OB Exam 4: Newborn Teaching

Whats the 4 mechanisms of heat loss in newborns?

1. convection

• cool air drafts across skin surface

2. evaporation

• wet skin loses heat (covered w/ amniotic fluid)

3. radiation

• skin nearby cold objects

4. conduction

• direct contact w/ cold surfaces

How can we prevent hypothermia during initial hours after birth? (5)

1. dry immediately after birth

2. skin to skin contact

3. warm blankets and hat

4. pre warm crib

5. avoid drafts

Newborn normal ranges:

1. temp

2. RR

3. HR

1. temp: 97.7-99.5F

2. RR: 30-60 breaths/min

3. HR: 110-160 bpm

Why do newborns have low Vit.K? (4)

1. sterile newborn gut (havent eaten yet)

2. low amt in breast milk

3. immature liver

4. poor placental transfer

Physiological Jaundice (3) vs Pathological Jaundice (2):

Physiological (normal)

1. appears AFTER 24 hrs

2. due to immature liver

3. mild and resolves on its own

Pathological: too high too soon (bilirubin rises too quick)

1. appears WITHIN 24 hrs

2. high bilirubin levels

Hyperbilirubinemia management: (3)

1. phototherapy

• strip down to diaper and expose skin

• cover eyes

2. NO lotions!!

• causes burns

3. the more they poop, the better bilirubin levels will be

Whens APGAR done and include categories and scoring

done @ 1min and 5 mins

• appearance: pallor, cyanotic, pink

• pulse: < 60 CPR; 110-160 bpm

• grimace: coughs/cries/sneezes

• activity: limp or active mvmt

• respirations: retractions, grunts, flares

→ 0-3 start interventions

→ 4-6 monitor

→ 7-10 good baby

newborn reflexes and how to elicit each of them: (7)

1. moro (startle reflex)

• “baby thinks they’re falling”

• let head drop slightly → arms open wide (good)

2. rooting

• “looking for food”

• stroke cheek→ turns head toward touch

3. sucking

• something in mouth = suck

4. palmar grasp

• put finger in palm → baby grips tightly

5. Babinski

• stroke sole of foot from toe→ heel

  • toes fan OUT=normal for baby but problem for > 2 y/o

6. tonic neck

• “baby looks like a fencer”

• baby looks one way and arm+leg points same way

  • other arm+leg bends

7. stepping

• hold upright → feet make stepping motions

newborn weight measurements:

lose up to 10% of birth weight by 48 hrs

• should regain by 2 weeks

newborn HYPOglycemia signs: (5)

• how to check?

1. shaky/ tremors

2. lethargic

3. poor muscle tone (weak)

4. cyanotic

5. heel stick to check glucose (normal: >45 mg/dL)

PKU test and timing

• collected after baby eats (breastmilk or formula) at least 24 hrs

  • PKU causes brain/nervous system issues

Newborn positive for Critical Congenital Heart Disease if one of the following: (2)

1. O2 < 90%

2. O2 < 95% in both extremities, 3 diff times, each separated by 1 hr

Newborn abduction interventions: (3)

1. 2 ID bands on infant @ delivery

• wrist and ankle

2. ID band on pt and other caregivers

3. foot and hand prints

When and how long to breast feed:

• feed q2-3 hrs, 8-12 times/day

• feedings should last 15-20 mins per breast

newborn indicators of adequate intake of breastmilk: (2)

• whens the best time to breastfeed?

1. 3 bowels mvmts

2. 6-8 wet diapers

→ all in 24 hrs after day 4

****best time to breastfeed is within 1st hr after birth!!

Neonatal nutrition guide for formula: (6)

1. formula fed q3-4 hrs; 6-8x/day

2. 15-30mL/feeding

3. burp them every ½ oz

4. head 15-20 degrees

5. look for hunger cues (rooting, sucking noise, crying)

6. note emesis (assess if allergy or normal behavior)

abnormal newborn assessment needs interventions: (7)

1. head:

• caput succedaneum

• cephalohematoma

• sutures

• fontanels (bulging or sunken)

2. eyes

• pupillary response

• strabismus (cross-eyed)

3. mouth

• cleft lip/palate

4. chest

• murmurs/breath sounds

• crepitus

5. extremities:

• pulses equal and deformities

• dysplasia

6. back

• spina bifida (hair tuft)

7. skin

• erythema toxicum (normal red rash)

• Mongolian spots (normal)

• jaundice (1st 24 hrs is pathological aka BAD and day 2/3 is physiological-normal)
  

How is pain assessed using Neonatal Infant Pain Scale (NIPS): (6)

1. Facial expression: relaxed or grimacing

2. Cry: none, whimper, vigoruos

3. Breathing: relaxed→ changed from baseline

4. Arms: relaxed or flexed

5. Legs: relaxed or flexed:

6. Alertness: calm or fussy