Neonatal Monitoring and Thermoregulation

Question 1

What are the normal vitals for a newborn?

Answer 1

HR- 95-160
RR- 30-60
BP- 72/55

Question 2

What are the normal blood gas values for a term baby after the first few hours of life?

Answer 2

pH- 7.3-7.4
PaCO2- 35-45
PaO2- 70-100
HCO3- 20-22

Question 3

What are the normal blood gas values for a baby born at 28-40 weeks?

Answer 3

pH- >7.25
PaCO2- 45-55
PaO2- 50-70
HCO3- 18-20

Question 4

What are the normal blood gas values for a baby born <28 weeks?

Answer 4

pH- >7.25
PaCO2- 35-55
PaO2- 45-65
HCO3- 15-18

Question 5

What differences will you see between an ABG, VBG, and CBG on neonates?

Answer 5

VBG will be most acidotic and hypoxemic, CBG will be in between in terms of pH and PaCO2 but oxygen levels are not clinically relevant

Question 6

What is transcutaneous monitoring?

Answer 6

A method of monitoring oxygen and carbon dioxide levels as a trend that electrochemically measures skin PO2 and CO2

Question 7

Where should a UVC be placed?

Answer 7

Tip of UVC should extend into the IVC to about the level of the diaphragm

Question 8

Why do we need to be careful of hypothermia in newborns?

Answer 8

They lack a shiver response, have increased surface area relative to body weight, have wet skin after birth, and have a limited ability to raise metabolism.

Question 9

How does body temperature affect a baby’s oxygen levels?

Answer 9

Lowering body temperature shifts the oxy-hemoglobin curve left so it is harder to offload oxygen from the Hb

Question 10

What is a unique way babies combat hypothermia?

Answer 10

They have brown fat that helps them regulate metabolism and generate heat. A surge of catecholamine release in response to hypothermia upregulates the metabolism of brown fat.

Question 11

Where is brown fat found?

Answer 11

It is concentrated around heart, neck, between scapula, and around the kidneys and spinal cord

Question 12

What are some consequences of prolonged cold stress?

Answer 12

Inability to provide adequate oxygen and ventilation becomes respiratory failure; precipitates into respiratory and cardiac arrest; surfactant production is reduced so baby is progressively less able to compensate

Question 13

What therapeutic use can hypothermia have in the NICU?

Answer 13

Cooling baby can help prevent injury from hypoxic-ischemic encephalopathy