Normal Newborn/Newborn Adaptations Flashcards
1
Q
What assessments should be done in the first 4 hours of life? (5)
A
Apgar score
Neonatal assessment
Gestational age assessment
Measurements/classificaiton
Vital signs
2
Q
What is D-A-B-C?
A
Dry
Airway
Breathing
Circulation
3
Q
What interventions should be done in first 4 hours of life? (7)
A
Temp regulation
Support respirations
Identification
Labs
Bath
Establish feeding
Promote parent - infant bonding
4
Q
What medications should be given in the first 4 hours of life?
A
Vitamin K
E-mycin opthalmic ointment
Hepatitis B
5
Q
What do you do after you dry the baby? Where? How? Why? What should you do first?
A
Stimulate the newborn
If stable may be done on maternal abdomen
Head first then body
Promotes warmth and respirations
Remove wet linens
Cover with warm dry blankets and hat
6
Q
What is skin to skin? What does it do for newborn?
A
Newborn placed directly on maternal abdomen after delivery
Kangaroo reflex- mom increases her temp until newborn’s temp normalizes
Olfactory stimulation so newborn can find nipple
7
Q
What does bulb suctioning do? What should be suctioned 1st? 2nd?
A
Help clear oro/naso pharynx
MOUTH 1st
NARES 2nd
8
Q
When do you use DeLee mucus trap suction? What needs to avoided?
A
Use if bulb ineffective
Avoid injury to mucus membranes and stimulation of vagus nerve (bradycardia)
9
Q
What does APGAR stand for? What are they used for?
A
Appearance
Pulse
Grimace
Activity
Respirations
Assessed to determine need for resuscitation
10
Q
What is a good APGARS score? When is it done?
A
Score of 7 or above=good
Done at 1 and 5 minutes after birth
Repeated q 5 min if score <7
11
Q
What should you do to prevent cold stress?
A
Keep newborn warm or rewarm newborn (Skin-to-skin contact, Radiant warmer, Warm blankets, Increase room temperature)
Keep newborn dry
Avoid exposure to cold surfaces (Warm hands and Pre-warm surfaces)
12
Q
How is identification done?
A
Foot prints are done
ID bands with identical numbers applied (Newborn- 2 bands, Mom- 1 band, Person of mom’s choice- 1 band)
Electronic security bands applied
13
Q
What is babies weight primarily made up of? When is baby weighed?
A
Water comprises 70-75% of the body weight
Usually weighed each day
14
Q
What are factors that may affect birth weight?
A
15
Q
What is average baby weight? Will they lose weight?
A
2500-4000g (5 lbs. 8 oz.- 8 lbs. 13 oz.)
In first 3-4 days may lose up to 10% of birth weight
16
Q
What is the average length of a term newborn? What are some issues with measuring them? How much do they grow in first 6 m?
A
Difficult to measure accurately
18-22 inches (48-52 cm)
Grow about 1 inch a month for first six months of life
17
Q
Head is about ___ of body size
A
1/4
18
Q
What should be measured on the head? Average?
A
Measure the occipital frontal head circumference (OFC)
13-14 inches (33-35 cm)
19
Q
Chest should be ___ smaller than the head. Average?
A
2 cm smaller than head
12-14 inches (30-35 cm)
20
Q
What is normal temp for newborn? Where it tested?
A
Axillary
36.5-37.2 C (97.7-99 F)
Skin temperature sensor-best placed over liver
21
Q
What are normal respirations for newborn?
A
30-60
22
Q
What does respiratory distress look like in newborn? Intervention?
A
grunting, retractions, nasal flaring
Clear airway if needed with bulb syringe
23
Q
What is the normal HR? What will you hear?
A
110-160
Irregular rate
Regular, soft “come & go” murmur
24
Q
What is the normal BP? Is this routinely measured?
A
70-50/45-40 mmHG at birth
May not be routinely measured on healthy newborns
25
When is E-mycin eye ointment required? How is it given? When?
Legally required for prevention of gonorrhea and chlamydia ophthalmic infections
At least ¼ inch strand
Within first hour of life- allow for period of bonding first
26
Why is vitamin K given at birth? Dose?
Prevention of hemorrhage
Lacks gut bacterial flora necessary for synthesizing vitamin K
One time injection
0.5-1 mg IM in vastus lateralis
Neonatal concentration 1 mg/0.5 ml
27
How many shot in Hep B vaccine? When is it begun? Where is it given?
