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NS 7100 > Module 6: The Neonate > Flashcards

Module 6: The Neonate Flashcards

1
Q

What 2 hormones plays an essential role in neonatal transition to extrauterine life?

A
  • catecholamines
  • cortisol
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2
Q

What role does hormone catecholamines (epinephrine, norepinephrine, and dopamine) play in neonatal transition?

A
  • promote fluid clearance from lungs

Surge in response to the normal birth process:
- responsible for increased blood pressure after birth, - adaptation of energy metabolism,
- initiation of thermogenesis from brown fat

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3
Q

What 3 roles does hormone cortisol play in neonatal transition to extrauterine life?

A
  • key regulatory hormone
  • Clearance of lung fluid
  • Lung maturation (anatomy and surfactant)
  • Gut maturation
  • cortisol level starts to increase around 30 weeks gestation
  • Maturation of glucose metabolic pathways in the liver
  • Maturation of the thyroid axis
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4
Q

The major adaptations associated with transition occur during the first 6-8 hours of life. What is the most critical adaptation required?

A
  • establishment of effective respirations
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5
Q

What are the fetal physiological (cardiopulmonary) changes that occur during transition?

A
  • initiation of gas exchange across alveolar membrane
  • expansion of lungs with air
  • rise in arterial pO2
  • rapid decrease in pulmonary vascular resistance and increase in pulmonary blood flow
  • pressure gradient changes (decreased right side pressure/increased left side pressure in heart)
  • closure of circulatory shunts (foraman ovale, ductus arteriosus)
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6
Q

What is persistent pulmonary hypertension of newborn?

A
  • During the stabilization period, which occurs over several hours, the pulmonary vessels remain very responsive to the effects of hypoxia.
  • Hypo-expansion of the lungs, hypoxemia, –> persistent acidosis –> result in high pulmonary vascular resistance, delayed clearance of lung fluid, –> persistent right to left shunting
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7
Q

What are the initial steps of NRP (4)?

A
  • dry
  • warm
  • stimulate the infant
  • ensure there is an open airway
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8
Q

What 4 factors stimulate the newborn to take first breath?

A
  • Chemical: factors in a newborn’s blood (low oxygen, high carbon dioxide, and low pH) which stimulate respiratory center in brain.
  • Mechanical: release of pressure on a baby’s chest, as the chest is born, may stimulate breathing and chest expansion.
  • Sensory: stimulation from drying, lights, sounds, smells all involved in stimulation of respiratory center
  • Thermal: change from temperature from warm intrauterine environment to cool extrauterine environment stimulate skin receptors which stimulate respiratory center.
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9
Q

What are the major changes that take place in a newborns cardiopulmonary system during the transition to extrauterine life?

A
  • the lungs become the primary organ of gas exchange (instead of the placenta); the lungs inflate, fluid is cleared from the alveoli, pulmonary vascular resistance decreases rapidly and there is increased pulmonary blood flow.
  • The pressure gradient in the newborn’s heart shifts. Right sided pressure which was high in fetal circulation decreases, and left sided pressures which were low now increases. As a result the foramen ovale closes.
  • Rising pO2 causes smooth muscle cells in the ductus arteriosus to constrict thereby closing the shunt.
  • Removal of the low pressure placental system increases the pressure in a newborn’s circulation which increases circulation and pulmonary perfusion.
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10
Q

What is the role of lung surfactant?

A
  • Surfactant lowers the surface tension of the alveoli thereby reducing the pressure required to keep the alveoli open.
  • Decreased surface tension also results in increased lung compliance.
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11
Q

What is the rapid assessment of 5 parameters that is performed after completing the initial steps of NRP? When is it performed?

A
  • Apgar score
  • performed and scored at one and five minutes
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12
Q

What does APGAR score stand for?

A
  • A: appearance (colour): generalized skin colour
  • P: pulse (heart rate): based on observed movement of chest wall
  • G: grimace (reflexes) “response to stimulation”: based on degree flexion and movement of extremities
  • A: activity (muscle tone): based on presence of grimace, crying or active withdrawal
  • R: respirations (breathing):
    based on auscultation or palpation of umbilical cord
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13
Q

What does APGAR score (at one minute) of 7 or above mean? score of 4-6 mean? score of 3 or less?

