Maternal & Newborn Lecture 10

Question 1

Physiologic, Anatomic & Behavioral Adaptations of the Newborn

Answer 1

• Physiological, Anatomical, and Behavioral Adaptations of the Newborn:
  
  • Establishing and maintaining respirations
  • Undergoing circulatory changes
  • Regulating thermoregulation
  • Regulating weight and blood glucose levels
  • Ingesting, retaining, and digesting nutrients (note: they no longer have their umbilical cord)
  • Developing arousal and sleep patterns (babies in the uterus are less active during the day and more active at night, which is why kick counts are encouraged during pregnancy; this pattern persists after birth)
  • Establishing a relationship with caregivers and the environment from day one; they recognize their mother’s voice (also people around her), smell, and energy
  • Processing multiple stimuli; transitioning from a stable, warm environment in the womb to a world with a lot of sensory stimulation, which can also help initiate the respiratory process

Question 2

Respiratory System:Function in Fetus

Answer 2

• Fetal Lung Function:
  
  • During fetal development, the lungs play a limited role and are not primarily used for gas exchange.
  • Gas exchange occurs through the placenta, which acts as the respiratory organ for the fetus.
• Fetal Lung Fluid: (similar to amniotic but not exactly the same)
  
  • The lungs of the fetus are filled with a fluid similar to amniotic fluid, but it is a filtered version and not actively inhaled.
  • This fluid must be removed from the lungs after delivery to allow air to fill them.
• Removal of Fetal Lung Fluid:
  
  • Fetal lung fluid is removed through the birth process and reabsorption into the body. (it’s sent somewhere else in the body: lymphatic system to be expelled)
  • Some of the fluid is reabsorbed into the fetal body, while the remaining portion is typically expelled during the birthing process.
• Gas Exchange and Cardiovascular Function in Fetal Structures:
  
  • Fetal gas exchange is closely connected to the cardiovascular system, which includes temporary passages or vessels called shunts.
  • These shunts are essential during fetal development but must close once the baby is born.
  • The path of blood circulation in the baby’s body undergoes significant changes immediately after birth.

Question 3

• The respiratory system: The respiratory system takes a back seat before the baby is born and is less involved compared to when the baby is born.

Answer 3

• Initiation of breathing: The exact trigger for starting respirations is not fully understood. Several theoretical ideas exist, and most of them are generally correct. Multiple stimuli are involved.
• Various variables that initiate the respiratory process include:
  
  • Chemical factors
  • Mechanical factors
  • Thermal factors
  • Sensory factors

Question 4

Chemical Resp

Answer 4

• Birth process and anoxia: The birth process involves a relative period of anoxia, meaning there is no oxygen and hypercapnia (high CO2) present. The low O2 and high CO2 levels act as chemical signals that stimulate the body’s sympathetic nervous system to initiate the respiratory drive.
• Umbilical cord clamping: When the umbilical cord is clamped, it stops the flow of blood from the placenta to the baby. The baby’s lungs gradually start taking over the oxygen supply as they begin to breathe, and the circulatory system adapts accordingly.
• Activation of chemoreceptors: Chemoreceptors in the aorta and carotid arteries are activated in response to hypoxia (low oxygen) and hypercapnia (high CO2).
• Prostaglandin level drop: (no prostaglandins=no dilatation. No dilatation = contriction of the smooth muscle surrounding the pulmonary artery. This constriction of smooth muscles and therefore of the pulmonary artery sends blood to the lungs) After cord clamping, prostaglandin levels decrease because the cord is cut. Prostaglandins were responsible for maintaining cardiac shunts. Once they decrease, these shunts start forming more ligament-like tissue. (Prostaglandins play a role in maintaining the patency

The transformation of a fetal circulatory shunt into a ligament occurs as part of the normal postnatal development process. Shunts are temporary structures in the fetal circulatory system that serve specific functions before birth. After birth, when these functions are no longer needed, these shunts gradually close and are replaced by ligamentous structures. Here’s how this process occurs:

1. Fetal Shunt Function: Before birth, certain shunts in the fetal heart are essential for redirecting blood flow to bypass non-functional fetal organs. The two most prominent shunts are the ductus arteriosus and the foramen ovale.
   • Ductus Arteriosus: This shunt connects the pulmonary artery to the aorta, allowing oxygen-poor blood from the pulmonary artery to bypass the non-functioning fetal lungs and enter the systemic circulation.
   • Foramen Ovale: This is an opening between the two atria (upper chambers) of the fetal heart, permitting blood to bypass the right ventricle and flow directly from the right atrium to the left atrium, again helping to bypass the non-functional fetal lungs.
     Ductus Arteriosus: Oxygenated blood from the placenta is carried to the fetal liver via the umbilical vein.

Bypassing the Liver: In the fetal liver, only a portion of the blood flows through the hepatic circulation for metabolic processes. The ductus venosus is a shunt or vessel that diverts a significant portion of the oxygenated blood from the umbilical vein, bypassing the liver.

2. Transition at Birth: After a baby is born and takes its first breath, there is a significant increase in oxygen levels in the bloodstream. This increase in oxygen triggers several changes in the circulatory system, including the closure of these shunts.
3. Closure Process: The closure of the ductus arteriosus and foramen ovale involves several steps:
   • Decrease in Prostaglandins: As the baby breathes and oxygen levels rise, prostaglandin levels, particularly prostaglandin E2 (PGE2), decrease. Prostaglandins help keep the ductus arteriosus open, so their decrease signals its closure.
   • Constriction of Smooth Muscle: With the decrease in prostaglandins and the increase in oxygen, the smooth muscle cells in the walls of the ductus arteriosus contract. This gradually narrows the vessel and ultimately closes it off.
   • Fibrous Tissue Formation: Over time (hours to days), the closed ductus arteriosus undergoes a process of fibrous tissue formation. It becomes gradually occluded by connective tissue, transforming it into a fibrous cord called the “ligamentum arteriosum.”
   • Foramen Ovale Closure: Similarly, the foramen ovale closes as the pressure in the left atrium exceeds that in the right atrium due to increased blood flow to the lungs. Over time, the two atrial septa (walls) grow together, sealing the foramen ovale, and it becomes the “fossa ovalis.”
4. Ligament Formation: The resulting fibrous structures, the ligamentum arteriosum and the fossa ovalis, are essentially remnants of the fetal shunts. They serve no functional purpose in postnatal life but persist as anatomical landmarks.

The closure of these shunts and their transformation into ligaments are essential steps in the adaptation of the circulatory system from fetal to neonatal circulation. This process ensures that oxygenated blood is properly directed through the fully functional lungs after birth, meeting the oxygen needs of the newborn.

