T3 - Newborn Adaptation (Josh) Flashcards
When is the first period of reactivity?
When is the second period of reactivity?
up to 30 mins past birth
2-8 hrs after birth (lastts 10 mins to several hrs)
After the first period of reactivity, what does the baby do?
sleeps or has a marked decrease in activity
What does the HR look like during the first 30 mins of reactivity?
increased at first but gradually falls back to b/t 100-120
What does the RR look like during the first 30 mins of reactivity?
high (60-80)
- audible grunting
- nasal flaring
- chest retraction
How long will the tachypnea and flaring, grunting, retractions of first reactivity stage last?
clear up within 1 hr
What do vitals look like during second reactive period?
Tachypnea
Tachycardia
Increased muscle tone (jumpy)
Increased mucous production (watch for gag and choking)
When is surfactant produced?
in utero (34-36 wks)
***alveoli would collapse w/ each breath w/out surfactant
Describe the initial respirations of a neonate.
Fetal lungs filled w/ AF
Fluid forced from lungs as fetus delivered (VAGINAL SQUEEZE)
Chest wall expands as pressure from maternal pelvis is relaxed
Lowered pressure from chest expansion draws air into lungs
Why would Cesarean babies be more likely to have bubbly lung fields?
they don’t experience the VAGINAL SQUEEZE that forces fluid out of lungs
What happens to O2 and CO2 immediately post birth?
CO2 increases and O2 decreases
What conditions interfere w/ initiation and maintenance of respirations?
Prolonged hypoxia in utero (variable decels due to compression of cord)
Colds stress (temp decrease
What is one of the first priorities for baby after delivery?
warmth
Normal newborn respirations
shallow, irregular breathing
30-60/min
short periods of apnea (
Which type of breathers are neonates?
obligatory nose breathers b/c they don’t have the reflex to open mouth to maintain airway
Apnea — is an indication of a pathalogic process and should be evaluated.
> 20 secs
How should we listen to respirations?
count for 1 full minute by observing abdomen
listen for sounds w/ the BELL of the stethescope
What are some causes of respiratory distress in neonate?
Maternal analgesics during labor
Hyper or Hypothermia
Hypoglycemia
Sepsis
Inadequate clearance of AF
Respiratory Distress Syndrome (RDS)
Signs of Respiratory Distress in a Neonate
Resp 60 secs at rest
Nasal flaring
Apnea > 20 secs
Retractions
Seesaw or paradoxical breathing
Is acrocyanosis during the first 24 hours a concern?
Acrocyanosis in hands and feet is normal in first 24 hrs
CV system adaptation postbirth?
Foramen Ovale closes as atria pressure gradient changes and pushes blood from R atria to R ventricle
Ductus Arteriosis constricts and closes as O2 content of blood increases w/ first few breaths
When is permanent closure of Foramen Ovale and Ductus Arteriosis?
functional closure is immediate…
permanent closure is in 3-4 wks
Cardiac Assessment of neonate
HR = 120-140
PMI = 4th ICS MCL
Color = pink at rest, red when crying
***BP not usually measured unless for specific reason
What can crying do to blood flow during first few days?
may reverse blood flow through foramen ovale and lead to mild cyanosis until foramen ovale permanently closes in 3-4 wks
What do the RBCs and Hgb look like for newborn
high due to transport of O2 in utero
What is the Hbg in cord blood?
17 g/dL
What is the HCT in cord blood?
55%
What is the Leukocyte level in neonate?
elevated to 9000 - 30,000 mm3
In neonates, — have a shorter lifespan than in adults.
RBCs
***breakdown leads to buildup of BILIRUBIN –> JAUNDICE
What contributes to RBC breakdown in neonates and what condition does this cause?
RBCs break down from trauma during birth (and they already have a shorter lifespan)
leads to buildup of bilirubin –> Jaundice!!!
