Neonates Flashcards
Jaundice
Yellowing of skin and whites of eyes (sclera) as a result of bilirubin build up
Normally RBCs breakdown in liver and are released into intestines as bile; in jaundice the bilirubin is absorbed back into the body from the intestines
Diaphragmatic tear
Abnormal opening in the diaphragm that allows abdominal contents to enter the chest cavity
S/S: decreased breath sounds, scaphoid (sunken) abdomen, cyanotic
Requires ET tube and OG tube to intermittently suction; BMV causes intestinal distension
Spina Bifida Occulta
Malformation of the vertebrae that creates a small gap, but no protruding contents (“closed” spina bifida)
Menginocele
A sac containing spinal fluid protrudes through a gap in the vertebrae
Myemenginocele
The spinal canal and backbone do not close and the spinal cord and meninges protrude
Types of neonatal seizures
Subtle seizure - sucking, blinking, pedalling legs, eye deviation
Tonic seizure - extension of limbs
Focal clonic seizure - localized jerking
Myoclonic seizure - repetitive flexion jerking
Causes of neonatal seizures
Hypoxic ischemic encephalopathy (secondary to perinatal asphyxia) - usually within first 24 hours, and can lead to severe developmental and cognitive delays, or motor impairment
Hypoglycemia - jitteriness, stupor, hypotonia (floppy), poor feeding, seizures
Average temperature of a newborn and neonate
Newborn = 37.5
Neonate = 36.6 - 37.2
Most heat loss is caused by evaporation
Nonshivering thermogenesis
Production of heat by metabolism and the primary source of heat in a neonate (brown fat)
Brown adipocytes contain numerous smaller droplets and a higher number of iron-containing mitochondria
Contains more capillaries than white fat since it requires more oxygen than most tissue
Stored around the scapula, kidney, adrenal glands, neck, and axilla
Risk factors for hypothermia
< 36 degrees
- All neonates in first 8-12 hours
- Home delivery
- Prolonged resuscitation
- Small gestational age
- CNS problems
- Prematurity
- Sepsis
- Not keeping infant warm during transport
Effects of heat loss on a neonate
Increased metabolic function to overcome heat loss, resulting in hypoglycemia, metabolic acidosis, and hypoxemia
Signs and symptoms of hypothermia
- Pale
- Skin cool to touch
- Acrocyanosis or central cyanosis
- Respiratory distress or apnea
- Bradycardia
- Irritability changing to lethargy
Risk factors for hypoglycemia
Disorders of fetal growth and maturity (SGA, LGA, twins)
Premature (<37 weeks)
Disorders of maternal glucose regulation
Neonatal conditions (distress, hypoxemia, shock)
Severe anemia
Congenital anomalies/genetic disorders
Neonates are only age group to develop hypoglycemia without having diabetes
Signs and symptoms of hypoglycemia
Cyanosis, apnea, irritability, poor feeding, hypothermia
Lethargy, tremors, seizures, coma
Tachycardia, tachypnea, vomiting
Signs and symptoms of severe diarrhea
Ill appearance, poor vital signs, cap refill > 2 seconds, dry mucous membranes, absent tears, weight loss, low urine output
Causes of delayed transition
Hypoxia Hypothermia Acidosis Meconium aspiration or pneumonia Delayed resorption of lung fluid Maternal narcotics or anesthesia
Foramen ovale
Hole between the right and left atrium that allows oxygenated O2 to mix with blood in the left ventricle bound for the aorta
Shunts most of the oxygenated blood from the right atrium to the left atrium rather than through the pulmonary system
Ductus arteriosus
Connects the pulmonary artery to the aorta, bypassing uninflated lungs
Fetal circulation after birth
Pressure on the chest from the birth canal squeezes fluid from the lungs - the first breath inflates the lungs - ductus arteriosus, ductus venosus, and foramen ovale constrict/collapse after birth
Infants hands and feet remain bluish until the process is complete
Transition of bypasses (before vs after)
Umbilical vein - ligamentum teres
Ductus venosus - ligamentum venosum
Foramen ovale - fossa ovals
Ductus arteriosus - ligamentum arteriosum
Umbilical arteries - medial umbilical ligaments
Positive pressure ventilation criteria
Heart rate less than 100
Apnea
Persistent central cyanosis
Ventilate with room air if born to term; ventilate with 100% oxygen if born < 32 weeks
Re-evaluate heart rate, and begin compressions if <60