Question 5

Mechanical resp

Answer 5

• Vaginal birth and lung fluid expulsion: Babies born through the vagina experience significant pressure (mechanical pressure exerted on the baby’s chest and lungs during the process of passing through the birth canal ), expelling a substantial amount of fetal lung fluid. Crying plays a role in this process, increasing thoracic pressure.
• Mechanical factors:
  
  • Increased thoracic pressure
  • Lung expansion through crying
  • Expulsion/absorption of fetal lung fluid (Lymphatic Clearance)
• Thermal factors: Cold stimulation helps stimulate the sympathetic nervous system and respiratory drive.
• Sensory factors:
  
  • Handling and tactile stimulation during birth
  • “Warm dry stem” when placing the baby on the mother’s chest, followed by wrapping the baby in a warm blanket for stimulation.
  • Tradition of stimulating the baby, akin to the traditional practice of the doctor gently slapping the baby to encourage breathing.
  • Suctioning, especially for babies born via C-section, where significant fluid may need to be suctioned, sometimes requiring deep suctioning.

Question 6

Factors in Neonatal Respiration

Answer 6

• Factors determining newborn’s breathing after birth:
  
  • Vaginal vs. C-Section delivery (The method of delivery can affect a newborn’s initial respiratory effort. Babies born vaginally often experience the natural process of clearing lung fluids and mucus during their passage through the birth canal, which can help initiate breathing. In contrast, babies born via C-section may not have this exposure and might require additional assistance to start breathing.)
  • Surfactant: A lipoprotein preventing alveolar collapse
  • Preterm babies have reduced surfactant, affecting their breathing
  • Surfactant production typically starts around week 24, varying among fetuses
  • Difficulty predicting breathing outcomes for babies born between 24 to 28 weeks
  • For preterm birth risk, administer two shots of betamethasone (steroid) 24 hours apart to promote lung maturation
  • Production of surfactant prevents alveolar collapse
  • Age is a factor due to the lack of surfactant
  • Surfactant production usually complete by 35 weeks
  • Meconium: Can lead to aspiration; it’s the earliest stool, appearing black and tar-like, challenging to suction, and attracts pathogens
  • Anatomical defects, like congenital heart issues or diaphragmatic hernia, can impact breathing; often detectable before birth but can still be unexpected.

Question 7

Respiratory SystemNormal Newborn Respirations

Answer 7

• Normal rate: 30-60 breaths per minute
• Breathing is shallow and irregular
• Rales are common within the first hour
• Abdominal breathers
• Nose breathers, also known as obligate nose breathers; they are required to breathe through their nose but can breathe through their mouth if necessary
• Short period of apnea < 10 seconds is considered “normal”
• Anything longer than 10 seconds requires a full workup (Anything longer than that, they will need a full workup. This is why we listen for a full minute. Because if we listen for 15 sec and we get 2 breaths then we get a resp rate of 8, then it’s probably not accurate. Shallow and irregular, if you just watch for the rise and fall you might miss it, this is why you have to auscultate.)
• Listening for a full minute is essential for accuracy
• Rales can also be common in the first hour

Question 8

Respiratory SystemAbnormal Newborn Respirations

Answer 8

• Grunting: A sound made by a baby working harder to open the glottis
• Flaring: The use of accessory costal and subcostal muscles to breathe
• Retractions: Intracostal and subcostal retractions indicate high intrathoracic pressure
• Bradypnea: Slow breathing
• Tachypnea: Rapid breathing
• Abnormal breath sounds: Crackles, rhonchi, wheezes, expiratory grunt
• Respiratory distress syndrome (RDS) indicators: Grunting, Flaring, Retracting
• Cyanosis and mottling: Color changes in extremities due to increased respiratory effort
  
  • Acrocyanosis: Normal color change in the first few hours, monitored for resolution
  • Central cyanosis: Baby becomes entirely blue, a concerning sign
• Low pulse oximetry value: Used only when the baby shows signs of respiratory distress

Question 9

CARDIOVASCULAR CHANGES

Answer 9

• Shunts close at birth
  
  • Pulmonary circulation established
  • Normal heart rate (HR): 110-160 beats per minute
  • Dysrhythmias are common, and any unusual heart sound should be reported (if you hear a weird heart sound tell somebody. Just because they are common it doesn’t mean that they are benign. Any baby with a murmur and any kind of audible dysrhythmia, skipped beat. We need to tell the doc that the baby needs an ECG and echo cardiogram. )
  • Murmur or audible dysrhythmia requires an ECG and echocardiogram
  • Initial increase in red blood cells (RBCs)

Question 10

Cardiovascular System:Fetal Circulation

Answer 10

• Placenta: Site of gas and nutrient exchange
• Umbilical Cord:
  
  • 1 vein (high O2) carrying oxygenated blood from placenta to fetus’s heart
  • 2 arteries (low O2) carrying deoxygenated blood from fetus to placenta
• Umbilical vein delivers oxygen (O2) to the fetus
• Liver mostly bypassed, as filtration occurs in the placenta
  
  • Ductus venosus (shunt 1) helps bypass the liver
• High O2 blood enters the inferior vena cava to the right atrium
• High O2 blood (majority) is shunted from the right atrium to the left atrium via the foramen ovale (shunt 2), avoiding pulmonary circulation
• High O2 blood proceeds from the left atrium to the left ventricle, then to the ascending aorta, and subsequently to various body parts to provide O2
• In contrast, low O2 blood bypasses the lungs via ductus arteriosus (shunt 3) and returns to the placenta through the descending aorta and umbilical arteries.

Question 11

Cardiovascular System:
Changes After Delivery

Answer 11

• Umbilical Vein:
  
  • Cord clamped: Changes resistance in the baby’s body.
  • High resistance. It happens when we cut the cord very early. The body causes vascular resistance by the contraction of smooth muscles and then vessels to make sure that there is enough BP to reach the tissues in the body.
• Ductus Venosus: Not used after birth
• Foramen Ovale: Pressure on the left > right to close the foramen ovale
• Ductus Arteriosus
• Umbilical Artery:
  
  • Even if the umbilical vessels are not clamped, they will eventually stop when the placenta detaches and they come in contact with the air. This because when the moms body senses that the placenta is not there it understands that there isn’t a baby to feed and therefore it stops working and supply baby with stuff.
  • The circulation will cease whether the cord is clamped or not.
  • Ductus arteriosus Contracts in response to increased oxygen (O2) and decreased prostaglandins. This is because usually the ductus arteriosus carries blood without o2 to the descending aorta then to the umbilical artery to send it to the placenta to get O2. Now that the baby’s lungs are working the blood that comes to the doctus arteriosus is rich in O2 and this is a signal that tells it that it’s no longer needed, so it starts closing.

