Newborn Flashcards
Low birth weight may be a combination of ____ birth and ____.
Preterm, SGA
Low birth weight is associated with multiple births. True or false?
True
What are some risk factors for preterm birth?
- Smoking
- infection
- previous preterm birth
- preeclampsia
- high maternal age
- assisted reproduction
- multiple pregnancy
- low SES
- substance abuse
- stress
- depression
Why are newborns lungs non-functional in utero?
their lungs are still full of fluid
What are the 3 different types of shunts called in fetal circulation?
- Ductus venosus
- foramen ovale
- ductus arteriosus
Where is the ductus venous located?
near the fetus’s liver.
Where is the foramen ovale located?
Between the right atrium and the left atrium
Where is the ductus arteriosus located?
Between pulmonary artery and the aorta
In fetal circulation how many umbilical veins and how many umbilical arteries are there?
- one umbilical vein
- 2 umbilical arteries
Does the umbilical vein or does the umbilical arteries carry oxygenated blood to the fetus?
the umbilical vein
The umbilical arteries carry _______ blood back to placenta.
deoxygenated.
Blood from placenta travels through umbilical vein to the fetus’s ____
liver
The blood that is sent to the fetus’s liver gets shunted to the ___________ through the ______ _____ shunt.
inferior vena cava, ductus venosus
Blood is shunted from the right atrium to the left atrium by the ____
foramen ovale
The blood that makes it through the right ventricle and the pulmonary artery will be shunted by the _____ ____ to the _____.
ductus arteriosus, aorta
In fetal circulation, what side of the heart has higher pressure?
The right side
It is easier for blood to move from higher resistance to lower resistance. True or false?
true
What allows the shunt to close after birth?
The pressure changes that occur.
The effects of cord clamping is that the placental vascular bed is eliminated. In the baby, systemic pressure ______ (decreases/ increases) while pulmonary pressure _______ (decreases / increases) with lung expansion.
increases, decreases
After cord clamping, the pressure on the left side ______ (decreases / increases) which forces the foramen ovale (flap) to close.
increases
Ductus arterioles closes 2-15 hours after birth due to increases in pO2. True or false?
true
What are the normal vitals for the newborn (respiration, heart rate, and temperature)?
Respiration: 30-60
Heart rate: 110-160
Temperature: 36.3-37.2
What are signs of respiratory distress?
- Nasal flaring: compensating
- Retractions- intercostal or xyphoid
- Expiratory grunting or sighing
- Cyanosis (Dusky/ruddy or mottled)
- Use of accessory muscles
- Seesaw respirations
- Rate >60 or <30 (AHS <40)
Apneic episodes >20 seconds
Caput succedaneum is _____ of the scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery.
swelling
Cephalohematomas are traumatic _______ of the skull that are usually caused by birth injury.
hematomas
What is Harlequin Sign?
Harlequin color change is a cutaneous condition seen in newborn babies characterized by momentary red color changes of half the child, sharply demarcated at the body’s midline. This transient change occurs in approximately 10% of healthy newborns. It is seen usually between two and five days of birth.
What is Erythema toxicum?
Erythema toxicum is a harmless rash, which many newborns get.
What is Milia?
Milia are tiny white lumps or clear blisters that sometimes appear on babies’ faces soon after birth. Milia are harmless and go away by themselves.
What is Port wine stain?
A port-wine stain is a permanent birthmark present from birth. It starts out pinkish or reddish and turns darker as the child grows. Most often, a port-wine stain appears on the face, but it can affect other areas of the body.
What is Strawberry hemangioma?
Hemangiomas are clusters of extra blood vessels on a baby’s skin. They may be there when a baby is born, or form within a few weeks or months of birth. Some may look like rubbery, bumpy red “strawberry” patches while others resemble deep bruises.
What is Mongolian spot?
a kind of birthmark that is flat, blue, or blue-gray. They appear at birth or in the first few weeks of life.
What is Moulding?
