New Born Care Flashcards by joseph dizon

Initiation of breathing

Factors that influence the first breath

Physical examination
Oxygen deprivation and carbondioxide accumulation
Thoracic compression

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Initiation of breathing

After the delivery, the residual alveolar fluid is cleared through the

Pulmonary circulation and

Pulmonary lymphatics

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Initiation of breathing

Delay in fluid removal from alveoli cause

Transient Tachypnea of the new born

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Initiation of breathing

With the fall in pulmonary arterial blood pressure

Ductus Areteriosus normally closes

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Initiation of breathing

Required to bring about the initial entry of air into the fluid-filled alveoli.

High negative intrathoracic pressures

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Initiation of breathing

Normally, from the first breath after birth

More residual air accumulates in the lung

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Initiation of breathing

Respiration is similar to those of the adult

5th breath

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Initiation of breathing

Surfactant synthesized by

Type 2 pneumocytes

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Initiation of breathing

Insufficient surfactant common in

Preterm infants leads to RDS

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Care in the delivery room

Reverse the effects of opioids

Naloxone

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Care in the delivery room

Percent of newborn require some degree of active resuscitation to stimulate breathing

10%

1% require extensive resuscitation

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Care in the delivery room

Newborn delivered at home and those delivered in hospital

Two to three fold risk of death

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Care in the delivery room

A fall in heart rate
Loss of neuromascular tone

Primary apnea

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Care in the delivery room

Primary apnea treatment

Simple stimulation

Exposure to oxygen

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Care in the delivery room

Primary apnea. If persist it continue to develop

Deep gasping respiration followed by

Secondary apnea

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Care in the delivery room

A further decline in heart rate
Falling blood pressure
Loss of neuromascular tone
Deep gasping respiration

Secondary apnea

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Care in the delivery room

Secondary apnea will not respond to

Stimulation,

Death follows unless ventilation assisted

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Care in the delivery room

The vigorous newborn is first placed in a

Warm environment
Airway cleared
Infant dried

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Care in the delivery room

Non beneficial and harmful

Routine gastric aspiration

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Care in the delivery room

For clear or Meconium stained fluid is not beneficial, even if the newborn is depressed

Bulb suctioning

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Care in the delivery room

Breath
Cray

Few seconds

Half a minute

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Assessment at 30 seconds of life

These should prompt administration of positive pressure ventilation with room air

Heart rate is

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Assessment at 30 seconds of life

Assisted ventilation rates of ________ are commonly employed

30-60bpm

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Assessment at 30 seconds of life

Percent of oxygen saturation is monitored by

Pulse oximetry

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Assessment at 30 seconds of life Adequate ventilation is indicated by

Improved heart rate

Assessment at 60 seconds of life HR remains

Ventilation is inadequate Head position should be checked Secretions cleared Inflation pressure increased

If HR persist below 100 bpm beyond 60 seconds

Tracheal intubation is considered

If bag and mask ventilation is ineffective or prolonged

Tracheal intubation

Other indication of tracheal intubation

Chest compression | Tracheal administration of epinephrine

Tracheal intubation Special circumstances such as

Extremely low birthweight | Congenital diaphragmatic hernia

Tracheal intubation Sizes

0 for a preterm infant | 1 for a term neonat

Tracheal intubation Procedure Laryngoscopes with a straight blade is introduced at the side of the mouth and then directed posteriorly at the

Oropharynx

Tracheal intubation Procedure 2nd step Moved gently to

Vallecula

Tracheal intubation Space between the base of the tongue and epiglottis

Vallecula

Tracheal intubation | Tube size

3. 5-4 mm term | 2. 5 mm

Tracheal intubation To ensure that the tube is positioned in the trachea and not the esophagus Observation for

Symmetrical chest wall motion

Tracheal intubation To ensure that the tube is positioned in the trachea and not the esophagus Auscultation for

Equal breath sounds

Tracheal intubation To ensure that the tube is positioned in the trachea and not the esophagus No longer recommended

Trachea suctioning

Tracheal intubation To ensure that the tube is positioned in the trachea and not the esophagus Puffs of air are delivered into the tube at

1-2 seconds interval

Tracheal intubation To ensure that the tube is positioned in the trachea and not the esophagus Pressure

Term- 30-40cm H2O | Preterm 20-25cm H2O

If heart rate is remains

Chest compression

Chest compression Delivered on the

Lower third of the sternum

Chest compression Compression ventilation ratio

3:1 90comprssion 30 breaths

Chest compression 3:1 ratio To achieve approximately

120 events/min

Chest compression 3:1 ratio Heart rate reassess every

30 secs

Chest compression 3:1 ratio Chest compression are continued until the spontaneous heart rate is

Atleast 60bpm

Indicated when heart rate remains

IV administered epinephrine

Epinephrine and volume expansion Epinephrine May be given through

Endotracheal tube

Epinephrine and volume expansion Epinephrine If venous access has not been established

