UNIT-7-CARE-OF-THE-NEWBORN Flashcards
includes a review of the mother’s pregnancy
history, physical examination of the infant, analysis of laboratory reports such as hematocrit and blood type if
indicated; and assessment of parent-child interaction for the beginning of bonding.
Assessment of a newborn or neonate (a baby in the neonatal period)
begins immediately
after birth and continued at every contact during a newborn’s hospital or birthing center stay, early home visits, and
well-baby visits
Assessment
Examples indicating achievement of outcomes
concerning newborns (Pillitteri, 2010) are:
- The infant establishes respirations of 30 to 60 per minute.
- Infant maintains the temperature at 97.8° to 98.6° F (36.5° to 37° C).
- Infant bottle feeds or breastfeeds well with a strong sucking reflex
a very significant and a highly vulnerable time due to critical transition from intrauterine to extrauterine life
The first 24 hours
It involves thoroughly drying the baby with warm towels or cloths while being
placed on the mother’s abdomen or in her arms or also known as
(unang yakap)
One of the first is to check
for the
Apgar.
It is the test that evaluates the newborn’s condition at 1 minute and 5 minutes after birth. The
healthcare provider or midwife and nurses will evaluate these signs and give a point value
Apgar.
The following are the key components of the immediate care for the newborn in the nursery
- Anthropometric Measurements including
- Bathing – Oil bath/ warm water bath
- Cord Care
- Dressing/ Wrapping - mummified
- Eye prophylaxis – Crede’s Prophylaxis
- Footprinting / Identification
- Get APGAR to score – 1 & 5 mins
- HR, RR, Temp, BP.
To initiate airway & breathing,
we may gently suction the mouth, and the nose of the baby gently & quickly
use a bulb syringe or suction catheter. We must start by suctioning the mouth first, then the nose to prevent
aspiration. Stimulate crying by rubbing the back, then position properly- side-lying and provide oxygen when
necessary
is the most crucial among newborns. T
The initiation of respiration and airways
blood – low oxygen, high carbon dioxide, and low pH initiates impulses that excite the
respiratory center in the medulla
Chemical factors:
blood – low oxygen, high carbon dioxide, and low pH initiates impulses that excite the
respiratory center in the medulla.
Chemical factors:
sudden chilling of an infant. From a warm environment to a cooler atmosphere. The abrupt
changes in temperature excite sensory impulses on the skin then transmitted to the respiratory center.
Thermal factor
tapping, flicking the sole of the feet, and gently rubbing
the baby’s back, trunk, and extremities. Prolong tactile stimuli is harmful to the baby
Tactile stimulation may assist in initial respiration
According to Pillitteri (2010), the following are the procedures to initiate breathing and respiration among
newborns:
a. Support the head and remove secretion
b. Removal of secretion by bulb syringe
c. Proper suctioning with a catheter
Turn baby’s head to side: to facilitate drainage & aspiration precautions, A NB should be positioned to
the R side to increase pressure to the L side of the heart. This position favors the closure of Ductus
Arteriosus and Foramen Ovale and gastric emptying, thereby preventing the reflux of gastric contents
and suctioning of mouth 1st, then nose (obligating nasal breather).
Rationale:
stimulation of the nasal
mucosa will cause reflex inhalation of pharyngeal material into the trachea and bronchi, causing
aspiration
Suctioning is always mouth before the nose to prevent
Gasp reflex
t or f
A 4 – 5sec but not more
than 10 seconds in terms of babies, less than 5 sec in preterm babies, gently & quickly
t
Prolonged and
deep suctioning can cause
Hypoxia, bradycardia, laryngospasm
If not effective, requires ____ to open the airway with deep suctioning, an endotracheal
tube is inserted & oxygen can be administered by a positive pressure bag & mask with 100% O2
40-60 b/min (full-term).
LARYNGOSCOPY
If meconium stained, never give O2 with pressure, it can cause
atelectasis.
is a scoring system that doctors and nurses use to assess newborns for one minute and five
minutes after birth
Apgar score
determine the general condition of the newborn.
1st minute –
determines the capacity of the newborn to adjust to extrauterine life (most important).
5 minute –
it will depend on the 5-minute APGAR score
10/15 minutes – optional –
s the failure to cry within 30 secs because the mother receives Demero
Asphyxia Neonatorum
is
the antidote of Demerol.
Narcan
The following are the areas of assessment for APGAR Score
Appearance – color – slightly cyanotic
Pulse – apical
Grimace – reflex irritability
Activity – Both upper and lower extremities are well flexed.
