Lecture 02 Neonatal Care Flashcards
Where is Wharton’s Jelly and what does it do?
It is gelatinous substance within the umbilical cord.
It protects and insulates the two arteries in umbilical cord.
What process beings in utero to prepare the baby to transition to extrauterine independence? (3)
In utero
- Fetal breathing
- Production of surfactant after 34 weeks
- Deposit of brown fat to help thermoregulate
What does the umblical cord consist of? What are the func of each vessel?
AVA. Two arteries that removes waste from the baby
One Vein that delivers oxygen and nutrients to the baby.
What are the chemical stimuli to intiate respiration? (3)
- Decrease pH
- Decrease PaO2
- Increase PaCO2
What are the sensory stimuli to intiate respiration? (5)
- Cold
- Gravity
- Pain
- Light
- Noise
What are the mechanical stimuli to intiate respiration? (1)
- Thoracic squeeze with vaginal delivery, helps squeeze out amniotic fluid.
In C Section they dont’ get this and will need suctioning.
Note that there’s dif adaptations done by the baby depending on what delivery method was used.
What is the First Period of Reactivity?
How long does it last for?
What is occuring at this time?
What helps baby to organize HR and RR?
What vital signs are elevated?
What are the normal vital signs and what are the new figures after Period of Reactivity?
First Period of Reactivity lasts 60 ~90 min
The newborn is awake, active, appears hungry and has strong suck. The motehr should attempt to intiate breastfeeding.
Skin to skin contact is important as it helps baby organize HR and RR
Normal Signs: HR 100~160 mmHg, RR 30~60 breathes/min
HR increases to 160 ~180 bpm
RR is irregular 60~80 breathes/min, may hear crackles
onset of bowel sounds
When does Period of Inactivity occur?
What happens during this time?
It occurs 3~4 hours after birth.
The newborn is difficult to awaken, and may last few min to several hours.
Vital signs return to normal and can do assessment now.
When does Second Period of Reactivity occur?
How long does it last?
What occurs during this time?
What should you observe for?
It occurs 4~8 hours after birth.
Lasts 4~6 hours after period of inactivity
The vital signs are variable, so observe newborn closely for apnea, gagging and regugitation
Tachycardia and tachypnea may occur.
Increased muscle tone, skin color changes, meconium may be passed.
What is the mnemonic for APGAR?
A: Appearance (color)
P: Pulse (Heart rate)
G: Grimace (response to stimulation)
A: Activity (muscle tone)
R: Respiration
How does the APGAR score work?
Each category has 2 points possible.
They total up to ten.
7~10: good, continue to asess for changes
4~6 fair, needs air passages cleared, oxygen
0~3 poor, needs resucitation
What kind of assessment is the APGAR scale?
It’s a transitional assessment
What are 4 problems that may occur during transition?
- Respiratory
- Circulatory
- Thermoregulation
- Neurologic
What is the normal newborn respiratory rate?
What do you expect when you auscultate RR for one full min?
Normal rate is 30~60 breathes/min
Auscultation: normally shallow and irregular
Common Newborn Problems: Hyperbilirubemia
How often does Physiologic Jaundice occur in term newborns?
What’s the increase in uncongulated bilirubin?
The peak may be higher in breast fed infants, what’s the level?
- Occurs in 50% of all newborns, arises >24 hours after birth
- Increase in unconjugated bilirubin is no more than 12 mg/dl by 3 days of age
- Peak may be higher in breast fed infants at range of 15~17 mg/dl
Describe the following respiratory problem: Tachypnea
RR >60 breathes/minute
Describe the following respiratory problem: Grunting
Infant closes glottis during expiration, in an attempt to increase intra thracic pressure
Describe the following respiratory problem: Retractions
Accessory muscles used to breath, noted by observing the chest
Describe the following respiratory problem: Nasal flaring
Nares expand to allow fuller inspiration
Describe the following respiratory problem: Unequal Breath Sounds
Air entry not equal bilaterally
Describe the following respiratory problem: Apnea
Absence of breathing >15 seconds
Describe the following respiratory problem: Oxygen Requirements
Signs that supplementary O 2 needed to maintain central pink color
What is the normal newborn heart rate?
120-160 bpm for NCLEX
Where could you palpate HR of infant?
After birth, can do it at the base of umblical cord
PMI in newborn: 4th intercostal space to the left of the midcalvicular line
Sometimes eprson taking bpm can count with their finger
What are 5 symptoms of circulatory problems during the transition phase?
- Unequal/weak pulses: brachial, femoral
- BP instability: monitoring is done only when they’re not transitioning well
- Pallor/ Mottled appearance: decreased perfusion
- Central Cyanosis
- Bradycardia: HR <80 beats/min
What is the normal axiallary temperature?
36.5~37.4 C
When are the risks of hypothermia, for an infant, the greatest?
In the first 8~12 hours of life
When does a newborn’s temp stabilize?
72 hours after birth. If not, they’ll be using up their energy to shiver and keep warm. This will make them hypoglycemic.
What are risk factors (7) for hypothermia?
- Decrease SQ fat and thin epidermis
- Blood vessels closer to skin compared to an adult
- Head larger than body
- Large body surface area compared to volume
- Prematurity or small for gestational age
- Prolonged resuscitation efforts
- Sepsis
What are the 3 newborn’s defense against the cold?
- Flexed posture: Decreases SA
- Brown fat: Appear at 26~30 weeks of gestation.
Richer vascular and nerve supply than ordinary fat.
Present for several weeks after birth, depleted by cold stress
Warms neonate by increasing production up to 100% - Peripheral vasoconstriction: acrocyanosis
Types of Heat Loss: Conduction
Loss of heat in direct contact with cool surfaces
Types of Heat Loss: Evaporation
Loss of heat as water evaporates from infants body
Types of Heat Loss: Convection
Loss of heat due to cool air
Types of Heat Loss: Radiation
loss of heat to cool surfaces not in contact wih the body
List heat loss in order from greatest to least
TIE: Radiation and convection
Evaporation
Conduction
What are the best ways to reduce risk for heat loss? Must know the 3 bolded ones
- Dry immediately, remove wet towels after drying
- Place skin to skin with mother, can place warm blankets over mother and child
- Hat & wrap the baby and promote flexion
- Do not place infant directly on to cold surfaces like scale
- Infant may be placed on radiant warmer if mother can’t do skin to skin
What are initial signs of an infant trying to compensate for heat loss? (4)
- Increased movement
- Flexed position
- Burn up glucose
- Increased RR, HR
What are some last symptoms as infant is unable to compensate for the cold stress anymore
- Mottled pale skin
- Lethargy due to low blood sugar, poor suck feeding
- Hypoglycemia
- Cry becomes weaker
What’s the Moro reflex?
What is it caused by?
What does it indicate?
The startle reflex
Best indicator of neurological integrity, and elicited by loud noise or change of position.
Infant flexes legs, embrace position of arm, thumb and index finger forms a C
should be symmetric
disappears by 3 months
What is the rooting reflex?
Reflex that helps with feeding. The baby will turn and open their mouth in direction to look for breast.
What is the sucking reflex and how is it tested?
Test by putting finger in mouth and rub the roof of their mouth.
When you try to pull your finger out, they will not let your finger go.
What is the tongue extrusion reflex?
Baby pushes out their tongue whenever something touches the tip of their tongue.
This is reflex lasts from 4 to 6 months. That’s why there shouldn’t be any solid fluids until the reflex is gone.
What is the plantar grasp reflex?
Toes grasp around the finger as well