IV dose is 0.01-0.03mg/kg

Epinephrine and volume expansion Epinephrine If given through the tracheal tube

Dose is 0.05-0.1mg/kg

Epinephrine and volume expansion Volume expansion

Crystalloid (NSS/LR) | Packed red cells

Discontinuation of resuscitation if without heartbeat for

10 minutes

Memorize

APGAR score

APGAR The total score is determined in all neonates at

1 and 5 minutes after delivery

APGAR If depressed infants the score may be calculated at

5 minutes interval until a 20 minute APGAR

APGAR Score reflects the need for immediate resuscitation

1 minute

APGAR Measures effectiveness of resuscitative efforts and also has significance for neonatal survival

5 minute score

APGAR Death in 1:5000

7-10 score

APGAR Death in 1:4000

5 min Or 3 or less score

Umbilical cord blood Acid Base studies Used for acid base studies to assess the metabolic status of the neonate

Blood from umbilical vessels

Umbilical cord blood Acid Base studies How many segments of cord

10-20 cm

Umbilical cord blood Acid Base studies Can alter both PcO2 and pH

Delays of 20-30 seconds of clamping

Umbilical cord blood Acid Base studies Arterial blood is drawn using

1-2 ml syringe containing lyophilized heparin | 1-2 ml syringe containing heparin solution

Umbilical cord blood Acid Base studies Can be analyzed as late as 60 hours after delivery

Birth acid- base status

Fetal acid base physiology Fetus produce both

Carbonic acid | Organic acid

Fetal acid base physiology Carbonic acid is formed by

Oxidative metabolism of CO2

Fetal acid base physiology Carbonic acid accumulates No increase in organic acids

Respiratory acidemia

Fetal acid base physiology Primary organic acid

Lactic acid | Beta HydroxyButyric acid

Fetal acid base physiology Increase organic acid result to

Anaerobic glycolysis

Fetal acid base physiology Organic acid accumulate Without increase in carbonic acid

Metabolic acidemia

Fetal acid base physiology With metabolic acidemia it is decrease because it is used to buffer the organic acid

HCO3 or bicarbonate

Fetal acid base physiology Increase H2CO3 Increase organic acid Decrease HCO3

Mixed respiratory-metabolic acidemia

Fetal acid base physiology One principal cause of fatal acidemia is

Decrease in utero placental perfusion

Fetal acid base physiology Decrease HCO3

Base deificit

Fetal acid base physiology Increase HCO3

Base excess

Fetal acid base physiology Large base deficit and a low HCO3

Mixed respiratory-metabolic acidemia

Clinical significance of acidemia Lower limit of normal pH ranges from

7.04-7.102

Clinical significance of acidemia NB with pH

``` 3% neonatal encephalopathy 8% neonatal death 13% seizures 14% intubation 39% ICU admission ```

Respiratory acidemia Acute interruption in placental gas exchange is accompanied by subsequent

CO2 retention and respiratory acidemia

Respiratory acidemia The most common antecedent factor

Transient umbilical cord compression

Metabolic acidemia Base deficit >12 mmol/L

Fetal acidosis

Metabolic acidemia Base deficit >16 mmol/Lq

Severe fetal acidosis

Metabolic acidemia Defined using umbilical cord blood gas cut offs that were

2 standard deviations below the mean

Metabolic acidemia Base deificit > 12mmol/L Ph

Cerebral palsy

Metabolic acidemia Associated with a high rate of

Multi organ dysfunction

Provide the most objective evidence of the fetal metabolic status at birth

Umbilical cord acid base blood determination

Metabolic acidemia Neurological impairment

Hypoxic ischemic encephalopathy

Metabolic acidemia Acid base status may be more closely linked to long term neurological outcome

Very low birth weight infants

Metabolic acidemia Risk of neonatal death is 3200 fold greater among infants with metabolic acidemia

Term neonates

Preventive care Gonococcal infection

Opthalmia neonatorum

Preventive care Gonococcal infection Opthalmia neonatorum most common causes

Gonococcal | Chlamydia

Preventive care Gonococcal infection Opthalmia neonatorum Blindness was previously common in children who develop

Neisseria gonorrhea

Preventive care Gonococcal infection A 1% opthalmic solution of silver nitrate Mandatory for all neonates

Credes prophylaxis

Preventive care Gonococcal infection Credes prophylaxis Opthalmic ointment used

1% silver nitrate 0.5 % erythromycin 1% tetracycline

Preventive care Gonococcal infection Conjuctivitis in a neonate born to a mother with untreated gonorrhea

Presumptive gonococcal opthalmia

Presumptive gonococcal opthalmia Treatment

Single dose of ceftriaxone 100 mg/kg IM or IV

Eye infection prophylaxis Chlamydial infection 12-25 % of babies will develop conjunctivitis for up to

20 weeks

Eye infection prophylaxis Chlamydial infection Ointments

2.5 % povidone iodine 1% silver nitrate 0.5% erythromycin

Eye infection prophylaxis Chlamydial infection Treatment

Oral Azithromycin for 5 days | Oral erythromycin for 14 days

If the mother is seropositive for hepatitis B surface antigen

The neonate should immunized with Hepatitis B immune globulin

To prevent hemorrhagic disease of the new born

Vitamin k Within 1 hour 0.5mg IM

New born screening