Series of 3 shots to prevent Hep B infection
Some providers will begin series in the hospital
Given IM in vastus lateralis
28
When in Hep B immunoglobulin given?
Given to newborn if mother is Hepatitis B positive
29
When is a cord blood gas collected? What is it collected from? What are the findings?
Non-reassuring FHR or depressed neonate
Extra section of cord is obtained for arterial and venous blood samples
pH >7
Base excess < -12
30
When is a glucose level done? Considerations? Result?
May be done routinely for all newborns
Use heel warmer
>40% and <300%
31
What are the newborn risk factors for DM?
SGA, LGA, infant of diabetic mother
32
What is cord blood drawn for? Who draws it?
Blood type/Rh (All Rh negative moms or O+ moms)
Direct Coombs
Drawn by provider
33
When should gloves be used?
First bath
Diaper changes
Procedures
Assessing genitals
34
What should be stable before bath? Where? How many?
Given when temperature stable
In Nursery or at bedside
Usually only one given during hospital stay
35
What is the evidence behind immersion baths? What type of bath is given to a male with a circumcision?
less temperature drop (0.1 vs. 0.3), tolerated better by newborn, no increased risk of cord infection, and does not increase length of time for cord drying
With males that are circumcised do sponge bath until site healed
36
LGA means? Percentile?
Large for gestational age
>90th percentile on chart
37
AGA means? Percentile?
Appropriate for gestational age
Between 10th and 90th percentile
38
SGA means? Percentile?
Small for gestational age
Less than 10th percentile
39
LBW means? Weight?
Low birth weight
<2500 grams
Depending on gestational age may also be SGA
40
When is gestations age assessment done? Purpose? Tools used?
Done in the first four hours of birth
Confirm or establish gestational age
Ballard or Dubowitz are tools used
41
What numerical ratings are given in a generational age assessment? What could cause it to be repeated in 24 hours?
Physical maturity
Neuromuscular maturity
Neurological system is unstable for 24 hours so may need to repeat
42
What is looked at when rating physical maturity?(6)
Skin
Lanugo
Sole (plantar) creases
Areola and breast bud tissue
Ear form and cartilage distribution
Genitalia
43
When assessing the skin what are you looking for?
Assessment includes texture, cracking, visualization of vessels, lanugo
44
When looking at plantar surfaces what are you looking for?
Sole of the foot is assessed for how much of it is covered with creases
45
When you are looking at the breast what are you looking for?
Assessment of the areolar development and measurement of the breast bud
46
When looking at the ear/cartilage what are you looking for?
Assessment of how well formed the pinna is and how quickly it recoils
47
When looking at the male genitalia what are you looking for?
Assessment consists of size of scrotal sac, descent of the testes, and amount of wrinkles on the scrotum
48
When looking at the female genitalia what are you looking for?
Size of labia majora, labia minora and clitoris is assessed
49
What is being rated for neuromuscular activity?(6)
Posture
Square Window (wrist)
Arm recoil
Popliteal Angle
Scarf Sign
Heel to ear
50
When looking at the posture what are you looking for?
Resting posture
Extension vs. flexion
51
When looking at the square window what are you looking for?
The newborn’s hand is flexed toward the forearm and the angle between the hand and wrist is noted
52
When looking at the arm recoil what are you looking for?
Arms are held extended at the baby’s sides for 5 sec then released
Once released the elbows should be flexed rapidly in a term newborn
Angle of flexion at the elbow is measured
53
When looking at the scarf what are you looking for?
Pull hand across chest towards opposite shoulder until resistance is met
54
When looking at the heel to ear what are you looking for? What could it be affected by?
May be affected by position in utero
Foot is gently drawn toward ear until resistance is felt or bottom begins to lift off the bed
55
When assessing popliteal angle what are you looking at?
Thigh flexed on the abdomen and the toes are grasped to attempt to straighten the leg
Once resistance is met the angle behind the knee is estimated
56
What should be done 4 hours prior to discharge?
Vital signs
Temperature regulation
Neonatal assessment
Promote parent – infant attachment
Promote sibling attachment
Prevent infant abduction
Assist with feedings
Education (Safety & Newborn care)
Labs
Procedures
Provide information on newborn characteristics
57
What is the NIPS pain scale?
