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OB > Normal Newborn/Newborn Adaptations > Flashcards

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

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2
Q

What is D-A-B-C?

A

Dry
Airway
Breathing
Circulation

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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

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4
Q

What medications should be given in the first 4 hours of life?

A

Vitamin K
E-mycin opthalmic ointment
Hepatitis B

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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

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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

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7
Q

What does bulb suctioning do? What should be suctioned 1st? 2nd?

A

Help clear oro/naso pharynx

MOUTH 1st

NARES 2nd

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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)

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9
Q

What does APGAR stand for? What are they used for?

A

Appearance
Pulse
Grimace
Activity
Respirations

Assessed to determine need for resuscitation

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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

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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)

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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

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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

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14
Q

What are factors that may affect birth weight?

A
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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

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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

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17
Q

Head is about ___ of body size

A

1/4

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18
Q

What should be measured on the head? Average?

A

Measure the occipital frontal head circumference (OFC)

13-14 inches (33-35 cm)

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19
Q

Chest should be ___ smaller than the head. Average?

A

2 cm smaller than head

12-14 inches (30-35 cm)

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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

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21
Q

What are normal respirations for newborn?

A

30-60

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22
Q

What does respiratory distress look like in newborn? Intervention?

A

grunting, retractions, nasal flaring

Clear airway if needed with bulb syringe

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23
Q

What is the normal HR? What will you hear?

A

110-160

Irregular rate
Regular, soft “come & go” murmur

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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

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25
Q

When is E-mycin eye ointment required? How is it given? When?

A

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

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26
Q

Why is vitamin K given at birth? Dose?

A

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

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27
Q

How many shot in Hep B vaccine? When is it begun? Where is it given?

A

Series of 3 shots to prevent Hep B infection

Some providers will begin series in the hospital

Given IM in vastus lateralis

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28
Q

When in Hep B immunoglobulin given?

A

Given to newborn if mother is Hepatitis B positive

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29
Q

When is a cord blood gas collected? What is it collected from? What are the findings?

A

Non-reassuring FHR or depressed neonate

Extra section of cord is obtained for arterial and venous blood samples

pH >7
Base excess < -12

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30
Q

When is a glucose level done? Considerations? Result?

A

May be done routinely for all newborns

Use heel warmer

> 40% and <300%

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31
Q

What are the newborn risk factors for DM?

A

SGA, LGA, infant of diabetic mother

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32
Q

What is cord blood drawn for? Who draws it?

A

Blood type/Rh (All Rh negative moms or O+ moms)
Direct Coombs

Drawn by provider

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33
Q

When should gloves be used?

A

First bath
Diaper changes
Procedures
Assessing genitals

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34
Q

What should be stable before bath? Where? How many?

A

Given when temperature stable

In Nursery or at bedside

Usually only one given during hospital stay

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35
Q

What is the evidence behind immersion baths? What type of bath is given to a male with a circumcision?

A

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

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36
Q

LGA means? Percentile?

A

Large for gestational age

> 90th percentile on chart

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37
Q

AGA means? Percentile?

A

Appropriate for gestational age

Between 10th and 90th percentile

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38
Q

SGA means? Percentile?

A

Small for gestational age

Less than 10th percentile

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39
Q

LBW means? Weight?

A

Low birth weight

<2500 grams
Depending on gestational age may also be SGA

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40
Q

When is gestations age assessment done? Purpose? Tools used?

A

Done in the first four hours of birth

Confirm or establish gestational age

Ballard or Dubowitz are tools used

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41
Q

What numerical ratings are given in a generational age assessment? What could cause it to be repeated in 24 hours?

A

Physical maturity
Neuromuscular maturity

Neurological system is unstable for 24 hours so may need to repeat

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42
Q

What is looked at when rating physical maturity?(6)

A

Skin
Lanugo
Sole (plantar) creases
Areola and breast bud tissue
Ear form and cartilage distribution
Genitalia

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43
Q

When assessing the skin what are you looking for?

A

Assessment includes texture, cracking, visualization of vessels, lanugo

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44
Q

When looking at plantar surfaces what are you looking for?

A

Sole of the foot is assessed for how much of it is covered with creases

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45
Q

When you are looking at the breast what are you looking for?

A

Assessment of the areolar development and measurement of the breast bud

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46
Q

When looking at the ear/cartilage what are you looking for?

A

Assessment of how well formed the pinna is and how quickly it recoils

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47
Q

When looking at the male genitalia what are you looking for?