Why is a serious infection not very well tolerated in neonate?
leukocytes don’t recognize foreign protein early in life
What is an important action that affects volume of blood in neonate?
time of cord clamping
***Delayed clamping may increase workload of infant’s heart
Why are clotting factors decreased in neonate?
newborn liver cannot synthesize Vit K except in presence of bacteria from GI tract and the GI tract in neonate is sterile (no bacteria yet)
What is the treatment to assist in development of clotting factors in neonate?
Vit K injection within 1 hr of birth
Which neonate position is used to conserve heat?
flexed position
Superficial deposits of brown fat and lipid activity increase heat production as much as –
100%
How is nonshivering thermogenesis accomplished in neonate?
metabolism of brown fat
metabolic activity of brain , heart, and liver
Why is nonshivering thermogenesis important?
b/c shivering mechanism in newborns is rarely operable (quivering lips is NOT shivering)
What is the most effective heat production in a newborn?
nonshivering thermogenesis (chemical reaction)
How does the Non-shivering Thermogenesis process work in a newborn?
Brown fat (brown adipose tissue) is highly vascular tissue around adrenal glands, kidneys, between scapula, neck, thorax, and axilla.
- Blood passing through brown fat is warmed –> distributes heat throughout body. Pg 528
- Brown fat may be depleted – Unable to respond to repeated episodes of cold stress
***Laid down from 26-30 weeks. Produces more heat than other fats.
What characteristics of neonate contribute to heat loss?
Little subq fat
Thin epidermis (BV close to surface)
Body mass is small in relation to surface area
Cannot shiver to generate heat
Why is body mass important in heat production?
body mass is the heat producing tissue such as muscle and adipose tissue
***baby’s have little of such tissue at birth compared to surface area (skin)
Mechanisms of Heat Loss:
— is moisture/heat evaporates from body surface.
Evaporation
Mechanisms of Heat Loss:
– is body heat lost from direct contact
Conduction
***can also be a source of heat gain if we use warm blankets and warm hands
Mechanisms of Heat Loss:
— is body heat loss from air currents flowing over newborn body.
Convection
***can also be a source of warmth if we blow arm air over baby
Mechanisms of Heat Loss:
— is body heat loss from heat transfer to cold object close by (but not touching)
Radiation
What are some effects of Cold Stress on neonate?
Hypoxia
Hypoglycemia
Metabolic Acidosis BAT metabolism
Increased Bilirubin (Jaundice and Kernicterus)
Why would cold stress lead to Hypoglycemia?
glucose levels depleted in efforts to raise core temp
Why would cold stress lead to Hypoxia?
heat production uses reserves of O2
Why would cold stress lead to Increased Bilirubin levels?
excessive fatty acids released will displace bilirubin from binding sites
–> Jaunidice and Kernicterus
When is brown fat laid down?
last weeks of gestation
***for this reason, preterm infant is at greatest risk for cold stress
How often will newborn void?
2-6 times for first few days of life
What is urine like in newborn?
Pale, straw colored urine (not concentrated) Sp. Gr. 1.001 to 1.020
**ability to concentrate urine is about 3 mths
What is avg urine output for neonate?
20-70 mL/day
What amount of voidings indicate adequate fluid intake?
6-8 per day after first 3-4 days
Infants will lose — of body weight during first 5 days of life.
5-7%
What is the newborn stomach capacity?
50-60 mL
**empty 2-4 hrs past feeding
Which newborns may not be able to suck?
preterm and SGA
Why can’t newborn digest complex carbs?
pancreatic amylase is deficient until 5-6 mths
lipase, necessary to digest fats, is absent
What should we see in the Stool Cycle?
Meconium (thick, tarry, dark green)
Transitional Stool (brown to green and loose)
Breast fed (seedy, mustard colored, loose and aromatic)
Bottle fed (pale yellow brown, more firm than breast fed)
Is constipation normal for neonate?
constipation is ABNORMAL for either formula or breastfed baby
Mom calls the medical clinic where you are the nurse…saying “my 2-week old neonate has dark green, diarrhea stools” What would you advise?
