Module Six Flashcards
Catecholamines
Epinephrine
Norepinephrine
Dopamine
- Surge in response to birth process and are responsible for inc BP after birth, adaption of energy metabolism, initiation of thermogenesis
Cortisol
regulatory hormone that aids in neonates transition, aids in lung maturation, clearance of lung fluid, gut maturation, maturation of glucose metabolic pathways in the liver, maturation of the thyroid axis.
Initiation of Resps triggered by:
Chemical, Mechanical, Thermal, Sensory
Chemical Factors
Progressive decline in PO2 during labour and a drop in prostaglandin levels that results from clamping the cord
Mechanical
Squeezing of chest during vaginal delivery
Thermal
Shifts from warm intrauterine environment –> extra stimulates resp center in medulla
Sensory
Drying the neonate also stimulates resp center
Key Physiologic Changes
- expansion of lungs with air
- rapid dec in pulmonary vascular resistance and increase in pulmonary blood flow
- Initiation of gas exchange across alveolar membrane
- Pressure gradient changes (dec R side pressure, inc L side pressure)
- Closure of circulatory shunts (foramen ovale, ductus arteriosus)
- increase in arterial PO2
Hypoexpansion of lungs hypoxemia, persistent acidosis —> high pulmonary vascular resistance, delayed clearance of lung fluid, persistent R to L shunting
APGAR
A- appearance (colour) P- pulse (HR) G- Grimace (reflexes) A- Activity R- Respirations - breathing
Transition Period of Reactivity
First, Sleep, Second
First Period of Reactivity
Birth –> 30-60min
Quiet Alert State
HR 160-180 bpm settling to 100-120 by 30 mins
Resps irreg, fine crackles
transitory grunting, nasal flaring, chest retractions may be evident
Sleep Period of Reactivity
After first period
deep sleep for 60-100 mins
Stabilization- temp regulation, adequate oxygenation, circulation, resps rapid but not laboured
Second Period of Reactivity
2-6 hours after birth
lasts 10 mins - several hours
tachycardia, tachypnea, inc muscle tone, skin colour changes, passage of meconium
Skin-to-skin
stabilizes resps, thermal regulation, reduces apnea and bradycardia, improve infant state organization and self regulation, reduces stress, facilitates neurodevelopment, accelerated wt gain, decrease pain response, increase incident and duration of breast feeding
Increase self confidence, infant attachment, positive mood/behaviour, increased milk supply
Behavioural tasks of newborn
establish regulated behavioural tempo independent of the mother
Processing, storing, organizing multiple stimuli
Establishing a relationship with caregivers and environment
First level organization
regulate physiologic function
Second level organization
Motor, reduce excessive activity and improve muscletone
Third level organization
State regulation, predictable sleep and wake states, able to react to stress
Fourth level organization
atten and social reaction, able to attend to visual and auditory stimuli
“Organized”
- regulate physiologic functioning
- Maintain good tone
- Modulate states
- Interact with Environment
State Modulation
Ability to transition smoothly between states
Deep Sleep (Quiet)
Regular breathing, eyes closed, no movement, no spontaneous activity except startles and occasional suck, delayed response to ext stimuli, cannot be easily roused
Light Sleep (Active)
Breathing irreg, REM, may smile or be fussy, sporadic sucking, short crying sounds, responds to ext stimuli with a startle, will feed without opening eyes
Drowsy
Breathing irreg, eyes open or close, variable activity level, react to stimuli with delayed responses, usually feeds well- becomes more alert
Quiet Alert
Breathing reg, eyes open and bright, minimal motor activity, focused attn on any stimuli, optimal for feeding
Active Alert
Breathing irreg, eyes open but not bright, considerable motor activity, sensitive to unpleasant stimuli
Crying
irreg breathing, eyes tightly closed, increased motor activity, facial grimaces and colour changes, extremely responsive to unpleasant stimuli, orient to breast for feeding, needs comforting to aid into moving into a more organized state
Alerting
Eyes widened and brightened, focus on stimuli
Drowsy or Active Alert - Quiet State
Visual Response
Pupillary Response, focus on faces 8-12 inches away. Complex patterns, human faces, moving objects
Quiet Alert
Auditory Response
Reaction to a variety of sounds, infant can locate sound if constant
Drowsy, Quiet Alert, Active Alert
Habituation
Ability to lesson ones response to repeated stimuli
Cuddliness
Infants response to being held- nestle and work to contour themselves to the caregivers body
Consolability
Measured when infants have been crying for at least 15 seconds. The ability of infants to bring themselves or be brought to a lower state
Self Consoling
Hand-mouth movement, sucking on fingers or fist, pay attention to voices or faces around them, changes in position
Motor behaviour and activity
Spontaneous movements of extremities and body when stimulated vs when left alone
Smooth, rhythmical movements vs jerky
Irritability
How easily infants are upset by loud noises, handling by caregivers, temperature changes, removal of blankets or clothes
Readability
The cues infants give through motor behaviour and activity, looking, listening, and behaviour problems.
Sensory Threshold
Level of tolerance for stimuli within which the infant can respond appropriately
Stress Cues
- Irritable
- Disorganized sleep-wake states
- Gaze Aversion
- Frowning
- Sneezing
- Finger splaying
- arching/stiffening
- yawning
- hiccoughing
- Irreg Resps
- Apnea
- Inc O2 Req
- HR Changes
Stability Cues
- Smooth Movements
- Quiet Alert state
- clear sleep states
- focused gaze
- dilated pupils
- reg resps
- reg HR
- Rhythmic sucking
- reaching or gasping
- hand to mouth movements
- can be consoled easily
- rhythmic, robust crying
Developmentally Supportive Care
Approach that provides individualized care of infants to maximize neurological development and reduce longterm cognitive behavioural problems
Pink
Establish and maintain resps
Transient Tachypnea of the Newborn
Tachypnea and signs of distress in first 1-2h
Warm
Regulate temp - vulnerable for first 48h. 36.5-37.4
thermoregulation
balance between heat loss and heat production
Sweet
maintain BS - establish feeding in 1st few hours, feeding cues. In first few hours, transient dec in BS
Organized
maintain an optimum state
Attached
Promote attachment with family
Clean
Employ infection control strategies
Preterm Infant
Birth after 20wks- before 37wks
Late Preterm Infants
34-37wks gest
Postterm infant
10% of all pregnancies, 14+ days past term
