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