See pediatrician.
May need to change formula. May have too much iron and infant is not tolerating
What are the functions of the Hepatic System?
Blood coagulation
Iron storage
Change bilirubin
Carb Metabolism
How long do newborn iron stores last?
4-6 mths of age
***less in preterm and SGA
Foods containing iron should start being given to neonates at —
4-5 mths
- **cereal
- **dark green veggies
Fetal — provided by mom’s placenta.
Fetal — is produced on its own by —
glucose
insulin
pancreas
Why does glucose decrease rapidly post birth?
supply from placenta cut off
used to produce heat
***leads to hypoglycemia
How do we prevent hypoglycemia in neonate?
early and frequent feedings to maintain an glucose level of 60-70 mg/dL by day 3
***colostrum contains high glucose
What glucose level are we shooting for in neonate?
60-70 mg/dL by day 3
What is the heel stick schedule to check for glucose in infant at risk for hypoclycemia?
20 mins 30 min 1 hr 2 hr 3 hr q 4hr until stable
S/S of neonatal hypoclycemia
Poor muscle tone
Tremors/Jitters
Poo suck reflex
High pitched cry
Tachypnea
Treatment for neonatal Hypoglycemia
Breast feed or D5W
Administer D10 by NGT or IV if poor suck ability
Keep warm (to reduce use of glucose for heat production)
Bilibubin is a by-product of —
RBC breakdown
Immature liver is overwhelmed by large volume of – –.
insoluble bilirubin
***leaves vascular system and permeates other tissue (Jaundice)
Serum bilirubin levels of — result in skin staining.
4-6 mg/dL
**starts in HEAD/FACE and progresses to TRUNK
In the liver the unbound bilirubin is conjugated (changed) in the presence of – – into a soluble form that is excreted from the liver as a constituent of bile.
Glucornyl transferase
***direct bilirubin is excreted into duodenum
What is kernicterus?
bilirubin encephalopathy
- may occur r/t high levels of insoluble bilirubin
***IRREVERSIBLE
What conditions exacerbate the development of Jaundice?
Excess RBCs (w/ a short life span)
Tissue damage from birth process
Liver immaturity (not enough glucornal transferace enzyme)
GI tract sterile (bilirubin excreted through urine/feces)
Life span of neonatal RBCs is —-
Life span of adult RBCs is —
80-100 days
120 days
What is difference b/t Physiological Jaundice and Pathological Jaundice?
Physiologic jaundice occurs after first 24 hours of life (usually day 2 or 3).
Pathologic jaundice due to pathologic destruction of rbc’s (example ABO incompatibility or Rh negative factor).
Treatment for Jaundice
Feedings (bilirubin is excreted through feces and urine)
Phototherapy to break down the bilirubin to an excretable form
Nursing care during Phototherapy for Jaundice
Minimal clothing (just bikini diaper)
Protect genitals, gonads and eyes
Prevent insensible water losses
Provide stimulation
Monitor temperature with skin probe
Turn frequently
What is Breast Milk Jaundice?
delay in elimination of meconium (which is high in bilirubin)
**levels rise on day 4-7 (true breast milk is developed ~6-7 days after delivery)
**discontinue breastfeeding and start phototherapy
Immune System Adaptation of Neonate:
— is from mom and confers passive immunity.
— is produced in utero in small amounts
— is abundant in colostrum/breast milk while a formula fed baby doesn’t have until about 1 year.
Immunoglobulin G
Immunoglobulin M
Immunoglobulin A
***produced by infant by about 4 wks of age
What is Caput Succedaneum?
edema usually on occiput
What is Cephalhematoma?
blood b/t skull and periosteum
***does not cross suture lines
What happens in female neonate reproductive system?
mucoid discharge and pseudo menstruation
What is Ortoloni’s Maneuver?
movement of hips to discover any hip dislocation
Nonmovement or Asymmetrical movement of arms may indicate which pathologies?
Erb-Duchenne Paralysis (Erb’s Palsy)