During a head first birth, pressure on the head caused by the tight birth canal may ‘mold’ the head into an oblong rather than round shape. Newborn head molding is a common occurrence that usually disappears after a few days.
What is Epstein Pearls?
Epstein pearls have become a common name for white bumps in your baby’s mouth. They can be deceiving since they resemble brand new baby teeth. Epstein pearls are like a benign form of acne but they occur in the mouth.
What is Macroglossia?
Macroglossia is a disorder in which the tongue is larger than normal.
What is Ankyloglossia?
Tongue-tie (ankyloglossia) is a condition in which an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the tongue’s tip to the floor of the mouth.
What are some of the rationales for delayed cord clamping? (clamping cord at 30 sec up to 5 min)
- increases blood volume
- increases iron stores
- increases oxygen to vital organs
Delayed cord clamping may be contraindicated if newborn needs immediate resuscitation. True or false?
true
What are the 4 mechanisms of heat loss?
- Evaporation
- Conduction
- Radiation
- Convection
what is loss of heat when water is converted to vapor ( include how to prevent)
evaporation
ex. Dry the baby
What is loss of heat to a cooler surface by direct skin contact ( include how to prevent)
conduction
ex. Skin to skin, Warmed blankets
what is body heat transferred to cooler surfaces and objects not in direct contact ( include how to prevent)
Radiation
ex. Hat, Cover with blankets/clothing, Radiant warmer
What is loss of heat from warm body surface to cooler air currents ( include how to prevent)
convection
Keep out drafts
Warmer away from door
low temp = low ___
glucose
What is the “golden hour”?
In the first hour of life where babies do the birth cry, become quiet and alert, focus on mom’s voice and face, begin to exhibit feeding cues and usually nurse very well. Our role is to be hands off unless you absolutely need to be hands on.
What is physiological jaundice?
Harmless condition caused by the normal reduction of red blood cells, occurring 48 or more hours after birth, peaking at the 5th to 7th days, and disappearing between the 7th and 10th days
How does physiological jaundice occur?
• Fetal circulation: ↓O2 so RBC’s↑
• Neonatal circulation: ↑O2 saturation, need less RBC’s, break down extra RBC’s
○ Increases bilirubin levels
• Immature liver can’t remove all bilirubin
○ Stools remove bilirubin
○ Extra bilirubin seen as Jaundice
What increases risk of getting jaundice
○ Bruising/trauma
○ Preterm
○ Cold stress
○ Sepsis
○ Poor feeding: increase reabsorption of bilirubin
○ Some drugs
○ Delayed cord clamping? (does not cause jaundice: old belief)
What are symptoms you might see with jaundice?
○ Yellow colour (icterus)
○ Sleepy baby not waking on own to feed
○ Dehydration
○ Less voiding: crystals in diaper
○ Less stooling
Pathologic jaundice usually indicates that _____ disease is present. This type of jaundice appears within 24 hours.
hemolytic
DAT (Coombs) detects presence of ______ in maternal blood
antibodies
ABO incompatibility happens when a mother’s blood type is ___, and her baby’s blood type is __ or __. The mother’s immune system may react and make antibodies against her baby’s red blood cells. The consequences and treatment are similar to Rhesus disease.
O, A or B
What is phototherapy?
exposure of newborn to high-intensity light to reduce serum bilirubin
What are nursing actions involved with using phototherapy?
Remove all clothing except diaper
Apply eye coverings
Place newborn in open crib about 45 to 50 cm below (12 in) the bank of phototherapy lights and reposition if high intensity ordered
Monitor vitals every 4 hours
Discontinue phototherapy and remove eye patches at least every 2-3 hrs when feeding baby and when parents visit
Maintain fluid intake and monitor in and outs
Turn off lights when blood is drawn
Avoid lotion or ointments
What are risk factors for hypoglycemia?
- Symptomatic newborn
- Newborns of mothers with diabetes
- LGA newborn
- SGA or IUGR newborns
- Neonates born with perinatal stress (e.g., MAS, polycythemia, hypothermia, birth asphyxia, cesarean birth for fetal distress, preterm, postmature, or born to mothers with preeclampsia or hypertension).