Question 12

Cardiovascular System:
Change in Blood Composition

Answer 12

• Fetal Hemoglobin:
  
  • RBC size initially larger than an adult’s.
  • RBCs have a greater affinity for oxygen (O2) than ours, making them better at binding to O2.
• After birth:
  
  • RBC count increases.
  • RBC cell size decreases.
• Newborn Blood Values:
  
  • Hemoglobin: 16-18 g/dL
  • Hematocrit: 46-68%
  • Hemoglobin and hematocrit levels are higher after birth and then gradually decline.
  • The destruction of RBCs leads to greater iron stores.
• Fetal hemoglobin and hematocrit are higher in newborns than in adults. A hemoglobin level of 18 and a hematocrit of 68, which would be problematic in adults, are normal for babies. Initially, babies have higher hemoglobin and hematocrit levels, which gradually decline over a couple of months.
• Fetal RBCs are initially larger than those of adults and have a greater affinity for oxygen (O2).
• After birth, there is an increase in the RBC count, but the size of individual RBCs decreases.

Question 13

DELAYED CORD CLAMPINGNew ACOG/AAP guidelines

Answer 13

• It’s important to ensure that the baby is dry initially.
• In the past, the standard procedure after a baby’s birth was immediate cord clamping, cutting, and then releasing the baby. However, this practice has shifted towards evidence-based methods. The collection of stem cells from placentas for storage has become less favorable. Instead, the trend is toward delayed cord clamping, which has several benefits:
  • Increases hemoglobin (Hgb) levels at birth.
  • Improves iron stores in the baby’s body as more Hgb breaks down.
  • Enhances transitional circulation in all babies, particularly benefiting preemies by reducing the need for blood transfusions. It is especially valuable for babies at risk of cerebral hemorrhage or GI system infections, such as necrotizing enterocolitis and intraventricular hemorrhage.
  • It’s worth noting that sometimes, babies subjected to delayed cord clamping may receive more blood volume than they require, leading to a condition called Polycythemia. This can make the blood denser and cause respiratory distress due to increased difficulty in oxygen transport.

Question 14

Assessment of NewbornTransition

Answer 14

• Apgar scoring is performed after 1 minute of birth because the baby is still adjusting. Various stimulations and interventions are carried out to assist the baby during this time. Another Apgar assessment is conducted after 5 minutes, and if the score is less than 7, an additional assessment is performed after 10 minutes.
• Inadequate perfusion can result from respiratory issues, cardiovascular problems, or a combination of both.
• During assessment, watch for signs of respiratory distress or compromised cardiac function.
• Additionally, assess for mottling (similar to bruising) and cyanosis as potential indicators of the baby’s health status.

Question 15

MOTTLING OF SKIN

Answer 15

Stress
Respiratory
Cold
Sepsis

Question 16

Acrocyanosis

Answer 16

Blue discoloration of extremities as blood preferentially circulates to organs during extrauterine transition. this is normal in the first 2h-

Question 17

Perioral/Circumoral Cyanosis

Answer 17

• Perioral/Circumoral Cyanosis: This condition involves a bluish discoloration around the baby’s mouth. It is quite common within the first 24 hours of life and is often associated with Transient Tachypnea of the Newborn (TTN or TTNB). Perioral cyanosis in this context typically indicates that the baby is breathing a bit more rapidly than usual, but otherwise, everything else is normal. It’s worth noting that it can sometimes be confused with facial bruising, particularly when the baby is delivered rapidly by the mother.
• TTNB usually resolves within 24-48 hours.
• It’s important to be aware that facial bruising may be mistaken for perioral cyanosis in some cases.

Question 18

Perioral Cyanosis

Question 19

CENTRAL CYANOSIS

Answer 19

• A crying baby at birth is a positive sign, even if they appear bluish at times, because it indicates respiratory effort and oxygen intake.
• Hypoxemia: This is a late sign of distress and indicates low oxygen levels in the blood.
• Meconium Aspiration: A condition where the baby inhales meconium (the first stool) into the lungs, potentially causing pneumonia.
• PPHN (Persistent Pulmonary Hypertension of the Newborn “
  Pulmonary circulation refers to the portion of the circulatory system that is responsible for the circulation of blood between the heart and the lungs”): This condition results from circulatory changes, such as shunts not closing properly, leading to abnormal lung pressure and improper lung expansion. Basically now baby is born so no blood with o2 from mom’s placenta. baby has to rely on it’s lungs to get o2, but the shunts don’t close after birth. this means that the blood without o2 is still bypassing the lungs to pick up o2. This bypassing including the lungs means less blood with o2 for the lung tissue. To compensate for the low o2 in the lung BV these BV constrict. This worsens the problem even more.
• Cardiac dysfunction: Refers to issues with the baby’s heart function, which can be a cause of distress and affect their overall well-being.

Question 20

Set up for Physiological Jaundice…

Question 21

THERMOREGULATION

Answer 21

• Babies have immature regulation abilities, and it’s crucial to keep them warm because they can’t effectively maintain their other physiological processes when they are cold. Cold stress in a baby can lead to increased oxygen (O2) consumption, but the body can’t use it efficiently (Immature Respiratory System), causing the baby to burn its brown fat stores (found in the neck, upper chest, and spine) rapidly. This can lead to a drop in blood glucose levels, contributing to respiratory distress. The increased O2 demand, inefficient utilization, and efforts to maintain warmth can lead to decompensation in various ways.
• Shivering can occur when the baby’s blood sugar is too low, indicating hypoglycemia, which is a serious condition in newborns.
• Placing a baby on the mother’s body is ideal because the baby can sense the mother’s body temperature and regulate its own accordingly. This close contact and warmth also help regulate the baby’s respiratory rate. While this can also be done with other caregivers, it’s not quite the same as the mother’s body.
• Newborns have a thin layer of subcutaneous (SQ) fat, with blood vessels close to the surface of the skin. They also have a larger surface-to-body ratio compared to adults, which means they can lose heat more quickly.
• Cold stress in newborns can increase their need for oxygen (O2).

Question 22

THERMOREGULATIONNewborn response to cold

Answer 22

Babies employ various mechanisms to warm themselves up when they are cold, including:

1. Crying to generate energy: The physical act of crying can help generate heat by increasing a baby’s metabolic rate.
2. Flexed position to retain heat: Babies often curl into a flexed position to conserve heat and minimize heat loss from their bodies. Less surface area means less exposure to environment = less heat loss.
3. Increased muscle activity: Babies may increase their muscle activity, such as moving their limbs, to generate some heat.
4. Acrocyanosis: This is a bluish discoloration of the extremities caused by reduced blood flow to the peripheral areas, helping to divert blood and conserve warmth for vital organs.
5. Unstable blood glucose: Cold stress can lead to fluctuations in blood glucose levels, which can affect the baby’s metabolism and overall temperature regulation.