Facial expression (Grimace vs. relaxed)
Cry (Vigorous, none, whimpering)
Breathing (Relaxed vs. different than baseline)
Alertness (Sleeping, active alert)
Arms/Legs (Relaxed vs. flexed)
58
In a neonatal assessment what is assessed for on head?
Symmetry
Fontanels (Anterior & Posterior)
Suture lines
Caput/cephalohemtoma
Bruising, lacerations
59
In a neonatal assessment what is assessed for on face?
Eyes- clearness/redness/discharge
Nose
Mouth/gums/palate/tongue
Ears-canals present, pinna, normal position
60
In a neonatal assessment what is assessed for on neck?
Short, stubby
Clavicles-check for intactness
61
In a neonatal assessment what is assessed for on chest?
Auscultate heart
Lungs
Assess for shape, use of accessory muscles
Breast buds
Normal to have abdominal breathing
62
In a neonatal assessment what is assessed for on abdomen?
Assess bowel sounds
Palpate for masses
Cord site (Redness, discharge and Number of vessels)
63
In a neonatal assessment what is assessed for on hands?
Number of digits
Creases
Grip reflex
Band number/correct information
64
In a neonatal assessment what is assessed for on arms?
Check brachial pulses
Moro reflex
Moving appropriately
65
In a neonatal assessment what is assessed for on legs?
Femoral pulses
Congenital hip dislocation- also called hip click
Gluteal folds symmetric
Hernias
66
In a neonatal assessment what is assessed for on feet?
Band number, electronic monitoring system
Number of toes, webbing (syndactyly)
Grasp reflex
Babinski reflex
Assessment for club foot
67
In a neonatal assessment what is assessed for on back?
Straight spine, intact
Sacral dimples
Nevus pilosus-tuft of hair
68
In a neonatal assessment what is assessed for on anus?
Check for patency
Stools
69
In a neonatal assessment what is assessed for on male genitalia?
Urinary meatus correctly positioned
Scrotum (Hydrocele or Swollen)
Testes descended
70
In a neonatal assessment what is assessed for on female genitalia?
Labia-note how well majora covers minora and clitoris
Psuedomenstruation
Vaginal skin tags
71
What is facial palsy? When is it most noticeable? When does it typically disappear?
Asymmetry of the face due to injury of the facial nerve
Most noticeable when infant cries and the affected side is immobile
Usually disappears in a few weeks but may be permanent
72
What are different ear positions?
Normal
Twisted or low set
True low set
73
What is a cleft lip/palate?
A incomplete closure of lip and/or palate
May be unilateral or bilateral
May only affect soft palate
74
What is a single transverse palmer crease on hand?
75
When checking for femoral pulses what are checking? What does absence mean?
Assess for equality
Absence may be sign of coarctation of aorta or hypovolemia
76
What are two maneuvers for congenital hip dislocation?
Barlow
Ortolani
77
How do you assess for club foot?
Newborn’s foot is moved to midline—resistance indicates talipes equinovarus
78
When does moro disappear?
by 6 months
79
When does rooting disappear?
by 4-7 months
80
When does sucking disappear?
by 12 months
81
When does palmer grasp disappear?
lessens by 3-4 months
82
When does stepping disappear?
4-8 weeks
83
When does tunic neck disappear?
3-4 months
84
When does babinski disappear?
by 12 months
85
What is the caloric need of a newborn? Water requirement?
Caloric needs: 105-108 kcal/ kg/ day
Water requirements: 140-160 ml/ kg/ day
86
Formula has how many kcal/oz? What is the max oz/day? How much/often are feeds?
20 kcal/ 30 ml (1 ounce)
Max: 32 oz./ day
Per feeding: 2-4 oz./ feed q 3-5 hrs.
87
How many kcal is breast milk per oz? How often are they feeding? What is the difference in breast milk?
20kcal/oz
Less protein than formulas, easier on renal system
Newborns “feed on demand” q 1.5 – 3 hrs.
88
What should be documented with breast feeding? What should be assessed?
Documented number of minutes fed on each side
Assess LATCH score at least once a day and if the score is 5 or less then assess each feeding
89
When does the first void usually occur?
First 24-48 hours
90
What are 3 different types of newborn stools?