A
  • A score of 7 or above at one minute indicates that an infant is making a good adjustment to extrauterine life.
  • A score of 4 to 6 at one minute indicates that an infant is having some difficulty
  • A score of 3 or less at one minute indicates severe distress.
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14
Q

What APGAR score warrants another assessment at 10 minutes?

A
  • Apgar of 7 or less at 5 minutes warrants another assessment of the five parameters at 10 minutes
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15
Q

What are the predictable phases of activity and rest during the transition period for full term healthy infant?
“What are the 3 stages of newborn transitions periods?”

A
  • first period of reactivity: within minutes after birth and lasting for 30-60 minutes
  • sleep: generally go into a deep sleep, lasting for 60-100 minutes
  • second period of reactivity: between two to six hours after birth and can last from 10 minutes to several hours
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16
Q

What is the “first period of reactivity” during the transition period (first hours of life) include for infant?

A
  • Within minutes after birth and lasting for 30-60 minutes.
  • In this period, infants are in a quiet alert state: eyes wide open and capable of responding to their environment.
  • Healthy infants are in an optimal state for the important first meeting with their parents. Heart rate increases to 160-180 bpm, then settles to 100-120 bpm by 30 minutes of age.
  • Respirations may be irregular and fine crackles may be audible on auscultation of lung fields.
  • Transitory grunting, nasal flaring, and chest retractions may be evident.
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17
Q

What is the “sleep period” during the transition period (first hours of life) include for infant?

A
  • Following this initial period of reactivity, infants generally go into a deep sleep, lasting for 60-100 minutes.
  • During this deep sleep, many physiologic needs stabilize: temperature regulation and adequate oxygenation and circulation.
  • Respirations may be rapid but not laboured.
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18
Q

What is the “second period of reactivity” during the transition period (first hours of life) include for infant?

A
  • this takes place approximately between two to six hours after birth and can last from 10 minutes to several hours.
  • brief periods of tachycardia and tachypnea, increased muscle tone, and skin colour changes.
  • meconium is usually passed in this period.
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19
Q

What 2 physiological adaptation tasks are included for neonate to be maintaining respirations?

A
  • adjusting to circulatory changes
  • regulating temperature

-other additional tasks of ingesting, retaining, and digesting nutrients, eliminating wastes, and regulating weight

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20
Q

What is the most effective ways of supporting physiologic transition for infants to extrauterine life?

A
  • skin to skin contact with mother
  • kangaroo care
  • involves placing the naked infant onto the naked chest of the woman
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21
Q

What are 4 benefits of neonatal skin to skin care?

A
  • stabilizing respirations and oxygen saturation
  • thermal regulation
  • reduces stress and crying (lower salivary cortisol levels)
  • increased incidence and duration of breastfeeding
  • improves infant state organization and self-regulation
  • reduces apnea and bradycardia
  • facilitates neurodevelopment
  • accelerated weight gain
  • decreases pain response to painful procedures
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22
Q

What are 4 maternal benefits of skin to skin care?

A
  • Increased self-confidence, competence, and self esteem
  • Enhanced parent-infant attachment
  • Increased incidence and duration of breastfeeding
  • Positively affects maternal mood/behaviour
  • increased milk supply
  • Increased confidence in meeting infant’s needs
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23
Q

What behavioural tasks must a neonate accomplish to adapt to extrauterine life?

A
  • establish regulated behavioural tempo independent of mother
  • processing, snoring, organizing multiple stimuli
  • establishing relationship with care givers and environment
  • regulating physiologic functioning,
  • motor organization,
  • responding to stimuli and
  • regulating states, and interacting with the environment
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24
Q

What are the 4 level of adaptations that Brazelton & Nugent (2011) describe infants progress as they adapt to their environment?

A
  • First level: regulate their physiologic functions: heart rate, respiration, and temperature.
  • Second level: motor organization; reduce excessive activity and improve muscle tone
  • Third level: state regulation, predictable sleep/wake states and able to react to stress
  • Fourth level: social interaction, able to attend to visual and auditory stimuli
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25
Q

What are the 4 necessary adaptations for neonate?

