Newborn

Question 1

APGAR Scoring

Answer 1

Heart rate: 0) absent 1) slow, less than 100/min 2) greater than 100/min
Resp. rate: 0) absent 1) slow, weak cry 2) good cry
Muscle tone: 0) flaccid 1) some flexion of extremities 2) well-flexed
Reflex irritability: 0) none 1) grimace 2) cry
Color: 0) blue, pale 1) acrocyanosis 2) completely pink

Question 2

Expected reference ranges

Answer 2

weight: 2,500 g (5.5 lbs to 8.8 lbs)
length: 45 to 55 cm (18 to 22 inches)
head circumference: 32 to 36.8 cm (12.6 to 14.5 in)
chest circumference: 30 to 33 cm (12 to 13 inches)

Question 3

Classificiation

Answer 3

AGA: weight is between 10th and 90th percentile
SGA: weight is less than 10th percentile
LGA: weight is greater than 90th percentile
LBW: weight is less than 2,500g at birth
IUGR: growth rate does not meet expected norms
Term: birth between 37 and 42 weeks gestation
Preterm: prior to the completion of 37 weeks
Posterm: born after completion of 42 weeks
Postmature: born after the completion of 42 weeks with evidence of placental insufficiency

Question 4

Newborn Vitals

Answer 4

Resp. rate: 30 to 60 breaths/min with short periods of apnea (less than 15 sec.)
Heart rate: ranges from 110 to 160/min with brief fluctuations above and below this range. Apical pulse rate is assessed for 60 seconds
Blood pressure: 60-80 systolic, 40-50 diastolic
Temperature: 36.5 to 37.5

Question 5

Vernix caseosa

Answer 5

protective, thick, cheesy covering, more present in creases and folds

Question 6

Lanugo

Answer 6

fine downy hair

Question 7

Milia

Answer 7

small raised white spots on the one, chin, and forehead

- disappear spontaneously

Question 8

Mongolian spots

Answer 8

bluish purple spots of pigmentation

- commonly found on shoulders, back, and butt of darker skinned newborns

Question 9

Telangiectatic nevi (Stork bites)

Answer 9

flat pink or red marks that easily blanch

- usually fade by the second year of life

Question 10

Head findings

Answer 10

head should be 2 to 3 cm larger than the chest circumference. Greater than 4 cm is hydrocephalus

• anterior fontanell diamond shaped
• posterior fontanel triangle shaped
• depressed fontanels can indicate dehydration

Question 11

caput succedaneum

Answer 11

localized swelling of the soft tissues of the scalp caused by pressure on the head during labor
- expected, does not require treatment

Question 12

epstein pearls

Answer 12

small white cysts found on the gums and at the junction of the soft and hard palates

• expected finding
• tongue should not protrude

Question 13

Meconium

Answer 13

should be passed within 24 to 48 hours after birth

Question 14

extremities

Answer 14

• assess for full ROM
• should be flexed
• no click should be heard when abducting the hips

Question 15

Reflexes: sucking and rooting

Answer 15

elicit by stroking the cheek or edge of mouth

- newborns turn head toward side that is touched and started to suck

Question 16

reflexes: palmar grasp

Answer 16

the newborns fingers curl around examiners fingers

- plantar grasp is same thing except with toes

Question 17

Moro reflex

Answer 17

falls backwards, the newborn will symmetrically extend and then abduct the arms

Question 18

Babinski

Answer 18

expected that toes will fan upward and out

Question 19

Stepping reflex

Answer 19

newborn responds with stepping movements

Question 20

Interventions for resuscitation of airway

Answer 20

routine suctioning of the mouth, then the nasal passages with a bulb syringe, is done to remove excess mucous
- aspirate mouth first, one nostril, then second nostril

Question 21

thermoregulation

Answer 21

neutral thermal environment that helps a newborn maintain a normal core temp with minimal oxygen consumption and caloric expenditure
- becoming chilled can increase the newborns oxygen demands and rapidly use up brown fat reserves

Question 22

mechanisms of heat loss

Answer 22

conduction: loss of body heat from direct contact with a cooler surface
convection: flow of heat from the body surface to cooler environmental air. use a radiant heat source
evaporation: loss of heat as surface liquid is converted to vapor
radiation: loss of heat from the body surface to a cooler solid surface that is close

Question 23

bathing

Answer 23

complete sponge bath should be given within the first 1 to 2 hours after birth under a radiant heat warmer

Question 24

feeding

Answer 24

breastfeeding is initiated as soon as possible
formula feeding is usually started at about 2 to 4 hours of age

Breastfeed every 2 to 3 hours
bottle feed every 3 to 4 hours

Question 25

elimination

Answer 25

• newborns should void once within 24 hours of birth
• they should void 6 to 8 times per 24 hrs. after day 4
• meconium should be passed within the first 24 to 48 hours after birth

Question 26

Newborn weight

Answer 26

• loss of 5% to 10% after birth (regain in 10 to 14 days)

- gain of 110 to 200 g/week for first 3 months

Question 27

boobfeeding

Answer 27

recommended exclusively for the first 6 months

- should occur 8 to 12 times within a 24 hour window

Question 28

successful boobfeeding

Answer 28

when latched on correctly, nose, cheeks, and chin will be touching the breast

Question 29

storing boobmilk

Answer 29

breast milk can be stored at room temperature for up to 8 hours
- thawing the milk in the refrigerator for 24 hours is the best way to preserve the immunoglobulins in it

Question 30

elimination

Answer 30

breastfed newborns should have three or more bowel movements per day
breastfed newborns should have 6 or more wet diapers per day

Question 31

circumcision

Answer 31

apply petroleum jelly with each diaper change for at least 24 hours after the circumcision to keep the diaper from adhering to the penis
- avoid wrapping the penis in tight gauze

Question 32

neonatal substance withdrawal

Answer 32

expected findings; high-pitches, shrill cry, increased deep-tendon reflexes, increased muscle tone, disturbed sleep pattern
NAS: increased incidence of seizures