Additionally, non-shivering thermogenesis is an essential process in newborns for warming themselves. It involves an increase in metabolism, mainly through the burning of brown adipose tissue (brown fat). Brown fat is specialized for heat production and is crucial for helping babies maintain their body temperature in cold environments.

Check slide 29 must and 30

Question 23

Brown
Adipose
Tissue (BAT)

Answer 23

Rapidly depleted by cold stress

Question 24

Cold stress in infants

Answer 24

Cold stress in infants can have several physiological effects, including:

1. Increased Oxygen Consumption: When exposed to cold, infants experience an increase in oxygen consumption as their bodies work to generate heat and maintain core temperature. This increased oxygen demand can place a strain on the respiratory system.
2. Pulmonary Vasoconstriction: Cold stress can lead to vasoconstriction (narrowing) of the blood vessels in the lungs. This constriction can reduce blood flow to the lungs, affecting oxygen uptake and potentially leading to decreased oxygen levels in the blood.
3. Peripheral Vasoconstriction: To conserve heat and prioritize blood flow to vital organs, the body undergoes peripheral vasoconstriction. This means that blood vessels in the extremities narrow, reducing blood flow to the skin and extremities. While this helps maintain core temperature, it can result in cold extremities and decreased oxygen supply to peripheral tissues.
4. Anaerobic Glycolysis: In response to cold stress, the body may rely more on anaerobic glycolysis, a metabolic pathway that does not require oxygen. While this can provide a short-term energy source, it can also lead to the accumulation of lactic acid and contribute to metabolic acidosis.
5. Decrease in PO2 (Partial Pressure of Oxygen) and pH: Cold stress can lead to a decrease in the partial pressure of oxygen (PO2) in the blood, potentially reducing the amount of oxygen available for tissues. Additionally, the increase in anaerobic metabolism can lead to a decrease in pH, resulting in metabolic acidosis.

Overall, these physiological responses to cold stress reflect the body’s efforts to maintain core temperature and ensure essential organ function. However, prolonged or severe cold stress can have detrimental effects on an infant’s health and may require medical intervention to restore normal metabolic and physiological processes.

Question 25

EvaporationHeat loss through evaporation of moisture on the skin.

Question 26

ConvectionHeat loss through cooler local air currents

Answer 26

Cooler Air Currents: Convection involves the transfer of heat from the body to the surrounding cooler air. When the air around the body is colder than the body’s temperature, it can absorb heat from the skin’s surface.

Question 27

ConductionHeat loss through contact with cooler solid object in contact with the baby

Answer 27

Contact with Cooler Objects: Conduction involves the transfer of heat from the body to cooler objects or surfaces in direct contact with the skin. When the skin comes into contact with a colder solid object, such as a cold surface or cold clothing, heat is transferred from the body to that object.

Question 28

RadiationTransfer of heat from to a cooler object not in contact with the baby

Answer 28

Yes, that’s correct! Anything that has a temperature above absolute zero (which is the lowest temperature theoretically achievable, at approximately -273.15 degrees Celsius or -459.67 degrees Fahrenheit) will continuously emit heat energy in the form of electromagnetic waves,

Question 29

Nursing Care after Birth

Answer 29

Inmidiate care of the newborn
- Airway
- Breathing
- Temperature. We don’t think about this when we are doing to an 80 year old ! A Baby is different.

Question 30

AIRWAY/BREATHING SKIN to SKIN with mom If infant is crying or breathing on their own:

Answer 30

Immediate Care for Newborn:

• AIRWAY/BREATHING: If the infant is crying or breathing independently, place the baby skin-to-skin with the mother.
• Monitor vital signs: Check vital signs every 30 minutes for the first 4 hours (q30 x 4), then every hour for the next 2 hours (Q1 x 2), totaling 4 hours. Conduct a vital sign assessment at the 3-hour mark and again at the 4-hour mark.
• Bulb Suction as needed: Minimize excessive use of bulb suction. If suction is necessary, start with the mouth and then proceed to the nose.

Question 31

AIRWAY/BREATHINGIf infant is apneic or poor color:

Answer 31

Keep the baby warm
Assess HR
Clear airway
Stimulate
Dry vigorously

Question 32

Remove Secretions

Answer 32

Wipe nose and mouth with gauze to help get rid of excess fluids.

Use bulb syringe if neonate had meconium staining.

No apparent anomalies.

Question 33

Open Airway“Sniff Position”

Answer 33

If infant is gasping or apneic initiate PPV

In summary, the “Open Airway” and “Sniff Position” are essential steps to ensure that an infant’s airway is clear and properly aligned. If the baby is not breathing or is gasping for breath, further intervention, such as Positive Pressure Ventilation (PPV), may be necessary to provide them with the necessary oxygen.

Question 34

Indications for Oxygen

Answer 34

Indications for Oxygen Administration in a Baby:

• Increased respiratory effort
• Respiratory distress with apnea
• Tachycardia
• Bradycardia
• Persistent Central Cyanosis

Question 35

Oxygen and/or Positive Pressure Ventilation for neonatal resuscitation

Answer 35

Oxygen and/or Positive Pressure Ventilation for Neonatal Resuscitation:

Indications:

• Apnea (No breathing)
• Gasping Respirations
• Start positive pressure ventilation (ppv) if HR < 100. HR is measured by palpation at the umbilicus.
• Persistent Central Cyanosis
• No response
• CAUTION: Consider the risk of Retinopathy of Newborn (ROP) when administering oxygen.

Question 36

Nursing Care: Initial Assessment & Medications

Answer 36

she said nothing anna

Question 37

Newborn Initial Head-to-Toe Assessment

Answer 37

1. Integument (Skin):
- Vernix: A white, waxy substance that can cover a newborn’s skin at birth.
- “Stork bites”: Pink or red birthmarks often found on the back of the neck or between the eyes.
- Milia: Tiny white or yellowish bumps on the baby’s face.
- Erythema Toxicum (normal newborn rash): A common rash in newborns characterized by red spots with a white or yellowish center.
- Congenital Dermal Melanocytosis (Mongolian spots): Bluish-gray or flat birthmarks often found on the lower back and buttocks.

2. Head:
- Examination of the head, including the nose, mouth, eyes, and ears, to check for any abnormalities or issues.

3. Neck, Clavicles, and Chest:
- Assessment of the neck, collarbones (clavicles), and chest area to check for any signs of fractures or other injuries.

4. Abdomen:
- Examination of the abdomen to ensure it appears normal and doesn’t show signs of any issues.

5. Genitalia:
- Inspection of the genitalia to ensure they appear healthy and normal for the baby’s sex.

6. Extremities and Spine:
- Evaluation of the baby’s arms, legs, hands, feet, and spine to check for any abnormalities, such as neurotube defects (e.g., spina bifida).

