Newborn Care Flashcards
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What must happen in establishment of respiratory function?
Fluid in the lungs must be replaced by air
What is the first few hours of life as the neonate stabilizes respiratory and circulatory function?
Neonatal transition
How is fluid in the lungs replaced by air?
It occurs by mechanical force or “squeezing”
Where is the fluid in the lungs absorbed?
Into the interstitial tissue, lymphatics and vascular system
How much fluid is in the lungs at birth?
Approx 20mL
How much fluid is in the entire respiratory tract at birth?
80-120mL
What does crying against closed glottis do at birth?
It creates positive pressure inflates alveoli
What does lungs expanding with subsequent breaths result in?
Decrease pulmonary vascular resistance
What does lungs expanding with subsequent breaths which decrease pulmonary vascular resistance allow?
More pulmonary blood flow (oncotic pressure)
What does the fetal experience in chemical stimulation of breathing?
Elevated CO2
Decreased O2
Decreased pH (acidosis)
What does the chemical change simulate?
Chemoreceptors in the aorta and carotid arteries
What happens after chemoreceptors are stimulated in the aorta and carotid arteries?
Causes stimulation of the respiratory center in medulla which triggers a breath
What three things are stimulated that cause a breath to trigger in an newborn?
Chemoreceptors in the aorta and carotid arteries and respiratory center in medulla
What is the thermal stimulation of breathing in the newborn?
The decrease in ambient temperature at birth
What does decrease in ambient temperature at birth stimulate?
Stimulates nerve endings in skin which sends signal to medulla which triggers a breath
When nerve endings in the skin are stimulated what does it send a signal to?
To the medulla which triggers a breath
What three things stimulate sensory of breathing?
Touch
Noise
Light
If newborn is depressed, what do you do to stimulate breathing?
Rub back vigorously
Flick bottom of foot
What is the fluid that lines the alveoli?
Surfactant
What is surfactant composed of?
Phospholipids
• lecithin
• sphingomyelin
What is the role of Surfactant?
Lowers alveolar surface tension promotes lung compliance
When does Lecithin production peak?
At 35 weeks
What does Sphingomyelin do?
Remains constant
What does the mature L/S ratio?
2:1
When a newborn grunts, what is it doing?
Attempting to increase positive pressure in alveoli to keep them down
What are the structures of fetal circulation?
Foramen Ovale
Ductus Ateriosus
Ductus Venosus
What takes place with the foramen ovale in the first breath?
Decrease in pulmonary vascular resistance
Increase in pulmonary flow
What does a fecrease in pulmonary vascular resistance and an increase in pulmonary flow result in?
An increase in venous flow to L heart an increased pressure in L atrium which closes the foramen ovale
What causes the foramen ovale to close?
Pressure change
When is there a permanent closure in the Foramn Ovale?
6 months
What takes place on closure of ductus arteriosus?
Systemic vascular pressure becomes greater than pulmonary vascular pressure
When systemic vascular pressure becomes greater than pulmonary vascular pressure what happens?
Blood flow is reversed through the DA and increased pO2 levels cause construction of DA
When does the closure of the ductus venosus occur?
When umbilical cord is clamped
What us neonatal jaundice?
Physiologic hyperbilirubinemia
What percentage of newborns does neonatal jaundice effect?
60% full term and 80% of preterm infants
What is the liver of a newborn responsible for?
Conjugating bilirubin for excretion (iron storage)
Where is Bilirubin is released in?
In unconjugated form from RBC’s
Where does bilirubin deposited in?
In tissues, skin, sclera
How long does fetal iron stora last?
5 months
What bilirubin levels may result in brain damage?
Levels > 17
What helps manage neonatal jaundice?
Phototherapy with bili-lights
When is jaundice observable?
When bilirubin levels reach 5 mg/dL in caucasions and AA
10-15 in Asians
When are bilirubin peak levels?
Term (3-5 days)
Preterm (5-7 days)
What are kernicteris?
Pigment deposit in brain
What should kernicteris levels be?
25-30mg/dL
What should newborn diet contain?
Protein Fat Carbohydrate Water Vitamins and minerals
How long should mother breast feed exclusively?
6 months
What is extrusive reflex?
Newborn infant spits out
What should the caloric intake be for a newborn?
50-55 kcal/lb/day
What is the fluid requirement for a newborn?
64-73 ml/lb/day
How much should an infant gain in the first 6 months?
1 oz per day
How much should an infant gain in the second 6 months?
0.5 oz per day
When should birthweight be regained when formula fed?
