Newborn Care I Flashcards
Terms (4)
- Extremely premature: less than 32 weeks gestation
- Late preterm: 34-36 weeks gestation
- Early term: 37-38 6/7th weeks gestation
- Full term: 39-40 6/7th weeks gestation
* Bigger is better! A baby’s brain at 35 weeks weights 2/3 of what it will weigh at 40 weeks; each day makes a huge impact on brain development
Birth Weights (3)
- LBW: less than 2500gm
- VLBW: less than 1500gm
- Chronological Age/birth age: time since birth
Gestational Age
Estimated time since conception, can be measured by
- LMP
- Early ultrasound
- Dubowitz/Ballard - done w/i first 48 hours
Corrected Age (4)
Age corrected for prematurity
- Actual age - weeks premature = corrected age
- Corrected for degree of prematurity for 2 years
* Correct pre-mature baby’s age for first 2years of life when assessing milestones and developments - Age correction most meaningful in first year of life
- Helps anticipate complications and expectations
Naegele’s Rule
Take first day of LMP and add one year, subtract three months, and add 7 days
Catch Up’s (4)
- Head circumference - early catch up within first few months post term (unless ELBW/VLBW)
Weight and length
- Catch up by first year if over 30 weeks
- By 2 years of less than 30 weeks
- Use preterm growth charts
* Sometimes weight surpasses if they get extra calories initially
Leading Causes of Infant Death (6)
- Prematurity
- Birth defects
- LBW
- Maternal complications of pregnancy
- Respiratory distress syndrome (RDS)
- SIDS
Contributing Factors to Prematurity (9)
- Advanced maternal age
- Hypertension
- IUGR
- Chromosomal abnormalities
- Gestational disorders
- Chronic Health disorders (DM, HTN)
- Assisted reproductive technologies
- Multiple births
- Cesarean sections
Four U’s of Late Preterm and Early Term Infants
- Unrecognized as premature
- Underestimated for morbidity and mortality
* 3x higher then full term infants
* 19% risk of admission to NICU - Unpredictable
* Hypothermia, hypoglycemia, respiratory support, antibiotics - Understudied
Key Pregnancy History Pieces with New Baby (10)
- ART (anti-retroviral therapy)
- Complications
- Overall health
- Screening tests
- Amniocentesis
- Use of folic acid / prenatal vitamins
- GBS status (and previous history)
Chronic Health Conditions - DM
- Lupus
- Thyroid disease
Labs to Send out for Newborn (5)
- Blood type - establishes ABO incompatibility
- Screening glucose
* Hypoglycemia - decreased glycogen stores in preterm infants - Bilirubin
* Elevated in first 24-48 hours = pathological - get total and direct bilirubin levels to check what the cause of the jaundice is - CBC
* Anemia - blood loss or hemolytic - Coombs test
* Positive test indicates fetal RBCs coated with antibodies; diagnostic of Rh incompatibility
ABO incompatibility
Mother O and Baby is A, B, or AB
Rh incompatibility
Mother gives birth to Rh+ baby - mixing antibodies attack lysing of the baby’s RBCs
(woman is Rh(-) and gives birth to Rh(+) baby)
Rhogram given at 28-30 weeks and 72 hours after delivery
First Visit (8)
- Premature infants should be seen within 48 hours of d/c (ideally 24)
Topics to review:
- Adaptation to home environment
- Parental adjustment
- Establish relationship with parent
- Reassurance
- Get to know the infant well
- Review thorough history and NICU discharge summary
- Discuss plans for HCM, immunizations and referrals
Maternal Depression (3)
- Higher rate with pre-term infants
- Depressed mother more likely to have an infant with poor growth and development; monitor closely with frequent visits or calls
- Edinburgh PP depression scale
* Max score of 30-10 or greater possible depression needs follow up
Main reasons for hospital readmission (3)
- dehydration
- respiratory issues
- feeding issues
PA of throat and respiratory tract (2)
- Throat – evaluate suck-swallow, tongue thrust, oralaversion, uvula movement, gag reflex
* Oral aversion could occur if baby was in NICU and intubated
* Premature babies have exaggerated tongue thrusts that keep them from feeding normally and exhausts them/burns calories - Respiratory tract rate and retractions, stridor, wheezing (RSV)
PA of neck and shoulder, trunk, and extremities (3)
- Neck and shoulder - evaluate poor head control, tight scarf sign, difficulty breathing
- Trunk - evaluate arching, decreased ROM, hypotonia
- Extremities - hypo or hyper tone, hyperreflexia, clonus, babinski testing
Landau reflex (2)
Postural reflex
- Hold infant in the air horizontally and infant will lift head and extend the neck and trunk
- Present by 5-6 months
Parachute reflex (3)
Postural reflex
- Present by 6-8 months
- Look for symmetrical response
- The child is held upright and the baby’s body is rotated quickly to face forward (as in falling). The baby will extend his arms forward as if to break a fall
Propping Reflex (2)
Postural reflex
- Anterior propping when sitting
- Lateral propping to maintain balance
postural reflexes
a more mature-support control of balance, posture and movement - presence indicates infant’s increasing ability to control body
*replaces primitive reflexes in a sequential manner
Pre-term Immunizations (3)
- Recommended according to chronological age
