Newborn Transition to Extrauterine Life Flashcards
What is the terminology for neonates?
- Perinatal period
- Neonatal period
- Neonatology
When is the perinatal period?
From the 28th week of gestation until the 7th day after birth
When is the neonatal period?
From birth through the first 28 days of life
What is neonatology?
Subspecialty of pediatrics; medical specialties that care for newborn babies, sick babies, and premature babies
What is the initiation of respiration?
Newborn goes from a fluid filled environment to a gaseous one with the first breath - pulmonary gas exchange begins
What is surfactant?
lipoprotein that coats lung tissue to prevents alveolar collapse
When is surfactant made and complete?
Made @ 24 weeks & complete @ 34 weeks
What does liquid surfactant do for the newborn?
given to newborn, into (alveoli) lungs, coats & keeps lungs open
When is betamethasone given?
To mom < 34 weeks
What is the respiration rate for a neonate?
30-60 breaths/minute
What is the respiration pattern like for a neonate?
Shallow & irregular, Periodic breathing: short periods of newborn resp pauses <10 seconds without changes in HR or oxygenation
What are some s/s of early respiratory distress?
retractions, flaring ↑ WOB, tachypnea (> 60) or < 30 , grunting, cyanosis/color change
How does fetal circulation work?
Placenta provides oxygen, removes waste
What 3 fetal structures prevent blood flow to lungs & allow maternal blood to give nutrients?
Ductus Venosus
Foramen Ovale
Ductus Arteriosus
These 3 fetal structures close at birth
What does the Ductus Venosus do?
Bypasses hepatic system to vena cava
What does the Foramen Ovale do?
Shunts blood from right to left atrium
What does the Ductus Arterious do?
Shunts blood from pulmonary artery to aorta
What does the umbilical vein do?
Provides nutrients and oxygen to the fetus from mom
What is the heart rate for a neonate?
110-160 BPM
What could a ↑ HR mean in the newborn?
crying, pain, fever, drug withdrawal, volume depletion, cardiac disease
What could a ↓ HR mean for the newborn?
respiratory issues, O2 problems, hypoglycemia, hypothermia, hypoxia (BAD)
What are “functional” murmurs in the newborn?
normal in neonatal period d/t fetal structures not having been closed yet
What is the blood volume like for a neonate?
80-85 ml/kg
How much percentage wise does delayed cord clamping increase blood volume by?
25-40%
What are the benefits of delayed cord clamping?
↑ cardiopulmonary status -> ↑ BP & oxygenation
↓ anemia (iron deficiency) by ↑ RBC
What are 3 blood components for a neonate?
- Fetal RBCs live 80-100 days
- Physiologic anemia of infancy
- Leukocytosis
How long do fetal RBC’s live?
80-100 days** -> do not last as long as adults
What causes physiologic anemia of infancy?
Early breakdown of RBC’s, seen at 6-8 weeks
What can cause leukocytosis in infancy and is it expected?
Birthing trauma, and yes it is expected
What is thermoregulation?
Maintaining balance between heat loss & production to maintain the body’s core internal temperature
What is the optimal body temperature for a neonate?
97.7 ̊F - 99.5 ̊F
What 2 things do we want to eliminate regarding thermoregulation of the newborn?
Eliminate cold stress & prevent overheating
What are some reasons for heat loss for a neonate?
Large body surface area, thin skin & lack of fat (glucose, glycogen)
Lack of shivering d/t limited muscle activity (no purposeful movement)
Limited glucose stores of energy sources - brown fat
Evaporation, conduction, convection, & radiation
What are some examples of heat loss evaporation in the newborn?
- Wet diaper
- Regurgitated milk on shirt
- Wet hair from a bath
- Insensible water loss from lungs
When does evaporation occur?
Evaporation can occur during birth or anytime the infant is wet, and from insensible water loss
What are some examples of heat loss conduction in the newborn?
- Cold hands
* Cold scale with thin paper line
When does conduction occur?
Conduction occurs when the infant comes in contact with cold objects or surfaces such as a scale
What are some examples of heat loss convection in the newborn?
- Blanket loose or off
- Open door to hall
- Air conditioner
When does convection occur?
Convection occurs when drafts come from open doors, air conditioning, or even air currents created by people moving about
What is heat loss by radiation in the newborn?
Heat is lost by radiation when the infant is near cold surfaces, thus heat is lost from the infants body to the sides of the crib or incubator and to the outside walls and windows
When is hepatic function functional for the newborn?
3 months of age
What components of hepatic function are not fully functional until 3 months of age?
- Blood coagulation
- Conjugation of bilirubin
- Storage of fat soluble vitamins (A,D,E,K)
- Carbohydrate metabolism
- Iron storage
- Detoxification
What is important to know about blood coagulation in the newborn?
o In utero, gets vitamin K from mom.
o Neonate has no liver stores of vitamin K
o ** RF severe bleeding
o Vitamin K given w/in 1st hour of birth – medication (not vaccine)
o Vitamin K made in intestinal flora, takes 1 week to develop (once eating)
What is bilirubin conjugation and why is it important?