7. Neurologic Status:
- Reflex tests to assess the baby’s neurological responses. This may include checking reflexes like the Moro reflex, sucking reflex, or grasping reflex. These tests help evaluate the baby’s nervous system and overall neurological health.

Question 38

NEWBORN MEASUREMENTS

Answer 38

Flat surface
Extend leg
Length range is 45-55 cm
(17.7—21.7 inches)

Question 39

NEWBORN MEASUREMENTS

Answer 39

Occiput-frontal
Diameter Widest diameter

Head circumference
range is 32 - 36.8 cm
(12/6 –14.5 inches)

Question 40

BIRTH WEIGHT for at term which is 40 weeks term

Answer 40

< 2500: SGA
>4000: LGA

Question 41

AGA, LGA, vs SGA?

Grpah

Answer 41

AGA, LGA, and SGA are terms used in obstetrics and neonatology to describe different categories of newborns based on their birth weight and gestational age:

1. AGA (Appropriate for Gestational Age):
   
   • Newborns who fall within the “AGA” category have a birth weight that is considered appropriate for their gestational age.
   • These babies have a weight that is in proportion to their length of gestation, meaning they are typically within a healthy weight range for their time spent in the womb.
2. LGA (Large for Gestational Age):
   
   • “LGA” refers to newborns who have a birth weight that is greater than what is expected for their gestational age.
   • These babies are larger or heavier than most babies of the same gestational age. LGA newborns often weigh more than the 90th percentile for their gestational age.
3. SGA (Small for Gestational Age):
   
   • “SGA” describes newborns who have a birth weight that is less than what is expected for their gestational age.
   • These babies are smaller or lighter than most babies of the same gestational age. SGA newborns often weigh less than the 10th percentile for their gestational age.
   • SGA can be an indicator of intrauterine growth restriction (IUGR), which means the baby did not grow as expected in the womb. SGA babies may require special medical attention and monitoring.

Question 42

ASSESSMENT OF GESTATIONAL AGE

Answer 42

Assessment of Gestational Age:

Methods for determining the baby’s age and weight estimation:

• Maternal Record
• Last Menstrual Period (LMP) using Naegele’s rule
• Ultrasound, especially in early pregnancy. The earlier the ultrasound is performed, the more accurate the estimation. In the first trimester, the estimate is only off by plus or minus a few days. If prenatal care begins in the 2nd trimester, the estimate may have a margin of plus or minus 2 weeks, and in the 3rd trimester, it may have a margin of plus or minus 3 weeks.
• Ballard Score: This assessment can also be used to determine the baby’s age shortly after birth.

Question 43

Slide 51

Question 44

52

Answer 44

lanugo depending how much they have it’s gonna tell you how long they are

Question 45

Posture slide 53

Question 46

Popliteal Angle

Question 47

Skin

Answer 47

Look up what vernex means

Question 48

Plantar (Foot) Creases

Question 49

Male Genitalia

Answer 49

Assessment of Testicular Descent:

• Check for the descent of the testicles. Undescended testicles can be a sign of immaturity.

Question 50

Female Genitalia

Question 51

59

Question 52

MEDICATIONS

Answer 52

Medications that we give after birth:

• Erythromycin ointment: Used for eye prophylaxis in newborns to prevent eye infections.
• Vitamin K: Administered to newborns to prevent bleeding disorders due to vitamin K deficiency.
• Prophylaxis for Neisseria gonorrhea: Treatment to prevent the transmission of Neisseria gonorrhea from mother to baby during childbirth.
• Prophylactic prevention of bleeding: Measures taken to prevent bleeding complications, typically involving the administration of vitamin K and other appropriate interventions.

Question 53

Hepatitis B

Answer 53

Hepatitis B Prophylaxis:

• Assess the maternal record for hepatitis B status.
• If the mother is Hepatitis B positive (Hep B+), administer Hepatitis B Immune Globulin (HBIG) as per MD (Medical Doctor) order.
• Administer the Hepatitis B Vaccine.

Question 54

Nursing Care: The 1st 24 Hours

Answer 54

The First 24 Hours of Life:

• The first 24 hours of life are a crucial and highly vulnerable period marked by the critical transition from intrauterine to extrauterine life.
• During this time, the baby is still adapting to the new environment outside of the uterus.

Question 55

NURSING GOALS IN THE FIRST 24 HOURS

Answer 55

Assessment and Care for Newborns During the Transition to Extrauterine Life:

• I/O Documentation: It is essential to meticulously document intake and output (I/O) to ensure that the baby’s physiological needs are being met. This includes monitoring urination, defecation, and breathing.
• Physiological Needs: During this crucial transition phase, the focus is on ensuring that the baby’s physiological needs are adequately addressed, including regular urination, defecation, and maintaining stable breathing patterns.
• Facilitate Positive Parent-Infant Relationship: Promoting a positive parent-infant relationship is paramount. Responding promptly to the baby’s cues, such as crying, and encouraging parent-infant bonding is not only emotionally beneficial but also contributes to the baby’s physiological stability.
• Education: Provide parents with essential education and guidance regarding newborn care, feeding, and safety to empower them to care for their baby effectively during the early days of life.

Question 56

Nursing in the 1st 24 Hours:Maternal History because this tells us what the prenatal conditions of the baby were.

Answer 56

Collecting Maternal History:

Maternal Age
Pre-existing Medical Conditions
Gravida (number of pregnancies) / Para (number of live births)
Gestational Age
Laboratory Results / Blood Type / Rh Status
Prenatal Care History
Labor History
Rupture of Membranes (ROM), Meconium Staining, Decelerations in Fetal Heart Rate
Group B Streptococcus (GBS) status
Type of Delivery (vaginal, cesarean)
Any Complications During Labor and Delivery
Anesthesia or Analgesia Used During Labor
Postpartum Bleeding Status

Question 57

slide 66

Answer 57

Not like it

Question 58

Nursing Care:Breastfeeding. Always refer for a consult as needed.

Answer 58

• Skin-to-skin
• “Golden Hour” first hour, immediately after birth
• LATCH score less than 6 would necesitate a lactation consult
• Lactation consult prn

Question 59

NEWBORN STOMACH SIZE

Answer 59

slide 60 check minute 1: 10 anna -

Question 60

NEWBORN SCREENING

Answer 60

Newborn Screening:

• Blood Test: Mandated by the state of California, this test checks for approximately 70 different diseases.
• Newborn Hearing Screen: Assessment to detect any hearing issues in the newborn.
• Congenital Heart Disease Screening: This screening involves the use of a pulse oximeter to measure pre- and post-ductal oxygen saturation. One sensor is placed on one extremity, while the other is placed on a different extremity to obtain two oxygen saturation readings. The goal is to assess blood returning to the heart (postductal) and blood coming from the heart (preductal). Typically, oxygen saturation should not fall below 98% due to the presence of oxygen bound to hemoglobin. Note: In cases of carbon monoxide poisoning, the pulse oximeter reading may appear high (close to 100%) because it measures the binding of gas to hemoglobin, not necessarily just oxygen.