Meconium-thick, tarry, black, very sticky
Transitional-strange colors from green to yellow to brown
Breast milk stools
Breast fed babies poop more often, not as “stinky”
Yellow with curds
91
To be certain they are getting enough nutrition/volume the newborn should (after milk begins to come in)
Poop: 1+ a day
Pee: at least 6-8 wet diapers a day
92
What is overall included in the care of a newborn?
Procedures (CCHD screening, hearing screen, circumcision, car seat challenge)
Labs
Safety
Education
93
When is the critical congenital heart defect (CCHD) screening done? What does it include?
Done on all newborns between 24-48 hours
Pulse oximetry to look for hypoxemia
Right wrist– pre-ductal
One lower extremity– post-ductal
94
What is a normal/negative CCHD screening?
More than 95% in right hand or foot with less than 3% difference between right hand and right foot
95
What is a positive/abnormal CCHD screening?
Less than 90% in right hand or foot
90-95% in right hand or foot with more than 3% difference between the two (repeat this 2 more times and if same result positive)
96
When is a hearing screening done? What does it assess? What could prevent a newborn from passing their hearing test?
Done prior to discharge
Assesses brain wave activity related to transmission of sounds
Retained amniotic fluid in ears may prevent passing the hearing screen
97
What is a circumcision?
Removal of the penile glans prepuce (foreskin)
98
What are the reasons behind circumcision? Who is the final decision up to?
Culture/religious
Social- “look like daddy”
Medical benefits- decreased STIs and UTIs
Final decision up to parents
99
What are the types of circumcision?
Gomco clamp
Mogan Clamp
Plastibell
100
What do be used for pain management in a circumcision?
Dorsal penile nerve blocker (lidocaine injected at base of penis)
Acetaminophen (before an PRN 24 hrs after)
Emla cream
SweetEase
101
What is Emla cream? What should be done after applying it?
Topical cream applied to penis about 1 hr. prior to procedure
Cover with occlusive dressing
102
What is sweet ease? What does it do for the body?
24% sucrose solution- dripped into mouth during procedure and suck on pacifier or gloved finger
May be beneficial in promoting endorphin release and decrease discomfort
103
What are nursing responsibilities for a circumcision? (8)
Patient identification
Ensure provider has obtained parental consent and for signed
After procedure care
Apply direct pressure for active bleeding and notify provider if it doesn’t resolve
Monitor for signs of infection and bleeding throughout hospital stay
Document first void after circumcision
Analgesics for pain- use NIPS pain score
Educate parents
104
What is after procedure care for a circumcision?
Vaseline applied to circumcisions done with Gomco and Mogan clamps
Plastibell- no creams or ointments applied
Wash off any betadine
Check site for bleeding q 30 min x 2 hours
105
What should parents be educated about regarding a circumcision?
Signs of infection
Circumcision care
Encouraged to comfort newborn after procedure is completed
106
What is the car seat challenge? When is it done?
Done on preterm or late preterm infants
Monitor pulse oxymetry while sitting in car seat for at least the length to drive home
107
What is spot oxygenation checked?
If family lives at higher altitude may need to set up a spot pulse oxymetry at the altitude of home
108
What does the Metabolic Screening for Inborn Errors of Metabolism (IEM) test for? When is it collected?
Sometimes referred to as “PKU test”
Phenylketonuria (PKU), hypothyroidism, cystic fibrosis, galactosemia, homocystinuria, maple syrup disease, Sickle cell
1st check at 24 hours of age & then in 2 weeks
109
When is total bilirubin done? How does it help determine risk?
Usually done prior to discharge and prn
Plotted on graph with age on one side and total bilrubin level on other side to determine risk
110
What is high risk for total bilirubin? High intermediate? Low-intermediate? Low risk?
High risk: >95th percentile and repeat in 4-8 hours
High-intermediate: 75-95th percentile and release in 8-12 hours
Low-intermediate: 40-75th percentile and repeat in 48 hours
Low risk: <40th percentile and follow up in 3-5 days
111
What are normal ranges for a CBC?
WBC: 10-30
Hgb: > 14, < 20
Hct: > 43 %, < 63%
I/T ratio < 2 (> 2 indicates infection)
# of bands/# of neutrophils
112
What should be included in cord care?
Assess for signs of infection/bleeding
Keep dry- fold diaper away from stump
Clamp usually removed 24-72 hours after birth once cord begins to dry
Plain water and air drying promotes quicker separation and drying than does alcohol
113
How do you prevent infant abduction?