``` Congenital hypothyroidism Congenital adrenal hyperplasia Galactosemia G6PD deficiency Phenylketonuria ```

Neonates who are either small or large for gestational age are at increased risk for

Hypoglycemia Polycythemia Measures blood glucose and hematocrit

Care of the skin and umbilical cord Any remaining vernix is readily absorb and disappears within

24hours

Care of the skin and umbilical cord Should be postponed until the neonates temperature is stabilized

First bath

Care of the skin and umbilical cord Should be observed in the immediate care of the cord

Aseptic precautions

Care of the skin and umbilical cord Umbilical cord begins to lose water from ______ shortly after birth

Whartons jelly

Care of the skin and umbilical cord Within 24 hours the cord stump loses its characteristic _____________, __________ and soon become dry and black

Bluish white | Moist appearance

Care of the skin and umbilical cord Separation usually takes place within the

First 2 weeks | 3-45 days

Care of the skin and umbilical cord Dry quickly when exposed to

Air

Care of the skin and umbilical cord Applied to the cord is superior to soap and water care in preventing colonization and exudate formation

Triple dye

Care of the skin and umbilical cord Cleaning the cord stump with __________ reduce severe omphalitis by 75% compared with soap

4% chorhexidine

Care of the skin and umbilical cord Superior to dry cord

0.1%

Care of the skin and umbilical cord Most likely offending organism are

SA EC Group B S

Feeding and weight loss Breast feeding is preferred until

6months

Feeding and weight loss Begin BF in the

Delivery room

Feeding and weight loss Term newborn thrive best when fed

8-12 times daily for 15 minutes

Feeding and weight loss Require feedings at shorter intervals

Preterm or | Growth restricted newborns

Feeding and weight loss Most neonates actually receive little nutriment for the

First 3-4 days of life

Feeding and weight loss Lose relatively more weight and regain their birthweight more slowly

Preterm

Feeding and weight loss Birthweight of term infants regain by the end of the

10th day

Feeding and weight loss Weight gain increases by about _______ for the first few months

25g/day

Feeding and weight loss Birth weight double

5months

Feeding and weight loss Birth weight triples

End of the 1st year

Stools and urine For the first 2-3 days after birth

Soft, brownish green Meconium | The color results from bile pigment

Stools and urine During fetal life

Intestinal of content is sterile | But bacteria quickly colonize the bowel

Stools and urine Seen in 90% of newborn Within the first 24-36 hours

Meconium stooling

Stools and urine Newborn first void shortly

After birth | But may not until 2nd day

Stools and urine Indicates patency of the gastrointestinal and urinary tracts

Meconium and urine passage

Stools and urine Congenital defect

Imperforate anus | Urethral valve

Stools and urine After the third or fourth day, as a result of milk ingestion, Meconium is replaced by

Light yellow homogenous feces

Icterus neonatorum At birth, normal bilirubin level is at

1.8-2.8mg/DL

Icterus neonatorum 2nd-5th day of life

Physiological jaundice

Icterus neonatorum 3rd-4th day Bilirubin level

>5mg/dl

Icterus neonatorum Bilirubin is bound to glucoronic acid Bilirubin is excreted in bile

Mature liver

Icterus neonatorum Less bilirubin, less excreted in bile

Immature liver

Icterus neonatorum Less bilirubin excreted in bile Increase erythrocyte destruction

Transient hyper bilirubinemia

Icterus neonatorum Treatment

Early sunlight exposure | Phototherapy (bilirubin converted to water soluble stereoisomers)

Newborn male circumcision Prevention of

Phimosis -constriction of orifice Para phimosis- retraction of phimosis Balanoposthitis- inflame glans penis

Newborn male circumcision Decreases the incidence of

Penile cancer Cervical cancer Transfusion of STD

Newborn male circumcision Contraindications

Hypospadias Bleeding disorders Genital anomalies

Newborn male circumcision Must before males are subjected to circumcision

Growth in penile length

Anesthesia for circumcision

Dorsal penile nerve block | Ring block

Anesthesia for circumcision Ring block

1% lidocaine(mx dose 1ml) | 180degree

Anesthesia for circumcision No vasoactive compounds such as

Epinephrine

This model of maternity care place newborns in their mother rooms instead of central nurseries

Rooming in

Foster early mother child realtionships

Mother fully ambulatory

24 hours

Most newborn discharged within

48hours

Average lenght of hospital days

2-3 days

Usual cause of re admission

Dehydration Jaundice Brain damage Icterus neonatorum

Initiation of breathing Indicate active perfusion

Breathe | Cry