A

Assessment consists of size of scrotal sac, descent of the testes, and amount of wrinkles on the scrotum

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48
Q

When looking at the female genitalia what are you looking for?

A

Size of labia majora, labia minora and clitoris is assessed

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49
Q

What is being rated for neuromuscular activity?(6)

A

Posture
Square Window (wrist)
Arm recoil
Popliteal Angle
Scarf Sign
Heel to ear

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50
Q

When looking at the posture what are you looking for?

A

Resting posture

Extension vs. flexion

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51
Q

When looking at the square window what are you looking for?

A

The newborn’s hand is flexed toward the forearm and the angle between the hand and wrist is noted

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52
Q

When looking at the arm recoil what are you looking for?

A

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

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53
Q

When looking at the scarf what are you looking for?

A

Pull hand across chest towards opposite shoulder until resistance is met

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54
Q

When looking at the heel to ear what are you looking for? What could it be affected by?

A

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

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55
Q

When assessing popliteal angle what are you looking at?

A

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

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56
Q

What should be done 4 hours prior to discharge?

A

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

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57
Q

What is the NIPS pain scale?

A

Facial expression (Grimace vs. relaxed)
Cry (Vigorous, none, whimpering)
Breathing (Relaxed vs. different than baseline)
Alertness (Sleeping, active alert)
Arms/Legs (Relaxed vs. flexed)

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58
Q

In a neonatal assessment what is assessed for on head?

A

Symmetry
Fontanels (Anterior & Posterior)
Suture lines
Caput/cephalohemtoma
Bruising, lacerations

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59
Q

In a neonatal assessment what is assessed for on face?

A

Eyes- clearness/redness/discharge
Nose
Mouth/gums/palate/tongue
Ears-canals present, pinna, normal position

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60
Q

In a neonatal assessment what is assessed for on neck?

A

Short, stubby
Clavicles-check for intactness

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61
Q

In a neonatal assessment what is assessed for on chest?

A

Auscultate heart
Lungs
Assess for shape, use of accessory muscles
Breast buds
Normal to have abdominal breathing

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62
Q

In a neonatal assessment what is assessed for on abdomen?

A

Assess bowel sounds
Palpate for masses
Cord site (Redness, discharge and Number of vessels)

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63
Q

In a neonatal assessment what is assessed for on hands?

A

Number of digits
Creases
Grip reflex
Band number/correct information

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64
Q

In a neonatal assessment what is assessed for on arms?

A

Check brachial pulses
Moro reflex
Moving appropriately

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65
Q

In a neonatal assessment what is assessed for on legs?

A

Femoral pulses
Congenital hip dislocation- also called hip click
Gluteal folds symmetric
Hernias

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66
Q

In a neonatal assessment what is assessed for on feet?

A

Band number, electronic monitoring system
Number of toes, webbing (syndactyly)
Grasp reflex
Babinski reflex
Assessment for club foot

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67
Q

In a neonatal assessment what is assessed for on back?

A

Straight spine, intact
Sacral dimples
Nevus pilosus-tuft of hair

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68
Q

In a neonatal assessment what is assessed for on anus?

A

Check for patency
Stools

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69
Q

In a neonatal assessment what is assessed for on male genitalia?

A

Urinary meatus correctly positioned
Scrotum (Hydrocele or Swollen)
Testes descended

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70
Q

In a neonatal assessment what is assessed for on female genitalia?

A

Labia-note how well majora covers minora and clitoris
Psuedomenstruation
Vaginal skin tags

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71
Q

What is facial palsy? When is it most noticeable? When does it typically disappear?

A

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

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72
Q

What are different ear positions?

A

Normal

Twisted or low set

True low set

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73
Q

What is a cleft lip/palate?

A

A incomplete closure of lip and/or palate

May be unilateral or bilateral

May only affect soft palate

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74
Q

What is a single transverse palmer crease on hand?

A
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75
Q

When checking for femoral pulses what are checking? What does absence mean?

A

Assess for equality

Absence may be sign of coarctation of aorta or hypovolemia

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76
Q

What are two maneuvers for congenital hip dislocation?

A

Barlow
Ortolani

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77
Q

How do you assess for club foot?

A

Newborn’s foot is moved to midline—resistance indicates talipes equinovarus

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78
Q

When does moro disappear?

A

by 6 months

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79
Q

When does rooting disappear?

A

by 4-7 months

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80
Q

When does sucking disappear?