Respiration – 30-60 breaths per minute
INTERPRETATION OF APGAR RESULT
is severely depressed, CPR, intubation & chest compression, @ NICU
score of 0-3
INTERPRETATION OF APGAR RESULT
moderately depressed, needs additional suctioning & oxygenation
score of 4-6
INTERPRETATION OF APGAR RESULT
it indicates good or healthy
score 7-10
– It is performed to observe for signs of respiratory distress (Pillitteri, 2010) such
as:
1. Chest lag
2. Retractions
3. Nasal flaring
4. Expiratory grunting
Silverman-Anderson Index
Interpretation of Result:
The score of Silverman Anderson Index
is normal, no Respiratory Distress Syndrome (RDS)
A score of 0-3
Interpretation of Result:
The score of Silverman Anderson Index
is with moderate RDS, needs additional suctioning & oxygenation
score of 4-6
Interpretation of Result:
The score of Silverman Anderson Index
indicate with severe RDS, needs CPR (incubation & chest compression)
score of 7-10
normal values for Normal Average Newborn child: head circumference –
34-35 cm
normal values for Normal Average Newborn child: temp
36-37c
normal values for Normal Average Newborn child: chest circumference
32-33 cm
normal values for Normal Average Newborn child: heart rate –
120/140 bpm
normal values for Normal Average Newborn child: respiration –
30-60 / min
normal values for Normal Average Newborn child: weight –
2.5 – 3.4 kg
normal values for Normal Average Newborn child: length –
46-54 cm
is babies that are delivered after 20 weeks of gestation but before 37 weeks of pregnancy. (
Preterm
According to Ballard and Dubowitz, the following are the signs of preterm (Pillitteri, 2010):
- Plus, frog legs or lax position.
- Hypotonic – prone to respiratory infection
- Scarf sign – elbow passes midline.
- Square window – wrist 90-degree angle
- Heal to ear sign
- Anterior transverse crease
- Abundant lanugo
- Prominent labia minora and clitoris
is initiated by Lung expansion and pulmonary ventilation
Circulation
dilates
the pulmonary vessels; pulmonary vascular resistance decreases, and systemic resistance increases, thus
maintaining blood pressure. P
Increased blood flow
results in closure of ductus venosus & inferior vena cava at 4th day of life
Pulmonary artery pressure → ↓ blood flow
results in the closure of ductus arteriosus soon after birth
Pulmonary artery pressure → ↑pO2
involves the umbilical cord, and the 2 umbilical arteries carry the
unoxygenated blood back to the placenta for oxygenation.
fetoplacental circulation
is the one responsible for oxygenation of the blood
PLACENTA
- ↑ pCO2 - ↓ PO2. The cry will initiate lung expansion that will increase
pressure from the left to the right side of the heart.
TANGENTIAL FOOT SLAP
should be strong,
vigorous & crusty cry
The normal cry of a baby
high-pitched cat-like cry, which will
lead to failure to close
CRI – DU- CHAT SYNDROME
PROPER POSITIONING
- ® SIDE LYING POSITION
it increases the pressure on the left side of the
heart, thus facilitating the closure of the foramen ovale. Failure to close might result in the atrial
septal defect (ASO) and Patent ductus arteriosus
PROPER POSITIONING - ® SIDE LYING POSITION
s just a temporary or palliative surgery that creates a shunt between the aorta and pulmonary
artery so that the blood can leave the aorta and enter the pulmonary artery, and this oxygenating the lungs and
return to the left side of the heart, then to the aorta then to the body
Blalock-Taussig
The blood volume of the newborn depends on the placental blood flow. Average for a full-term infant is
80 to 85ml/kg of the body weight after birth, the total blood volume is 300 ml, but it depends on how
long the umbilical cord clamping is delayed or if the cord is milk 100 ml can be added.
Hematopoietic System.
Hematopoietic System.
Average for a full-term infant is
___ of the body weight after birth
80 to 85ml/kg
Hematopoietic System.
the total blood volume is
300 ml
Changes occur in the total body water volume, extracellular fluid volume during the transition from fetal
to postnatal life. The infant’s fluid is 73% of total body weight, while adults’ fluid is 58% of total body
weight
Fluid and Electrolytes.
The infant’s fluid is ____ of total body weight, while adults’ fluid is ___ of total body
weight
The infant’s fluid is 73% of total body weight, while adults’ fluid is 58% of total body weight
The ability of the newborn to digest absorbs and metabolizes but has limited function. Enzymes are
adequate to handle proteins and simple carbohydrates. The liver is the most immature organ.
Gastrointestinal System.
is the most immature organ.