- Bile pigment made from destruction of RBCs (erythrocyte hemolysis)
- Conjugated by liver for excretion
- Risk for jaundice - mild or severe (encephalopathy)
What is carbohydrate metabolism and why is it important?
o Glucose = essential fuel for brain development
o Hypoglycemia = 1 of the most common problems in neonates
o Liver releases glycogen stores when feeding is intermittent or poor
How does iron storage work in the newborn?
o Fetal stores depends on mom’s intake
o Lasts about 4-6 months, then supplemented via diet (iron cereal)
How long does it take for infants to detoxify medications?
o Take longer for infants to excrete meds -> Its why low doses of meds are used
What is mucosal barrier development like in the newborn?
Absence of intestinal bacteria (sterile gut at birth)-> no longer sterile @ 1st feeding
•Colonization within 24 hours once food is introduced-> colonization of flora will protect GI tract-> Vit. K starts to synthesize
What is the stomach capacity for a newborn?
ONLY 10-20 mL first 24 hrs
Capacity 30-90 mL
What is the stomach and digestion like for the newborn?
o Immature GE sphincter* (wet burps, spit-up)
o ↓ stomach motility (initially food moves slower)
o Stomach rigid & non-elastic first 48 hours
What are the bowel elimination stools like for the newborn?
o Meconium: greenish-black, tarry – first 24 hours: **Abnormal: none w/in first 24 hours
o Transitional stool: greenish - brown/yellow, seedy
o Breastmilk: light yellow, more seedy (undigested milk fat)
o Formula stool: yellow
What are renal changes for the newborn?
o Body mass = 75% water-> Fluid loss occurs quickly ** RF Dehydration
↓ GFR -> puts infants at **RF fluid overload
↓ specific gravity -> harder to excrete fluids = ↑ RF overload
What is the normal urine output for the newborn?
> 1 mL/kg/hr
What are some things to know about renal changes in the newborn?
o Important to check d/t RF dehydration / overload
o Normal: > 1 mL/kg/hr (minimum 1 mL/kg/hr) -> 6-8 wet diapers/day
o May contain pink uric acid crystals in first voids
What is natural immunity?
- Skin
- Mucous membranes
- Gastric acids
- Enzymes
What are the 2 components of acquired immunity?
o Active - none until exposure to foreign organism
o Passive - maternal transfer of antibodies
What is immunoglobulin?
Immunoglobulins, also known as antibodies
They act as a critical part of the immune response by specifically recognizing and binding to particular antigens, such as bacteria or viruses, and aiding in their destruction
Which immunoglobulin is most abundant?
IgG
Which immunoglobulin is present at birth and DOES CROSS the placenta at 20-22 weeks?
IgG
Which immunoglobulin is a major source in maternal breast milk?
IgA
Which immunoglobulin is a first responder to infection?
IgM
Which 2 immunoglobulins are not present at birth and DO NOT cross the placenta?
IgA
IgM
What does skin do for the newborn?
- Provides protective barrier to pathogens
- Low fat and high water content compared to adults
- Limits loss of water
- Assists with thermoregulation
- Protects from physical trauma
Skin is one of the largest newborn organs
What are some things to consider regarding skin for newborns?
- Fragile with high risk for breaks
* May look dry, and peel after birth
How does the body develop for the newborn?
Development follows a cephalocaudal (head to toe) and proximal-distal(center to periphery) pattern
What are the 5 senses for the newborn?
- Hearing: Well developed at birth, turns to sound
- Taste: Distinguishes sweet & sour at 72 hours old
- Smell: Distinguishes mother’s breast milk
- Touch: Sensitive to pain, responds to tactile stimuli
- Vision: Incomplete at birth, focuses at 8-10 inches
Why are reflex important in the newborn?
Important indicators of neuro function
•Absence, persistence, or reappearance = pathology
What is the first period of reactivity?
(0.5 hr - 2 hours)
Alert, HR/RR are increased. Good time for bonding & initiating breastfeeding
What is the period of decreases responsiveness?
(lasts 1-2 hrs)
Sleepy, decreased activity. Difficult to arouse newborn
What is the second period of reactivity?
(lasts 2-8 hours)
Awake, interested in surroundings, HR/RR increase. May pass meconium or void. Bonding encouraged, teaching may begin
What is stability?
Stability of sleep /wake cycle after 24 hours
•Start their regular
wake/sleep cycle
•Q3 hours infant will eat,
sleep, wake up
What are neurobehavioral responses?
How the newborn reacts to the world
What are some expected neurobehavioral responses?
- Orientation - response of newborns to stimuli
- Habituation - responds to and then blocks out stimuli
- Motor maturity - controls and coordinates movement
- Self-quieting ability - “consolability”
- Social behaviors - “cuddling” and positive responses