A

by 12 months

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81
Q

When does palmer grasp disappear?

A

lessens by 3-4 months

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82
Q

When does stepping disappear?

A

4-8 weeks

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83
Q

When does tunic neck disappear?

A

3-4 months

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84
Q

When does babinski disappear?

A

by 12 months

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85
Q

What is the caloric need of a newborn? Water requirement?

A

Caloric needs: 105-108 kcal/ kg/ day

Water requirements: 140-160 ml/ kg/ day

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86
Q

Formula has how many kcal/oz? What is the max oz/day? How much/often are feeds?

A

20 kcal/ 30 ml (1 ounce)

Max: 32 oz./ day

Per feeding: 2-4 oz./ feed q 3-5 hrs.

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87
Q

How many kcal is breast milk per oz? How often are they feeding? What is the difference in breast milk?

A

20kcal/oz

Less protein than formulas, easier on renal system

Newborns “feed on demand” q 1.5 – 3 hrs.

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88
Q

What should be documented with breast feeding? What should be assessed?

A

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

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89
Q

When does the first void usually occur?

A

First 24-48 hours

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90
Q

What are 3 different types of newborn stools?

A

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

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91
Q

To be certain they are getting enough nutrition/volume the newborn should (after milk begins to come in)

A

Poop: 1+ a day
Pee: at least 6-8 wet diapers a day

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92
Q

What is overall included in the care of a newborn?

A

Procedures (CCHD screening, hearing screen, circumcision, car seat challenge)
Labs
Safety
Education

93
Q

When is the critical congenital heart defect (CCHD) screening done? What does it include?

A

Done on all newborns between 24-48 hours

Pulse oximetry to look for hypoxemia
Right wrist– pre-ductal
One lower extremity– post-ductal

94
Q

What is a normal/negative CCHD screening?

A

More than 95% in right hand or foot with less than 3% difference between right hand and right foot

95
Q

What is a positive/abnormal CCHD screening?

A

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
Q

When is a hearing screening done? What does it assess? What could prevent a newborn from passing their hearing test?

A

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
Q

What is a circumcision?

A

Removal of the penile glans prepuce (foreskin)

98
Q

What are the reasons behind circumcision? Who is the final decision up to?

A

Culture/religious
Social- “look like daddy”
Medical benefits- decreased STIs and UTIs

Final decision up to parents

99
Q

What are the types of circumcision?

A

Gomco clamp
Mogan Clamp
Plastibell

100
Q

What do be used for pain management in a circumcision?

A

Dorsal penile nerve blocker (lidocaine injected at base of penis)
Acetaminophen (before an PRN 24 hrs after)
Emla cream
SweetEase

101
Q

What is Emla cream? What should be done after applying it?

A

Topical cream applied to penis about 1 hr. prior to procedure

Cover with occlusive dressing

102
Q

What is sweet ease? What does it do for the body?

A

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
Q

What are nursing responsibilities for a circumcision? (8)

A

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
Q

What is after procedure care for a circumcision?

A

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
Q

What should parents be educated about regarding a circumcision?

A

Signs of infection
Circumcision care
Encouraged to comfort newborn after procedure is completed

106
Q

What is the car seat challenge? When is it done?

A

Done on preterm or late preterm infants

Monitor pulse oxymetry while sitting in car seat for at least the length to drive home

107
Q

What is spot oxygenation checked?

A

If family lives at higher altitude may need to set up a spot pulse oxymetry at the altitude of home

108
Q

What does the Metabolic Screening for Inborn Errors of Metabolism (IEM) test for? When is it collected?

A

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
Q

When is total bilirubin done? How does it help determine risk?

A

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
Q

What is high risk for total bilirubin? High intermediate? Low-intermediate? Low risk?

A

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
Q

What are normal ranges for a CBC?

A

WBC: 10-30
Hgb: > 14, < 20
Hct: > 43 %, < 63%
I/T ratio < 2 (> 2 indicates infection)
# of bands/# of neutrophils

112
Q

What should be included in cord care?

A

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
Q

How do you prevent infant abduction?

A

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
Q

How do you prevent SIDS?

A

“Back to Sleep”
Place neonate in supine position for sleeping
Avoid pillows, loose blankets, bumper pads
Encourage smoking cessation for parents

115
Q

What are seat recommendations?

A

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
Q

Can babies wear puffy jackets or swaddles in the carseat?

A

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
Q

What should be completed prior to discharge?

A

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
Q

When is early discharge?

