The Newborn- Ch 18

Neonate

newborn baby

How do babies know its time to start breathing

-Thermal

-Mechanical

-Chemical cues

-Change in circulation

Mechanical influences

-Squeezing (birthing canal)

-Absorption of fluid

-Crying

How does a clamped cord stimulate breathing

There is no gas exchange via placenta which will lead to hypoxia and stimulate breathing

What does estrogen do

fills things with blood

What progesterone do

makes things soft

Thermal influences

Goes from warm stomach to cold room, shocks the baby to breathe

Chemical influences

CO2 goes up and will make you want to breathe

Three shunts that aid in the flow of oxygenated blood to the lungs

Ductus arteriosus

Ductus venosus

Foramen ovale

How to maintain temperature

-Dry neonate

-Remove wet blankets

-Place baby skin to skin

How to maintain/monitor airway

-suction mouth and nose

- Stimulate baby if needed

-Monitor work of breathing

How to maintain/monitor circulation

-Heart rate

-Tone

-Color (centrally pink)

Fetal lungs

nonfunctional and collapsed, so two shunting mechanisms ensure that blood bypasses the lungs.

Neonatal lungs

normal alveoli that are now open

When does the alveoli open

when the baby is born, holes in the heart close and force alveoli open

What to do if baby is born feet first

cover feet with blanket because temp difference will stimulate breathing and they will breathe in amniotic fluid

How many holes are there in the heart

3 holes

What is the purpose of having holes in the heart

Bypass the lungs to the placenta

What happens if you dont keep the baby warm when first born

the baby will use too much brain power to remember to stay warm and might forget to do other things

What type of breathers are babies

Obligate nose breathers

Acrocyanosis

blueness of the extremities (fingers and toes)

Bulb suction

-Mouth

-Nose

Suction catheter

use when you have blood or thick secretions

-goes down to the vocal cords

Extensive interventions

-Intubation (comes with extra O2)

- Meconium aspirator (inhaled poop)

-Oxygen therapy

Signs of respiratory distress

Centrally cyanotic

Grunting

Retractions

Tachypnea

Nasal flaring

Grunting

struggling to pop open alveoli

infants whine babies dont

Subcostal retractions

seeing the chest move up and down

Intercostal retraction

seeing the ribs when breathing in

What is the most important thing to assess

temperature, color and blood

(respiratory distress, temp regulation, blood sugar)

APGAR

Appearance

Pulse

Grimace

Activity

Respiration

How often do you do an APGAR test

1 min & 5 mins (if low at 5 mins check again at 10 mins)

Average score for APGAR

8-9

Score 2 APGAR

Pink

>100bpm

-cries and pulls away

-active movement

-strong cry

Score 1 APGAR

Extremities blue

<100 bpm

Grimaces or weak cry

Arms, legs fixed

Slow, irregular

Score 0 APGAR

Pale or blue

No pulse

No response to stimulation

No movement

No breathing

First phase of transition

-1-2 hours after birth

-awake and alert

-optimal time for initiating breastfeeding and bonding

Second phase of transition

-time to sleep

-several hours

Final phase of transition

- 2-8 hours after birth

What vital sign for a baby is regular

Pulse (HR)

-count 15 secs x 4

What vital sign is irregular for a baby

Respiration

30-60 breaths per minute is normal

-Must count for a full minute

Why are babies are risk for hypothermia

They have a high body surface to mass ratio & blood vessels are close to the surface of the skin

babies dont shiver to produce heat

what do babies use to stay warm

Metabolizing brown fat (preterm babies dont have brown fat)

Normal temperature

97.7- 98.9 (36.5- 37.2 C)

Methods of heat loss- Evaporation

Moisture on skin (after birth or bathing)

Methods of heat loss- Conduction

Comes in contact with cold surfaces (scale, cold hands)

Methods of heat loss- Concection

Air draft (air conditioning, open doors)

Methods of heat loss- Radiation

Heat loss from near cold surfaces

Thermal Regulation

Baby wears 1 more layer than parents (mom has on shirt, baby has shirt and sweater