The liver
Functional deficiency of the kidney is to concentrate urine and cope with the condition of the fluid and
electrolytes stress, such as dehydration or a concentrated solute load. A 200-300 ml total volume of urine
for 24 hours by the end of the first week and an average of 20 voidings per day total of 15ml. Colorless,
odorless urine with a specific gravity of 1.02. NBS involves several types of testing. Phenestix test is a
diagnostic that uses a fresh urine sample (diapers) and mixed with ferric chloride. If (+), there will be a
presence of green spots at the diapers. Guthrie test is another test for PKU and is the one that mostly
used. The specimen used is the blood, and it tests if CHON is converted to an amino acid.
Renal System.
is a
diagnostic that uses a fresh urine sample (diapers) and mixed with ferric chloride
Phenestix test
Present at birth but has an immature function. The epidermis and dermis are loosely bonded to each
other and very thin. Rete pegs or the anchoring of the epidermis to the dermis is not yet developed. Still,
the Sebaceous gland is active in fetal life and early infancy because of the high level of maternal
androgens.
Integumentary system.
are loosely bonded to each
other and very thin.
he epidermis and dermis
is active in fetal life and early infancy because of the high level of maternal
androgens
Sebaceous gland
At birth, the skeletal system contains more cartilage than ossified bones.
Musculoskeletal System
Developed at birth but has an immature function
Endocrine System.
produces limited quantities of antidiuretic hormones or
vasopressin, which inhibits diuresis making infant risk of dehydration.
posterior lobe of the pituitary gland
hormones are
evident in newborns such as labia hypertrophied, the breast is engorged, and the milk’s secretion is
present a few days of life to 2 months, pseudomenstration from the sudden drop of estrogen and
progesterone level.
Maternal sex
incompletely integrated but sufficiently developed to sustain extrauterine life.
Nervous system
These are crucial during transition because they stimulate initial respiration and help maintain acid-base balance and partially regulate temperature control.
Autonomic nervous system.
The newborn infant displays extraordinary sensory development
and an astonishing capability for self-organization in social interactions. Infants’ muscles are
very firm and resilient. They could engage when triggered but cannot control them. The
stretches and wiggles, but their movements are uncoordinated.
Neuromuscular system.
The following are the common infant reflexes
Reflex: Babinski
Reflex: Blinking
Reflex: Grasping
Reflex: Moro
Reflex: Rooting
Reflex: Stepping
Reflex: Sucking
Reflex: Swimming
Reflex: Tonic neck
1.1. Stimulation: Sole of foot stroked
1.2. Response: Fans out toes and twists foot in
1.3. Duration: Disappears at nine months to a year
Reflex: Babinski
2.1. Stimulation: Flash of light or puff of air
2.2. Response: Closes eyes
2.3. Duration: Permanent
Reflex: Blinking
3.1. Stimulation: Palms touched
3.2. Response: Grasps tightly
3.3. Duration: Weakens at three months; disappears at a year
Reflex: Grasping
4.1. Stimulation: Sudden move; loud noise
4.2. Response: Startles; throws out arms and legs and then pulls them toward the body
4.3. Duration: Disappears at three to four months
Reflex: Moro
5.1. Stimulation: Cheek stroked or side of mouth touched
5.2. Response: Turns toward the source, opens mouth and sucks
5.3. Duration Disappears at three to four months
Reflex: Rooting
6.1. Stimulation: Infant held upright with feet touching the ground
6.2. Response: Moves feet as if to walk
6.3. Duration: Disappears at three to four months
Reflex: Stepping
7.1. Stimulation: Mouth touched by an object
7.2. Response: Sucks on object
7.3. Duration: Disappears at three to four months
Reflex: Sucking
8.1. Stimulation: Placed face down in the water
8.2. Response: Makes coordinated swimming movements
8.3. Duration: Disappears at six to seven months
Reflex: Swimming
9.1. Stimulation: Placed on the back
9.2. Response: Makes fists and turns head to the right
9.3. Duration: Disappears at two months
Reflex: Tonic neck
is completely different from the macula
Fovea centralis
muscles are immature, limiting the eye’s ability to accommodate and
focus on the object
Ciliary.
Tear gland functions
– 2-4 weeks
– newborn has auditory acuity after draining the amniotic fluid from the ear.
Hearing
– reacts to alcohol and vinegar by turning their heads away
Smell
–can distinguish among tastes, and various type of solution elicits deferring facial
reflex
Taste
– able to perceive a tactile sensation
Touch
is the most crucial to a newborn’s survival.
