Unit 1 - Newborn Assessment

Question 1

What is the foramen ovale? What causes it to close?

Answer 1

Connects R and L atria to allow blood to bypass pulmonary system. Closes after birth d/t increased systemic pressure.

Question 2

What is the ductus arteriosus? When does it close?

Answer 2

Duct from Pulmonary Artery to Aorta. Closes hours after birth.

Question 3

What is the ductus venosus?

Answer 3

Causes blood to bypass liver

Question 4

What is the approximate O2 sat of a fetus?

Answer 4

Approximately 10%

Question 5

What should capillary refill time be for a newborn?

Answer 5

< 2 seconds

Question 6

Describe newborn cardiac findings

Answer 6

• Heart beat may be irregular at first, and murmurs are common for the first 24 hours
• Heart rate 110-160, but can be 180s initially
• Volume 80-85 mL/kg

Question 7

How long could it take for PO2 to reach 95%+?

Answer 7

Within 24 hours

Question 8

Describe taking BP on a newborn assessment? What is a major concern?

Answer 8

Take BP at R arm and L calf to check for CCHD (critical congenital heart disease).

Report systolic >= 10 on arm vs leg or PO2 > 3% difference

(This is checked at 24 hours @ ProHealth, but varies by policy)

Question 9

What stimulates newborn respirations? What characteristics would you expect? What about limbs?

Answer 9

Respiration is stimulated by pressure changes, increased CO2 and decreased O2.

Normal resp rate is 30-60 breaths/min. Breaths will be shallow and irregular, possible apnea (less than 15 seconds is normal).

Peripheral cyonosis is normal

Question 10

What is RDS? Which newborn is most susceptible? What is the main reason this occurs?

Answer 10

Respiratory distress syndrome. It is most common in premature infants, mainly due to the fact that the respiratory system the last system to develop.

Question 11

What specific group of ‘stress hormones’ does fear and anxiety trigger?

Answer 11

Catecholamines

Question 12

What does APGAR measure? What does it stand for? When is it performed? What does the score mean?

Answer 12

APGAR - Appearance, Pulse, Grimace, Activity, Respirations. It is performed at 1 min and 5 min. It measures the newborn’s response to the birthing process.

>7 = Healthy
5-7 = Re-check
<5 = emergency

Question 13

What newborn vitals would you expect to see?

Answer 13

HR: 110-160 bpm
Resp: 30-60
BP: 50-85/30-55
Temp: 97.7 - 99.7

Question 14

What condition does cold stress lead to in a newborn?

Answer 14

Acidosis

Question 15

What vitamin is given to newborns? Route? Why is this necessary?

Answer 15

Vitamin K is given IM in the vastus lateralis. They are deficient d/t a sterile gut.

Question 16

What are average measurements (head, chest, weight, length) for a newborn? What is the newborn growth rate?

Answer 16

Head: 32-37 cm (2 cm greater than chest)
Chest: ~32 cm (measured at nipples)
Weight: 5 lb 8 oz - 8 lb 13 oz
Length: 18-22 inches

• • Low weight < 5.5 lbs
• • Grow 7 oz/week for 6 months (double by 5 mo and triple by 1 year)

Question 17

What is a low birth weight?

Answer 17

< 5.5 pounds

Question 18

What is a regular pregnancy term? What happens after this time frame?

Answer 18

37-42 weeks. After 42 weeks, the placenta slows down.

Question 19

What are abnormal pregnancy terms?

Answer 19

Preterm: < 37 weeks
Post-term: > 40 weeks
Post-mature: >40 weeks and placenta aging

Question 20

What is SGA and what are the associated complications?

Answer 20

Small gestational age, less than 5.5 pounds.

Hypoxia, hypothermia, hypoglycemia, hyper-bilirubinemia

Question 21

What is LGA and what are the associated complications?

Answer 21

Large gestational age, greater than 9 pounds.

Placental deprivation –> hypoxia
Oligiohydramnios –> cord compression
Macrosomia –> difficult delivery
Hypoglycemia –> (mom DM) d/t cessation of high glucose blood supply
Hyperbilirubinemia –> d/t polycythemia (increased hematocrit)

Question 22

Describe what you would expect to find with the newborn urinary system

Answer 22

• Wet diaper within 24 hours
• Light and odorless, but may be “rusty” at first
• No of diapers = days old
• • Until day 4, at which point should be 6-10

Question 23

What are the fontanelles? How long do they last?

Answer 23

Posterior fontanelle = 4-6 weeks

Anterior fontanelle = 4-6 months

Question 24

What is a hypospadias?

Answer 24

Abnormal urethral opening

Question 25

Term for the first 28 days of newborn’s life? (Or birth to one month)

Answer 25

Neonatal period

Question 26

What are the four key areas of the neonatal period?

Answer 26

Circulation, respiration, thermoregulation, glucose regulation

Question 27

What are the names of the major catecholamines and what do they do?

Answer 27

Epi and Nor-epi (also dopamine). Stimulate cardiac, surfactant, fluid clearance

Question 28

What is HR at birth and what does it decrease to?

Answer 28

110-160 decreasing to 120-130

Question 29

What is early clamping? Late clamping?

Answer 29

Early is 30-40 seconds, late is 3-4 minutes

Question 30

What is TTN? What causes it? Which type of birth can lead to this?

Answer 30

Transient tachypnea of the newborn, caused by fluid retention in the lungs. C-sections can lead to TTN due to the lack of vaginal thoracic compression.

** May require thoracic compression after delivery

Question 31

When should APGAR be rechecked? What score would require a recheck?

Answer 31

Rechecked @ 10 minutes if score is 5-7

Question 32

What are the typical characteristics of a postterm newborn?

Answer 32

• Dry, cracked, peeling, wrinkled skin
• Vernix caseosa and lanugo are absent
• Long, thin extremities
• Plantar creases covering soles of feet
• Wide-eyed, alert expression
• Abundant hair on scalp
• Thin umbilical cord
• Long fingernails
• Limited vernix and lanugo
• Meconium-stained skin and fingernails

Question 33

Why is erythromycin put on a newborn’s eyes? What causes this?

Answer 33

Prevents ophthalmia neonatorum (conjuctivitis) caused by chlamidia or gonorrhea

Question 34

How often would you take a newborn’s temperature?

Answer 34

Every 30 min for two hours (or until stable)

Question 35

What three conditions are hypoglycemia risk factors?

Answer 35

• Pre-mature
• FGR (Fetal growth restriction)
• Maternal diabetes