Week 6 Flashcards
What is the role of Surfactant?
Surface tension–reducing lipoprotein that prevents alveolar collapse
What is surfactant?
Type of phospholipid which maintains surface tension over the alveoli, which keeps them open.
Created by type II cells within the lungs
Present at 21 weeks gestation, increases at 24 weeks, is usually sufficient at gestational ages above 32 weeks and is optimal at 35 weeks
Delayed Cord Clamping
The SOGC recommends delaying cord clamping for 60 seconds for term and preterm infants not requiring resuscitation regardless of the mode of delivery.
Benefits of cord clamping
Increase placental transfusion, leading to an increase in neonatal blood volume at birth of approximately 30% (JOGC, 2012)
Hepatic System Function
Iron storage
Carbohydrate metabolism
Bilirubin conjugation
GI System Adaptations
Development of a mucosal barrier to prevent the penetration of harmful substances
Cardiac sphincter and nervous control of stomach are immature, leading to regurgitation and uncoordinated peristaltic activity
To gain weight the newborn requires an intake of 108 kcal/kg/day from birth to 6 months of age
Renal System Adaptations
Limited ability to concentrate urine until about 3 months of age (urine has a low specific gravity)
Six to eight voidings per day considered normal
Intake, Output, Weight Loss and Weight Gain
A maximum of 10% of weight loss should occur in the newborn
Weight should return to birth weight by 10-14 days
First 2 days of life (intake and output)
60 – 80 mL/kg/day (18-27 mL/lb/day) intake
8-12 feeds/day if breastfeeding
1 to 2 voids/day
After first 2 days of life (intake and output)
100 – 150 mL/kg/day (45-68 mL/lb/day) intake
8 – 12 feeds/day if breastfed
At least 6 voids/day by 4th day
What immunoglobulins does the newborn primarily depend on?
Newborn primarily dependent on three immunoglobulins:
IgG: protects the baby from many infections in the first months of life
IgA: it coats and seals your baby’s respiratory and intestinal tract to prevent germs from entering their body and bloodstream
IgM: Plays role in immune regulation
Neurologic System Adaptations
Development follows cephalocaudal and proximal–distal patterns
Acute senses of hearing, smell, and taste
Adaptations of respiratory, circulatory, thermoregulatory, and musculoskeletal systems
Reflexes: indication of neurologic development and function
First Period of Reactivity
Birth to 30 minutes to 2 hours after birth
Newborn is alert, moving, may appear hungry
Period of Decreased Responsiveness
30 to 120 minutes old
Period of sleep or decreased activity
Second Period of Reactivity
2 to 8 hours
Newborn awakens and shows an interest in stimuli
Orientation
response to stimuli
Habituation
Ability to process and respond to auditory and visual stimuli
Ability to block out external stimuli after newborn has become used to activity
Motor Maturity
ability to control movements
Self Quieting Ability
consolability
Social Behaviours
cuddling or snuggling
Hearing Screening
Non-invasive testing
Initial screening - evoked otoacoustic emissions (EOAE) test
Follow-up for abnormal screen - auditory brainstem response (ABR) test
Apgar Scoring System
Apgar score at 1 minute and 5 minutes, scoring from 0 (very poor) to 2 (excellent) in following areas: heart rate, respiratory rate, muscle tone, reflex irritability, skin colour
8 to 10: No intervention required except to support infant’s spontaneous efforts.
4 to 7: Gently stimulate; rub infant’s back; administer oxygen to infant.
0 to 3: Requires resuscitation.
typical body measurements
Length: 45 to 55 cm (18-22 in)
Weight: 2500 to 4300 g (5.5-8.75 lb)
Head circumference: 33 to 35.5 cm (13.2-14 in)
how is heat lost in newborns
conduction, evaporation, radiation and convection
Cold Stress
Oxygen and vast amounts of energy are redirected to sustain thermogenesis.
This means that the brain and heart do not receive as much oxygen and energy.
Blood pH drops as a result of inadequate pulmonary perfusion.
Metabolism increases to maintain warmth, which results in glycolysis – glycolysis worsens jaundice
Appropriate for Gestational Age
approximately 80% of newborns; normal height, weight, head circumference, body mass index
Small for Gestational Age
weight <2,500 g (5 lb 8 oz) at term or below the 10th percentile
Large for Gestational Age
weight >90th percentile on a growth chart; weight >4,000 g (8 lb 13 oz) at term
Typical Characteristics of SGA
Head disproportionately large compared with rest of body
Wasted appearance of extremities; loose dry skin
Reduced subcutaneous fat stores
Decreased amount of breast tissue
Scaphoid abdomen (sunken appearance)
Wide skull sutures
Poor muscle tone over buttocks and cheeks
Thin umbilical cord
Typical Characteristics of LGA
Large body, plump, full-faced
Proportional increase in body size
Poor motor skills
Difficulty regulating behavioural states
full term
Born from the first day of the 38th week through 42 weeks
preterm
Born before completion of 37 weeks
late preterm (dumb)
Born beyond 42 completed weeks
postterm
Born beyond 42 completed weeks
Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks
Typical Characteristics of Postterm baby
Dry, cracked, peeling, wrinkled skin
Meconium-stained skin and nails; long nails
Long, thin extremities; creases over entire soles of feet
Wide-eyed, alert expression
Abundant hair on scalp
Thin umbilical cord
Limited vernix and lanugo
Discharge planning; newborn must be able to
Thermoregulate
Control breathing (no apneic spells for 5-7 days)
Demonstrate respiratory stability (be free of a ventilator) and maintain SPO2 at 90-95%
Demonstrate ability to feed without ‘spells’, and gain weight
Parents must be emotionally ready to take on the task of having a premature newborn at home.
Family involvement is promoted, and parents can often stay with their newborns in hospital.
Parental Eval prior to discharge
Confidence in caring for their newborn
Administer medications/medical care as needed
Demonstrate knowledge re: management of signs of symptoms of illness and when to return to hospital
Maintaining infection control at home
Maintaining a smoke-free environment
What is Horner Syndrome?
damage to nerve which controls pupil dilation, eyelid control and perspiration
Hyperbilirubinemia
Imbalance in rate of bilirubin production and elimination; total serum bilirubin level >5 mg/dL
