Newborn Care Fundamentals Flashcards
Define: Transition to Extrauterine Life
The major adaptations occur during the first 6 to 8 hours after birth.
Changes are mediated by the SNS
What are the major changes needed to transition to extrauterine life?
heart rate
respirations
temperature
GI function
What are the time periods for the 3 stages of the “Transition Period”
I: minute 0-30 PP - period of reactivity 1
II: minute 60-100 PP - decreased responsiveness
III: 2-8 hours PP - period of reactivity 2
What happens during the first stage of the Transition Period
- HR increases to 160-180 bpm then decreases to 100-160
- RR may be irregular (60-80 bpm)
- Fine crackles may be present on auscultation; audible grunting, nasal flaring
- infant is alert and may have spontaneous startles or tremors
- bowel sounds are audible, meconium may be passed
What happens during the second stage of the Transition Period
- the newborn either sleeps or has a marked decrease in motor activity
- RR will shallow (30 bpm) but not be laboured + infant should be pink
What happens during the third stage of the Transition Period
- periods of tachycardia, tachypnea, increased muscle tone, mucus prodoction, increased colour
- meconium commonly passed in this stage
- very preterm infants do not experience this phase
What physiological adaptations occur in the respiratory system? What causes this?
The site of gas exchange changes from the placenta to the lungs
Clamping the umbilical cord = rise in BP = which increases circulation and lung perfusion
What are some signs of respiratory distress?
- nasal flaring
- intercostal or subcostal retractions
- paradoxical respirations (exaggerated rise in abdomen, with respiration, as chest falls)
- RR outside of 30-60 bpm
- central cyanosis (bluish lips and mucous membranes)
= hypoxia
T or F: the RR of the baby can be negatively influenced by analgesics or anesthetics given to mom
true
T or F: acrocyanosis is a normal finding in a nb infant
Acrocyanosis (bluish discolouration of hands and feet) is a normal finding in the first 7 to 10 days after birth
What are some common respiratory complications
Respiratory distress syndrome (RDS)
Meconium aspiration
Pneumonia
Persistent pulmonary hypertension
T or F: the symptoms of all respiratory complications last for hours
False: only serious respiratory problems have pronounced symptoms that last beyond the first 2 hours after birth
Ex. symptoms of transient tachypnea usually subside within 2 hours
What physiological adaptations occur in the cardiovascular system after birth? What causes this?
First breath -> alveolar distension -> inflation of lungs -> 1) increased blood flow to pulmonary arteries -> 2) closure of the foramen ovale
3) increase in PO2 in blood
Changes in BP PP
Range: 60/40 - 80/50
first hour of life: drop in bp (about 15 mmHg)
By second day of life: BP increases and stabilizes
- The number of weeks of gestation can be used as a guide for the mean arterial pressure (MAP).
Ex. Infant born at 40 weeks = MAP of at least 40
What do we use to measure bp on infants? Is this a routine measure?
oscillometric device (bp machine) - not a routine measurement in healthy newborns
What are sign of cardiovascular problems?
- HR >160 bpm or HR >100 bpm
What components of the hematopoietic system are higher in infants than in adults?
RBC, Hb, leukocytes
How long does adjustment to extrauterine environment temperature take?
12 hours after birth
Should settle between the normal range of 36.5-37.5
What factors are controlled for to help the thermogenic system while it adapts?
Convection - flow of heat from body surface to cooler air in the room
Conduction - loss of body heat from body surface to colder objects in direct contact with body
Radiation - heat lost from the body to cooler solid surfaces not in direct contact with baby ex. window
Evaporation - cold caused by body heat lost to evaporation of fluids
T or F: infants remain warm by shivering
False.
The shivering mechanism is non-functional in newborns.
To stay warm nb will:
assume a position of flexion and use nonshivering thermogenesis
What types of heat loss does S2S protect from?
Conductive and radiant
What is nonshivering thermogenesis
The metabolism of brown fat reserves to preserve body heat
What are the effects of cold stress?
Can cause
- increased RR
- vasoconstriction
- ultimately metabolic acidosis
What factors contribute to cold stress
- Larger body surface to body mass
- Higher metabolic rate with limited glycogen stores
- Poorly developed shivering response
- Heat loss through any of 4 modes
Describe the expected findings for the GI system?
- Mucous membranes should be moist and pink; the hard and soft palates are intact.
- mucus is common in the first few hours after birth.
