Newborn Complications

Question 1

What is convection heat loss?

Answer 1

Convection: when the newborn is exposed to cool surrounding air or to a draft from open doors, windows or fans, the transfer of heat from the newborn to air or liquid. Newborn Thermoregulation is affected by the newborn’s large surface area, air flow (drafts, ventilation systems, etc), and temperature gradient.

-Blowing, moving, flowing

Question 2

What do we monitor when a newborn is reciving phototherpay for jaundice?

Answer 2

Monitor vitals q4 h
Occasionally discontinue and remove eye patches (q2-3 h)
Assess intake and output (weigh diapers; weigh infant daily)
Assess skin and provide care prn
Assess serum bilirubin levels as ordered
Encourage parent-newborn attachment

Question 3

What are the 4 physiologic reasons for jaundice?

Answer 3

1.) High RBC mass, short RBC lifespan

2.) Reduced ability of liver to conjugate

3.) Fewer bilirubin binding sites

4.) Conjugated changes to
unconjugated in intestines

Question 4

What is the physiological pathway for Nonshivering Thermogenesis (NST)?

Answer 4

Usually triggered at a mean skin temperature of 35-36° C
↓
Thermal receptors in the skin perceive a drop in environmental temperature and transmit impulses to the hypothalamus
↓
Stimulates the sympathetic nervous system
↓
Release of norepinephrine
↓
Stimulates brown fat metabolism by the breakdown of triglycerides
↓
Generates heat
↓
Increases body temperature

Question 5

What is conduction heat loss?

Answer 5

Conduction: when the newborn is placed naked on a cooler surface, such as table, scale, cold bed. The transfer of heat between two solid objects that are touching, is influenced by the size of the surface area in contact and the temperature gradient between surfaces.

Question 6

Do healthy, term babies require blood glucose screening?

Answer 6

No

Healthy, term babies do not require blood glucose screening

Question 7

What can neonatal hypoglycaemia be defined as?

Answer 7

Neonatal hypoglycemia cannot be defined by a single value of glucose applicable to all clinical situations and to all infants

Question 8

How do we check for jaundice?

Answer 8

Blanch the skin over a bony prominence

After pressure is released, does the area appear yellow before normal color appears?

Can also check oral mucous membranes if not sure

Question 9

What is the source of hyperthemia in a newborn?

Answer 9

Comes from inapproperiate use of external heat source

Question 10

Is routine screening of blood glucose recommended for term infants?

Answer 10

Routine screening of appropriate-for-age (AGA) infants at term is not recommended

Question 11

What are some screening guideline for newborns at risk for low blood glucose?

Answer 11

Screening should be initiated in asymptomatic, at-risk infants (after at least one effective feeding), at 2 hours of age and should be encouraged to feed regularly thereafter

Some infants may require an intravenous (IV) dextrose solution

Symptomatic and unwell babies require immediate glucose testing

Question 12

Nursing care/measure we provide to a child who is reciving phototherpy treatment for jaundice?

Answer 12

Obtain vital signs
Remove all infant’s clothing except diaper
Apply eye coverings
Ensure lights are at appropriate distance
Reposition infant every 2 hours

Question 13

What is non shivering thermogenesis?

Answer 13

• Heat is produced by metabolism of brown fat.
• Thermal receptors transmit impulses to the hypothalamus, which stimulate the sympathetic nervous system and causes norepinephrine release in brown fat (found around the scapulae, kidneys, adrenal glands, head, neck, heart, great vessels, and axillary regions).
• Norepinephrine in brown fat activates lipase, which results in lypolysis and fatty acid oxidation. * This chemical process generates heat by releasing the energy produced instead of storing it as Adenosine-5-Triphosphate (ATP).

Question 14

What are the effects of cold stress?

Answer 14

Peripheral Vasoconstriction

Less activity, lethargy, hypotonia, weakness

Depleted brown fat stores

Respiratory Distress

metabolic acidosis

Hypoglycemia

Question 15

What is hyperbilirubinemia?

Answer 15

Hyperbilirubinemia refers to elevated serum bilirubin levels and is toxic to the brain

Question 16

How high do unconjugated serium bilirubin levels need to be in order for it to be classified as hyperbilirubinemia?

Answer 16

The Canadian Pediatric Society suggests that an unconjugated hyperbilirubinemia > 340 mcmol/L in the first 28 days of life constitutes hyperbilirubinemia

Question 17

What is radiation heat loss?

Answer 17

Radiation: when the newborn is near cool objects, walls, tables, cabinets, without actually being in contact with them. The transfer of heat between solid surfaces that are not touching. Factors that affect heat change due to radiation are temperature gradient between the two surfaces, surface area of the solid surfaces and distance between solid surfaces. This is the greatest source of heat loss after birth

Question 18

What happens id bilirubin remains unconjugated and does not bind to albumin (plasma protein)?

