Module 2: Normal Newborn Care

Question 1

List the components of immediate care of the newborn according to Varney’s Midwifery (Chapter 39 in the 5th edition and Chapter 38 in the 6th edition).

Answer 1

Skin-to-skin
Delayed cord clamping
Preventing/Monitoring for Neonatal Hypothermia
Preventing/Monitoring for Neonatal Hypoglycemia
Initial Prophylaxis treatment: within 4 hours of delivery
-Ophthalmic: to prevent conjunctivitis from G/C
-Vitamin K: lack of vitamin K can result in hemorrhagic disease of the newborn or vitamin-K deficiency bleeding.

Question 2

What is an APGAR score?

Answer 2

Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the healthcare provider how well the baby is doing outside the mother’s womb.

Question 3

What is the origin of the APGAR?

Answer 3

Originally developed by an anesthesiologist to assess the effects of maternal anesthesia on a newborn.

Question 4

What does the APGAR tell us? Aka what is it an indicator of?

Answer 4

It is NOT a reliable measure of perinatal asphyxia or long-term outcomes. It IS an indication of resuscitation success.

Neonatal mortality IS associated with the 5-minute APGAR

Question 5

Explain what we are assessing with the APGAR

Answer 5

Appearance: Color
Pulse: Heart Rate
Grimace: Reflex Irritability
Activity: Tone
Respiration: Breathing

Question 6

Explain the scoring for the Appearance of APGAR

Answer 6

0: Blue, Pale
1: Body pink, extremities blue
2: Completely pink

Question 7

Explain the scoring for the Pulse of APGAR

Answer 7

0: No heart rate/Absent
1: Heart rate <100 bpm
2: Heart rate >100 bpm

Question 8

Explain the scoring for the Grimace of APGAR

Answer 8

0: No response to stimuli
1: Grimace/feeble cry with stimulation
2: Sneezing, coughing, pulling away when stimulated

Question 9

Explain the scoring for the Activity of APGAR

Answer 9

0: Limp
1: Some flexion
2: Active motion

Question 10

Explain the scoring for the Respiration of APGAR

Answer 10

0: Absent
1: Weak, slow, or irregular breathing
2: Strong cry

Question 11

Why might it be important that the person giving the Apgar score not be the person who attended the birth?

Answer 11

So as to decrease bias.

Question 12

What are newborn vital sign ranges? HR, Temp, RR, SPO2

Answer 12

Temperature. Able to maintain stable body temperature of 97.0°F to 98.6°F (36.1°C to 37°C) in normal room environment.

Heartbeat. Normally 120 to 160 beats per minute. It may be much slower when an infant sleeps.

Breathing rate. Normally 40 to 60 breaths per minute.

Blood pressure. Normally an upper number (systolic) between 60 and 80, and a lower number (diastolic) between 30 and 45.

Oxygen saturation. Normally 95% to 100% on room air.

Question 13

What are the three stages of the newborn transition?

Answer 13

First Stage “first period of reactivity”
Second Stage: “period of decreased responsiveness.”
Third Stage: “second period of reactivity.”

Question 14

What is the first stage of the newborn transition? Describe changes in vital signs and assessment.

Answer 14

Timing: the first 30 min of life
Temperament: Alert, tremors, crying. Increased motor activity
Vitals: HR elevated 160-180bpm but lowers to 100-120bpm by 30m. Lower temp, Irregular breathing (60-80bpm)-rales, grimace, flaring, retractions, apnea.
GI: absent bowel sounds

Question 15

What is the second stage of the newborn transition? Describe changes in vital signs and assessment.

Answer 15

Timing: 30m to 2 hours of life
Temperament: Sleep, normal tone, decreased responses. Decreased motor activity with spontaneous movements
Vitals: 100-120bpm by 30m. Fast shallow breaths 60 per min.
GI: bowel sounds present

Question 16

What is the third stage of the newborn transition? Describe changes in vital signs and assessment.

Answer 16

Timing: 2-8 hours of life
Temperament: Increased responses. Abrupt changes in tone
Vitals: Labile HR. Some brief rapid respirations
GI: bowel sounds present. Possible gagging/vomiting, passing mec.

Question 17

What is the importance and purpose of the New Ballard Scale (gestational age assessment)?

Answer 17

To determine the maturity of the newborn, in order for us to screen for problems and plan appropriate care. Even if by super accurate dates the newborn is 39 weeks, she could have the maturity of a 36-week newborn. Age is just a number! Assess for maturity.

Question 18

Why is vitamin K routinely given to newborns?

Answer 18

Vitamin K is given to prevent Hemorrhagic disease of the newborn (HDN/Vitamin K Deficiency Bleeding (VKDB). VKDB is bleeding that can occur in the first twelve weeks of life due to vitamin K deficiency in the newborn. This is not common but deadly.

Question 19

What is the difference between early VKDB and late VKDB?

Answer 19

Early is more common (0.25-1.7%) vs. late (0.0044-0.0072%)

Early occurs within 2 weeks vs. late occurs at 2-12 weeks.

Early causes bleeding in GI, cutaneous, & penile vs. late causes IC.

Question 20

Is PO Vit K as effective as IM?

Answer 20

They are reported to have the same efficacy, but many countries report higher rates of early VKDB even with several doses of PO. PO Vit K decreases the rate of late, but IM is essentially preventative.