10 days
When should birthweight be regained when breast fed?
14 days
What properties does breast milk have?
Antiviral
Antibacterial
Antigenic inhibiting properties (fewer allergies)
What does breast milk lower the risk of?
Childhood: obesity Diabetes Ear infections/tubes Childhood cancers
When breast fed, infants have less _____ and bowel movements are less _________.
Less spit-ups
BM less offensive
When is breastfeeding contraindicated?
HIV/AIDS in mother
Breast cancer
When mother requires certain medications
Active TB, HSI in breast
When should mother initiate breast feeding?
1st 30 minutes
What are the first signs of hunger before crying?
Hand to mouth motions
Whimpering
Sucking
Rooting
How often should mother breast feed?
On demand - usually every 1 1/2 to 3 hours
8-10 feedings in 24 hours
What can “watching the clock” do to milk production?
Impair milk production
When should mother feed until?
Until signs of infant satiety - relaxes, falls asleep, slows down r stops sucking
When does Colostrum production begin and end?
Begins during pregnancy and ends a few days after birth?
What is colostrum high in?
Protein
Fat-soluble vitamins
Minerals
Antibodies
Transitional milk
Until about two weeks
What does transitional milk contain?
More fat,
lactose,
water-soluble vitamins
More calories than colostrum
What does mature milk contain?
Carbohydrates
Protiens
Fats
Water
What is foremilk and hindmilk in?
Mature milk
When assessing proper breastfeeding, feeding is appropriate if?
- 6 or more wet diapers/day
- adequate weight gain
- adequate bowel movements
- infant is satisfied
What can pacifiers help prevent?
SIDS
What helps assess for proper breastfeeding?
LATCH
What does L in LATCH stand for?
Latch
What does A in LATCH stand for?
Audible swallowing
What does the T in LATCH stand for?
Type of nipple
What does the C in LATCH stand for?
Comfort
What does the H in LATCH stand for?
Hold or positioning
What amount size should breast milk be stored in?
2-4 ounces
Refrigeration time for breast milk?
72 hours to 8 days
Freezer time for breast milk?
6 months
Whole milk should be used until when?
For the 1st to years of life
When is semi-solid foods be introduced?
At 4-6 months
What food seldom causes allergies when introduced at 4-6 months?
Rice cereal with iron
What foods can be introduced 6-8 months?
Vegetables and fruits
How should you introduce fruits and vegetables?
Introduce one new food at a time and then wait 3 days to introduce another
What foods can be introduced at 8-10 months?
Strained meats and proteins
Soft finger foods
Begins to use cup with a lid
What can be introduced between 10-12 months?
Eats soft table foods w/ family
Attempts to feed self with spoon
Eats 4x/day
What foods need to be delayed until 4 months?
Carrots
Beets
Spinach
What foods need to be delayed until 1 year?
Cow milk
What foods need to be delayed until 2 years?
Eggs
What foods need to be delayed until 3 years of age?
Peanuts
Nuts
Fish
Shellfish
What foods need to avoided to prevent choking?
Hot dogs Hard vegetables Candy Whole grapes Chunks of peanut butter
What food needs to be avoided to prevent botulism?
Honey
When can newborn have first tub bath?
After cord fall off
How should cord be taken care of?
Kept dry and exposed to air
Clean cord and skin with cotton ball 2-3 x per day. Alcohol 1-2 x per day.
Fold diaper below the cord
Following circumcision how often do you check for signs of bleeding or infection?
q 30 min X 2 hours
How should circumcision care be cared for?
Clean with Soap and water, rinse, pat dry
What does normal drainage look like after circumcision?
Light, sticky, and yello
If circumcision has a plastibell, when should it fall off?
In 8 days
If there is no plastibell placed after circumcision, what needs to be applied with each diaper change?
Petroleum jelly
When should head control be achieved by newborn?
3-4 months
How should newborn be positioned for sleeping?
On their backs
What things help reduce SIDS risk?
Sleep on back
Baby’s head uncovered
Avoid overheating
Offer a pacifier for sleep
What does the AAP say about tummy time?
Recommends that when the infant is alert, he should be placed in his tummy for “play” sessions
If baby chokes, how should parents help?
Turn baby’s head to the side to bulb suction
Where is the safest spot for the car seat?
Middle of the back seat
How long does the baby need to face the rear in the car?
Until 1 year-old or weighs 20 pounds
What temperature are signs of illness?
Above 101 R or 100.4 ax
Below 97 R or 97.8 ax