Temperature regulation
– from the body to air; TSB
EVAPORATION
– from the body to cold solid object; ice pack
CONDUCTION
– from the body to a cooler surrounding air
CONVECTION
– from the body to a cold object not in contact with the body; ACU (air conditioning
unit)
RADIATION
Preterm babies are born ____ quickly adapt to the temperature of the
environment due to immaturity of the thermoregulating system of the body (hypothalamus).
poikilothermic (cold-blooded)
the newborn is not capable of shivering – because they produce heat through ___ which involves increase metabolism and O2 consumption
NST (non-shivering
thermogenesis)
sources are the heart liver and brain. An additional source, unique to a
newborn is brown adipose tissue or brown fat
Principal Thermogenic
is a condition wherein the newborn’s body temperature drops below the normal range. This
can be a life-threatening condition so we must address this right away by providing a warm environment
and monitoring their temperature.
Hypothermia
The following are the possible effects of hypothermia in neonate’s body
INCREASED RESPIRATORY RATE.
HYPOGLYCEMIA
METABOLIC ACIDOSIS
KERNICTERUS
This the first sign of hypothermia among newborns
INCREASED RESPIRATORY RATE.
here will be a decrease in blood glucose levels due to the utilization of glucose.
Normal glucose level is 45-55 mg/dl while average /borderline is – 40 mg/d
HYPOGLYCEMIA. T
Normal glucose level is ___ while average /borderline is – ___
Normal glucose level is 45-55 mg/dl while average /borderline is – 40 mg/d
due to catabolism of brown fats (vest-like, best insulators of a newborn)
best insulators of a newborn) leading to the formation to the formation of ketone bodies
METABOLIC ACIDOSIS
This is irreversible brain damage due to the presence of a high amount of bilirubin
in the brain that may result in the degeneration of nerve cells
KERNICTERUS.
Below are ways to prevent hypothermia among newborns:
- Prevent heat loss, dry & wrap the baby – cover the head
- Mechanical measures – especially preterm (incubator)
- Prevent unnecessary exposure to cold- expose only the examined areas
- Cover with tin foil- if there is no electricity
- Embrace baby – kangaroo care
a special mutual relationship between mother and infant ideally started on the first period of reactivity.
BONDING –
also facilitates the release of colostrum which is highly beneficial among newborns. It also stimulates
the production of prolactin and oxytocin and prevents jaundice
Breastfeeding
According to Pillitteri (2010), Breastfeeding has an impressive list of health benefits. This includes the
following:
- economical
- always available
- help in rapid involution – return to N
- help ↓ breast Ca incidence
- ↓ obesity incidence
- higher IQ than bottle feed
- contains lactobacillus Bifidus
- contains macrophages
- can be stored for 6 mos.
- has antibodies Ig M
Although breastfeeding possesses numerous amounts of advantages some disadvantages include:
- no iron – anemia
- father can’t feed & bond as well
- possibility of HIV (13-39% chance), Hepa B & CMV transfer
is produced naturally by women and provides basic nutrition for a baby during the first several
months of life.
Breast milk
Breast milk has three different and distinct stages: (
colostrum, transitional milk, and mature
milk
It is the first stage of breast milk. Produced at 4th lunar mos.; present from 2-4 days.
It Contains ↓ fat, ↓ carbohydrates, ↑ protein, ↑ minerals, ↑ IGM. ↑ Fat-soluble vitamins.
COLOSTRUM
This occurs after colostrum and lasts from 4- 14. It contains ↑ lactose, ↑ minerals,
↑ H2O soluble vitamins
TRANSITIONAL.
Is the final milk produced t starts from (14) 2 y/o – 14 → up to present. it has ↑
fats with linoleic acid (responsible for brain growth & skin), ↑ CHO, & lactose (easily digested, soursmelling odor stool), ↓ protein lactalbumin)
MATURE MILK.
- ↑ fats, ↓ CHO (add sugar), ↑ protein (casein has a curd that is had to digest), ↑
phosphorus, ↑ minerals
COWS MILK
Touch side of lips, the baby will turn to stimulus. Disappear – 6 wks.
ROOTING.
Touch middle of lips, the baby will suck. Disappear – 6 mos.
SUCKING.
. Stimulate the post portion of the tongue; it will swallow. Disappear – never
SWALLOWING
When food touches an anterior portion of the
tongue, protruded or extruded (prevent baby from poisoning). Disappear – 4 mos.
EXTRUSION / PROTRUSION COMPLEX.
Disappear of rooting
6 wks
disappear of suckling
6 mos.
disappear of swallowing
neve
disappear of EXTRUSION / PROTRUSION COMPLEX
4 mos
the feeling of fullness & tingling sensation in the breast sometimes
accompanied by fever: milk fever. Mx: breast pump, ice pack, tight bra
ENGORGEMENT.