Identification bands are placed on mother, baby and one other person of mother’s choice
All personnel wear a special badge for identification
Electronic security bands have radio alarm system
ALWAYS CHECK BANDS WITH MOTHER AND SIGNIFICANT OTHER!
114
How do you prevent SIDS?
“Back to Sleep”
Place neonate in supine position for sleeping
Avoid pillows, loose blankets, bumper pads
Encourage smoking cessation for parents
115
What are seat recommendations?
Birth to age 2- rear facing car seat
2-4 years (or up to 40 lbs.)- forward facing car seat
4-8 years (or 4’9”)-booster seat
Best place-rear middle seat
Not near air bags
Must have prior to discharge
116
Can babies wear puffy jackets or swaddles in the carseat?
Need to make sure the blankets and clothes allow for belt to be correctly positioned between legs
Un-swaddle and then cover with blankets
117
What should be completed prior to discharge?
Admission and Discharge physical by pediatric provider (MD or NNP)
Follow-up appointment scheduled
Hearing screen completed
Metabolic Screening for Inborn Errors of Metabolism completed
Card given for repeat testing
CCHD screening completed and passed
Discharge instructions
118
When is early discharge?
within 48 hours
119
What are the guidelines for early discharge?
Term infant with normal exam
Stay of at least 12 hours
Able to maintain homeostasis
Feeding normally
Exam by pediatric provider
Follow-up appointment within 48 hours
All state required screening tests completed
Cord blood saved on O+ mothers
Parents able to demonstrate correct usage of approved car seat
120
What does home newborn care include?
Bulb syringe
Umbilical cord care
Hygiene
Circumcision care
How to take an axillary temperature
121
What are danger/warning signs once baby is home?
Vomiting (more than 1 feeding)/ Refuses to feed
Difficulty breathing
Drastic behavior changes to irritable or overly sleepy
Inability to void/ Diarrhea
Axillary temperature of 99.6 F or higher
Change in skin color- pale white, blue or yellow
Rashes
Umbilical stump infection signs- foul discharge, redness around site
Drainage from eyes or ears
122
What is polydactyly? What is the cause? Treatment?
Extra digits on hands or feet.
May be familial or associated with a syndrome—make sure to assess for other abnormal findings
Usually tied off or removed
123
What is vernix? What does it do? When does it start to go away?
White cheesy substance on skin
Consists of sebum & desquamated epithial cells
Protects and lubricates skin in-utero
Decreases as fetus nears term
124
What is acrocyanosis?
Hand and feet are blue due to poor circulation
125
What are tetangiectatic nevi? When do they go away?
Dark red spots on baby
AKA “Stork bites” (nape of neck) and “Angel’s kisses” (face)
No clinical significance and usually fade by 2nd year
126
What is erythema toxicum? Peak time? Where is it? Cause? Treatment?
AKA “Newborn rash”
No known cause and no treatment
Peak around 24-48 hrs.
Eruption of lesions surrounding the hair follicle
Moves around body and disappear spontaneously
127
What is slate gray spots? When do they go away? What is the consideration with these?
AKA Mongolian spots
Macular areas of blue/black pigmentation usually found on sacrum/buttocks
Fade by 2nd year
May be mistaken for bruises so very important to document them
128
What is nevus flammeus? Does it go away? Commonly located?
AKA “Port Wine Stain”
Capillary angioma
Non elevated, does not blanch and does not fade
Commonly on the face
129
What is milia? When does it go away?
Exposed sebaceous glands (looks like little white heads)
No clinical significance
Clear up spontaneously by 1 month
130
What are overriding structures? When do they go away? What can be affected?
Normal finding related to pressure exerted on head
Usually diminishes within a few days after birth
Head measurements may be affected
131
What is cephalohematoma?
Collection of blood between skull bone and periosteal membrane
Does not cross suture lines
132
What is Caput?
Collection of fluid under the scalp
Crosses suture line
133
What are natal teeth?
AKA “Milk teeth”
Not the primary teeth and are usually removed
134
What is Epstein pearls?
Keratin containing cysts often found on gums and palate
No clinical significance
135
What is syndactyly?
Webbing of fingers or toes
136
What is a sacral dimple? What could it be associated with? Testing?
May also be called a Pilonidal dimple
May be associated with spina bifida
If able to see the base of the dimple there is low risk of spina bifida
May need ultrasound to determine if there is a connection to spinal column
137
What is a sucking blister? Found where? Treatment?
