newborn care

what are the three physiological adaptations of the newborn?

• establishing and maintaining respirations

• adjusting to circulatory changes

• regulating temp

what factors does establishing and maintaining respirations include

• chemical factors

• thermal factors

• mechanical factors

• sensory factors

how do the chemoreceptors get activated?

• when the fetus does not get enough oxygen (hypoxia), the chemoreceptors in the carotid arteries and aorta get activated

what happens during contractions?

• during contractions blood flow and oxygen from the placenta temporarily 

what happens with the O2, PCO2, blood pH

• decrease PO2

• increase PCO2

• decrease blood pH

what happens with low O2 and high PCO2

• stimulates respiratory centre 

thermal factors?

• after the baby leaves the warm uterus and enters a cooler enviornment, decrease in extrauterine enviornment

• this stimulates receptors on the skin that stimulates the respiratory centre in the medulla to trigger the baby to breathe 

what can cold stress do?

• important for initializing breathing, but prolonged exposure MUST be avoided 

what happens from when the baby first born to when it comes out

• when the baby being born, the chest gets squeezed (intrathoracic pressure), which helps push fluid out of babys lung as it passes the birth canal

• once the baby is born, the pressure stops, and the chest is able to expand again, when the chest expands it creates a tiny vacuum (negative pressure), that pulls air into lungs

what happens when the baby cries

• when the baby cries it

  • spreads air through lungs, promoting expansion of the alveoli 

  • creates positive pressure which helps the alveoli stay open

sensory factors?

• handling, drying, lights, sounds and the smells of the new enviornment can be involved in stimulation of resp centre

• pain associated with birth can be a factor

what circulatory changes occur after birth?

• as the babys lungs expand, the baby BP increases

• pressure in the lungs drop; since lungs are full of air, its easier for blood to move through them

• decreased blood skipping the lungs from the ductus arterisosus as the lungs are working now, so the ductus arteriosus naturally closes. 

• increase pressure in the left atrium of the heart and lower pressure in the right atrium, causing foramen ovale to close.

what happens if the foramen ovale does not close

• foramen ovale (hole in heart)

• surgical repair is needed

what characteristics puts newborns at risk for heat loss-hypothermia?

• larger body surface to body weight

• less adipose tissue and fat in newborn 

• underdeveloped sweating and shivering mechanisms

• blood vessels closer to skin surface contribute to heat loss when dilated

what enviornmental factors affect themoregulation?

• temp and humidity of air

• flow and velocity of air

• temp of surfaces in contact with and around newborn 

what is the goal of care in thermoregulation?

• maintain a neutral thermal enviornment where heat balance is maintained

  • allow newborn to maintain a normal body temp to minimize oxygen and glucose consumption

what are the four ways of heatloss?

• evaporation

• conduction

• radiation

• convection

what is evaporation?

• loss of heat when water evaporates from the skin and resp tract

  • if baby isnt dried completely after a bath, they can lose body heat faster 

  • important to dry the baby quick and take away any wet towels to keep them warm.

what is conduction?

• heat loss from body surface to cooler surfaces in DIRECT CONTACT 

  • prewarm incubator/radiant warmer to ensure warm mattress

  • cover xray plates and scales

  • prewarm hands, stethoscopes, blankets and other equipment 

  • weighing newborn should have protective cover to minimize conductive heat loss

why is skin to skin benefical?

• keep newborns warmer than swaddled

• minimize heat lost from conduction

what is radiation?

• heat lost to surrounding colder solid objects; not direct contact but in close proximity

  • keep incubator warmer examination table, crib away from outside walls and windows 

  • dress baby

  • avoid exposing baby to direct air drafts 

what is convention?

• heat lost from body surface to cooler ambient air

  • raise surrounding 22c and 26c

  • cover baby head

  • wrap and dress baby

  • warm o2

    • when they recieve oxygen, make sure its warm

what are the effects of cold stress?

• when the baby gets too cold, the body tries to make more heat, and to do this, the body uses more oxygen and pulmonary and peripheral vasoconstriction occur (blood vessels tighten to keep warmth inside) which makes it harder for oxygen to reach tissues and lungs. since the baby is not getting enough oxygen, the body starts using a backup system, anaeobic glycolysis to make energy. This buildup in acid, causes decrease in po2 and pH→metabolic acidosis

what happens with po2, pco2 and pH in cold stress?