Crack, wet, painful nipple. Mx: “pahanginan,” 20 watts
SORE NIPPLE.
– hemolytic disease
erythroblastosis fetalis
– severe edema of the fetus
hydrops fetalis
– a metabolic disorder
Galactosemia
Also known as physiologic stool, blackish-gray, sticky, tar-like, odorless (sterile intestine)
MECONIUM.
.. 4-14 days characterized by greenish, loose & slimly, appear to be like diarrhea
to an untrained eye
TRANSITIONAL STOOL
These are golden yellow, soft, mushy, frequently passes almost nearly every
feeding, sour-smelling odor
BREASTFED STOOL.
Pale yellow, farmed, hard, seldom passed, 2-3 x/day. Has an offensive odor,
greenish, loose & slimly, appear to be like diarrhea to an untrained eye
BOTTLEFED STOOL.
Brown & odorous
WITH SUPPLEMENTARY FOODS ADDED.
light stool –
jaundice
bright green –
under phototherapy
mucus mixed with stool –
milk allergy
clay-colored -
the destruction of bile duct
chalk clay or whitish clay stool –
underwent Ba enema
black stool –
bleeding or melena (UGIB, BPUD/ hematemesis)
blood-flecked –
anal fissure
. currant jelly
– intussusception – obstruction
. ribbon-like –
Hirschsprung’s disease
steatorrhea/fatty, bulky, foul-
smelling malabsorption
provide routine medical care, including assessment and
newborn screening. They also provide care for premature babies born at 35 weeks
. Nurseries
length
19.5 – 21 in – 20 Normal
47.5 – 52.75 cm – 50 cm Normal
head circumference
13 – 14 in – 13 in Normal
33.35 cm – 34 cm Normal
chest circumference
12-13 in – 13 in Normal
31 – 33 cm – 32 cm Normal
to cleanse baby & remove vernix caseosa function: the insulator
OIL BATH
safely is given when the cord falls
FULL BATH
are given a full bath, phenol
HIV + mother babies
infection of the umbilical cord
(antibiotics), failure of the cord to fall after 2 weeks without foul odor, Bring the baby back to the hospital
and will be given Silver Nitrate or will be cauterized, NSS for cleaning or 70% isopropyl alcohol
GRANULATION OMPHALYTIS/ UMBILICAL GRANULATION
f the cord is always moist, suspect a fistula between the bladder & umbilicus.
PATENT
URACHUS
prevent ophthalmia neonatorum or gonorrheal conjunctivitis’s
Credes prophylaxis.
To prevent hemorrhage related to physiologic hypoprothrombinemia.
Administration of synthetic Vit K.
It is the Bluish discoloration of palms of hands & soles
of feet due to immature peripheral circulation and is exacerbated by
cold temperatures. It is Normal within 1st
24 hrs of life.
Acrocyanosis.
May indicate hypothermia, infection, anemia,
hypoglycemia, cardiac, respiratory or neurological problems
Pallor/ Cyanosis.
. Under natural light, there is s Blanch skin over the chest or tip of the nose.
Jaundice
Management of Jaundice
Monitoring of serum bilirubin levels; in Physiologic: not more
than 5 mg/dl per day. Pathologic: more than 15-20 mg/dl (critical levels). Maintain
hydration. Place in bilirubin lights as needed. Provide emotional support to parents.
Phototherapy units
are the fine, downy hair that covers the newborn’s shoulders, back, and upper arms. d may disappear within 2
weeks
Lanugo
Are the white cream-cheese like that serves as a skin lubricant, a mixture of
sebum, and desquamating cells. It offers protection from the watery environment
of the uterus and serves as a natural moisturizer. It is Absorb by the body within
24-28 hrs
Vernix Caseosa
Multiple, tiny white papules approx. 1 mm wide
It is due to the enlarged or clogged sebaceous gland
And usually found on the nose, chin, cheeks, eyebrows, and forehead
Milia
The Dryness/ peeling of the skin that usually occurs after 24-36 hours.