- Hepatitis B only after 2 kg (unless mother is Hep B positive)
- Palivizumab (Synagis) for preterm infants born at or before 28 weeks and 6 days gestation (so before 29 weeks)
* 15mg/kg 5 doses maximum
* No more 2nd year of life unless still on oxygen
* Stop if breakthrough RSV occurs with hospitalization
Daily weight gains of premature infants
15-20gm/day
Length gains of premature infants (3)
- Length gain by 1.1 cm per week until term
- Then .75cm for 3 months
- Then .5cm for 3-6 months
Head circumference gain in preterm infants
- 0.5cm/week until 3 months
- 0.25cm/week for 3-6 months
- 1.25cm/week or more = hydrocephalus
Preterm Nutritional Needs (6)
- 137-165 calories/kg/day
- If Chronic Lung Disease (CLD) need a higher caloric intake (b/c they are expending more energy)
- Multivitamins daily 1ml
- Vitamin D – 400 IU per day; beginning in first few days of life
* Wean when consuming at least 32 oz/day of Vitamin D fortified formula or whole milk - Iron supplementation of 2-4 mg/kg/day in breastfed infants preterm
- Caveat – higher energy and nutrient requirements due to IUGR, Immaturity of the gut, increased body surface area
Growth in VLBW Infants (5)
*AGA infants will grow normal or faster rate
VLBW - Take longer to catch-up
- 24 months for weight
- 18 months for head circumference
- Growth spurt at 38-48 weeks
- Growth spurt again at 6-9 months
- Most catch up by 2-3 years
Feeding problems in pre-term infant (5)
- Tonic bite reflex
- Tongue thrust
- Hyperactive gag reflex
- Oral hypersensitivity
- Refer to speech therapist or PT with specialty in oral motor problems/feeding specialist/swallow study
Transition to Extrauterine Life (6)
- Pulmonary capillary bed expands
- Right atrial and ventricular pressure fall
- Systemic resistance increases
- Left atrial and ventricular pressure rise
- FO closes (left atrial pressure increase)
- Umbilical arteries, ductusvenosus and ductus arteriosus constrict in response to increase in oxygen tension
*Can take up to 6-12 hours to have normal breathing
Normal Newborn Vitals (3)
- HR: 90-140 (180)
- RR: 30-60
- Temp: 97.8-98.6 F or 36.5-37 C
Newborn Temperature Control: Heat Loss (4)
- Radiation: loss to a cold nearby object not in contact (window)
- Convection: loss by air motion (cool breeze-O2)
- Evaporation: loss of heat by moisture vaporizing from skin or respiratory
- Conduction: direct heat loss to surface in contact (cold mattress)
* takes a while to recover from this
Brown Fat Metabolism
Non-shivering thermoregulation; a natural method for newborns to produce heat by increasing metabolic rate (generate heat by breaking down brown fat)
*Storage begins at 26-30 weeks in scapula, kidneys, axilla and neck
How do term infants conserve heat? (5)
- Skin to skin
- Light clothing
- Avoidance of heat loss elements - environmental cold spot
- Preemies do not shiver (hypothalamus and limbic system not developed)
- Posture (curling up)
Consequences to heat loss (8)
- Hypoxia
- Hypoglycemia
- Metabolic acidosis
- Decreased growth
- Apnea
- Pulmonary hypertension
- Use up oxygen
- Can lead to acidosis and/or death
Definition and Symptoms of Cold Stress (8)
- Defined as a body temperature less than 36.5C or 97.6F rectally with system wide sequelae
- Cool to touch
- Central cyanosis
- Poor feeding
- Bradycardia
- Apnea
- Lethargy
- Mottling
Umbilical Cord Care: Stump (3)
Dry it out!
- Dry cord care includes keeping the cord clean and leaving it exposed to air or loosely covered by a clean cloth. If it becomes soiled, the remnant of the cord is cleaned with soap and sterile water
- Typically falls off within 7 days (if not by 2 months look for underlying cause)
- Observe for infection
* Umphilitis - fowl smelling redness and swelling around umbilical cord; can spread to cellulitis or bacteremia
Nursery Penile Care (4)
- Circumcision care- make sure normal anatomy; no hyposapdias, epispadias (bladder extrophy), chordee, ambiguous
- Vaseline gauze/petroleum ointment and observe bleeding after circumcision
- Watch for urinary retention
- Care of the uncircumcised penis: teach parents, clean, paraphimosis (urologic emergency), balanitis-smegma
Sleeping position and pattern (3)
- BACK TO SLEEP
- No soft bedding, pillows, quilts or stuffed animals
- Healthy term newborns sleep 16-17 hours/day
Newborn Weight loss vs. Weight Gain (5)
- Weight loss of 5-8% is typical, but over 10-12% in first week is a concern
- Healthy for newborns to regain BW by 2 weeks
- Double BW by 5 months
- Triple BW by 1 year
- An ounce a day is ok!
Feeding Patterns and Techniques (7)
- Encourage and support breastfeeding (Q2-3hours)
- No shame or guilt if not (formula every 3 hours)
- Healthy full term requires ~120 kcal/kg/day
- Vitamin D supplementation if breastfed (400 IU daily)
- Iron - 1mg/kg/day in breastfed full term infants
- If formula fed –Use iron fortified infant formula (4-12mg)
- When burping, do not hit, rub
Elimination Patterns (2)
- Urine of 8-10 wet diapers/day is normal
- Should be soft, yellow stools
* Pooping every feeding is normal
* Blockage could be biliary atresia
When can pacifiers begin?
Once adequate feeding is established