T3-Newborn Adaptation Flashcards
What is the first period of reactivity?
Up to 30 min past birth
What happens after the first period of reactivity?
Baby sleeps or has marked decrease in activity
What is second period of reactivity? How long does it last?
2-8 hours after birth; lasts 10min-several hrs
What happens in first period of reactivity?
- HR increased at first but gradually falls between 100-120
- RR: 60-80
- Audible grunting, nasal flaring, chest retraction can be present but should clear w/in 1 hr
- Infant is alert
What happens in second reactive period?
- Tachycardia
- Tachypnea
- Increased muscle tone (jumpy)
- Increased mucus production (watch for gag and choking–may have to suction)
Surfactant is produced in utero as fetal lungs mature (____). What does surfactant do? What happens if there is no surfactant alveoli?
34-36 weeks
Surfactant reduces surface tension in alveoli; without surfactant, alveoli would collapse with each breath
Describe the initiation of respirations.
- Fetal lungs are filled with AF
- That fluid is forced from lungs when fetus is delivered (“Vaginal squeeze”)
- The baby chest wall expands as pressure from maternal pelvis is relaxed
- The lowered pressure from chest expansion draws air into lungs
*C/s dont experience this pressing of AF so more likely to have bubbly lung fields
Negative pressure is established as ____
Infant draws first breath
How are respirations established?
- Pressure changes (neg pressure as infant has first breath)
- Increased CO2 and decreased O2 in resp. center
- Skin responds to changed environ
- Sensory to breath
In most cases, respiratory reaction follows within ____ of birth
1 min
What are some conditions that interfere with the initiation/maintenance of respirations?
- Prolonged hypoxia in utero bc variable decels r/t cord compression
- Cold stress (temp decreased to below 97.5)
*cold stress uses all energy (glucose and O2)
What are normal newborn respirations?
- Shallow, irregular
- Rate: 30-60/min
- Short periods of apnea (less than 20 seconds) are normal r/t immature resp. center
- Crackles may be present r/t fluid in lung field
How do we count respirations?
Count 1 full min when neonate is at rest; count by observing abdomen
List some causes of resp. distress?
- Mom has analgesic in labor
- Hyper or hypothermia
- Hypoglycemia
- Sepsis
- Inadequate clearance of AF
- RDS
Signs of resp. distress?
- RR less than 30 or greater than 60 at rest
- Nasal flaring
- Apnea greater than 20 sec
- Retractions
- Seesaw or paradoxical breathing
T/F: Acrocyanosis in hands and feet is normal 1st 24 hours
True
What is seesaw breathing?
Exaggerated rise in abdomen w/ breathing, chest falls instead of abdominal respirations
When does foramen oval close?
As atria pressure gradient changes and the blood forced from R atria goes to R ventricle
The ductus arteriosus constricts and closes as ______ increases with first few breaths
O2 content of blood increases
Cardiovascular adaptation–functional closer occurs then permanent closure within ____
3-4 weeks
- What is HR?
- Where is PMI?
- How long do we auscultate breath sounds?
HR: 120-140 bpm
*rate varies with sleep wake states, activity, and crying
PMI: 4th ICS to left MCL
*adult is at 5th ICS
Auscultate breath sounds for 1 min
What is color of baby? what about if crying?
Pink; if crying red
During the first few days of life, crying may reverse the flow through the foramen oval and lead to _____
Mild cyanosis
Why are RBC and Hgb levels high in utero?
For transport of O2
What is average Hgb on cord blood? Hct? Leukocytes?
Hgb: 17 g/dL on cord blood
Hct: 55%
Leukocytes: 9000-30000
RBC have ____ life span than adults
Shorter
Bilirubin results from break down of ___
RBC
Build up of bilirubin in blood= ?
Jaundice
Bruising/birth trauma contribute to RBC breakdown…which means?
More bilirubin
GI tract is sterile…what does this mean? Treatment?
Newborn liver cannot synthesize Vit K, prothrombin, or other clothing factors except in the presence of bacteria from GI
Treatment: Vit K injection w/in one hour of birth
A balance between heat production and heat loss
Thermoregulation
What position conserves heat?
Flexed
Non shivering thermogenesis is accomplished by?
- Metabolism of brown fat
2. Metabolic activity in brain, heart, and liver
What are characteristics of the neonate that lead to heat loss?
- Little SQ fat
- Thin epidermis and BV close to surface
- Body mass is small in relation to surface area
- Being extended contributes to rapid loss of heat
- Cannot shiver to generate heat
What are 4 mechanisms of heat loss?
Evaporation
Conduction
Convection
Radiation
Body heat–> colder object in direct contact
Conduction
- infant placed on cold scales
- conduction can also be source of heat GAIN (warm blankets; warm hands)
Heat transferred to cold object but not touching
Radiation
*walls of nursery near baby bed/warmer
Air currents flow over newborns body
Convection
- unconvered in cool room
- can be a source of WARMTH if air is warmer
Moisture/heat evaporates from body surface
Evaporation
*Infant covered in AF
Why can hypoglycemia occur during neonatal cold stress?
Glucose is depleted in efforts to raise core temp
Why is bilirubin level increased during neonatal cold stress?
Incrased r/t excessive FA released and displace bilirubin binding sites–can cause jaundice and potential for kernicterus
Why is there hypoxia in neonatal cold stress?
Heat production uses reserves of O2
What kind of infants are at greatest risk for cold stress?