Marked scaliness & desquamation is a sign of post maturity
Desquamation
Hard and stiff skin
Sclerema
Distended sweat (eccrine) glands that appear as minute blisters, especially on the face
Miliaria or sudamina
Head held to one side with chin pointing to the opposite side
Torticollis
Ventral curvature of the penis (
Chordee
are colored skin spots that either is present at birth or develop shortly after birth. can be
many different colors, including brown, tan, black, pale blue, pink, white, or red
Birthmarks
appears in irregular areas and is characterized by blue-black colorations on the
infant’s lower back, buttocks, and anterior trunk. The spots are not bruising, nor are
they associated with mental retardation. They disappear in early childhood by 4 years
of age. Color may also vary from Blue-green or gray pigmentation. It can always be
found on Lower back, sacrum & buttocks
Mongolian Spots
It is also known as naevus simplex, “angel kisses” (when on the forehead or eyelids),
and “stork bites” (over the nape of the neck). Midline malformations are consisting
of ectatic capillaries in the upper dermis with normal overlying skin
Salmon Patches
These are flat red or purple lesions and can be found at the back of the neck, lower
occiput, upper eyelid, and bridge of the nose. It usually disappears after 2 years of
age
Stork bites / Telangiectatic Nevi
These are Elevated areas formed by immature capillaries and endothelial cells
and can be found in the head, neck trunk & extremities It disappears after 7 to 9
years of age
Strawberry marks / Nevus Vasculosus or Capillary Hemangioma.
Capillary malformation they are flat Red to purple sharply demarcated
dense areas beneath the capillaries. They are found in the face of the
infant and does not fade with time. It is associated with Sturge-Weber
syndrome (
Port-wine stain / Nevus Flammeus or Capillary Angioma
There is a reticulated pattern of constricted capillaries and venules due to
vasomotor instability in immature infants. Bluish mottling or marbling of skin
in response to chilling, stress, or overstimulation
Mottling / Cutis marmorata
These are the small, white, yellow, or pink to red papular rash in the Trunk, face & extremities
It disappears within 48 hours
Erythema toxicum / Newborn rash
Are also known as the Pinpoint hemorrhages on the skin Due to increased vascular pressure,
infection, or thrombocytopenia
Petechiae
As a result of the rupture of blood vessels, it may appear over the presenting part as a result
of trauma during delivery. May also indicate infection or bleeding problems
Ecchymosis / Bruises.
When on the side, the dependent side turns red and upper side/ half turns pale due to
gravity and vasomotor instability or immature circulation. The skin may resemble a
CLOWN’S SUIT
Harlequin Sign
Tan or light brown macules or patches there is no pathologic significance, if <3cm in
length and <6 in number. If > 3 or 6 = Cutaneous neurofibromatosis (
Café-au-lait spots
Are the spaces where more than two bones come together. Should be flat, soft, and firm. Anterior Fontanel: diamond
shape (2.5- 4 cm); closes at 12 to 18 months. Posterior Fontanel: triangular shape (0.5- 1 cm); closes at 2 months.
Bulging fontanel may due to crying & coughing
Fontanelles
It is the edema of the soft scalp tissue at the presenting part of the head due to
pressure on the presenting part of the fetal head. It Crosses the suture lines
Caput Succedaneum
Is a collection of blood between the periosteum of the skull bone and the bone. It is
caused by the pressure of the fetal head against the maternal pelvis during
prolonged or difficult labor. Does not cross suture lines. It lasts within several
weeks (
Cephalhematoma
Localize softening of the cranial bones caused by the pressure of the fetal skull against the
mother’s pelvic bone in utero. It can be indented by the pressure of fingers
Craniotabes
Premature closure of the fontanelles. Microcephaly or premature closure of the
sutures (
Craniosynostosis
e is bleeding into the subgaleal compartment. The injury occurs as a
result of forces that compress and then drag the head through the pelvic outlet
Subgaleal Hemorrhage
is a potential space that contains loosely arranged connective tissue; it is
located beneath the galea aponeurosis, the tendinous sheath that connects the frontal
and occipital muscles and forms the inner surface of the scalp.
The subgaleal
compartment
Color: White sclera. Slate gray, dark blue, or brown final eye color: 3- 6 months or may take a year. Pupils equal,
round, reactive to light. (+) Blink reflex. Lids are usually edematous. Eyes can move and fixate momentarily. Crosseyed is referred to as (strabismus) and twitching is called (nystagmus). Absence of tears until one to three months
of age
Eyes
They are normally nasal breathers’ nose is small and narrow, has Flattened midline, (+) Periodic sneezing. Nasal
flaring may indicate respiratory distress and (+) Low nasal bridge be associated with Down’s syndrome (
Nose
Folded and creased. Pinna is in line with outer canthus of the eye, flexible and cartilage present. Startle reflex is
elicited by the loud, sudden noise. (+) Low set ears may signal chromosomal defect & kidney anomaly. The internal
and middle ear is large at birth, but the external canal is small (
Ears
Are normally pink and moist in appearance, the intact soft and hard palate.
Mouth and Throat
The following are considerations for the tongue:
- Ankyloglossia – tongue-tie
- frenotomy, a safe and effective surgical procedure that improves.