Normal finding from vigorous fetal sucking
May be found on hands, feet, lips
May be intact or ruptured
No treatment needed
138
What is eyelid edema caused by? When does it resolve?
May be caused by a chemical conjunctivitis from ophthalmic ointments
Resolves in a few days after birth - Normal puffiness
139
What is lanugo?
Protective hair that is present inutero
As fetus matures lanugo disappears
140
What is pseudomentstruation? Usually occurs?
Withdrawal bleeding noted in female infants
Usually occurs day 3-4 after birth
141
What is different regarding the lungs in a newborn? (6)
No need for oxygenated blood from lungs
Blood shunted away from lungs
High pressure system
Pulmonary vessels are constricted
PaO2 is low
Fluid filled- 80-100 ml at birth
142
What does breathing practice do for the fetus?
allows development of chest wall muscles & diaphragm and lungs to grow
143
What is the foramen ovale?
Shunts blood from right atrium to left atrium
Shunts blood from pulmonary artery and lungs by never letting it get to the right ventricle
144
What is the ductus arteriosus?
Shunts blood away from pulmonary artery and lungs into the descending aorta
Shunts blood away from the left side of the heart
145
What is the ductus venosus?
Branches of umbilical vein that carries blood away from the fetal liver, directly into inferior vena cava
146
What do the umbilical arteries do?
Carries un-oxygenated blood from fetus to placenta
147
What do the umbilical vein do?
Carries oxygenated blood from placenta to fetus
148
How long does the neonatal period last?
lasts 28 days
149
What occurs after the first breath? (3)
With first breath blood flows to lungs
Umbilical arteries immediately constrict
Pulmonary bed moves from high resistance bed to low resistance bed
150
What occurs to the umbilical vein after birth?
continues to receive blood from intervillous space
Delayed vs. immediate cord clamping
151
What occurs in the respiratory immediately postpartum?
Must move fluid out of lungs
Establish blood flow to lungs
Ensure blood circulating through lungs becomes oxygenated
Establish functional residual capacity—air remaining in the lungs at the end of exhalation
152
Fetal neonatal pulmonary and CV cascade
First breath
Increased PaO2
Increased pulmonary BF
Decreased pulmonary vascular constriction
Increased blood return to left heart
Mechanical closure of ducti
Blood pumped from lungs to body
Blood returned to right side of heart
Placental system, UA/UV shut down
Blood is oxygenated in neonatal lungs and sent to the body
153
What are the mechanical to help initiate the first breath? (4)
Chest compression increases intrathoracic pressure
Some fluid expelled
Fluid reabsorbed
Chest recoil causes passive air entry into alveoli
154
What are the stimuli to help initiate the first breath?(4) What do they do?
Auditory
Visual
Touch/pain
Proprioceptor Stimulation (Baby scares itself)
Helps maintain respirations
155
What are the chemical changes to help initiate the first breath?
Transitory asphyxia (Rise in PCO2, decreased pH, decreased O2)
Chemoreceptors stimulated & triggers respiratory center
Prostaglandin levels fall increasing respiratory drive
156
What are the thermal stimuli to initiate the first breath?
Temperature of environment drops from 98.6 F to about 70F
Skin sensors stimulated
Causes rhythmic respirations
157
What mechanisms cause the foramen ovale to close?
With first breath
PaO2 rises
Pulmonary arteries dilate
Increased blood returns to left atrium
Foramen ovale closes due to increased pressure gradient in left side of heart
158
When are the foramen ovale functionally closed? What could cause it to reopen?
at 1-2 hours
Crying, acidosis, cold stress or hypoxia may cause reopening
159
When is the foramen ovale permanently close?
by 6 months
160
What causes the ductus arteriosus to close?
Constriction of ductus arteriosus caused by (Increased PaO2 and drop in prostaglandins E2 from placenta)
Pressure from left heart causes mechanical closure of ductus arteriosus
161
When is the functional closure of the ductus arteriosus
10-15 hours
162
Fibrosis of ductus arteriosus occurs when? What does it become?
Complete within 4 weeks
Ligamentum venosum
163
What occurs when the ductus venosus closes?
