Mod 3 Basic Neonte Assessment Flashcards
What are 4 Pre-birth Questions to ask?
- Gestational age?
- Clear Amniotic Fluid?
- Additional Risk factors?
- Umbilical Cord Management Plan?
What are the dates for micro-premature and premature?
Micropremature < 26 weeks
Preterm = 26-32 weeks
First 28 days of life is considered what gestational age?
Neonate
How are adjusted ages determined?
Weeks and days.
How is Gestational Age/Estimated Due Date determined?
- Ultrasound (gold standard)
- Last menstrual period
What is premature rupture of membranes (PROM)?
When the water breaks early
- Most women will go into labor on their own within 24 hours.
- If the water breaks before the 37th week of pregnancy, it is called preterm premature rupture of membranes (PROM).
What questions to ask immediately after delivery?
Rapid Assessment
- Term
- Tone
- Breathing or crying?
When is the Rapid Assessment of the newborns performed?
Regardless of delivery, it is done Immediately after delivery
Why is crying after birth important?
Crying establishes FRC
What is the Dubowitz/Ballard Score?
Scores gestational age after neonate is stable, w/first 24hs of delivery
- Assists in care plans, especially around time of viability
- Usually performed on babes < 2000 gs
When does the Vernix Caseosa appear?
20-24 wks, disappears week 41-42
(waxy coating on babes)
When does red, gelatinous, fragile skin appear?
Around 32 weeks gestation
When does the Lanugo (hair) appear?
26 weeks, starts to disappear around 32 weeks
When do foot creases on soles of feet appear?
Week 26
When does the Pinna appear?
Cartilage of ear is fully formed after 32 weeks
When do reproductive organs appear
- Breasts not obvious < 25 weeks, areola and nips present at full gestation
- Genitalia not easily recognizable until 27 weeks
What is the Vernix Caseosa?
Wax substance in skin of newborn, produced in cells and protects for immunity.
- Vernix is rough to get off so its usually left on
- red gelatinous fragile skin
- gelatinous because the skin has a shin stretch
Why is brown fat important?
Helps regulate temperature.
- if not present, babes should be put into a bag (preffered) to maintain temperatures or wrapped in a blanket (at the min)
What is hypotonia?
Decreased tone aka floppy or flaccid
what is hypertonia
high tone/rigid
- manifests in flexor/extensor muscles of extremities.
- severe cases = neck stiffness and posturing
- might be cerebral palsy or brain injury.
What are hypotonia and hypertonia indicative of?
Neuromuscular injury.
- Therapeutic hypothermia may be performed on hypertoned babes
What is rooting?
when babes look for a nipple. Its a testable milestone where you put a finger near their mouth.
What are expected neurological milestones for a 28 weeks gestational babe?
- Can be awoken from sleep and stay awake for a few mins.
- Flicker eye movement in response to light
- active
What are expected neurological milestones for a 38 weeks gestational babe?
- Can self-wake and stay awake/alert for long periods
- can smile
- active with good gross motor function
- responds to stimulation like light and sound
- cries for food, mom, discomfort
- can express pain
Why is it normal for babes < 28 weeks to sleep more?
They’re still growing (underdeveloped).
- rare to wake them up for procedure and they stay awake.
What is a indicator of strong respiratory effort?
Breathing/crying after delivery.
- if babe is not crying, observe chest for breathing effort
What is primary apnea?
When the infant has undergone in-utero stress, it is self limiting and a reversable condition.
- Usually cord problems
- lasts a few seconds
- may require mild to mod stimulation to initiate respiration
- may be accompanied by mild bradycardia
What is secondary apnea
when respirations will not resume spontaneously
- requires PPV
- HR may be severely bradycardic
If fetal stress in utero has been observed, and the babe is not breathing. what can you assume?
secondary apnea
How do you identify primary apnea?
Fetal heart rate, when babe is stimulated they will breath in response.
- usually associated with cord problems
How do you differentiate primary and secondary apnea?
babes w/Secondary apnea don’t have a respiratory response. You will need to take action.
What is the most common cause of bradycardias in kids?
Ventilation problems
What do you run through if HR does not increase?
MR SOPA
What should you have before compressions start?
Artificial airways like ETT
What drug can be given to help stimulate babes?
Caffeine
What are signs of resp. distress in neonates?
- Retractions
- Grunting
- Nasal Flaring
- Increased O2 requirements
- Cyanosis
- Tachypnea (RR >60 bpm)
What is Grunting a sign of in Neos/infants?
- Interventions?
A sign of resp. distress where peds/babes are trying to create their own PEEP.
- To maintain FRC in babes
- Interventions would be CPAP or increase
- try to prevent alveolar collapse?
How long are infants obligate nose breathers?
until aprox 4 months of age.