A
  • regulating physiologic functioning
  • motor organization
  • responding to stimuli and regulating states
  • interacting with the environment
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26
Q

What is the difference between an infant described as organized vs disorganzied?

A

Organized infant who is able to:
- regulate physiologic functioning,
- maintain good tone,
- modulate states, and
- interact with their environment

  • disorganized: infant who is unable to manage these things due to gestational age or health status
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27
Q

What is sleep-wake states?

A
  • Variations in the state of consciousness of infants
  • affected by health status and gestational age
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28
Q

What is essential for neurodevelopment? What 2 factors affect it?

A
  • ability to regulate sleep/wake states
  • affected by health status and gestational age
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29
Q

What is state modulation?

A
  • state modulation: ability to transition smoothly between states
  • sleep-wake states: variations in the state of consciousness of infants
  • Healthy term infants are able to transition smoothly through the six sleep/wake states
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30
Q

What are the 6 sleep-wake states?

A

(1) DEEP SLEEP (quiet): breathing regular, eyes closed, feed poorly
(2) LIGHT SLEEP (active): breathing irregular, rapid eye movements (REM), usually feed well
(3) DROWSY: breathing irregular, eyes open or closed, usually feed well
(4) QUIET ALERT: breathing regular, eyes open/bright, optimal state for feeding
(5) ACTIVE ALERT: breathing irregular, eyes open but not as bright,
(6) CRYING: breathing irregular, eyes tightly closed, difficult to feed

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31
Q

What 4 factors affect sleep-wake states?

A
  • room temperature: the warmer the room, the longer an infant sleeps,
  • amount of light: more active under minimal light versus moderate light,
  • close contact with parents: (infants calm easier when in close contact with parents
  • gestational age: preterm infants sleep longer and may have delayed responses to stimuli
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32
Q

What 4 factors about the infant should health care providers consider when interpreting what an infant is communicating?

A
  • their health status
  • their gestational age
  • their environment
  • their level of arousal
  • knowledge of individual infant “knowing the infant”
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33
Q

What two key factors impact how an infant is able to communicate its needs?

A
  • health status
  • gestational age
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34
Q

What 2 factors make it difficult for NICU nurses to understanding the individual needs and behaviours of infant (knowing the infant)?

A
  • First: newborn infants have very limited behavioural repertoires (the same behaviour may have different meanings in different situations)
  • Second: they lack the energy to display characteristic behavioural responses (behaviour of critically ill infants is even more difficult to interpret)
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35
Q

What are 3 causes of apnea in infants?

A

Apnea: the cessation of breathing for longer than 20 seconds:

  • blocked airway
  • respiratory depression due to hypoxia
  • immature central nervous system
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36
Q

Who are a great source of information when nurses need to know and understand the infants they care for?

A
  • parents
  • families
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37
Q

What are some infant behavours?

A
  • alerting
  • visual response
  • auditory response
  • habituation
  • cuddliness
  • consolability
  • self-consoling
  • consoling by caregivers
  • motor behaviour and activity
  • irritability
  • readability
  • smile
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38
Q

What are the 6 behavioural categories that the Neonatal Behavioural Assessment Scale (NBAS) uses to assess infant ability for social ineraction?

A
  • habituation,
  • auditory and visual stimuli,
  • motor maturity,
  • state regulation,
  • self-consoling ability, and
  • social behaviours
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39
Q

What is sensory threshold?

A
  • the level of tolerance for stimuli within which the infant can respond appropriately
  • when infant reach their threshold, they can become stressed
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40
Q

What are 4 stress cues of infant?

A
  • irritable
  • Disorganized sleep-wake states
  • Gaze aversion
  • Frowning
  • Sneezing
  • Yawning
  • Hiccupping
  • Irregular respirations
  • Apnea
  • Increased oxygen requirements
  • Heart rate changes
  • Finger splaying
  • Arching/stiffening
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41
Q

What are 4 stability cues of infants?

A
  • Smooth movements
  • Regular respirations
  • Regular heart rate
  • Hand to mouth movements (self-consoling behaviour)
  • Focused gaze
  • Quiet alert state
  • Clear sleep states
  • Dilated pupils
  • Rhythmic sucking
  • Reaching or grasping
  • Can be consoled easily
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42
Q

What is developmentally supportive care (DSC)?