- comfort, effectiveness, and ease of breastfeeding for the mother and infant.
is a triad of micrognathia (small mandible), cleft palate, and
glossoptosis (a tongue malposition downward).
Pierre Robin
Syndrome (also called Pierre Robin sequence)
Short, creased with skin folds, the head rotates freely but cannot support the full weight of the head, the Trachea is
midline. Thyroid gland not palpable, clavicles are intact.
Neck
Chest circumference- should be = or < 2 cm than Head circumference Antero-posterior & lateral diameters equal
Symmetrical, Cylindrical thorax, and flexible ribs, (+) Breast engorgement subsides after 2 wks., (+) Witch’s milk,
Respirations appear diaphragmatic. Bilateral equal bronchial breath sounds (Pillitteri, 2010)
Chest and Lungs
The following are the considerations for the chest and lungs (Pillitteri, 2010):
- Cough reflex: absent at birth; present by 1- 2 days
- Periodic apnea- common in preterm infants
- In Physical assessment, a newborn’s abdomen shaped like a dome and cylindrical. A SCAPHOID shape
indicates DIAPHRAGMATIC HERNIA. - The liver of a newborn is palpable 2-3 cm BELOW RIGHT COSTAL MARGIN, the kidneys at about 1-2 cm
above the umbilicus and the spleen on the left quadrant
Heart rate: 120- 140 bpm (apical), Apex: 4TH to 5th ICS, lateral to the left sternal border, S2 slightly sharper and
higher pitch than S1, Transient cyanosis when crying, Potential signs of distress:, Dextrocardia- heart on the right
side, Displacement of apex, Murmurs and thrills, ASD, VSD, PDA, Persistent cyanosis (
Heart
is shaped like a dome and cylindrical.
Newborn’s abdomen
is palpable 2- 3 cm below the right costal
margin
The Liver
are about 1-2 cm above the umbilicus.
Kidneys
Consideration when assessing for the umbilical cord (Pillitteri, 2010):
- 2 arteries and 1 vein
- Bluish white at birth
- It begins to dry between 1-2 hrs. following birth
- Gradually falls off by 7 day
Considerations when taking care of the umbilical cord (Pillitteri, 2010):
- Keep the cord dry and clean & clamp secured
- Cleanse cord with 70% isopropyl alcohol with each diaper change and at least 2- 3 times a day
- Keep the newborn’s diaper below the cord
- Note for any signs of infection (redness, drainage, swelling, odor)
- Avoid using creams, lotions or oils near the cord
Capacity: 90 ml, with rapid intestinal peristalsis ( 2 ½ to 3 hrs). Bowels sounds; (+) within 1-2 hrs after birth, (+)
Scaphoid = diaphragmatic hernia, (+) Distended = LGIT obstruction/ mass (+) Visible peristalsis= Hirschsprung’s
disease (Pillitteri, 2010).
Gastrointestinal tract
Check patency, First stool (Meconium) usually passed within 12-24 hrs. after birth. It is sticky, tarlike, blackishgreen, odorless (
Anus
Edematous labia and clitoris, Urethral meatus
behind the clitoris, first voiding should occur within 24 hours
Female genitalia
blood-tinged mucus from the
vagina at 1st week after birth
Pseudo menstruation-
Prepuce covers the glans penis, A small opening in the
foreskin = Phimosis, Scrotum: edematous, An excessive
amount of fluid= Hydrocele, Meatus: central, (+) ventral/
dorsal = Hypo/epispadias, Testes: descended, (+) undescended = Cryptorchidism, First voiding should
occur within 24 hrs. (Pillitteri, 2010).
male genitals
Spine: Intact, straight and flat, No openings, masses or prominent curves, Trunk incurvation reflex- disappears by 4
weeks, (+) A small tuft of hair or dimpling at the base= Spina Bifida
Back
- extra digits on either fingers or toes
Polydactyly
- the fusion of 2 or more digits
Syndactyly
are the inborn behavioral patterns that develop during uterine life
Neonatal reflexes or primitive reflexes
. rapid eyelid closure when intense light is shown, never disappear - for protection of the eyes
Blink reflex-
– when a solid object is placed on the palm, a baby will grasp the object – disappear
6wks – 3 mos.
Palmar grasp reflex
occurs as the palmar reflex when a finger is placed in the neonate’s palm, and the neonate
grasps the finger. The palmar reflex disappears around the sixth month. Similarly, the plantar reflex occurs
by placing a finger against the base of the neonate’s toes, and the toes curl downward to grasp the finger. This
reflex becomes inhibited around the ninth to the tenth month
Grasping reflex
– neonate placed on a vertical position with their feet touching
a hard surface will take a few quick, alternating steps.