Redistribution of blood through newborn liver
Flows through hepatic vein into the inferior vena cava
Increases blood return to right side of heart
164
What causes mechanical closure of ductus venosus?
umbilical cord clamping/cutting
165
When does fibrosis of the ductus venosus occur? What does it become?
within 2 months
Ligamentum venosus
166
What is normal oxygenation in utero? How long does it take to get over 90%?
Normal oxygen saturation inutero-60%
Takes up to 10 minutes to be >90%
167
Where should the pulse ox be placed on newborn? Why?
On right wrist- same oxygen saturation as vital organs
Pre-ductal- blood prior to reaching ductus arteriosus before mixing with blood with low O2 levels coming from the pulmonary artery across the ductus
168
What temp does newborns require? What does this do?
Neutral Thermal Environment
higher ambient temperature than adults:
89.6-93.2 F ideal
Minimizes rate of oxygen consumption and consumption of calories
169
What are occurs r/t newborns skin?
Large body surface in relation to mass
Thin epidermis
Limited subcutaneous fat
Blood vessels nearer to skin
170
What does different posture of a newborn cause r/t heat?
Flexed promotes heat retention
Extended increases heat loss
171
How does a newborn produce heat for themselves? (3)
Increased basal metabolic rate --> result of increased glucose conversion to energy
Muscular activity
Non-shivering thermogenesis -->
stimulation of SNS by the cold on skin receptors causes newborn to use brown fat stores to produce heat --> metabolism of triglycerides for heat production
172
When does brown fat appear? How much does the newborn have? Does it replenish?
Appears around 26-30 weeks gestation
Comprises 2%-7% of infant’s body weight
Once depleted, brown fat is not replenished
173
How much heat do newborns lose? Why?
Lose about 4 x as much heat as adult
Inability to maintain normal temperature is usually related to excessive heat loss not impaired heat production
174
What are four methods of heat loss?
Convection
Radiation
Evaporation
Conduction
175
Once newborn is dried, what is the most common method of heat loss?
Convection and radiation
176
What is convection?
Heat lost to cooler ambient air
177
What is radiation?
Heat lost to cooler surfaces in close proximity
178
What is evaporation?
Heat lost as skin moisture is vaporized
179
What is conduction?
Heat lost to cooler surface area in direct contact with body
180
What is cold stress? What does this lead to?
Increased heat production and metabolism in response to cold
Leads to hypoglycemia
Increased O2 consumption
Increased anaerobic metabolism
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Metabolic acidosis occurs r/t to cold stress leading to
pH decreases, PaO2 drops, PaCO2 rises
Ductus arteriosus reopens
Pulmonary vasoconstriction occurs
Blood shunted away from lungs
Increased pulmonary vascular resistance
REVERTS BACK TO FETAL CIRCULATION but there is no placenta to supply O2
182
How much blood volume does a term newborn have? What are the contributing factors?
~80-85 ml/kg
Antenatal hemorrhage
Rh alloimmunization
Time of cord clamping/ level of baby R/T placenta
183
Fetal RBC have... this contributes to ..
Fetal RBC have short half life
Contributes to physiological jaundice
184
What kind of anemia do newborns have? Do they clot normally?
Physiologic anemia
Abnormal clotting
185
Due to the neonatal liver being immature there is... (2)
Lack glucuronyl transferase- more difficult to conjugate bilirubin and excrete it
Higher levels of unconjugated bilirubin leads to physiological jaundice
186
Since the neonatal gut is sterile this means
No bacteria to synthesize vitamin K
Liver does not produce vitamin K dependent clotting factors-- factors I, VII, IX & X
187
Can you palpate the liver in a newborn?
Yes, about 40% of abdominal cavity is the liver
188
How long are iron stores from maternal intake sufficient?
5 months
189
What is bilirubin conjugation?
Breakdown of heme-containing proteins
190
What occurs during bilirubin conjugation?
Conversion of fat soluble to water soluble
Total serum bilirubin= conjugated (direct) + unconjugated (indirect) bilirubin
191
After the the ___ must conjugate bilirubin. What helps this structure do this?
Liver
Early feedings & getting gut moving to pass stools assists liver in removal of conjugated bilirubin
192
When does physiologic jaundice occur? When does it peak? When is it no longer apparent?
Appears: after 24 hours
Peaks: 3-4 days
No longer apparent: 14 days
193
What are the causes of physiologic jaundice? Is it normal?