A
  • an approach that provides individualized care of infants to maximize neurological development and reduce long term cognitive and behavioural problems
  • incorporates the ideas of normal neonatal development,
  • assumes that infant behavioural cues can be interpreted to provide information about an infant’s needs and feelings, and
  • recognizes the role that the environment plays in either nurturing an infant or adding to an infant’s vulnerability
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43
Q

What is the key concept of developmentally supportive care (DSC)?

A

individualized care with the intention of supporting the infant’s neurodevelopment according to:
- infant’s state,
- sensory threshold,
- physiologic homeostasis, and
- stability or stress cues

44
Q

What is the basis for developmentally supportive care (DSC)?

A
  • is based on the fact that infant behavioural cues communicate the infant’s needs, feelings, and overall neurologic status
  • is based on the fact that infants continually interact with their environment
  • involves altering the neonatal environment to nurture each of the infants’ sensory processes (tactile/kinesthetic, auditory, visual, and olfactory/gustatory)
  • guides our decision making when providing care to infants
  • creates an environment that nurtures brain growth and minimizes brain injury for optimal overall development
45
Q

What are the 2 goals of developmentally supportive care (DSC)?

A

To create an environment that:
- nurtures brain growth and
- minimizes brain injury for optimal overall development.

46
Q

What does habituation mean?

A
  • infant is able to tune out and decrease their response to a stimuli.
47
Q

What is the primary method used for communication by infants?

A
  • Infants primarily use behaviours to communicate with their parents/care providers.
48
Q

Can infant see?

A
  • Infants can see objects as far away as 2 feet, but clearest visual distance is 8-12 inches.
  • They prefer faces and can recognize their mother’s face.
49
Q

What are 4 interventions or care practices by care giver to support developmentally supportive care (DSC)?

A
  • skin to skin care
  • decrease noise when feeding infant
  • reading infant behavioural cues
  • swaddling infant
  • gentle touch to calm infants
  • encouraging parents to talk to their infant
50
Q

When is the first and second physical assessment of newborn done by primary care provider?

A
  • first physical assessment of the newborn is usually done in the first hour after birth
  • second physical assessment including behavioural assessment is performed prior to discharge
51
Q

What is the PWSOAC framework?

A
  • organizes the goals of care for infants

Neonatal program has created:
- Pink
- Warm
- Sweet
- Organized
- Attached
- Clean

52
Q

Are neonates primarily nasal or mouth breathers?

A
  • neonates are primarily nasal breathers and the normal respiratory rate of the newborn is 30-60 breaths per minute
  • respirations are initially shallow and irregular with occasional pauses lasting less than 20 seconds
  • breathing should be effortless but the rate will vary with sleep-wake patterns and when the infant is crying
53
Q

What should infants RR, colour, tone and HR be?

A
  • colour: pink
  • tone: flexed
  • HR: 100-160bpm
  • RR: 30-60bpm
54
Q

Are heart murmurs normal in health newborn?

A
  • irregular heart rate: heard for brief periods in the first few days after birth due to changes in activity or respiratory pattern of the newborn
  • heart murmur: heard in the first few days of life; most are not pathological and disappear by 6 months once the ductus arteriosus is fully closed
55
Q

When does hearing a heart murmur require urgent follow up?

A
  • heart murmurs can also be heard in the first few days of life; most are not pathological and disappear by 6 months once the ductus arteriosus is fully closed
  • presence of a murmur along with poor feedings, apnea, cyanosis or pallor may indicate significant cardiac defects
56
Q

What are 3 factors during birth or labour can compromise respiratory function and oxygenation for neonates?

A
  • medications administered during labour and birth,
  • inadequate clearance of lung fluid which may result from caesarean birth,
  • meconium aspiration,
  • congenital defects, and
  • absent or decreased surfactant
  • respiratory distress or apnea: may be related to hypoglycemia, hypothermia, or sepsis
57
Q

What are the 3 cardinal signs of respiratory distress in newborn?

A
  • nasal flaring
  • in-drawing or retractions
  • grunting
58
Q

Whats transient tachypnea of the newborn (TTNB)?