A

within 48 hours

119
Q

What are the guidelines for early discharge?

A

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
Q

What does home newborn care include?

A

Bulb syringe
Umbilical cord care
Hygiene
Circumcision care
How to take an axillary temperature

121
Q

What are danger/warning signs once baby is home?

A

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
Q

What is polydactyly? What is the cause? Treatment?

A

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
Q

What is vernix? What does it do? When does it start to go away?

A

White cheesy substance on skin
Consists of sebum & desquamated epithial cells

Protects and lubricates skin in-utero

Decreases as fetus nears term

124
Q

What is acrocyanosis?

A

Hand and feet are blue due to poor circulation

125
Q

What are tetangiectatic nevi? When do they go away?

A

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
Q

What is erythema toxicum? Peak time? Where is it? Cause? Treatment?

A

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
Q

What is slate gray spots? When do they go away? What is the consideration with these?

A

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
Q

What is nevus flammeus? Does it go away? Commonly located?

A

AKA “Port Wine Stain”
Capillary angioma

Non elevated, does not blanch and does not fade

Commonly on the face

129
Q

What is milia? When does it go away?

A

Exposed sebaceous glands (looks like little white heads)
No clinical significance

Clear up spontaneously by 1 month

130
Q

What are overriding structures? When do they go away? What can be affected?

A

Normal finding related to pressure exerted on head

Usually diminishes within a few days after birth

Head measurements may be affected

131
Q

What is cephalohematoma?

A

Collection of blood between skull bone and periosteal membrane

Does not cross suture lines

132
Q

What is Caput?

A

Collection of fluid under the scalp
Crosses suture line

133
Q

What are natal teeth?

A

AKA “Milk teeth”
Not the primary teeth and are usually removed

134
Q

What is Epstein pearls?

A

Keratin containing cysts often found on gums and palate
No clinical significance

135
Q

What is syndactyly?

A

Webbing of fingers or toes

136
Q

What is a sacral dimple? What could it be associated with? Testing?

A

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
Q

What is a sucking blister? Found where? Treatment?

A

Normal finding from vigorous fetal sucking

May be found on hands, feet, lips

May be intact or ruptured

No treatment needed

138
Q

What is eyelid edema caused by? When does it resolve?

A

May be caused by a chemical conjunctivitis from ophthalmic ointments

Resolves in a few days after birth - Normal puffiness

139
Q

What is lanugo?

A

Protective hair that is present inutero

As fetus matures lanugo disappears

140
Q

What is pseudomentstruation? Usually occurs?

A

Withdrawal bleeding noted in female infants

Usually occurs day 3-4 after birth

141
Q

What is different regarding the lungs in a newborn? (6)

A

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
Q

What does breathing practice do for the fetus?

A

allows development of chest wall muscles & diaphragm and lungs to grow

143
Q

What is the foramen ovale?

A

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
Q

What is the ductus arteriosus?

A

Shunts blood away from pulmonary artery and lungs into the descending aorta

Shunts blood away from the left side of the heart

145
Q

What is the ductus venosus?

A

Branches of umbilical vein that carries blood away from the fetal liver, directly into inferior vena cava

146
Q

What do the umbilical arteries do?

A

Carries un-oxygenated blood from fetus to placenta

147
Q

What do the umbilical vein do?

A

Carries oxygenated blood from placenta to fetus

148
Q

How long does the neonatal period last?

A

lasts 28 days

149
Q

What occurs after the first breath? (3)

A

With first breath blood flows to lungs

Umbilical arteries immediately constrict

Pulmonary bed moves from high resistance bed to low resistance bed

150
Q

What occurs to the umbilical vein after birth?

A

continues to receive blood from intervillous space

Delayed vs. immediate cord clamping

151
Q

What occurs in the respiratory immediately postpartum?

A

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
Q

Fetal neonatal pulmonary and CV cascade

A

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
Q

What are the mechanical to help initiate the first breath? (4)

A

Chest compression increases intrathoracic pressure
Some fluid expelled
Fluid reabsorbed
Chest recoil causes passive air entry into alveoli

154
Q

What are the stimuli to help initiate the first breath?(4) What do they do?

A

Auditory
Visual
Touch/pain
Proprioceptor Stimulation (Baby scares itself)

Helps maintain respirations

155
Q

What are the chemical changes to help initiate the first breath?