- Small whitish areas (Epstein pearls) may be found on the gum margins and at the juncture of the hard and soft palates.
- The infant is unable to move food from the lips to the pharynx; place nipple well inside the baby’s mouth
- Peristaltic activity: uncoordinated to coordinated in first few days
- Bowel sounds can usually be heard shortly after birth.
- Stomach capacity 30 mL to 90 mL by day 7
- The normal nb digests carbs and proteins but has a limited ability to digest fats. Lipase in human milk aids in digestion of fats by the newborn.
Describe the changes in stool
o Meconium
Infant’s first stool, composed of amniotic fluid and its constituents, intestinal secretions, shed mucosal cells, and possibly blood (occurs in first 24-48 hours; may be delayed in very-low-birth-weight infants)
o Transitional Stool
Appear by the 3rd day after initiation of feeding. Greenish to yellowish brown in colour
o Milk Stool
Appears by 4th day
breastfed -> yellow, pasty, odour of sour milk
Formula -> yellow/brown, firmer, odour of normal stool
How much fluid intake should a nb >1500g have?
day 1-2: 60-80mL/kg/day
day 3-7: 100-150mL/kg/day
Signs of GI problems:
- abnormalities in: stool + regurgitation
- fullness of the abdomen above the umbilicus
- Intolerance to formula
What is the major function of the hepatic system in respect to jaundice? What types of problems can arise from this?
- excretion of bilirubin
Pathological jaundice -> within the first 24 hours and fast rise, something pathological ie: blood incompatibility - Physiological jaundice -> immature liver to excrete broken down RBCs, normal day 2-3
- Breast milk jaundice -> not getting enough hydration to excrete bilirubin
Why is vit K necessary for babies
to prevent hemorrhagic issues, coagulation factors made in liver depend on this, not naturally made in liver until intestinal microflora present
What are some signs of infection
temp. instability
hypothermia
prematurity
What are some common findings of the integument in nb?
Vernix erythematous (red) skin cyanotic hands and feet (acrocyanosis) lanugo hair Venous lacerations may occur underneath the skin
How may a forceps-assisted birth or vacuum extraction cause integument damage?
edema of the face and ecchymosis (bruising)
What is desquamation?
peeling of the skin (normal after a few days)
What are some concerning findings during an integument assessment?
pallor, plethora (deep purplish colour from increased circulating RBCs),
petechiae, central cyanosis, or jaundice
What are some normal findings in the assessment of the genitalia
Edema (swelling) Tight prepuce (foreskin) is common in newborns and completely covers the glans penis
Signs of reproductive system problems
Abnormal placement of urethral opening (hypospadias/epispadias), absence of hymenal tags, fecal discharge from the vagina, undescended/maldescended testes
- If the male infant is born in a breech presentation, the scrotum is edematous and may be bruised
Extra digits and missing digits are called
polydactyly and oligodactyly
T or F: the neurmuscular system is almost completely developed at birth
True
Are tremors and jitteriness normal?
Yes unless persistent / cannot by ceased with gentle restraint
Describe the following reflex: Extrusion
Touch or depress tip of tongue -> newborn forces tongue outward.
Describe the following reflex: tonic neck or “flexing”
With infant in a supine neutral position, turn head quickly to one side -> with infant facing left side, arm and leg on that side extend; the opposite arm and leg flex (turn head to right, and extremities assume opposite postures).
Describe the following reflex: Moro (startle)
Hold infant in semisitting position, allowing head and trunk to fall backward (with
support) or place infant supine on flat
surface; make a loud, abrupt
noise -> Symmetrical abduction and extension of arms are seen; fingers fan out
Describe the following reflex: Magnet
Place infant in supine position, partially flex both lower extremities, and apply light
pressure with fingers to soles of feet -> Both lower limbs should extend against examiner’s pressure
Describe the following reflex: pull-to-sit
Pull infant up by wrists from supine position with head in midline -> Head lags until infant is in upright position; then head is held in same plane with chest and shoulder
momentarily before falling forward; infant attempts to right head.
Describe the following reflex: babinski (plantar)
On sole of foot, beginning at heel, stroke upward along lateral aspect of sole, then move
finger across ball of foot all toes hyperextend, with dorsiflexion of big toe—recorded as a positive sign.
What is the normal range for: weight, height, head circ, chest circ
2600 - 4000 g
48-55 cm
Head 33-38 cm
Chest - 2-3 cm smaller than head
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