Increased breakdown of fetal RBCs
Impaired conjugation of bilirubin- lack of glucuronyl transferase
More bilirubin reabsorbed by GI tract
Normal adaptation after birth
194
What is the main source of energy in a newborn after birth? Why is their fuel source consumed so quickly?
Glucose main source of energy 4–6 h after birth
Stress of delivery rapidly uses up hepatic glycogen
Carbohydrate reserves low
195
Once there is no longer carbohydrates what do the baby move to for energy?
Fat metabolism
196
What does a decrease GFR lead to in a newborn?
Limited capacity to concentrate urine
Urine may be cloudy
197
How much urine can the bladder hold?
6-44 ml
198
When does the newborn void by?
48 hours
199
How much urine is made/voided in the first 2 days? How much in 3 days?
First 2 days of life: produce about 15 ml/kg/day = 2 to 6 wet diapers/day
Day 3: produce 25 ml/kg/day = 5-25 wet diapers/day
200
Why does pseudo menstruation occur in newborns?
maternal hormone withdrawal
201
What are the GI adaptations in newborns?
Adequate intestinal and pancreatic enzymes
Experienced at swallowing/sucking
Stomach capacity 50–60 ml (1-2 oz.) capacity
Cardiac sphincter immature
5–10% shift of intracellular fluid
202
Because newborns have adequate intestinal and pancreatic enzymes what occurs?
Proteins require more digestion
Absorbs and digests fats less efficiently
203
How many calories does a newborn require?
105-108 kcal/kg/day
204
What enters the stomach immediately after birth?
Air
205
D/t the immune system not fully active, ___ is not a reliable indicator of infection
Fever
206
What immunoglobulins are present in newborn?
IgG: Only type small enough to cross placenta; passive acquired immunity from mother usually in 3rd trimester
IgM: begin to produce on own by 15 weeks of age
IgA: receive from breast milk especially colostrum
207
What are the neuro adaptations in a newborn?
Brain one-quarter size of adult brain
Myelination of nerve fibers incomplete
Responses to different stresses vary
Perinatal factors (antenatal maternal substance abuse, antenatal CNS abnormalities, congenital CNS abnormalities)
Maturity of neurological system progresses in cephalocaudal direction
208
What can happen in deep sleep with newborns?
Reflexes diminished
209
When is not a good time to feed an infant?
Crying vigorously & inconsolable will not feed well
Deep sleep won’t be able to wake to feed
210
When is the optimal time to promote bonding and attachment?
Quiet time
211
What is the first period of reactivity?
Birth to about 30 minutes after birth
Bonding, initiate breastfeeding
Respirations and heart rate rapid
212
What occurs in the period of inactivity to sleep?
Heart rate, respirations decrease
Sleep phase will last from minutes to 2–4 hours
Deep sleep
213
What happens in the second period of reactivity? How long is it?
Awake and alert
Physiologic responses vary
GI tract more active
Good time for bonding
Lasts 2 to 5 hours
214
What is deep/quiet sleep?
Closed eyes with no eye movements
Regular, even breathing
Jerky movements or startles easily
215
What is REM sleep?
Eyes closed with eye movements noted
Irregular breathing
Irregular sucking motions
Minimal activity
External stimuli will initiate a startle reaction
216
What is drowsy alert?
Open or closed eyes
Semi-dozing appearance
Slow regular movements
Mild startles may be noted
217
What is wide awake alert?
Alert and focuses on objects
Minimal motor activity
Good time to feed
218
What is active alert?
Eyes open
Intense motor activity with thrusting movements of the extremities
Startles easily and increased movement from stimuli
219
What is crying alert?
Intense crying
Jerky movements
Attention getting
Very hard to feed in this state
220
How do babies self sooth?
Sucking on hand, toes, fingers, lip
Hand to mouth
221
What is habitation?
Eventually blocks out annoying stimuli
222
What is orientation?
Follows faces, shiny objects, lights
223
What are visual adaptations for newborns?
Prefers the human face and eyes
High contrast items
8-15 inches ideal distance for focusing
224
What is the auditory response?
Responds to auditory stimuli with organized behavior
225
Are newborns sensitive to touch?
Yes very sensitive to touch
226
When can a baby differentiate moms smell? What nerve helps them do this?
by 1 week
Olfactory
227
What are babies able to taste? When do taste buds fully develop?
Sweet and sour
Fully develop at 4 years old
228
What reflex is exhibited when newborn is hungry?
Rooting