Answer 18

1.) Leaves vascular system and enters other extravascular tissues such as skin, sclera, and oral mucous membranes

2.) Crosses blood brain barrier - can cause neurotoxicity

Question 19

When does cold stress occur?

Answer 19

occurs when heat loss overwhelms the newborn’s ability to compensate

Question 20

What are the sings of hyperthemia in a newborn?

Answer 20

They varry according to the reason

(Too hot due to external cause: flushed skin, hands and feet warm to touch, posture of extension)

Question 21

What is the purpose of phototherapy for jaundice in babies?

Answer 21

Exposure to high intensity light (blue wavelengths) to reduce serum bilirubin levels

-Helps break down bilirubin

Question 22

What is evaporation heat loss?

Answer 22

Evaporation: when amniotic fluid evaporates from the skin. Evaporative losses may be insensible (from skin and breathing) or sensible (sweating). Other factors that contribute to evaporative loss are the newborn’s surface area, vapor pressure and air velocity. This is the greatest source of heat loss at birth.

Question 23

What are clinical manifestations of neonatal hypoglycemia?

Answer 23

Clinical Manifestations: jitteriness, lethargy, cyanosis, high-pitched or weak cry, poor feeding, hypotonia, temperature instability, respiratory distress, apnea, seizures

Question 24

When does physiologic jaundice typically appear?

Answer 24

Appears after 24 hours of age and usually resolves without treatment

Question 25

What is more common, hypo or hyperthermia?

Answer 25

Hypotherima is more common than hyperthermia

Question 26

What level of plasma glucose concerntration is considered to be abnormal and require intervention?

Answer 26

A plasma glucose concentration less than 2.6 mmol/L appears to be abnormal for term and preterm infants and requires intervention

Question 27

When are peak bilirubin levels reached in a full term new born with physiologic jaundice?

Answer 27

Peak bilirubin levels are reached between days 3 and 5 in the full-term newborn

Question 28

What are some prevention techniques for neonatal hypoglycaemia?

Answer 28

Prevention: For at-risk newborns, frequent monitoring via heel stick, early initiation of feedings, maintain NTE (Put the infant skin-to-skin)

Question 29

When is phototherpay institutsed in newborns with jaundice?

Answer 29

Instituted when the TSB level reaches the treatment threshold appropriate for the newborn’s gestational age and age in hours

Question 30

What is on the checklist for evaluating the risk of hyperbilirubinemia?

Answer 30

Was the baby born before the expected due date (premature)?
Did the baby experience birth trauma or bruising?
Is the baby of Asian or Indigenous ethnicity?
Did any of the baby’s siblings have newborn jaundice?
ABO incompatibility with mom?
Fewer than 6 wet diapers/day?
Is the baby a boy?

Question 31

Why does unconjugated bilirubin need to become conjugated?

Answer 31

so that it becomes SOLUBLE & EXCRETABLE

Question 32

What are symptoms of a child with hyperthemia from sepsis?

Answer 32

To hot sue to sepsis - pale, hands and feet are cool

Question 33

Who do we do we do routine neonatal blood glucose screening for?

Answer 33

Routinely screen: IDMs, preterm infants (<37 weeks) & SGA infants

LGA infants weighing >90th percentile should be considered at risk

Question 34

What is the greatest source of heat loss after birth?

Answer 34

-Radiation heat loss

Question 35

When temp is considered to be hyperthermic?

Answer 35

Body tem more than 37.5

Question 36

What determines hwo extensive the jaundice is? How does it vary?

Answer 36

The level of bilirubin at which jaundice is evident varies considerably

Question 37

What are some possible complications of hyperbilirubinemia?

Answer 37

1.) Kernicterus (yellowing of the skin, eyes, etc. - High levels of unconjugated bilirubin can possibly reach toxic levels resulting in a severe condition called kernicterus)

2.) Encephalopathy

3.) Motor abnormalities

4.) Hearing and vision loss

*Excessive indirect serum bilirubin may lead to neurotoxicity - bilirubin readily crosses the blood-brain barrier

Question 38

What are some contributing factors for hyperbilirubinemia?

Answer 38

Hemolyisis of excessive RBCs
(erythrocytes)

Short RBC life

Liver immaturity

Lack of intestinal flora

Delayed feeding

Fatty Acids from cold stress or asphyxia

Trauma resulting in bruising or cephalohematoma

Question 39

What is the primary source/mechanism of heat in a hypothermic newborn?

Answer 39

Nonshivering thermogenesis (NST) from brown adipose tissue (BAT

Question 40

Within how may hours of life is it recomded to do trancutaneous bilirubin (TcB) screening? How many times do we measure it and where?

Answer 40

recommends that all infants have a TSB (total serum bilirubin) OR a TcB (transcutaneous bilirubin) measured in the first 72 hours of life or earlier in the presence of clinical jaundice

TcB measured three times on sternum