Newborn Flashcards
Patho of hyperbilirubinemia.
Caused by excessive hemolysis, ABO blood type incompatibility, hepatocellular injury, and bile duct obstruction or decreased excretion
Immature liver function and cannot break down the products of hemolysis easily (Bilirubin is by-product)
Due to their hepatic immaturity, newborns are unable to conjugate bilirubin or naturally break down bilirubin
Results is an excess of serum bilirubin and a decrease in bilirubin excretion through both a newborn’s urine and stool
What is jaundice?
Yellowish or “jaundice” appearance of the skin, progresses from head to feet
When is jaundice considered pathological?
it presents within the first 24 hours after birth
the total serum bilirubin level rises by more than 5 mg per dL (86 micromol per L) per day or is higher than 17 mg per dL (290 micromol per L)
an infant has signs and symptoms suggestive of serious illness.
Treatment for hyperbilirubinemia. Complications of treatment?
Increase infant’s oral intake
Phototherapy- Causes unconjugated bili to transform into photoproducts that can easily be excreted. Complications include temperature instability due to an imbalance of the thermal environment, electrolyte imbalance, separation of family and newborn, and interference with family bonding
Exchange transfusion
IV Immunglobulin G
Patient education for hyperbilirubinemia.
Patient education: The family should contact the newborn’s provider if they notice fever, vomiting, inconsolable crying, new or worsening yellow skin or eyes, trouble feeding, decreased voiding or stooling, dark urine that stains the diaper, or pale, chalk-colored bowel movements.
Healthy infants will need bili check at 3-5 days of life
What are normal and abnormal O2 sats in newborns?
What would constitute a referral to cardiology?
The hand and foot are greater than 95% and a difference of no more than 3% oxygen saturation exists
Finding outside this range should be referred to cardiology
Ductus Venous
Fetal structure that directs blood that has been oxygenated by the placenta to the fetus’ heart (blood doesn’t need to go to lungs for oxygen)
Foramen Ovale
Opening between atria that allows blood to bypass fetal lungs
Ductus Arteriosus
Fetal structure that guides oxygenated blood from the pulmonary artery to the aorta
What happens to the circulation pattern after a baby is born while establishing their own ability to breathe?
infant begins to breath
pulmonary vascular resistance drops and pulmonary blood flow increases
Gas exchange is now occurring in the infant’s lungs
Pressure in the left atrium increases and eliminates shunting through foramen ovale.
Fetal structures are no longer necessary and will begin to disappear within hours.
APGAR Score (may need additional cards)
Apgar assessments and scoring should be performed at 1 and 5 minutes of life and up to 10 and 20 minutes if initial scores are low. Apgar scores range from 0 to 10, with 10 being the highest, healthiest score.
Appear
Pulse
Grimace
Activity
Respiration
What is surfactant?
What is its role in respiration in newborns?
What factors can contribute to newborn transitioning?
Surfactant is a phospholipoprotein substance that is made by type II alveolar cells.
The fetus begins producing surfactant at 35 weeks’ gestation.
Surfactant lowers the airway surface tension in the alveoli to support the initial lung alveoli expansion and maintenance of expansion through respirations.
How do you assess the respiratory status of a newborn?
The visual assessment includes: The chest symmetry, respiratory rate and depth, effort of breathing, and use of accessory muscles should be visualized when conducting a respiratory assessment.
Auscultation of the lungs anteriorly and posteriorly is an important assessment to conduct, but it is not considered a visual assessment.
Nonpharmacologic respiratory treatment for infants.
Oxygen - (NC, facemask, oxy hood) to maintain normal oxygen levels
Non-invasive ventilation (cpap, bipap, hiflow)
Mechanical ventilation – some infants progress to respiratory failure requiring mechanical ventilation
Inhaled Nitrous Oxide (iNO) - – causes pulmonary vasodilation, encourages pulmonary blood flow
NPO – reduce metabolic demand, keep stomach empty to protect airway
ECMO - cardiopulmonary bypass that provides oxygenation outside the body for life-threatening conditions (cardiac or pulmonary, such as PPHN or MAS)
S/S of respiratory compromise in a newborn. What are the red flags?
Signs of respiratory compromise in a newborn include
grunting, wheezing, stridor, increased respiratory rate, chest retractions, cyanosis, excessive secretions, elevation in temperature, difficulty eating, decrease in stooling and voiding, lethargy, and excessive crying.
What should be assessed at delivery in the newborn?
Gestational age and weight should be assessed at delivery to determine appropriate care for the newborn
APGAR score at one minute of life and then again at five. Your baby will continue to be scored in five-minute increments until he achieves a 7 or higher.
APGAR score ranges
A score between 7 and 10 is considered normal.
A score between 4 and 6 indicates that breathing assistance may be required.
A score under 4 means that prompt, life-saving resuscitation measures are necessary.
APGAR scoring of darker skin infants
During the assessment and Apgar scoring of the newborn with darker skin, the health-care team will assess the soles of the feet, palms of the hand, and roof of the mouth before assigning the score for color.
What are the risk factors associated with infection in premature newborns?
male sex
administration of antibiotics
low socioeconomic status
low birth weight
use of instruments in delivery
surgical procedures
increase in maternal temperature
maternal infection
What can lower the risk of newborn infection?
Breastfeeding lowers the risk of developing an infection.
What are some assessment findings associated with newborn infections?
Temperature instability (hypo or hyperthermia)
Poor cardiac output (tachycardia, bradycardia, hypotension, pallor, poor peripheral perfusion, weak pulses, decreased urine output)
Neurological changes (irritability, lethargy, seizures)
Feeding abnormalities (poor feeding, vomiting, abdominal distension)
Jaundice
Skin changes (rash, purpura, erythema, petechiae)
Metabolic changes (acidosis, hypoglycemia, hypoxia)