A
  • mild TTN: result from tachypnea and signs of respiratory distress in first 1-2hours of life
  • Consultation with the primary care provider is required as supplemental oxygen may be needed along with increased observation
59
Q

What is the normal temperature for newborn?

A
  • normal temperature for a newborn should be between 36.5 and 37.4 degrees Celsius axilla
  • newborn are vulnerable to heat loss
  • during the first 48hours: newborn still trying to achieve thermal balance or thermoregulation
60
Q

What is thermoregulation?

A
  • maintenance of constant internal body temperature independent of the environment temperature
61
Q

What 3 characteristics of newborns that make them vulnerable to heat loss?

A
  • thin layer of subcutaneous fat
  • blood vessels are close to the surface of skin
  • larger surface-to-body weight ratios
  • changes in environment temperature alter blood temperature which impact temperature regulation centers in the hypothalamus
62
Q

What are 4 ways to prevent heat loss at the beginning of birth?

A
  • drying of infant immediately after birth
  • placing infant skin to skin with mother
  • putting cap/hat on infants head
  • covering with warm blankets or towels
  • keep infant off of cool surfaces and away from drafts
  • delaying bath until newborn has minimum of 3 normal body temperature readings one hour apart
63
Q

What are some behaviours that newborn are communicating they are hungry and ready to feed?

A
  • turning toward breast and opening mouth
  • making sucking motions with mouth and tongue
  • bringing hands/fists towards mouth
64
Q

In order to maintain normal blood sugar, what should infant be doing?

A
  • in order to maintain a normal blood sugar, infant feeding should be established in the first few hours of life
  • at birth when the umbilical cord is cut, the newborn no longer receives the maternal source of glucose.
  • the first feed occurs during the infant’s first period of reactivity
65
Q

Is it normal for healthy newborn to have blood sugar as low as 2.0mmol/L (or even 1.8mmol/L)?

A
  • Canadian Pediatric Society (CPS) position statement on hypoglycemia states hypoglycemia cannot be defined by a single value of glucose
  • blood glucose levels as low as 2.0 mmol/L (or even 1.8 mmol/L at 1 h of age) are not uncommon in healthy newborns
  • blood sugar of less than 2.6mmol/l in at risk newborns is associated with adverse outcomes
66
Q

What are 3 factors affect blood sugar of newborns?

A
  • gestational age
  • birth weight
  • presence risk factors: maternal diabetes, stress during labour and birth and immediate care at delivery
67
Q

What 3 type of infants are at risk for hypoglycemia? When should they have their blood sugar tested?

A
  • preterm and late preterm infants
  • SGA and LGA infants
  • infants of diabetic mothers
  • infants who have had difficult births
  • infants who required resuscitation
  • infants who experience hypothermia

-infants who are at risk of hypoglycemia usually have their blood sugar tested within 2 hours of age

68
Q

What are 4 signs of hypoglycemia in newborns?

A
  • tremors
  • jitteriness
  • irritability
  • lethargy
  • pallor
  • temperature instability
  • breathing difficulties
69
Q

What are some characteristics of an “organized” infant?

A
  • Stable heart rate, color
  • Tolerance of feeding
  • Smooth and synchronous movements
  • Smooth transitions between sleep and wake cycles
  • Uses self-consoling behaviours
  • Ability to shut out (Habituation) noxious or repetitive stimuli
70
Q

What are some characteristics of an “disorganized” infant?

A
  • Fluctuations in heart rate and respiratory rate. May experience bradycardias and/or apnea
  • Inability to tolerate feeds, increased stooling
  • Hiccups, sneezing, gagging, yawning
  • Frantic body movements and jitteriness, changes in muscle tone
  • Inability to modulate state, sudden changes from sleep to wake
  • Limited use of self-consoling behaviours
  • Inability to be consoled
  • Inability to habituate
71
Q

What are 2 care practices that will promote organization (disorganize to organized infant)?

A
  • skin to skin
  • recognition and response to stress cues
72
Q

What is parent-infant attachment?

