-Newborn-36, 37, & 38

Question 1

4 moost dramatic extrauterine transitions that happen after birth are…

Answer 1

1. Respiratory (breathe)
2. Circulatory (beat)
3. Thermoregulation (balance)
4. Glucose metabolism (break down)

Question 2

3 Primary events that occur in the lung after birth are…

Answer 2

1. clearance of alveolar fluid
2. lung expansion
3. circulatory changes that increase pulmonary perfusion
   (increase in circulatory resistance, decrease in pulmonary resistance)

Question 3

What element is needed for surfactant to be produced?

Answer 3

Choloride ion Cl-

Question 4

What channel helps clear alveolar fluid prior to delivery?

Answer 4

ENaCs–Epithelial sodium channels (Na+ pulls Cl- into the channel, then NaK pump exchanges 3 Na+ for 2 K+, and K+ passes freely out of the cell to give more room for more Na; while Cl- leaves with H2O)

Question 5

What upregulates genes to express more ENaCs, which changes lungs from active fluid secretion to active fluid absorption?

Answer 5

Fetal catecholamines and cortisol, which increase in labor

Question 6

Normal resp rate for an NB

Answer 6

40-60 breaths/min (<30 or >60 breaths/min is an issue)

Question 7

What are the 3 major components of a NB exam?

Answer 7

1. NB history, gestational age assessment, and physical assessment

Question 8

What are possible NB complications that could arise during a shoulder dystocia?

Answer 8

• Brachial plexus injury: along cervical, possibly thoracic spine; transient or permanent damage
• Erb’s palsy: C5 & C6, flaccid, weak arm
• Klumpke’s Paralysis: C8 and T1 –loss of grasp reflex
• Hypoxic-ischemic encephalopathy: changes in white matter
• Clavicle and humerus fractures
• Death

Question 9

Complications of an operative vaginal birth

Answer 9

Cephalohematoma, intracranial hemorrhage, subgaleal hemorrhage, retinal hemorrhage, shoulder dystocia

Question 10

Risks of >42 wks/postdates

Answer 10

Postmaturity syndrome, meconium aspiration syndrome, and NICU admissions

Question 11

NB behaviors that are concerning:

Answer 11

Jitterness, lethargy, poor or absent sucking, unsual cry

Question 12

During your physical assessment of the NB, how can one allow the infant to conserve oxygen & glucose?

Answer 12

Provide adequate warmth, minimize touching, perform 1 hour after a feed when the infant is content, & perform physical assessments last.

Question 13

What are late PT and early term infants at risk for?

Answer 13

Jaundice, respiratory issues, thermoregulation, problems with feeding, and even death (compared to infants at term).

Question 14

What are the 3 types of physical evaluation?

Answer 14

1. Anthropomorphic measurements: length, weight, and chest & head circumferences
2. Eval of organ systems
3. Neuro evaluation

Question 15

“Normal” anthropomorphic measurements & how to measure each one

Answer 15

Measure in cm!

1. Length: 18-22cm; mark where the head is on table, then extend legs and mark where heels reach to.
2. Head circumference: 32-38cm; measure just above eyebrows, around occiput and parietal bosses. (May decrease in first week of life)
3. Chest: 30-36cm; nipple line under arms
4. Weight: 2500g-4500g; *varies by ethnicity, sex & age; use drape or warmer to minimize heat loss

Question 16

When does Moro reflex disappear by?

Answer 16

2-4 mons

Question 17

When does the anterior fontanelle close by?

Answer 17

12-18 mons

Question 18

Classic signs of Erb-Duchenne paralysis:

Answer 18

“waiter’s tip” involving adduction of the lower portion of the arm with finger and wrist flexed. Moro reflex is weak on the affected side, but grasp is intact with Erb-Duchenne paralysis because it only affects C5-C6

Question 19

Classic signs of Klumpke’s paralysis:

Answer 19

Claw-like posture on the affected side, grasp reflex is absent due to affected roots C8-T1

Question 20

Signs of broken or fractured bones

Answer 20

Swelling, skin discoloration, lack of movement, abnormal positioning, pain with movement, asymmetric Moro reflex, and possibly crepitus.

Question 21

Name common minor malformations & how many must one have before referral is necessary?

Answer 21

Refer if 3 or more minor malformations
1. Large fontanel 2. Epicanthal folds 3. Hair: widow’s peak, whorls, low posterior hair line 4. preauricular tags and pits 5. Ears: protruding, rotated, low-set, Darwinian tubercle (thickening of ear on helix), 6. Hands: palmar crease, and curved, webbed, or extra fingers. 7. Shawl scrotum (when the scrotum surrounds penis) 8. Redundant umbilicus 9. Widespread or supernumerary nipples

Question 22

What should you be concerned with ambiguous genitalia?

Answer 22

Possible congenital adrenal hyperplasia –> dehydration –> death