Newborn (Part 2) - Unit 4 Flashcards
How does the newborn position itself at birth to warm itself?
Position of flexion, which reduces skin surface temp. Unless they are preterm, then they can’t do this.
Why are newborns at risk for temp issues?
Thin skin, blood vessels closer to the surface of the skin, little subcutaneous fat, transfer of heat, 3x more surface to body mass than adults, lose heat 4x greater than adults.
What is evaporation?
Air drying, resulting in cooling.
What is conduction heat loss?
Direct contact, touching something hot. Like, the cold plastic scale for babies!
What is convection?
Heat loss from mass through air or water - like a lava lamp. As it gets hot, it rises. As it cools, it lowers. Think of air movements in a nursery, etc.
What is radiation heat loss?
NOT direct - wall of an incubator, double walls fix that!
What happens when infants become cold?
Exposure to cold temp –> peripheral vasoconstriction –> skin feels cold to touch –> acrocynosis (hands and blue feet) –> increased metabolic rate.
Infants can increase their metabolic rate __ to ___ rate.
200-300%
When cold, babies burn sugar. T/F?
TRUE
What is nonshivering thermogenesis?
This is the metabolism of brown fat to produce heat. Increases heat production by 100%. Brown fat has a lot of blood vessels and is found on the neck, axillae, around the heart, kidneys, and adrenals. etc.
When does nonshivering themogenesis start?
When SKIN (not core) temp falls to 95-96.8 - thermal receptors in skin detect this.
Cold stress - increased O2 need can lead to respiratory distress. T/F?
TRUE
Metabolism of glucose without proper oxygen levels will lead to increased acids in the blood. T/F?
TRUE
What causes jaundice?
Hyperbilirubinemia- an increased level of bile.
Bilirubin is formed from what?
Hemolysis of RBC’s.
What is the difference between indirect (unconjugated) or direct (conjugated) bilirubin?
Unconjugated = fat soluble - absorbed by fat in body and causes yellowing of the skin.
What is the conjugation process for the bilirubin?
Conjugation is in liver - UC attaches to albumin, goes to liver, gets with enzyme and becomes conjugated, then goes through bile, then you poop it out!
Bili staining of the tissues causes what?
Acute bilirubin encephalopathy or a severe/chronic form (kernicterus)
What are some factors that increase bilirubin?
excessive production (babies form more), red blood cell life is shorter (80-100 days), lower albumin levels, liver immaturity, blood incompatibility, gestation, intestinal factors, delayed feeding, trauma (bruising), fatty acids, family background, other factors.
Bili - anything above 75th percentile requires a blood draw. T/F?
TRUE
what is the difference between physiologic jaundice and nonphysiologic jaundice?
Physiologic - occurs after 24 hours - not a big concern.
Non = occurs in first 24 hours, abnormalities w RBC destruction, treated with phototherapy.
What is breastfeeding jaundice?
rare - early onset, occurs with insufficient feeding. About 3-5 days after, lasts about 3weeks-3 months. They need to be FED so they can SHIT out the bili.
What are the caloric needs of a breastfed baby?
85-100 kcal/kg daily
What are the caloric needs of a formula fed baby?
100-110 kcal/kg daily.
Babies may lose up to 10% of their weight. T/F?
TRUE _- but we start worrying at 7%
How much water do babies need per day?
60-100 ml/kg for first 3-5 days, then 150-175 thereafter. BUt, this comes in formula, etc. DO NOT GIVE WATER
What is lactogenesis 1?
Colostrum
What is lactogenesis 2?
transitional milk - 2-3 days after
What is lactogenesis 3?
Mature, Day 10 - also looks thin and bluish, but it’s still good!
What are some of the nutrients in breast milk?
Protein, carbs, fat, vitamins, minerals, enzymes, 50% of fat, etc.
If mom stops eating well, does the breastmilk suffer?
Not really! It just hurts the mom.
Formula - is it modified cow’s milk?
Yes
What is the nursing role for choosing a feeding method?
Educate & support. Also talk about advantages and such.
What are some factors influencing choice of choosing a feeding method?
Support from others, cultural influences, employment, other factors
What hormone increases breast milk production?
Prolactin
Do women feel tingling at let-down of milk?
YEs
Should we assist women during their first feeding?
Yes - help them with latching on, what to look for (good vs. bad sucking), etc.
what are some common breastfeeding concerns for the infant?
Sleepy baby (as long as they’re feeding well, it’s okay), nipple confusion (when babies think they have a bottle when it’s actually a breast), suckling problems (clicking? not good), infant complications, etc.
What are some common breastfeeding concerns for the mom?
Breast problems (engorgement, 72-96 hours), illness in mother, medications, breast surgery, employment, milk expression, storing milk, multiple births, weaning, home care, etc.
Nipple piercing - can breastfeed, just remove the jewelry?
YES
How long can we store breastmilk for?
Unrefrigerated 3-4 hours, refrigerated for 72 hours, frozen for 6-12 months.
What are some different types of formula?
ready to use, concentrated liquid formula, powdered formula (cheapest)
How do we position the baby for feeding?
Baby sitting up at angle, burping, every 3-4 hours, etc.
what are some early problems when taking the baby home early?
Crying, colic, sleep, concerns for working parents, dressing/warmth, eyes (warm water to get the crust off), baths (not before cord falls off), and file nails.
When should we introduce babies to solid foods?
4-6 months.
When do the babies need to go to the doctor (schedule?)
48 hours-2 weeks, then 1 mo, 2 mo, 4mo, 6 mo, 9 mo, 12 mo.
