diet
Social interaction and vaccination
Feeding and sleeping position
How should families be dealt with when they have a newborn?
Advise of changing family structures
Parenting = not always instinct
Positive feedback and confidence = parent-child attachment
Community support
Recognising baby blues vs post natal depression