-Preterm infants because extended position, thiner skin, less SQ fat, and NO brown fat (brown fat laid down last weeks of gestation!!)
How many times does baby void first few days of life? What color is urine? Output average?
- Voids 2-6x
- Color pale, straw (not concentrated)
- 20-70 mL/d
____ voidings/d after first 3-4 days of life indicate adequate fluid intake
6-8 voids/d
How much % weight is loss during first 3-5 days of life?
Lose 5-7%
When do babies get ability to concentrate urine?
~3 months
Stomach has capacity of ____. Empty ___ past feeding
Capacity of 50-60 mL
Empty 2-4 hr past feeding
Sucking uncorrdinated=?
Feeding problems
Why is there regurgitation?
R/t immature cardiac sphincter
What can babies digest?
Protein and simple sugars
What do babies have intact taste for?
Sweet
Sour
Salty
When is solid food tolerated?
4-5 months
Stool cycle
What is first excreted and how does it look?
Meconium; thick, tarry, dark green
What is transitional stool?
Brown to green; loose
What color does stool look for breast fed baby?
Seedy, mustard colored; loose and aromatic
What color does stool look for bottle fed baby?
Pale yellow to brown; more firm than breast fed stools
Is constipation or diarrhea normal for breast fed babies? what about bottle fed?
Abnormal for both!
What is the function of the liver?
- Blood coagulation
- Iron storage
- Change bilirubin
- CHO metabolism
Liver function: Adequate iron is stored until ___ months of age.
4-6 months
*Iron stores for preterm and SGA depleted sooner than full term baby
Liver function: Foods containing iron given to baby at 4-5 months. Ex?
- Cereal
- Dark green veg
Liver function: Fetal _____ produces own insulin
Pancreas
Liver function: Fetal glucose was supplied from mom via placenta; glucose ____ past birth when sugar is cut off and ____ may result
decreases rapidly; hypoglycemia
Liver function: What is prevention of hypoglycemia?
Early and frequent feedings to maintain glucose level 60-70 mg/dL by 3rd day
Does colostrum contain glucose?
Yes, high amounts and helps maintain BG in early days of life
What infants are at risk for hypoglycemia?
LGA or IDM
High insulin + low glucose = ?
Hypoglycemia
What is heel stick for blood glucose schedule?
- 20 min
- 30 min
- 1 hr
- 2 hr
- 3 hr
- then q4h till stable
Symptoms of neonatal hypoglycemia? (4)
- Poor muscle tone; jittery
- Poor suck reflex
- HIGH PITCHED CRY
- Tachypnea
Treatment for hypoglycemia?
- Breast feed or D5W
- Administer D10 by NGT or IV if poor suck
- Keep warm
Liver function: Jaundice
Bilirubin is a by product of RBC breakdown. It gets in blood stream. The immature baby liver is overwhelmed by large volume of INSOLUBLE bilirubin (aka can’t be excreted). Bilirubin leaves the vascular system and permeates other tissues. This causes jaundice. Serum levels of ____ results in skin staining first on _____ and progress to ___
4-6 mg/dL–skin staining first on head/face and progresses to trunk
What are conditions that exacerbate the development of jaundice?
- Excess RBC (plus the fact RBC have short life span)
- Tissue damage/bruising= greater hemolysis of RBC
- Liver immature (not enough enzyme glucornyltransferase)
- GI tract is sterile (bilirubin excreted through urine or feces)
What jaundice:
Occurs after first 24 hours of life (usually day 2 or 3)
Physiologic
What jaundice: Due to pathologic destruction or RBCs (ex: ABO incompatibility or Rh neg factor)
Pathologic jaundice
Treatment of jaundice?
- Feedings
- Phototherapy
Care during phototherapy?
- Minimal clothin (bikin diaper)
- Protect genitals, gonads, eyes
- Prevent insensible water losses
- Provide stimulation
- Monitor temp with skin probe
- Turn frequently
Delay in elimination of meconium which is high in bilirubin
Breast milk jaundice
True breast milk jaundice:
- Bili levels rise day ____
- Treatment?
day 4-7
DC breastfeeding and perhaps phototherapy treatment
Liver function: Coagulation of blood
- What are potential hemorrhage sites?
- What is there risk of clotting deficiency?
- What does sterile gut have to do with coagulation?
- When do we give Vit K?
- Injections, circumcision, cord
- Bc clotting factors are synthesized in liver and are activated in presence of Vit K
- The gut can’t synthesize until normal bacterial flora is established
- Vit K given within one hour of birth
IGA is abundant in colostrum/breast milk. Formula fed baby doesnt have IGA until about ___
1 year
*IGA is produced in infant by 4 weeks of age; teach to protect from crowds, etc until that time
What creases are sign of gest. age: hand or foot?
Foot
Edema usually on occiput
Caput succedaneum
Blood between a skull bone and periosteum; does not cross suture lines
Cephalhematoma
What is male reproductive system like?
Descent of testes into scrotal sac
Scrotal sac rugated and darker skin color
What is female reproductive system like?
Mucoid discharge and pseudo menstruation
What does babinski reflex have to do with? When does it disappear?
Neuro; 12 months
What maneuver can be done to see about hip dislocation?
Ortoloni maneuver
What does non movement or asymettrical mvnt of arms possible indicate?
Erb-Duchenne paralysis or Erb’s palsy
