Newborn Assessment Flashcards
VS
RR 30-60
BP 60-80/ 40-50
What is the blood volume of an infant?
300 mL
Pretern babies blood volume
increases d/t greater plasma vol
hematopoietic system
increased RBC and hemoglobin and initial leukocytes
What is special about vit K?
newborns can not synthesize
vit K injection within the first few days of birth to assist with clotting
Thermoregulation
the balance of heat production and loss
What is the goal of thermoregulation?
neutral thermal environment
Convection
flow of heat from body surface to cooler ambient air. (Need warmer ambient temps, use overhead warmers), wrap baby in blanket, hats (if in open bassinets).
Radiation
loss off heat from body surface to cooler not in direct contact with newborn (position exam tables, bassinets away from open windows or direct air drafts).
Evaporation
loss of heat when liquid converted to a vapour. (moisture vaporization from skin – be sure to dry skin of newborn after birth/bath quickly. The less mature the more evaporative heat loss. Component of insensible water loss.
Thermoregulation – conserve heat in position of flexion to guard against heat loss (diminishes body surface exposed to environment. Also vasoconstriction of peripheral blood vessels. No shivering mechanism!!!
Conduction
heat loss from body surface to cooler surface (use protective cover on weigh scales)
What is important about skin-skin?
reduces heat loss, enhances temp and bonding
Thermogenesis
internal attempts to generate heat (cellular metabolic activity in brain, heart and liver increases oxygen and glucose consumption)
Brown fat
Thermogenesis
Non-shivering thermogenesis occurs through the metabolism of brown fat
Located in interscapular region, axillae, thoracic inlet, vertebral column, around kidneys
Amount increased with gestational age
Cold stress
increased RR with oxygen needs - leads to vasoconstriction - can decrease pulmonary perfusion – reopen R to L shunt across ductus arteriosus
Hyperthermia
Temp > 37.5 (99.5 F) due to excess heat production or sepsis (radiant warmers, phototherapy, sunlight, increased environmental temp, excess clothing – vasoconstriction)
NEED THREE GOOD TEMPS (before baths, etc)
Voiding
Most newborns void at birth (can be missed)
1st day = 1 void
2nd day = 2 voids
3rd day = 3 voids
1 week – 6 – 8 voids
Weight loss
5 – 10 % wt. loss in 1st 3 – 5 days is normal due to urine, feces, lungs, increased metabolic rate, intake (colostrum is high fat but not high volume)
Uric acid crystals
Uric acid crystal stains can occur, watch for persistence
What is a newborns first stool called?
Meconium
greenish/black because it contains occult blood
early, frequent feeds assist in removing stools (and helps with jaundice)
What are signs of GI problems?
No stools (bowel obstruction, imperforated anus)
White stools (biliary atresia is blockage in tubes carrying bile from gallbladder to liver)
Transition stools
day 3
after feeding
may contain milk curds
Milk stool
Day 4
BF - yellow to golden, pasty, smell of sour milk
Formula - pale yellow - light brown, firmer consistency, more odor
Iron storage
in liver. At birth - Iron storage sufficient to last 4 to 6 months.
Preterm and SGA infants have lower iron stores
Superior bioavailability of iron in breast milk than in formula
Exclusive BF for 6 months is recommended (WHO) – then supplement with iron rich foods
Formula should contain supplemental iron
What does colostrum contain
high levels of glucose
Vernix caseosa
cheese-like whitish substance after 35 weeks
Contains sebaceous gland secretions
Emollient (waxy/fatty substance) and antimicrobial properties preventing fluid loss through skin
Antioxidant properties
Leave vernix intact – decreases skin pH, decreases skin erythema, improves skin hydration
Acrocyanosis
when hands & feet are slightly cyanotic due to vasomotor instability (if central and persists, then it is treated)
Lanugo
fine hair over face, shoulders and back
Eccymosis
edema of face due to face presentation, forceps-assisted birth, vacuum extraction
Sweat glands
newborns have sweat glands; term infants do not sweat for first 24 hours.
Milia
small white sebaceous glands on newborn face
Desquamation
peeling of skin of term newborn begins several days after birth
Mongolian spots
congenital birthmarks, bluish black areas of pigmentation over any part of exterior (back or buttocks) or body/extremities.