A
  • attachment is the process in the brain that motivates infants to seek proximity and communication with parents and other primary caregivers
  • process of parent-infant attachment begins well before the birth of a baby, and continues on throughout the child’s life
  • Attachment is developed and maintained by proximity and consistent responses to infant cues
73
Q

Why is attachment crucial for in infants?

A
  • crucial for the infant’s physical, psychological, and emotional health and survival
74
Q

What is bonding vs attachmment?

A

Bonding:
- refers to earlier processes through which the parents becomes acquainted with infant, identifies the infant as an individual, and claims the infant as a member of the family
- Over time, positive interactions between the parent and the infant through social, verbal, and nonverbal responses (whether real or perceived) facilitates the development of secure parent-infant attachment

Attachment:
- is developed and maintained by proximity and consistent responses to infant cues

75
Q

What 3 interventions can nurses do to encourage/support parent-infant attachment?

A
  • rooming in
  • skin to skin care
  • parental involvement in care
  • other helpful strategies to support bonding and attachment include pictures/videos of the infant, providing frequent updates on the condition and care of the infant
76
Q

Is it possible to spoil infant by picking them up every time they cry?

A
  • no
  • parents need reassurance that responding to crying quickly is an important aspect of attachment.
77
Q

What are the goals of clean related to infant care?

A
  • keeping work surfaces clean
  • preventing infections applies to all practice settings where infants are cared for
  • hand washing
78
Q

What makes all newborns at risk for infection in first few months of life?

A
  • due to generalized hypo-functioning of immune response
79
Q

What are 4 signs of infection?

A
  • newborns do not typically respond with a fever but instead will show signs of hypothermia or temperature instability
  • lethargy
  • irritability
  • poor feeding
  • pale or mottled skin
  • respiratory symptoms
  • vomiting or diarrhea
  • decreased reflexes
80
Q

What are 3 factors increases risk of infection?

A
  • preterm birth
  • prolonged rupture of membranes
  • maternal fever/infection
  • asphyxia
  • invasive procedures
  • stress
  • congenital anomalies
81
Q

All babies are vulnerable, what heightened their vulnerabilities?

A
  • when there are variations in gestational age, birth weight, challenges during labour and birth
82
Q

What is preterm birth defined as?

A
  • any birth after 20 weeks and before 37 weeks
83
Q

What are 4 key concerns for preterm infants?

A
  • respiration
  • thermoregulation
  • feeding (hypoglycemia)
  • infection
84
Q

What is mother/baby care?

A
  • Some NICUs are now moving towards a new model of care where NICU nurses provide care to the vulnerable neonate and the healthy postpartum mother at the infant’s bedside. These units, often called Mother/Baby Care, are designed for stable infants requiring NICU care
  • Both mother and neonate are cared for in the same room by the neonatal nurse. (Some units have perinatal and neonatal nurses working collaboratively to care for the mother/infant dyad).
85
Q

What defines late preterm infants?

A
  • infants born between 34 and 37 weeks (34 weeks and 0 days to 36 weeks and 6 days)
  • these infants are often close to the size of term infants and often appear mature
  • because of their gestational age they are at increased risk of problems related to respiratory function, thermoregulation, hypoglycemia, feeding issues, sepsis, and hyperbilirubinemia
86
Q

What defines post term infants vs post mature infant?

A
  • infants born after 42 weeks gestation may be referred to as post term or post mature
  • infant who is born after 42 weeks gestation but does not show any signs of reduced placental functioning; meaning they continue to grow in utero, is considered a post term infant
  • a post mature infant has experienced placental insufficiency which results in a loss of subcutaneous fat, dry cracked skin, and increased risk of meconium being present in the amniotic fluid
  • post mature infant has experienced placental insufficiency resulting in increased risk of perinatal mortality/morbidity related to intrauterine hypoxia
87
Q

Is the passage of meconium into the amniotic fluid normal function?

A
  • passage of meconium into the amniotic fluid may be a normal physiologic function
  • a result of hypoxia-induced peristalsis and sphincter relaxation,
  • or the result of umbilical cord compression-induced vagal stimulation in mature fetuses
88
Q

What is meconium aspiration syndrome (MAS)?

A
  • fetus will aspirate this fluid in utero
89
Q

What are 4 factors that can make pulmonary transition challenging for preterm infant?