A

Transitory asphyxia (Rise in PCO2, decreased pH, decreased O2)
Chemoreceptors stimulated & triggers respiratory center
Prostaglandin levels fall increasing respiratory drive

156
Q

What are the thermal stimuli to initiate the first breath?

A

Temperature of environment drops from 98.6 F to about 70F
Skin sensors stimulated
Causes rhythmic respirations

157
Q

What mechanisms cause the foramen ovale to close?

A

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
Q

When are the foramen ovale functionally closed? What could cause it to reopen?

A

at 1-2 hours

Crying, acidosis, cold stress or hypoxia may cause reopening

159
Q

When is the foramen ovale permanently close?

A

by 6 months

160
Q

What causes the ductus arteriosus to close?

A

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
Q

When is the functional closure of the ductus arteriosus

A

10-15 hours

162
Q

Fibrosis of ductus arteriosus occurs when? What does it become?

A

Complete within 4 weeks

Ligamentum venosum

163
Q

What occurs when the ductus venosus closes?

A

Redistribution of blood through newborn liver
Flows through hepatic vein into the inferior vena cava
Increases blood return to right side of heart

164
Q

What causes mechanical closure of ductus venosus?

A

umbilical cord clamping/cutting

165
Q

When does fibrosis of the ductus venosus occur? What does it become?

A

within 2 months

Ligamentum venosus

166
Q

What is normal oxygenation in utero? How long does it take to get over 90%?

A

Normal oxygen saturation inutero-60%

Takes up to 10 minutes to be >90%

167
Q

Where should the pulse ox be placed on newborn? Why?

A

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
Q

What temp does newborns require? What does this do?

A

Neutral Thermal Environment

higher ambient temperature than adults:
89.6-93.2 F ideal

Minimizes rate of oxygen consumption and consumption of calories

169
Q

What are occurs r/t newborns skin?

A

Large body surface in relation to mass
Thin epidermis
Limited subcutaneous fat
Blood vessels nearer to skin

170
Q

What does different posture of a newborn cause r/t heat?

A

Flexed promotes heat retention
Extended increases heat loss

171
Q

How does a newborn produce heat for themselves? (3)

A

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
Q

When does brown fat appear? How much does the newborn have? Does it replenish?

A

Appears around 26-30 weeks gestation

Comprises 2%-7% of infant’s body weight

Once depleted, brown fat is not replenished

173
Q

How much heat do newborns lose? Why?

A

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
Q

What are four methods of heat loss?

A

Convection
Radiation
Evaporation
Conduction

175
Q

Once newborn is dried, what is the most common method of heat loss?

A

Convection and radiation

176
Q

What is convection?

A

Heat lost to cooler ambient air

177
Q

What is radiation?

A

Heat lost to cooler surfaces in close proximity

178
Q

What is evaporation?

A

Heat lost as skin moisture is vaporized

179
Q

What is conduction?

A

Heat lost to cooler surface area in direct contact with body

180
Q

What is cold stress? What does this lead to?

A

Increased heat production and metabolism in response to cold

Leads to hypoglycemia
Increased O2 consumption
Increased anaerobic metabolism

181
Q

Metabolic acidosis occurs r/t to cold stress leading to

A

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
Q

How much blood volume does a term newborn have? What are the contributing factors?

A

~80-85 ml/kg

Antenatal hemorrhage
Rh alloimmunization
Time of cord clamping/ level of baby R/T placenta

183
Q

Fetal RBC have… this contributes to ..

A

Fetal RBC have short half life
Contributes to physiological jaundice

184
Q

What kind of anemia do newborns have? Do they clot normally?

A

Physiologic anemia

Abnormal clotting

185
Q

Due to the neonatal liver being immature there is… (2)

A

Lack glucuronyl transferase- more difficult to conjugate bilirubin and excrete it
Higher levels of unconjugated bilirubin leads to physiological jaundice

186
Q

Since the neonatal gut is sterile this means

A

No bacteria to synthesize vitamin K
Liver does not produce vitamin K dependent clotting factors– factors I, VII, IX & X

187
Q

Can you palpate the liver in a newborn?

A

Yes, about 40% of abdominal cavity is the liver

188
Q

How long are iron stores from maternal intake sufficient?

A

5 months

189
Q

What is bilirubin conjugation?

A

Breakdown of heme-containing proteins

190
Q

What occurs during bilirubin conjugation?

A

Conversion of fat soluble to water soluble

Total serum bilirubin= conjugated (direct) + unconjugated (indirect) bilirubin

191
Q

After the the ___ must conjugate bilirubin. What helps this structure do this?

