OB Ch 14 PowerPoint

What prevents alveoli from sticking together when the newborn takes 1st breath?

Surfactant

What begins before birth?

Lungs develop and mature

A body fat infants use to regulate body temperature

Brown fat

What is stored in the liver as glycogen and provides energy source for a newborn at birth?

Glucose

What produces catecholamines

Adrenal glands

What is catecholamines?

The hormones : dopamine, norepinephrine & epinephrine

What does Catecholamines do ?

• Increase the level of surfactant in the fetal lungs

• increase blood flow to the heart, lungs and brain

• increase energy

• stimulates WBC production

Four mechanisms of heat loss:

• Evaporation

• Conditioning

• Convection

• Radiation

Evaporation

Loss of heat as amniotic fluid on infant evaporates

Conduction

Transfer of heat from infant's body to cooler surface

Convection

Transfer of the infant's body heat to surrounding cool air

Radiation

Transfer of infant's body heat to cooler object that infant is not in contact with

Problems with heat regulation:

• lack of subcutaneous fat to provide insulation

• blood vessels close to the surface

metabolism of brown fat

nonshivering thermogenesis

Term infants rely on this to provide additional heat, where as preterm infants may not have any.

Brown fat/ temp regulator

Cold stress

Brown fat rapidly metabolized

• can lead to metabolic acidosis in the newborn.

• increased need for oxygen

• increased use of stored glycogen ➡ hypoglycemia

• decreased surfactant production

After birth what to do with infant

• dry immediately

• skin-to-skin with mother

• cover head with cap

• check temp every 15 mins. ( 1st hr)

• avoid uncovering/exposing body

• place under warmer for procedures

• avoid bathing until temp stable (2hr)

• don't place crib near draft/window

respiratory system

For breathing to occur, sequence of events must happen including internal and external stimuli

internal stimuli

Chemically focused

external stimuli

Mechanical, sensory, thermal changes in newborns body

Breathing at birth

• Chest pressure squeezes out secretions and amniotic fluid

• Chest recoils causing air to fill the lungs

• Surfactant increases to keep alveoli open after initial
  breaths

• Cutting umbilical cord causes respiratory centers in brain to begin working in response to dropping blood pH

What to do for the respiratory system

• Count RR per min

• Suction mouth and nose

• Monitor respiratory effect

• observe abdomen

infants abdomen and breathing

Involves of the diaphragm and abdominal muscles

Allowing "Short burst" of crying will:

Increase the depth of respirations and aid in opening the alveoli at birth

cardiovascular system in the infant

• Blood flow changes

• More RBCs than adults

• Provides extra oxygen for labor

• hemoglobin 17-18g/mL

• hematocrit 45% - 50%

• after birth oxygen has passed/RBCs not needed

• elevated WBCs

• absence of vitamin K

What is released when breakdown of RBCs increases

Bilirubin released

Bilirubin

Waste product of breakdown of RBCs

What's going on with the elevated WBCs?

Does not reflect infection but does reflect how stressful the birth was for the infant

Absence of vitamin K

Diminished ability of blood to clot

Intervention during cardiovascular transition

• Monitor HR ( <100 bpm stimulate)

• ineffective- use positive pressure ventilation to increase HR

• Begin chest compressions HR below 60 bpm

• Monitor color of trunk, mucous membranes, & the capillary refill time

renal system of infant

• kidneys immature

• urine not concentrated til 6wks

• urine odorless & light color or clear

• Void within 24 hrs, Vol at least 15 mL

• Volume rises 300 mL/day

Total daily output for infant within the first 2 days of life

30-60 mL

Renal system interventions

• Monitor 1st void

• weigh diapers

• Encourage frequent breastfeeding

• # of wet diapers = the age of the baby for the 1st wk( 2 day old = 2 wet diapers)

Gastrointestinal system for infant

• Sterile at birth

• bacteria enters body & become Probiotics

• intestinal bacteria that aids in digestion & synthesize Vitamin K

• Compacity of stomach 60-90 mL

• pancreas immature

• Cardiac sphincter between Esophagus & stomach is weak

• Meconium stool expelled within 24-48 hrs of birth

Gastrointestinal interventions

• Monitor for meconium stool, report if not expelled within 24 hours

• teach not to overfeed

• teach about immature, cardiac sphincter, and regurgitation

Hepatic syndrome for infants

• liver immature at birth, high number of unneeded RBCs

• if not removed efficiently ➡ normal physiological jaundice by day 2-4

Liver's job

Remove indirect bilirubin and convert/conjugate it to a form that can be excreted

Indirect bilirubin

Causes jaundice - yellow discoloration of skin.

Direct bilirubin

Conjugated, excreted mainly as yellowish - brown still a small amount in urine

Hepatic interventions

• Monitor for yellow Scalera and skin

• teach about normal physiological jaundice

• developed by days 2-4

• an expected range for a newborn is less than 5.8 mg/dL

• will rise and should peak by day five but should be below 11.7 mg/dL

• elevated levels must be reported

The appearance of jaundice before 24 hours of life indicates what

Abnormally rapid destruction of RBCs and could indicate an ill newborn

Immune system

born with passive antibodies, passed from the mother through the placenta

Is the newborn protected from polio, measles, diphtheria, pertussis, chickenpox, rebel, and tetanus if the mother is vaccine or had these illnesses before?

Yes for up to the first 2 to 4 months of life

Immune system interventions

• Strict handwashing

• Protect from infection

• Healthcare personnel, and visitors for illness

• Teach hand hygiene

• Encourage immunizations to begin at two months of age

How does a newborn initiate interaction?

Crying, quiet when soothed, engaged in mutual gazing

How to tell if a newborn likes something

When focusing eyes, tracking objects or person

How to tell when a newborn demonstrates dislike

When turning away, crying, yawning

self-soothe

Thumb or hand sucking

First period of reactivity

• occurs 30 to 60 minutes after birth

• Alert, active, and cooperative

• vigorous reflex present - introduce latch on for BF

Period of inactivity

• Fall into a deep sleep 2-4 hours or longer

• Unresponsive to external stimuli

• HR & R are both decreased, but stay WML. The parents may have trouble waking the baby for feedings.

Second period

• Wakes up from long sleep

• Alert, active, and hungry

• encourage family interactions with newborn and educate about hunger cues

Deep sleep

Very steel with occasional twitch. Usually there are no eye movements, and breathing as regular. It is difficult to awaken the baby.

Light sleep

Wrap eye movement sleep. Eye movements may be visual beneath the eyelids, and the baby may occasionally fuss or make sucking movements. Typically right before the baby wakes up.

Drowsy

As may be open. Not fully asleep and may go back to sleep or wake up more.

Alert

As will be open. Baby is most interested in eating.

Active alert

Sensitive to hunger, discomfort, and fatigue. May require comforting in the state.

Crying

Conveys that something is bothering them