What is the treatment for hypoglycemia?
- Should be fed by 1 hour of age
- Check glucose at 2 hrs of life and every 3-6 hours (before feeds)
- Continuous <2.6mmol/L = initiate IV infusion of dextrose at rate of 80 ml/kg/day
- Start weaning IV 12 hours after stable blood glucose established
When do you stop testing for hypoglycemia?
- IDM and LGA do not require retesting if sugar is >2.6mmol/L after 12 hours of age
- Preterm and SGA do not require retesting after 36 hours w/ stable levels and intake
Who is at risk for sepsis?
• Premature
• PPROM (prolonged rupture of membranes >24 hours)
• Break in 1st line of defense (i.e. birth trauma, scalp electrode, heel prick, circumcision, vit k injection)
• Maternal infection (i.e. GBS+, increased temps in labour)
• Meconium aspiration
Breaks in aseptic technique by caregivers (hand washing)
Signs and symptoms of sepsis
• Subtle behavioral changes (ask mom)
• Poor feeding
• Lethargy, irritability
• Colour changes (pale, dusky- cyanosis)
• Temp instability (↓* or ↑), cool skin
• Tachypnea, possible apnea, ↑ heart rate
**Leukocytosis is normal; this is not a sign of sepsis
When is colostrum produced and when does it end?
Produced: during pregnancy(16 weeks) up to 14 days postpartum
What colour is colostrum?
yellow
What is the composition of colostrum compared to mature milk?
colostrum: ↑ proteins & minerals
mature milk: high in lactose, fat & water-soluble vitamins
When does mature milk start secreting?
day 2-5
What are contradictions to breastfeeding?
- Maternal substance abuse
- Active tuberculosis in mother
- Galactosemia: a rare, hereditary disorder of carbohydrate metabolism that affects the body’s ability to convert galactose to glucose (Newborn cannot metabolize galactose and lactose in galactosemia)
- HIV in mother*
- If there are lesions from herpes
- Any viral infection (COVID, hep B, etc)
What are feeding cues?
- Lip smacking
- Hand to mouth movements
- Sucking on hands
- Hands fisted
- Rooting
- Late feeding cue: crying
What are satiation cues? (full)
- Arms & legs extended
- Fingers extended
- Pushing away: extend arm and touch caregiver or object
- Halt cues: halt hand (extended fingers & wrist moved towards unwanted object)
What is the normal weight loss within 48 hours?
7-10%
When does baby regain birth weight?
7-14 days
what are signs of effective milk transfer?
- Strong tugging (not painful)
- Uterine contractions (first 3-5 days)
- Milk leaking from other breast
- Relaxation, thirst
- Breast softer after feed (once milk in)
- Alert baby, wakes for feeds, cues, is satisfied after feeds
- Nutritive sucking, audible swallow, evidence of milk
- Adequate output
- Adequate gain
What are signs of ineffective milk transfer?
- Persistent sore nipples,
- Engorgement
- No signs of transfer in feed ; sleepy, lethargic or irritable baby
- Inadequate output, meconium stools
- Inadequate gain, weight loss
- Dry mucous membranes (mouth)
- Depressed fontanel
How many voids should they be having?
- one wet diaper per day of age (days 1 to 4)
- 6-8 per day after 4 days of age
How many stools are should they be having?
- one stool per day of age (days 1 to 4)
- Minimum of 4 to 5 stools after 4 days of age
How often should you be feeding baby?
8-12 times a day
every 2-3 hours
what is the quantity of formula baby should be getting in the first 24 hours?
2-10 ml/feed
what is the quantity of formula baby should be getting in 24-48 hrs?
5-15 ml/feed
what is the quantity of formula baby should be getting in 48-72 hrs?
15-30ml/feed
what is the quantity of formula baby should be getting in day 22 or older?
90-150 ml/feed
