Neonatal unit Flashcards
What is a low birth weight?
Below 2500g
What is a very low birth weight?
Below 1500g
What is an extremely low birth weight?
Below 1000g
What is a neonatal death?
Baby born at 20 wks+ or with a birthweight of 400g or more (where an accurate estimate of gestation is not available) who died before 28 completed days after birth
What is an early neonatal death?
Baby born at 20 wks+ or with a birthweight of 400g or more who died before 7 completed days after birth.
What is a late neonatal death?
Baby born at 20 wks+, or with a birthweight of 400g or more who died from 7 -28 days completed days after birth
What is the difference between the resting posture of a term baby and a premature baby?
Term babies- lie with limbs flopping outwards, premature babies- limbs curve inwards. Babies become more flexed as muscle tone increases with advancing gestational age
What is a premature baby’s skin like?
Fragile, transparent skin. Skin becomes thicker, more opaque, and veins become less visible as gestational age increases
What is lanugo?
Soft, fine hair that is abundant over the body of the neonate from 20-28 weeks gestation, and declines as the infant matures. Most prevalent over the baby’s back, and retains the vernix caseosa on the surface of the skin. By term it has essentially disappeared
What is the difference between the plantar surface (sole of foot) of a premature baby and a term baby?
Premature- smooth until 28-30 wks, term- creased
What is the difference between the breasts of a premature baby and a term baby?
Premature babies born before 34 wks gestation exhibit barely visible nipples and areola; these babies also have no palpable breast
What is the difference between the ears of a premature baby and a term baby?
Cartilage formation in the ears and incurvature of the pinna generally occurs after 34 weeks gestation. Thus babies born prior to this will typically exhibit a flat, shapeless pinna, which lacks recoil when folded on itself and released
What is the difference between the eyes of a premature baby and a term baby?
Babies eyelids fuse at approx 9-10 weeks gestation, and do not fully open until the 26-28th wk. 23-27 wks, babies may vary between tightly fused (closed) eyelids, loosely fused (closed but separation can be achieved with gentle manipulation), and open eyelids
What is the difference between the genitalia of a premature baby and a term baby?
In male infants, testicular descent begins at approx 30 wks gestation, and both testicles should be palpable by 34 wks gestation; Rugae becomes more prominent as the scrotal sac thickens as gestation advances. In female infants, the labia majora and minora become more developed with advancing gestational age; at term the clitoris is completely covered
What are the features of an IUGR baby?
Relatively large head compared with whole body
Shrunken abdomen with “scaphoid” appearance (must be distinguished from diaphragmatic hernia)
Loose skin, sometimes dry, peeling, with the appearance of “hanging”, occasionally meconium stained
Long fingernails, especially in term and postterm infants with severe IUGR, occasionally meconium stained
Face with shrunken appearance or wizened
Widened or overriding cranial sutures, anterior fontanel larger than usual
Thin umbilical cord, sometimes meconium stained
Why might a baby be admitted to a neonatal unit?
Birth less than 37 weeks or more than 42 weeks
Birth weight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces)
Small for gestational age
Medication or resuscitation in the delivery room
Birth defects
Respiratory distress including rapid breathing, grunting, or apnea (stopping breathing)
Infection such as herpes, group B streptococcus, chlamydia
Seizures
Hypoglycemia
Need for extra oxygen or monitoring, intravenous (IV) therapy, or medications
Need for special treatment or procedures such as a blood transfusion
Why do baby’s grunt?
Usually means they’re learning how to have a bowel movement. They haven’t yet figured out how to relax the pelvic floor while also using abdominal pressure to move stool and gas through their system. Their abdominal muscles are weak, and they must bear down with their diaphragm against their closed voice box (glottis). This leads to a grunting noise
Only ever happens on expiration- the air goes pass the epiglottis that has come down over their trachea so their next inspiration will be easier
Why is it concerning if a baby grunts?
Grunting paired with…blue tongue or skin, weight loss, fever, lethargy, nasal flaring, pauses in breathing, asthma, pneumonia, sepsis, meningitis, heart failure could be a sign of…
asthma, pneumonia, sepsis meningitis heart failure
A term baby will grunt when cold as it causes surfactant production to reduce
How might prolonged light exposure affect a premature baby?