Nevi
Nevus Simplex (aka stork bites, angle kisses)
Flat, pink capillary hemangiomas; easily blanched. Fade in 1-2 years
Erythema toxicum
transient newborn rash
What does bruising increase?
increase risk of hyperbilirubinemia
Pseudomenstration
Females
mucoid vaginal discharge with slight bloody spotting (increase in estrogen in pregnancy & drop at birth)
Male reproductive system
testes descend into scrotum by birth; tight prepuce (foreskin) is normal and may cover the urethral opening.
urethra at tip of penis (epispadias and hypospadias are congenital deformations)
Smegma – white cheesy substance found under foreskin
Epithelial pearls – seen on tip of the prepuce (keratinization in squamous cells)
Rugae appear on scrotum (28 – 36 weeks gestation); > 40 weeks – testes palpated in scrotum; rugae cover scrotal sac
Scrotum has extra pigmentation due to maternal estrogen
Hydrocele – accumulation of fluid around testes that usually resolves without intervention
Caput succedaneum
edematous area of scalp (occiput) due to compression of vessels from pressure on cervix (slows venous return)
Cephalhematoma
collection of blood between skull bone and periosteum due to pressure against bony pelvis , low forceps, extraction
Subgaleal hemorrhage
bleeding into subgaleal compartment (loose connective tissue that connects frontal & occipital muscles and forms inner surface of scalp)
assess - boggy scalp, pallor, increased head circ.
spine
vertebrae flat and straight. Assess for pilonidal dimple (associated with spina bifida)
Extremities
symmetrical, equal in length, 5 fingers, 5 toes, nails
Fontanelles
Front (anterior fontanelle)
back (posterior fontanelle)
Side (sphenoidal fontanelle, mastoid fontanelle)
Regulation of physiological system
- Involuntary – HR, Resps, temp
- Motor Organization – control random movements, muscle tone, reduce extra activity
- State Regulation – ability to modulate consciousness
Develops predictable sleep and wake states
Able to react to stress (self-regulation & communication – crying and consolation) - Attention and Social Interaction – stay alert for longer periods; engage socially
Areas of assessment
Pink (resps)
Warm (temp reg)
Attached (attachment to family)
Sweet (blood sugar)
Organized (maintain optimal state)
Clean (infection prevention strategies)
APGAR
Appearance
Pulse
Grimace
Activity
Respiration
Jaundice definition
Jaundice increased level of unconjugated bilirubin in the body. Bilirubin is the yellow product produced by the breakdown of RBC
Coagulation of bilirubin
When bilirubin is attached to protein and is unable to be excreted is called uncoagulated bilirubin. Needs to be conjugated to be excreted (enzymes help with this)
Physiological Jaundice
Immature liver. Common in newborns. Develops in 2-4 days (can undevelop it)
Pathological Jaundice
Within 24 hours after birth – happened right away (encopalopathy and cornictorius). Disease (did not happen naturally). Challenges are more common.
Jaundice related to breastfeeding
Jaundice caused by not great breastfeeding. Not optimal feeding. Suboptimal intake jaundice. Response – more breastfeeding is good
Interventions for jaundice
Phototherapy, encourage breast feeding
Physiological – phototherapy (indirect sunlight at home with unsevere jaundice)
Patho – same interventions (more intensive phototherapy) – stays in hospital longer
Reflexes
Stepping/walking
crawling
babinskys
Swallow
Startle (moro)
sucking
rooting
Grasp
First period of reactivity (adaptations of the newborn)
Lasts up to 30 minutes after birth
Newborn’s heart rate increases to 160 to 180 beats/min
Respirations may be irregular: 60 to 80 breaths/min (there may be fine crackles, grunting, nasal flaring, retractions)
Baby is alert, spontaneous startle reflex, tremors, crying, movement of head
Bowel sounds present, may pass meconium
Followed by a decrease in motor activity and sleep
Period of decreased responsiveness
lasts 60-100 minutes
Second period of reactivity
Occurs 2 to 8 hours after birth
Lasts 10 minutes to several hours
Tachycardia, tachypnea may occur
Meconium commonly passed
Increased muscle tone, changes in skin color, and mucus production
Newborn assessment
Heart rate - stethoscope or palpation of umbilical cord
RR - resp effort and ausc.
Muscle tone - flexion and movement of extremities
Reflex irritability - response to stimulation
Generalized skin colour