- small nasal airways = high obstruction risk
Why are infants at higher risk of developing hypoxia?
- Higher metabolic rate (double adults)
- Lung volumes are smaller, less SA (alveoli) for exchange, and muscles tirer faster.
- Chest wall more compliant (easily collapse) and bc ribs are horizontal, they can’t expand as much.
- Premature nervous system, Neos easily fall into bradycardias (rate dependent) leading to hypovolemia which easily leads to shock-decreased perfusion
What are cardiac factors that would lead infants to be hypoxic?
Heart rate and stroke volume
- LV are underdeveloped and can’t compensate by increasing stroke volume
- hypovolemia decompensate quicker (due to reduced pumping)
What are the 4 conditions of a routine delivery (babe given to mom instead of warmer)
- Infant born at full term gestation
- Amniotic fluid clear with no evidence of infection
- crying or normal breathing
- good muscle tone
Why do body temperatures fall rapidly in infants at neutral thermal environments?
- They haven’t developed the ability to regulate temp. (they can’t shiver yet aka ).
- Haven’t developed brown fat
- SA to body mass ratio 4x of an adult, but ability to increase heat production in 1/3 of an adult
- labile temp. from intrautrine to extra uterine
What is thermogenesis?
Regulating heat by shivering
How to infants manage tempature?
They produce brown fats to maintain.
- If brown fat isn’t produced, babes have to be put into a ziplock bag for thermoregulation.
Physiological affect if infants can’t regulate heat?
Heat loss releases epinephrine
- Epi release causes hypoglocemia and high lactate bc of elevations in PVR and SVR
Target Temperatures in a newborn
36.5-37 degrees Celsius
What are consequences of cold stress in a newborn?
Increased O2 and calory uptake to compensate for heat loss. Resulting in…
- Depletion of brown fat and glycogen (energy stores)
- Increase CO2 and lactate
- Norepi release -> raises PVR and SVR causing metabolic acidosis and hypoglycemia.
What should room temperature be for babes in the NICU?
23-25 degrees C to maintain NTE. The NICU is hot.
How are baby temperatures measured?
skin temperature probes
What are 4 mechanisms of heat loss?
- Evaporation
- Convection
- Radiation
- Conduction
What are 2 mechanisms of heat loss that deal with proximity and not contact?
Radiation and conduction.
How do you prevent heat loss from conduction?
Occurs when body heat is lost to a cooler contact surface so.
- keep stethoscope under warmer
- keep babe in warm spots
How to prevent heat loss to evaporation?
Wrap the baby up in blankets or in a bag
What devices are used to regulate temperature?
Radiant warmer and close isolette
Functions of Radiant Warmer
Used for overhead warming
- Body temp can be maintained via servo mode, with skin probe.
- panda
Functions of Closed Isolette?
Used for low birth weight infants w/temp instability
- maintains a constant body temp by using either a servo controlled skin probe, air temp control device, or air temp probe.
- should be double walled or heat shielded
- Unicorn/giraffee
For micropremature infants (<28wks), what should you do instead of dry stimulation?
- Wrap in polyurethane bag to prevent heat loss and reduce risk of IVH.
- Adjust body position to reduce risk of IVH (germinal matrix is mature and at high risk of bleeds)
- Look for bulging fontanels (sign of high ICP and potential IVH)
How should you adjust body position of premature infants (<28wks) at delivery?
- why would you do it?
- **ask someone why supine is preferred to proning)
first 72hrs, supine, neck extended, midline.
- prevents IVH by preventing abrupt changes in cerebral perfusion, prompting neuroprotection.
Which mechanism of heat loss associated with heat loss to the surrounding air?
Convection
Which mechanism of heat loss is associated with heat loss through fluid evaporating from the skin?
Evaporation
Which mechanism of heat loss is associated with heat loss from an infant to a colder nearby object?
Radiation
Which mechanism of heat loss is associated with colder object that the infant comes in contact with?
Conduction
What is the gold standard for determining Gestational Age?
Prenatal sonography
What are intrapartum risk factors?
Factors/conditions that could pose a risk to the mom and babe.
- maternal health conditions
- fetal positioning
- Previous C-sections
- preterm labor
- Placenta abruption
- Meconium stained amniotic fluid
Why is epidural pain control not considered a intrapartum risk factor
Because its a med intervention used to alleviate pain and discomfort during the intrapartum period rather than a risk factor that poses a potential harm or complication.
- Helps women manage the discomfort associated with contractions and childbirth.
- Epidurals are a well-established and effective method for reducing pain and improving the overall birthing experience for many women.
Ideal fetal scalp pH is what?
anything > 7.25
What does the lung bud emerge from?
Pharnyx
Why could Preterm infants be unable to maintain thermal homeostasis?
- Lack brown fat
- No ability to shiver
- High body surface area to body weight area