Step in / walk-in Place Reflex (Dance Reflex)
– almost the same with step in place reflex only that you are touching the anterior surface of
a newborn`s leg.
Placing Reflex
– when an object touches the sole of the newborn`s foot at the base of the toes, the toes
grasp in the same manner as the finger does.
Plantar grasp reflex
– when newborns lie on their backs, their heads usually turn to one side or the other. The
arm and the leg on the side to which the head turns extend and the opposite arm and leg contract.
Tonic-neck-reflex
is activated as a result of
turning the head to one side. As the head is turned, the arm and leg on the same side will extend while
the opposite limbs bend, in a pose that mimics a fencer. The reflex should be inhibited by six months of
age in the waking state. If this reflex is still present at eight to nine months of age, the baby will not be
able to support its weight by straightening its arms and bringing its knees beneath its body.
Asymmetrical tonic neck reflex (sometimes called the labyrinthine tonic reflex)
occurs with either the extension or flexion of the infant’s head. Extension
of the head results in extension of the arms and flexion of the legs, and flexion of the head causes flexion
of the arms and an extension of the legs. This reflex becomes inhibited by the sixth month to enable
crawling.
Symmetrical tonic neck reflex
- with a loud jarring, baby assumes C position – disappear 4-5 mos. The inhibition of this reflex
occurs from the third to the sixth month. An asymmetrical response with this reflex may indicate a fractured
clavicle or a birth injury to the nerves of the arm. The absence of this reflex in the neonate is an ominous
implication of underlying neurological damage
Moro Reflex
– when there is the pressure at the sole, he pushes back against the pressure.
Magnet Reflex
when a sharp object stimulates the sole, it causes the foot to rise, and the other
foot extended.
Crossed extension reflex –
while in a prone position and the Para vertical area is stimulated, it causes flexion
of the trunk and swings his pelvis towards the touch
Trunk Incurvation reflex –
while in a prone position and the trunk is being supported, the baby exhibits some muscle
tone
Landau reflex –
when the sole is stimulated by an inverted ‘J” it causes fanning of toes – disappear by to 2
months
Babinski reflex-
can be stimulated by placing the neonate prone (face down) on a flat surface. The neonate
will attempt to crawl forward using the arms and legs. This reflex will be inhibited by three to four months of
age
Prone crawl reflex
can be noted with the infant supine (lying on the back) and slowly turning the head to either
side. The infant’s eyes will remain stationary. This reflex should disappear between three to four months of
age.
Doll’s eye reflex
.Closing eyes in response to touch or a sudden, bright light
Blinking reflex:
Gagging in response to the back of the mouth or throat being touched
Gag reflex:
Coughing in response to airway stimulation
Cough reflex:
Sneezing in response to nasal airway irritation
Sneeze reflex:
.Yawning in response to the body’s need for more oxygen (or tiredness)
Yawn reflex:
Also known as the “what-is-it?” reflex, draws attention to a new stimulus
Orienting reflex:
Also called the patellar reflex, a sudden kick in response to a tap on the patellar tendon
(located just below the knee)
Knee-jerk reflex:
is the most important
physiologic change required of newborns.
The transition from fetal or placental circulation to independent respiration
help initiate a neonate’s first respiration.
Chemical and thermal factors
result from shifts in pressure in the heart and major vessels and functional
closures of the fetal shunts
. Circulatory changes in neonates
Newborns’ large surface area, a thin layer of subcutaneous fat, and a unique mechanism for producing heat
predispose them to
excessive heat loss.
nfants’ high rate of metabolism is closely correlated with the ____, which is much higher
in infants than in adults.
rate of fluid exchange
t or f
The skin and mucous membranes, the macrophage system, and antibodies are the first, second, and third
lines, respectively, of defense against infection
t
, the initial assessment of newborns, focuses on heart rate, respiratory effort, muscle tone,
reflex irritability, and color
The Apgar score
includes the clinical assessment of gestational age, general
measurements, general appearance, head-to-toe assessment, and parent-infant attachment or bonding
Physical assessment of newborns
focuses on localized reflexes and posture, muscle tone, head control, and
movement and is best accomplished during the general physical examination.
The neurologic assessment
. includes maintaining a patent airway, maintaining stable body temperature,
protecting from infection and injury, and providing optimal nutrition
Physical care for newborns
Although the attachment, or bonding, a process primarily affects infants and parents, ___ also play an
essential role.
siblings
An essential aspect of discharge teaching is ensuring newborns’ safe transportation home in federally
approved,
backward-facing car safety seats.