Additionally, there is a “24-hour work-up” that includes:

• Blood Test
• Total Serum Bilirubin (TSB) Measurement
• Heart Disease Screening

Question 61

70 heel stick ?

Question 62

Hearing Screening

Answer 62

Hearing Screening:

• Automated Auditory Brainstem Response (AABR): This test evaluates the auditory nerve and brainstem pathways to assess hearing function.
• Otoacoustic Emissions (OAE): This test assesses the functioning of the outer hair cells in the cochlea to evaluate hearing capability.

Question 63

Screening for Critical Congenital Heart Disease

Answer 63

Screening for Critical Congenital Heart Disease (CCHD) is a vital part of newborn care to identify infants with potentially life-threatening heart conditions. The screening process typically involves non-invasive tests that can detect signs of CCHD shortly after birth. The specifics of CCHD screening can vary by region and healthcare facility, but a common approach includes the following steps:

1. Pulse Oximetry Screening: Pulse oximetry is a painless and non-invasive test that measures the oxygen levels in a newborn’s blood. It is typically performed in two stages:
   • Pre-ductal Screening: This initial test is done on the right hand or wrist (before the blood reaches the ductus arteriosus, a fetal shunt). It helps assess oxygenation and is usually performed within the first 24 hours after birth.
   • Post-ductal Screening: If the pre-ductal screening shows low oxygen levels or other concerning results, a post-ductal screening is performed on either foot (after the blood has passed through the ductus arteriosus). This can help identify specific types of heart defects.
2. Interpretation of Results: Healthcare providers assess the results of pulse oximetry screening to determine whether they are within normal ranges. Abnormal results may suggest the presence of CCHD or other medical conditions requiring further evaluation.
3. Additional Evaluation: If the screening indicates abnormal oxygen levels or other concerning findings, the healthcare team will conduct further assessments. This may include a physical examination, echocardiography (ultrasound of the heart), and consultation with a pediatric cardiologist.
4. Monitoring and Follow-Up: Newborns with suspected CCHD may be closely monitored, and additional diagnostic tests may be performed to confirm the diagnosis. Early detection and intervention are crucial for the management of CCHD.

It’s important to note that CCHD screening is generally performed on all newborns shortly after birth, typically before they are discharged from the hospital. While the specifics of the screening process can vary, the goal is to identify infants with critical congenital heart disease early, allowing for prompt intervention and specialized care. Early detection can significantly improve the long-term outcomes for infants with CCHD.

Question 64

73

Question 65

74

Answer 65

Look at it later not very important

Question 66

PARENTAL EDUCATION&DISCHARGE TEACHING

Answer 66

ROUTINE INFANT CARE
SIDS
SHAKEN BABY
CIRCUMCISION CARE
WARNING SIGNS (when to call doctor )/DISCHARGE TEACHING
CPR

Question 67

Discharge Teaching: Routine Care Must check slide min 1;16 on video onward must must

Answer 67

Temperature
Respirations
Feeding
Pacifiers
Infant safety/Safe Sleep
Elimination
Rashes
Clothing
Cord Care
Bathing
Crying

Question 68

slide 77

Question 69

78

Question 70

79

Question 71

80

Question 72

82

Question 73

Period of PURPLE Crying

Question 74

NEWBORN BATH

Answer 74

Newborn Bathing Guidelines:

• WHO Recommendation: Whenever possible, delay the newborn’s first bath for at least 24 hours after birth.
• Delayed Bathing: Delayed bathing has been associated with higher rates of beneficial early breastfeeding (BRF).
• Vernix Utilization: Keep the vernix (the white, waxy substance on a newborn’s skin) on the baby’s skin, as it has moisturizing and antimicrobial properties. Gently rub it into the skin. Avoid using moisturizers or creams during this time.
• First Bath at Home: It is advisable to give the baby’s first bath at home, once the umbilical cord stump has healed.
• Supervision: Never leave the baby unattended during a bath to ensure their safety.

Question 75

CIRCUMCISION CARE

Answer 75

Circumcision Care Instructions:

1. Check for Bleeding: Regularly inspect the circumcision site for any signs of bleeding.
2. Apply Petroleum Jelly: To prevent the diaper from sticking to the area, apply a thin layer of petroleum jelly (Vaseline) to the diaper.
3. No Need to Void Before Discharge: There is no requirement for the baby to void (urinate) before discharge.
4. Cleaning: Clean the circumcision site gently with water, avoiding the use of wipes or soap. Continue this practice for 5-6 days.
5. Monitor for Infection: Keep an eye out for any signs of infection.
6. Don’t Remove Yellow Exudate: Do not attempt to remove the yellowish exudate that may be present; this is a normal part of the healing process.
7. Comfort Care: Provide comfort care to keep the baby calm and comfortable during the healing period.

Question 76

SIGNS OF ILLNESS after circumcision

Answer 76

Fever
* Hypothermia
* Poor feeding
* Vomiting
* Diarrhea
* Decreased BM
* Decreased urination
* Breathing difficulties
* Cyanosis
* Lethargy كسل
* Inconsolable cry
* Infected circumcision
* Infected umbilical cord
* Eye drainage
Gut colonization/mucosal barrier development takes 4-6 months
Immune system: “immature”

Question 77

Diaper Rash

Answer 77

• Frequent diaper changes using water.
• Change in diet
• Breastfeeding mother eats
  certain foods
• Use plain water / mild
  soap
• Unscented baby wipes, no
  alcohol
• Expose to air to heal
• Zinc oxide ointment
• Candida yeast Tx

Diaper rash is a common condition in infants and young children. Here are some tips and recommendations for managing and preventing diaper rash:

1. Frequent Diaper Changes: Change your baby’s diaper frequently, ideally as soon as it becomes wet or soiled. Keeping the diaper area clean and dry is essential in preventing diaper rash.
2. Use Water: When changing diapers, use plain water or a mild, fragrance-free baby soap to clean the diaper area. Avoid using harsh soaps or wipes with alcohol, as they can irritate the skin.
3. Dietary Changes: If your baby is on solid foods and experiences diaper rash, consider whether recent changes in their diet may be a contributing factor. Some foods can lead to more acidic or irritating stools.
4. Breastfeeding Mother’s Diet: If you are breastfeeding, be mindful of your diet. Some foods that you consume can affect your baby’s stool and potentially contribute to diaper rash. Common culprits include citrus fruits, tomatoes, and spicy foods. It may be helpful to keep a food diary to identify potential triggers.
5. Air Exposure: Allow your baby’s bottom to air out for short periods of time. This can help keep the skin dry and promote healing. Place your baby on a clean, dry towel or diaper-free during supervised “diaper-free time.”
6. Barrier Creams: Apply a protective barrier cream, such as zinc oxide ointment, to the diaper area during diaper changes. These creams create a barrier between the skin and moisture, helping to prevent and heal diaper rash.
7. Candida Yeast Treatment: If the diaper rash appears to be caused by a Candida yeast infection (commonly known as a yeast diaper rash), your healthcare provider may recommend an antifungal cream or ointment specifically designed for babies.