A

Liver

Early feedings & getting gut moving to pass stools assists liver in removal of conjugated bilirubin

192
Q

When does physiologic jaundice occur? When does it peak? When is it no longer apparent?

A

Appears: after 24 hours

Peaks: 3-4 days

No longer apparent: 14 days

193
Q

What are the causes of physiologic jaundice? Is it normal?

A

Increased breakdown of fetal RBCs
Impaired conjugation of bilirubin- lack of glucuronyl transferase
More bilirubin reabsorbed by GI tract

Normal adaptation after birth

194
Q

What is the main source of energy in a newborn after birth? Why is their fuel source consumed so quickly?

A

Glucose main source of energy 4–6 h after birth

Stress of delivery rapidly uses up hepatic glycogen
Carbohydrate reserves low

195
Q

Once there is no longer carbohydrates what do the baby move to for energy?

A

Fat metabolism

196
Q

What does a decrease GFR lead to in a newborn?

A

Limited capacity to concentrate urine
Urine may be cloudy

197
Q

How much urine can the bladder hold?

A

6-44 ml

198
Q

When does the newborn void by?

A

48 hours

199
Q

How much urine is made/voided in the first 2 days? How much in 3 days?

A

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
Q

Why does pseudo menstruation occur in newborns?

A

maternal hormone withdrawal

201
Q

What are the GI adaptations in newborns?

A

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
Q

Because newborns have adequate intestinal and pancreatic enzymes what occurs?

A

Proteins require more digestion
Absorbs and digests fats less efficiently

203
Q

How many calories does a newborn require?

A

105-108 kcal/kg/day

204
Q

What enters the stomach immediately after birth?

A

Air

205
Q

D/t the immune system not fully active, ___ is not a reliable indicator of infection

A

Fever

206
Q

What immunoglobulins are present in newborn?

A

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
Q

What are the neuro adaptations in a newborn?

A

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
Q

What can happen in deep sleep with newborns?

A

Reflexes diminished

209
Q

When is not a good time to feed an infant?

A

Crying vigorously & inconsolable will not feed well
Deep sleep won’t be able to wake to feed

210
Q

When is the optimal time to promote bonding and attachment?

A

Quiet time

211
Q

What is the first period of reactivity?

A

Birth to about 30 minutes after birth

Bonding, initiate breastfeeding

Respirations and heart rate rapid

212
Q

What occurs in the period of inactivity to sleep?

A

Heart rate, respirations decrease

Sleep phase will last from minutes to 2–4 hours

Deep sleep

213
Q

What happens in the second period of reactivity? How long is it?

A

Awake and alert
Physiologic responses vary
GI tract more active
Good time for bonding

Lasts 2 to 5 hours

214
Q

What is deep/quiet sleep?

A

Closed eyes with no eye movements
Regular, even breathing
Jerky movements or startles easily

215
Q

What is REM sleep?

A

Eyes closed with eye movements noted
Irregular breathing
Irregular sucking motions
Minimal activity
External stimuli will initiate a startle reaction

216
Q

What is drowsy alert?

A

Open or closed eyes
Semi-dozing appearance
Slow regular movements
Mild startles may be noted

217
Q

What is wide awake alert?

A

Alert and focuses on objects
Minimal motor activity
Good time to feed

218
Q

What is active alert?

A

Eyes open
Intense motor activity with thrusting movements of the extremities
Startles easily and increased movement from stimuli

219
Q

What is crying alert?

A

Intense crying
Jerky movements
Attention getting
Very hard to feed in this state

220
Q

How do babies self sooth?

A

Sucking on hand, toes, fingers, lip
Hand to mouth

221
Q

What is habitation?

A

Eventually blocks out annoying stimuli

222
Q

What is orientation?

A

Follows faces, shiny objects, lights

223
Q

What are visual adaptations for newborns?

A

Prefers the human face and eyes
High contrast items
8-15 inches ideal distance for focusing

224
Q

What is the auditory response?

A

Responds to auditory stimuli with organized behavior

225
Q

Are newborns sensitive to touch?

A

Yes very sensitive to touch

226
Q

When can a baby differentiate moms smell? What nerve helps them do this?

A

by 1 week

Olfactory

227
Q

What are babies able to taste? When do taste buds fully develop?

A

Sweet and sour

Fully develop at 4 years old

228
Q

What reflex is exhibited when newborn is hungry?

A

Rooting

OB (16 decks)

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