Premature infants lack simple adaptive functions to assist in protecting their eyes from light. They have thinner eyelids than term neonates and adults. They have larger pupils as well as a decreased ability to constrict their pupils in response to light exposure at less than 30-32 weeks gestation Younger infants spend more time with their eyes open despite the intensity of illumination in their environment, can’t blink until 6 months old- stare a things that attract their attention for a long time, too weak to turn their head away Very low birth weight infants may therefore be uniquely susceptible to retinal damage from exposure to bright light. Can disturb their sleep and therefore the time they have brain development Pre-term babies are unable to deal with stresses of extraueterine life so are unable to self-console (bracing limbs, hand to mouth sucking, crying) and so demonatrate signs of negative response to stress (disruptions to vital signs, colour, tone, eye movements , frantic body movements, fixed positions, gaze aversion)
How could nursing staff minimise the effect of bright light in the NNU/SCBU?
not turning the lights on unless they are absolutely necessary incubator covers are used to reduce light exposure, thus encouraging good quality sleep.
What are the two ways sound can be heard?
Pitch (frequency) and loudness (decibels)
How might noise affect babies in NNU? How can noise be reduced?
Excessive auditory stimulation creates negative physiologic responses such as apnea and fluctuations in heart rate, blood pressure, and oxygen saturation. Preterm infants exposed to prolonged excessive noise are also at increased risk for hearing loss, abnormal brain and sensory development, and speech and language problems. Reducing noise levels in the NICU can improve the physiologic stability of sick neonates and therefore enlarge the potential for infant brain development. Recommendations include covering incubators with blankets, removing noisy equipment from the incubator environment, implementing a quiet hour, educating staff to raise awareness, and encouraging staff to limit conversation near infants.
What does evidence suggest is the greatest source of stress in a premature baby?
Touch signs of physiological instability (falling temperature and oxygen pressures, and increasing heart rates), preterm or unwell infants can express stress or pain through a number of well recognized signs or cue
What is the new ballad score?
A tool that estimates gestational age through the neuromuscular and physical assessment of the newborn infant. By confirming gestational age and growth patterns, paediatricians are able to appropriately identify babies that are at high risk of complications, and subsequently develop a suitable care plan
What is the metabolic triangle? And according to what it shows, what should we assess for in relation to cold stress?
Energy required for effective breathing- energy required to keep warm- energy required for adequate glucose homeostasis Since cold such stress can be associated with hypoglycaemia, increased oxygen demands and respiratory compromise, it is important to assess temperature, blood glucose and oxygenation together.
What is the metabolic triangle? And how does it explain how cold stress causes metabolic acidosis and causes RDS, hypoglycaemia and jaundice?
Respiratory rate increases in response to the increased need for oxygen.
In the cold-stressed infant oxygen consumption and energy are diverted from maintaining normal brain and cardiac function and growth to thermogenesis for survival. If the infant cannot maintain an adequate oxygen tension (measure of ‘how much’ oxygen there is pressure which oxygen in a mixture of gases would exert if it were on its own- Po2), vasoconstriction follows and jeopardizes pulmonary perfusion
As a consequence the Po2 is decreased, and the blood pH drops.
These changes can prompt a transient respiratory distress or aggravate existing RDS. Moreover, decreased pulmonary perfusion and oxygen tension can maintain or reopen the right-to-left shunt across the ductus arteriosus.
The basal metabolic rate increases with cold stress. If cold stress is protracted (lasting for a long time), anaerobic glycolysis occurs, resulting in increased production of acids. Metabolic acidosis develops; and, if a defect in respiratory function is present, respiratory acidosis also develops.
Excessive fatty acids can displace the bilirubin from the albumin-binding sites and exacerbate hyperbilirubinemia.
When an infant is stressed by cold, oxygen consumption increases, and pulmonary and peripheral vasoconstriction occur, thereby decreasing oxygen uptake by the lungs and oxygen to the tissues; anaerobic glycolysis increases; and there is a decrease in Po2 and pH, leading to metabolic acidosis.
Hypoglycemia is another metabolic consequence of cold stress. The process of anaerobic glycolysis uses approximately 3 to 4 times the amount of blood glucose, thereby depleting existing stores. If the infant is sufficiently stressed and low glucose stores are not replaced, hypoglycemia, which can be asymptomatic in the newborn, can develop.