Question 78

PREVENT RE-ADMISSION

Question 79

Medical Follow-Up

Answer 79

• MD visit within 72
  hours after DC
• Monitor weight gain
• Monitor hydration
• Monitor jaundice
• Prevent kernicterus

Question 80

2 shunts that avoid the lungs because they are not used yet close after birth and taking the first breath and due to other phenomena that we will discuss later.

These 2 shunts are: Ductus Arteriosus: This shunt connects the pulmonary artery to the aorta, allowing oxygen-poor blood from the pulmonary artery to bypass the non-functioning fetal lungs and enter the systemic circulation.

Foramen Ovale: This is an opening between the two atria (upper chambers) of the fetal heart, permitting blood to bypass the right ventricle and flow directly from the right atrium to the left atrium, again helping to bypass the non-functional fetal lungs.

Answer 80

Yes, your understanding is correct. Prostaglandin E2 (PGE2) relaxes the smooth muscle cells in the walls of the ductus arteriosus, and this relaxation has the effect of decreasing the pressure within the ductus arteriosus. When the pressure within the ductus arteriosus is lower, it cannot push blood toward the fetal lungs, and instead, the blood flows into the aorta, bypassing the non-functional fetal lungs.

Question 81

would you say that Prostaglandins are vasodialitor lipids ?

Yes, prostaglandins are lipid compounds that often act as vasodilators, meaning they have the ability to relax and widen blood vessels,

Question 82

The word “hernia” has its origins in Latin. It comes from the Latin word “hernia,” which means “a rupture” or “a protrusion.” In medical terminology, a hernia refers to the abnormal protrusion of an organ or tissue through an opening or weakened area in the body’s muscle or tissue wall.

Question 83

PPHN (Persistent Pulmonary Hypertension of the Newborn)

Answer 83

PPHN (Persistent Pulmonary Hypertension of the Newborn) is a condition that affects newborn infants. It is characterized by high blood pressure in the blood vessels of the lungs, which leads to inadequate oxygenation of the blood. Here’s a more accurate explanation:

1. Circulatory Changes: PPHN is not solely caused by circulatory changes or shunts not closing properly. It primarily occurs due to a failure of the normal circulatory transition that should happen after birth. In a fetus, the lungs are not used for oxygen exchange because oxygen is received from the mother’s placenta via the umbilical cord.
2. Transition to Breathing: When a baby is born, there should be a transition from receiving oxygen through the placenta to using the lungs for oxygen exchange. In some cases, this transition does not occur as it should, and the baby continues to have high blood pressure in the pulmonary (lung) vessels.
3. Shunts and Oxygen: Shunts, such as the ductus arteriosus and foramen ovale, are natural connections in the fetal heart that allow blood to bypass the lungs. They should begin closing shortly after birth. In PPHN, these shunts may remain open, which can contribute to the problem, but it’s not the primary cause.
4. Constriction of Lung Blood Vessels: In response to the low oxygen levels in the lungs, the blood vessels in the lungs can constrict (narrow), which increases the pressure in the pulmonary circulation. This makes it harder for the blood to flow through the lungs and pick up oxygen, worsening the baby’s oxygenation.
5. Treatment: PPHN is a medical emergency and requires immediate treatment. Treatment often involves providing supplemental oxygen, mechanical ventilation, and medications to relax the constricted blood vessels in the lungs. In severe cases, extracorporeal membrane oxygenation (ECMO) may be necessary to provide temporary heart and lung support.

In summary, while your description mentions some aspects of PPHN, it’s important to clarify that PPHN is primarily a disorder of the transition from fetal to neonatal circulation, resulting in high blood pressure in the lung vessels and poor oxygenation. The persistence of certain fetal shunts can contribute to the condition, but they are not the sole cause.

Question 84

Birth Process and Anoxia

Answer 84

• Birth Process and Anoxia:
  
  • The birth process involves a relative period of anoxia, meaning there is no oxygen and hypercapnia (high CO2) present.
  • Low O2 and high CO2 levels act as chemical signals that stimulate the body’s sympathetic nervous system to initiate the respiratory drive.
• Umbilical Cord Clamping:
  
  • When the umbilical cord is clamped, it stops the flow of blood from the placenta to the baby.
  • The baby’s lungs gradually start taking over the oxygen supply as they begin to breathe, and the circulatory system adapts accordingly.
• Activation of Chemoreceptors:
  
  • Chemoreceptors in the aorta and carotid arteries are activated in response to hypoxia (low oxygen) and hypercapnia (high CO2).
• Prostaglandin Level Drop:
  
  • After cord clamping, prostaglandin levels decrease because the cord is cut.
  • Prostaglandins were responsible for maintaining cardiac shunts because they are vasodialtors and they keep those vessels open
  • Once they decrease, these shunts start forming more ligament-like tissue.

1. Fetal Shunt Function: Before birth, certain shunts in the fetal heart are essential for redirecting blood flow to bypass non-functional fetal organs. The two most prominent shunts are the ductus arteriosus and the foramen ovale.
   
   • Ductus Arteriosus: This shunt connects the pulmonary artery to the aorta, allowing oxygen-poor blood from the pulmonary artery to bypass the non-functioning fetal lungs and enter the systemic circulation.
   • Foramen Ovale: This is an opening between the two atria (upper chambers) of the fetal heart, permitting blood to bypass the right ventricle and flow directly from the right atrium to the left atrium, again helping to bypass the non-functional fetal lungs.
2. Transition at Birth: After a baby is born and takes its first breath, there is a significant increase in oxygen levels in the bloodstream. This increase in oxygen triggers several changes in the circulatory system, including the closure of these shunts.
3. Closure Process: The closure of the ductus arteriosus and foramen ovale involves several steps:
   
   • Decrease in Prostaglandins: As the baby breathes and oxygen levels rise, prostaglandin levels, particularly prostaglandin E2 (PGE2), decrease. Prostaglandins help keep the ductus arteriosus open, so their decrease signals its closure.
   • Constriction of Smooth Muscle: With the decrease in prostaglandins and the increase in oxygen, the smooth muscle cells in the walls of the ductus arteriosus contract. This gradually narrows the vessel and ultimately closes it off.
   • Fibrous Tissue Formation: Over time (hours to days), the closed ductus arteriosus undergoes a process of fibrous tissue formation. It becomes gradually occluded by connective tissue, transforming it into a fibrous cord called the “ligamentum arteriosum.”
   • Foramen Ovale Closure: Similarly, the foramen ovale closes as the pressure in the left atrium exceeds that in the right atrium due to increased blood flow to the lungs. Over time, the two atrial septa (walls) grow together, sealing the foramen ovale, and it becomes the “fossa ovalis.”
4. Ligament Formation: The resulting fibrous structures, the ligamentum arteriosum and the fossa ovalis, are essentially remnants of the fetal shunts. They serve no functional purpose in postnatal life but persist as anatomical landmarks.

