Apgar and newborns

in what period should breast feeding be initiated with a newborn?

first period

first period of reactivity

first 15-30 minutes

newborn will be alert and watching

they will have a vigorous reaction

second period of reactivity

from 30 minutes to 2 hours where the newborn is sleeping and is difficult to arouse (normal)

third period of reactivity

from 2-6 hours where the newborn is awakening and becomes responsive again

when is apgar scoring done?

within 1 minute and 5 minutes after birth

how can stimulation be provided to a newborn?

with suctioning or gently flicking the sole of the foot

what apgar score is considered vigorous?

7 and above

heart rate on apgar scoring

done by auscultation (best way)

can also be done by observing pulsations of the umbilical cord

rating:

• 2 if HR is above 100 bpm

• 1 if HR is below 100 bpm

• 0 if theres no HR

respiratory effort on apgar scoring

are counted by observing chest movements

spontaneously begins about 30 seconds after birth and by 1 minute should be regular and rapid

may be irregular if parent received anesthesia

rating:

• 2 - strong vigorous cry

• 1 - weak cry, slow or difficult respirations

• 0 - no respiratory effort

muscle tone on apgar scoring

newborn should hold extremities tightly flexed (simulating intrauterine position)

measured by observing their resistance to any effort to extend their extremities

rating:

• 2 - maintains position of flexion with brisk movements

• 1 - minimal flexion of extremities

• 0 - limp and flaccid

reflex irritability on apgar scoring

assess by checking their response to a suction catheter in the nostrils or flicking the soles of the feet

rating:

• 2 - cries or sneezes when stimulated

• 1 - grimaces when stimulated

• 0 - no response to stimulation

color on apgar scoring

most are cyanotic and grow pink after a few breaths = corresponds with how well they are breathing

rating:

• 2 - body and extremities are pink (rare)

• 1 - body is pink, extremities are blue (normal)

• 0 - body and extremities are blue or pale

acrocyanosis

cyanosis of the hands and feet for the first 24-48 hours of birth

central cyanosis around the mouth, chest, and abdomen is BAD

what takes highest priority in newborn care?

respiratory evaluation ***

assessment is ongoing at every newborn contact

check chest movement, intercostal retraction, xiphoid process, nares dilation, and expiratory grunt

ears of a newborn should be stiffened by thick cartilage (T/F)

true

physiologic jaundice

yellowing of the sclera and skin on the second or third day of life due to a breakdown of fetal RBCs

is jaundice within the first 24 hours of birth normal?

NO; newborn will require urgent examination as it can indicate a pathologic cause and can lead to permanent brain cell damage and impaired vision or hearing

phototherapy

common therapy for pathologic jaundice in a newborn

exposes infant to light to initiate maturation of liver enzymes

vernix caseosa

white, cream cheese-like substance that serves as a skin lubricant in utero and protects the infant’s skin

can help with temperature regulation, skin hydration, prevention of water loss, and acts as a antimicrobial

lanugo

fine, soft, downy hair that covers a newborn’s shoulders, back, upper arms, and maybe even forehead and ears

disappears by 2 weeks of age

milia

plugged sebaceous glands found on a newborn’s cheek or nose

disappears by 3-4 weeks of age as glands mature

teach parents to not pop it

desquamation

dryness on the palms and soles of an infant’s feet within 24-48 hours of birth

no treatment or lotion is needed

erythema toxicum

a rash that commonly appears on term newborns in the 1st or 4th day of life

can start as small papules, develop into a rash, and disappear by the third day

where is the anterior fontanelle located

at the junction of the two parietal bones

should not be indented or bulging

molding

term used to describe the asymmetric shape of the newborn’s head due to it molding to fit the cervix during labor

reassure parents it will evolve within a few days

caput succedaneum ****

edema of the scalp that forms on the presenting part of the head; it crosses suture lines but will gradually be absorbed and disappear within several days

cephalohematoma ***

collection of blood between the periosteum of the skull bone and the bone itself, caused by rupture of periosteal capillary because of the pressure of birth (is confined to an individual bone)

looks egg shaped

subsides without treatment but may take weeks

why is visualization of the ears not attempted in a newborn?

due amniotic fluid and vernix in ear canal

they still need to be screened for hearing before getting discharged

is a red spot in a newborn’s eye normal?

yes - small subconjunctival hemorrhage

caused by rupture of a conjunctival capillary in the eye due to the pressure of birth

why does the palate of a newborn need to be palpated?

to check for a short or “tied” tongue which can make it difficult for feeding

what happens if a newborn is born with teeth?

it’ll need to be removed

pseudomenstruation

mucus vaginal secretions in a female newborn

caused by maternal hormones

why is it important to do routine hip examinations throughout infancy?

to screen for developmental dysplasia of the hips

correction is most successful if discovered early

what is used to check a newborn’s blood glucose and risk of anemia?

heel stick test

order of bathing a newborn

eyes and face → trunk and extremities → diaper area → scalp

how should a newborn sleep?**

on their back with a firm mattress

when is the hepatitis B vaccine given to a newborn?

within 12 hours of birth

signs of hunger

• restlessness

• tense body posture

• mouth movements

late sign of hunger

crying

how can a parent monitor voiding and stooling patterns of their newborn to assess for adequate nutritional intake?

counting the number of diapers

how does breastfeeding benefit the baby and the mom?

lowers risk of asthma, obesity, T1D, N/V/D in the child and breast cancer, ovarian cancer, T2D, and HTN in mom

caloric intake in infancy

exceeds those of any other age

formula and breastmilk have 20 calories/oz

why is cow’s milk not recommended for newborns

newborn’s kidneys can become overwhelmed due to its rich solute load and can cause microscopic bleeding in the GI → blood loss and anemia

is fat free milk healthier for newborns?

NO; they need essential fatty acids for brain growth and skin integrity

what minerals are most important in the life of a infant?

calcium, IRON*, and fluoride

what formula does the AAP recommend for the entire first year of life of an infant? *

an iron-enriched formula

what vitamin does the AAP recommend for breastfed newborns?

400 IU per day of vitamin D

is cramping normal when the mother is breatfeeding?

yes; it is due to the release of oxytocin, which helps with uterine involution