A
  • have decreased number of functioning alveoli
  • deficient surfactant
  • weak or absent gag reflex
  • immature or friable capillaries in lungs
  • smaller lumen in respiratory system
  • greater collapsibility
  • obstruction of respiratory passages
90
Q

What are 4 factors increase vulnerability to heat loss in the preterm infant?

A
  • Minimal subcutaneous fat,
  • limited stores of brown fat,
  • decreased or absent shiver response,
  • inadequate muscle mass activity,
  • poor muscle tone resulting in more body surface area being exposed to environment, and
  • immature temperature regulation center in the brain

-muscle tone: Muscle tone is the amount of tension (or resistance to movement) in muscles

91
Q

Why are preterm infants more susceptible to infection (2)?

A
  • have a shortage of maternal immunoglobulins
  • immature immune system.
  • They are also exposed to more care providers, and more invasive procedures such as respiratory support and intravenous therapy.
92
Q

What are 3 challenges to maintaining adequate nutrition in the preterm infant?

A
  • weak or absent suck, swallow, and gag reflexes,
  • difficulty coordinating sucking and swallowing,
  • small stomach capacity, and immature digestive and enzyme systems
93
Q

What are small for gestational age (SGA) vulnerable for (3)?

A
  • Perinatal asphyxia
  • Temperature instability
  • Hypoglycemia
  • Meconium aspiration
  • Polycythemia (blood disorder)
94
Q

What are large for gestational age (LGA) infants vulnerable to (3)?

A
  • Birth injuries
  • asphyxia
  • Hypoglycemia
  • Congenital anomalies
95
Q

How many disorders are all newborns routinely screened for in BC?

A
  • routinely screened for 24 different disorders
  • all of these disorders are rare but treatable and when identified early can prevent and minimize serious complications
96
Q

When is newborn screening done?

A
  • between 24 to 48 hours of birth
  • PKU and MCAD require collection after 24 hours for optimal test sensitivity
  • Screening requires a newborn blood specimen, generally obtained by pricking the infant’s heel
97
Q

How is newborn blood specimen collected for newborn screening?

A
  • generally obtained by pricking the infant’s heel.
  • The newborn blood is collected on a special blood dot card along with pertinent information - date of collection, date of birth, name of infant and primary physician or midwife.
  • This card is sent to the newborn screening program in Vancouver for testing
98
Q

Will newborn discharged prior to 24hrs of birth require another blood screening?

A
  • Newborns discharged prior to 24 hours of birth can have a preliminary screen done prior to discharge.
  • However, due to the time sensitivity with PKU and MCAD detection, this initial test must be followed up with another test within 14 days of discharge to ensure accuracy
99
Q

What useful strategy can be used to reduce pain and crying when blood for newborn screening is drawn?

A
  • skin to skin
  • breastfeeding
100
Q

What is acrocyanosis?

A
  • bluish colouration of hands and feet which is normal finding in the first 24 hours after birth
101
Q

What is central cyanosis?

A
  • is abnormal and signifies hypoxemia (below-normal level of oxygen in your blood)
  • lips and mucous membranes are bluish
102
Q

What are some reasons for central cyanosis?

A
  • result of inadequate delivery of oxygen to alveoli
  • poor perfusion of lungs that inhibits gas exchange
  • cardiac dysfunction
103
Q

What are 4 signs of respiratory distress?

A
  • RR > 120 bpm
  • severe retraction
  • grunting
  • pallor
  • central cyanosis
104
Q

What are 4 common respiratory complications?

A
  • respiratory distress syndrome (RDS)
  • meconium aspiration
  • pneumonia
  • persistent pulmonary hypertension of the newborn (PPHN)
105
Q

What are 4 common reflexes found in normal term newborn?

A
  • rooting and sucking
  • swallowing
  • grasp: finger or toe curl around examiner finger
  • extrusion: tongue force tongue outward
  • tonic neck
  • moro
  • stepping
  • crawling
  • deep tendon
  • crossed extension
  • babinski: all toes hyperextend
  • pull to sit
  • truncal incurvation: trunk is flexed
  • magnet: both lower limbs extend against examiner pressure

NS 7100 (7 decks)

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