Question 85

The Moro reflex, also known as the startle reflex, is one of the primitive reflexes observed in newborns and infants. It is a normal and automatic response to a sudden change in a baby’s position or a loud noise. Here’s how the Moro reflex typically works:

1. Stimulus: The Moro reflex is triggered when a baby experiences a sudden movement, change in position, or a loud noise. This stimulus startles the baby.
2. Response: In response to the startle, the baby will typically react in the following way:
   
   • The baby will extend their arms and legs outward.
   • They will arch their back.
   • They may open their fingers wide, spreading them apart.
   • The baby may also cry or make a startled noise.
3. Resolution: After this initial response, the baby will often bring their arms and legs back in toward their body and may seek comfort or reassurance from a caregiver.

The Moro reflex is most prominent in the first few months of a baby’s life and gradually diminishes as the baby’s nervous system matures. It serves a protective function by helping the baby respond to sudden stimuli or changes in their environment. Over time, as the baby develops better control over their voluntary movements, the Moro reflex becomes less noticeable and eventually disappears.

The presence of the Moro reflex is a normal part of early infancy, and its gradual disappearance is an expected developmental milestone. If the Moro reflex persists beyond the typical age range or is absent when it should be present, it may indicate a neurological or developmental issue, and a healthcare provider should be consulted for further evaluation.

Question 86

The Ballard Score, also known as the Ballard Maturational Assessment, is a clinical assessment tool used by healthcare providers to estimate the gestational age of a newborn infant. Gestational age refers to the number of weeks a baby has spent in the womb, which is an important factor in assessing the baby’s growth and development. The Ballard Score takes into account various physical and neuromuscular characteristics of the newborn to estimate gestational age.

Here are some key points about the Ballard Score:

1. Purpose: The primary purpose of the Ballard Score is to estimate gestational age, especially when the exact gestational age is uncertain or needs confirmation. This information can be essential for assessing the baby’s growth and development and guiding medical care.
2. Components: The assessment involves evaluating the baby’s physical and neuromuscular characteristics. These include the baby’s posture, skin texture, physical features (such as the ear and breast development), and neuromuscular signs (such as muscle tone and reflexes).
3. Scoring System: Each characteristic is assigned a score, and the total score is used to estimate gestational age. For example, a baby with a higher total score may be estimated to have a greater gestational age.
4. Accuracy: While the Ballard Score is a widely used tool, it is an estimation and not always precise. It is most accurate when performed within the first 12-24 hours after birth. In some cases, additional assessments and medical information may be used to refine the estimated gestational age.
5. Clinical Use: The Ballard Score is commonly used in neonatal care, especially when caring for premature or low-birth-weight infants. It helps healthcare providers make decisions about the baby’s care and monitor their development.
6. Variations: There are variations of the Ballard Score, and healthcare providers may use modified versions or adapt the assessment to suit their specific clinical needs.

The Ballard Score is a valuable tool for assessing gestational age in newborns, particularly when clinical judgment is needed to estimate the baby’s age. Accurate gestational age assessment is essential for providing appropriate care and monitoring the health and development of newborns, especially those born prematurely.

Question 87

Collecting maternal history within the first 24 hours of labor and delivery is crucial for assessing the health of both the mother and the baby. This information helps healthcare providers provide appropriate care and interventions. Here’s a breakdown of the key elements to collect in the maternal history:

1. Maternal Age: Note the age of the mother, as it can have implications for maternal and neonatal health.
2. Pre-existing Medical Conditions: Inquire about any pre-existing medical conditions the mother may have, such as diabetes, hypertension, heart disease, or other chronic illnesses. This information is important for managing potential complications.
3. Gravida (number of pregnancies) / Para (number of live births): Determine the number of pregnancies (gravida) and the number of live births (para). This information helps assess the mother’s obstetric history.
4. Gestational Age: Determine the gestational age of the current pregnancy. This helps in assessing the readiness of the baby for delivery and planning care accordingly.
5. Laboratory Results / Blood Type / Rh Status: Review any available laboratory results, including blood type and Rh status. Knowledge of the blood type is essential for preventing Rh incompatibility issues.
6. Prenatal Care History: Ask about the mother’s prenatal care history, including the frequency of prenatal visits, any complications during pregnancy, and the use of medications or supplements.
7. Labor History: Document the progression of labor, including the start time, frequency, and duration of contractions. Note if the labor is spontaneous or induced.
8. Rupture of Membranes (ROM), Meconium Staining (also known as meconium aspiration, refers to a condition in newborn infants where meconium, which is the earliest stool of a baby, is present in the amniotic fluid or has been aspirated (inhaled) into the baby’s airways and lungs before or during the process of birth.), Decelerations in Fetal Heart Rate: Record details about the rupture of membranes (if applicable), the presence of meconium staining in the amniotic fluid, and any fetal heart rate decelerations. These factors can indicate potential fetal distress.
9. Group B Streptococcus (GBS) Status: Determine whether the mother has been screened for GBS during pregnancy and if she is GBS positive or negative. This information is crucial for preventing neonatal GBS infection.
10. Type of Delivery (vaginal, cesarean): Document the mode of delivery, whether it is vaginal or cesarean section (C-section).
11. Any Complications During Labor and Delivery: Note any complications that occurred during labor and delivery, such as shoulder dystocia, placental abruption, or cord prolapse.
12. Anesthesia or Analgesia Used During Labor: Record any anesthesia or analgesia administered to the mother during labor, including epidurals or regional anesthesia.
13. Postpartum Bleeding Status: Assess and document the mother’s postpartum bleeding status, as excessive bleeding (postpartum hemorrhage) can be a concern.

Collecting this maternal history provides healthcare providers with essential information to make informed decisions about the care and management of both the mother and the newborn during the critical first 24 hours after delivery.

Answer 87

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