Where to take temperature

under the arm, if abnormal may require rectal temp

What does gestational age have to deal with

Neuromuscular maturity in a baby

How should the chest look

should be symmetrical and barrel-shaped

Resting posture for a term baby

Flexed

Resting posture at approx 30 weeks

unflexed

How to measure chest circumference

measure all the way around from nipple line

Chest is usually bigger than abdomen

Vernix

cheesy white coat found on full term baby

Mongolian spots

bluish purple spots of pigmentation

Telangiactic nevi (stork bites)

common birthmark that form on newborns skin, typically on the head or neck

Port wine stain

a flat vascular birthmark made up of dilated blood capillaries, creating a large, reddish-purple discoloration on the face or neck

What should corners of eyes align with

the tops of ears

What is common in the head

Molding and caput, Fontanels may be slightly depressed

Stepping reflex

When held upright by the torso and held so the feet touch a surface, the infant makes a walking motion

Fencing reflex

Turning an infant's head to one side quickly causes the baby to extend the arm and leg on that side and flex the other side

Caput

Fluid collects under baby's scalp and causes swelling and bruising

Cephalhematoma

subperiosteal collection of blood between the skull and the periosteum

When should the passage of meconium happen

within 24 hours

Male genitalia

Urinary meatus should be located at the tip of the scrotum and testes palpable within the scrotum

Female genitalia (term babies)

Labia majora covers the labia minora, clitoris, and introitus

What is normal after birth for a female baby

Pseudomenses (mucus or bloody discharge)

-May be concerning to family

How much should an infant urinate daily

urinate 6-8 times daily

pseudomenses

vaginal discharge in the newborn female

Uric acid crystals

-Red ("brick like dust") in color and can be alarming

when would uric acid crystals appear

appears day 3 or more

-sign of dehydration

Meconium

Greenish black with a thick, sticky, tarlike consistency

-Consists of particles from amniotic fluid

Transition stool

combination of meconium and milk stools

Breastfed infants stools

-Stools are seedy and mustard colored

-Stools are more frequent than with formula

-Stools have a sweet-sour smell

Formula-fed infants stools

-stools are pale yellow to light brown

-Stools are firmer in consistency

-stools have the characteristic odor of stools

Rooting reflex

when the mouth or cheek is touched, the infant turns toward the stimulus and opens the mouth

Sucking reflex

When fed, the neonate coordinates sucking, swallowing, and breathing

Extrusion

When the tip of the tongue is touched, the infant sticks out the tongue

Palmar reflex

The infant curls fingers around the object placed in the hand

Plantar reflex

The infant curls toes around the object placed at the base of the toes

Babinski reflex

When an infants foot is stroked along the lateral aspect and then across the ball of the foot, the toes fan outward

Moro reflex

The infant abducts and extends arms when startled by a loud noise or if experiencing a dropping sensation

Umbilical cord care

-Two arteries and one vein

-White or grayish color

-Odorless

-Leave open to air

-Falls off in two weeks

Circumcision

An elective procedure that removal of the foreskin of the penis

When is a circumcision done

Within 1-8 days of life

What should be administered before a circumcision

Vitamin K

Requirements for circumcision

Be at least 12 hours old and void prior to surgery

Circumcision care

- Wrap penis in gauze covered with petroleum jelly, maintain for at least 3-5 days

Normal findings post circumcision

-swelling

-yellowish crust on penis

-blood-tinged diaper (less than a quarter in size0

-Should void wihtin 12 hours of procedure

How long should infants receive formula

The first 6 months

What can happen if meconium is not passed

Baby can develop jaundice which can cause brain damage & interrupt mom & baby time

How much do breastfed babies feed per day

8-12 times a day

Infant feeding & hunger signs

-Feed infant whenever they start rooting, sucking or smacking

-Opening the mouth

- Crying

-Opening the mouth

-Moving hand to mouth

When is breastfeeding successful

If there is a proper latch

-lips flanged outward

-wide open mouth

-full cheeks

-audible swallowing

LATCH score

Latch

Audible swallowing

Type of nipple

Comfort

Hold (positioning)

Mastitis

inflammation of the breast

Abscess

localized collection of pus

Candidal infection

thick white plaques on the hard palate

Bloody nipple discharge

intraductal papilloma