Neonate Flashcards
What are the 5 circulatory structures that are involved with the fetus?
Ductus arteriosus
foramen ovale
ductus venosus
umbilical vein (one)
umbilical arteries (2)
umbilical cord
What is the ductus arteriosus?
connects the pulmonary artery to the descending aorta to allow blood most of the blood to bypass the lungs
What is the ductus venosus?
it is a shunt that allows most oxygenated blood to bypass the liver
What is the average length of the neonate?
50 cm
What is the average weight of the neonate?
3.5kg
What is the average circumference of the neonate head?
35 cm
what is the average length of the umbilical cord?
50cm
What is the normal rate of breathing and what happens to the rate when crying and sleeping?
30-60 bpm
increase with crying
decrease with sleep
What are the three factors opposing the first breath?
1) alveolar surface tension - need adequate surfactant
2) viscosity of lung fluid within the respiratory tract
3) degree of lung compliance
Why is the first breath the hardest?
normally, alveolar sacs always have some level of air
the first breath is difficult because the sacs start with 0 air and therefore have a greater resistance to breathing
What is the expected HR at birth?
120-160 bpm
Why do nurses dry the baby right after delivery?
- tactile stimulation
- temperature control
What are some factors that attribute to heat regulation/loss in newborns?
- dec subcutaneous fat and thin epidermis (preterm have very thin skin)
- blood vessels lie close to skin
- posture is important (normal curled up conserves heat, preterm sunbathers lose heat)
babies lose ____ times the amount of heat as the grown adult.
4
What are the 4 ways babies can lose heat. Which are the two main ones after drying?
Convection (currents)
Radiation
Evaporation
Conduction (contact with surfaces)
radiation and convection are the main ones after the baby is dry
How does the baby respond to cool environments?
1) inc metabolic rate
2) inc muscle activity
3) chemical thermogenesis (NST)
What is non-shivering thermogenesis (NST)?
a heat generating process unique to newborns
metabolizes store of brown fat for heat
- appears about 26-30 wks
- around neck, axilla’s, trachea, esophagus, abdominal aorta, kidneys, and adrenal glands
How is temperature taken in the newborn? What is the average value?
axilla
36.5-37.2 C
Explain the apgar score
HR 0 = absent 1 = slow one min 1 = irregular and slow 2 = good breathing and norm crying
Muscle tone
0 = limp and flaccid
1 = weak, inactive, slight flexion
2 = strong, active motion
Body color
0 = blue and pale
1 = body pink, extremities blue
2 = entire body pink
Reflex irritability
0 = no response
1 = grimace
2 = coughing, sneezing, and crying
describe the initial physiological assessment
symmetry of body
Head (symmetry, fontanels, suture lines for molding, presence of hair)
FACE
- open eyelids, for presence of eyes. sclera white or red (whites of eyes)
- nose presence and open nares
- mouth; gums with no teeth, moist, pink, tongue, alignment, feel palate
SKIN
- lanugo (body hair), stork bites, milia (blocked glands on nose), Mongolian spots
NECK
- no webbing or masses
BODY
- chest symmetry, auscultate lungs, HR, assess breasts, abdominal sounds, examine umbilical cord
EXTREMITIES
- proper number of fingers/toes
- color
GENITALS
female: majora bigger than minora
male: have two testes, look for a formed urethra
CHECK SPINE - run finger along to make sure vertebrae are connected, check back dimple
MEASURE circumference and length
assess temp
How is iron stored in the newborn?
full-term babies have enough iron stored in their body for the first 5 months of life
after that, supplements and food need to be given that contain iron (can’t have too much)
What is bilirubin?
by-product of RBC breakdown
explain the process of getting rid of bilirubin
unconjugated (indirect) until it can bind with albumin in the blood stream
then becomes conjugated (direct) bilirubin
conjugated bilirubin is then excreted in the stool
What is physiological jaundice?
caused by destruction of fetal RBCs and the inability to conjugate the inc bilirubin
appears 2-3 days after birth
need to educate parents
what are the three types of stool?
Meconium - the first stool; thick, tarry black or dark green (8-24 hrs)
Transitional - thin brown to green (48-72 hrs)
Breastfed - pale yellow, liquid, and frequent to begin with (once every 5-7 days))
Describe urinary function in newborns.
93% void in first 24 hrs
- pink stains may appear in male diapers - caused by urates
- blood in female diapers - pseudomenstration
What are the 6 basic reflexes of the newborn?
1) suckling
2) grasping
3) stepping/walking (hold them up on surface)
4) moro (startle
5) rooting
6) babinski
What is the moro (startle) reflex? how do you test this?
lift shoulders off table and let go, arms should spread as if startled
What is the rooting reflex?
touch nipple to baby’s cheek, baby should turn towards the nipple
What is the Babinski reflex?
take finger and run down sole of feet, toes should flare then go down
How do babies behave when they are first born?
wide awake and looking around everywhere
What are the two states of babies?
Sleep states
- deep or quite sleep
- active rapid eye movement (eyes may be open)
Alert state
- drowsy/semi-dozing
- wide awake
- active awake
- crying
What are the 14 signs of distress in newborns?
- increased resp rate (normal is 30-60)
- sternal retractions
- nasal flaring
- grunting
- excessive mucus
- facial grimacing
- cyanosis
- abdominal distention/mass
- vomiting of bile stained material
- absence of meconium within 24 hrs
- absence of urine within 24 hrs
- jaundice within 24 hrs
- temp instability
- jitteriness or low blood glucose
How do temperature changes in babies in response to sickness differ from older humans?
tend to go hypo rather than hyper
do babies shiver?
no, they are chemoregulated so shivering is a sign of distress
When is blood screening done in newborns? why?
done 24 hrs after birth
wait 24 hrs to allow for normal protein lvls in the blood
Define acrocyanosis.
persistent cyanosis in the extremities (esp. hands and feet)
Define erythema toxicum.
a common skin rash that clears and is not harmful in newborns
Define milia.
clogging of glands esp common on the nose
define vernix caseosa
white residue found on the surface of the skin in newborn babies after birth
most comes off after cleaning
define Mongolian spots
blue birth mark on the skin
usually goes away by age 5 and almost always by puberty
define nevus flammeus
(stork bites)
capillary malformation that results in a red birth mark. usually temporary
25-50% of newborns
define nevus vasculosus
swelling or growth of capillaries in dermal and subdermal layers that resolves itself
what is the foramen ovale?
it is a shunt that connects right and left ventricles (helps avoid pulmonary circulation)
when is an apgar scoring conducted? what is a normal value?
1 and 5 mins after birth
7 and up is normal, anything lower requires medical intervention