• increase PCO2

• decrease PO2

• decrease pH

what newborn assessment is done immediately after birth?

• APGAR

• min; 0

• max; 10

when is it done

• 1 and 5 mintues after birth

what does APGAR stand for

• Appearance

• Pulse

• Grimace

• Activity

• Respiration

what does the score 0-3 mean

• severe distress

what does the score 4-6 indicate

• moderate diffculty

what does 7-10 mean

• newborn having minimal or no difficulty adjusting to extrauterine life

what is done if score less than 7?

• reassessment is done 10 and 20 mins

when could resuscitation occur?

• resuscitation can occur at any point when the newborn is compromised and not wait until intial 1-min apgar score

what is assessed with resp system; respirations

• observe rise/fall of chest for 1 min 

• asuscultate lung sounds 

• shallow and irregular 

• apenic periods of 5-10 seconds as fluid being absorbed/expelled

  • 5-10 seconds of pauses inbetween breathing cuz lungs still have fluid 

• may hear crackles 1st hour after birth 

• acrocyanosis

  • extermities being blue, may stay for few days

what is normal resps for newborn

• 30-60 bpm

what are signs of resp distress?

• chest retractions 

• grunting with expirations

• increase use of intercostal muscles

• nasal flaring 

• resp rate lower than 30 or higher than 60

what is normal HR for newborn

• between 110-160 bpm

• hr drops as u age

what to do if hr is less than 110 or higher than 160

• re-evaluate after 30mins-1hr

cardiovascular findings

• heart murmurs heard for the first few weeks

  • disappear by 6 months

what is the average bp

• systolic 60-80

• diastolic 40-50

what is fetal hb?

• fetal Hb

  • Fetal hemoglobin holds onto oxygen tightly so the baby gets enough oxygen before birth, and this helps keep the baby oxygenated while their body slowly starts making adult hemoglobin after birth.

  • 14-24g/dl

what is the normal fetal blood volume

• 300mls

  • time taken to clamp cord

what are signs of cardiovascular concern?

• persistant tachycardia (more than 160bpm)

• anemia, hypovolemia, hyperthermia or sepsis

• persistant bradycardia (less than 100bpm) congential heart block, hypoxemia, normal sinus bradycardia or hypothermia 

• unequal or absent pulses, bounding pulses and decreased or elevated bp

what is fontanelles?

• anterior fontanel 5cm, diamond shaped, increases as moulding resolves

  • closes within 18 months 

• posterior fontanel triangle 0.5 × 1 cm, smaller than anterior

  • closes within 8-12 weeks after birth

what are sutures?

• allow brain growth

• should be palpable and separted suture, possible overalp of sutures with moulding 

• widely spaced (hydrocephaly)

  • accumulation of fluid in head

• premature closure (fused) (craniosynostosis)

  • skull bones fuse too early → odd head shape

what are signs of fontanel concerns?

• full, bulging (tumour, hemorrhage, infection)

• large, flat, soft (malnutrition, hydrocephaly, delayed bone age, hydrothyroidism)

• depressed (dehydration)

what is cephalhematoma

• collection of blood between skull bone and its periosteum

• does not cross suture lines

what is cephalhhematoma caused by

• caused by external 

  • pressure during L AND D

  • forceps delivery 

when is cephalhematoma largest

• largest on 2nd or 3rd day 

how does cephalhematoma feel

• feels boggy(squishy), edemtous to touch

when does it resolve

• resolves in 3-6 weeks 

why is it not aspirated

• not aspirated due to risk of infection

what is it at increased risk for

• increased risk for jaundience

what is caput succedaneum?

• localized edematous area of soft tissue of the scalp

• extends across suture lines of skull

What causes caput succedaneum in a newborn?

• The top part of the baby’s head pressed during birth (presenting part) gets compressed.

• This slows blood flow in local vessels → fluid collects under the scalp.

• Results in a soft, swollen area on the head called caput succedaneum.

when does caput succedaneum go away

• disappears spontanously within 3-4 days

what should the mouth look like

• lips should be symmetrical

• pink, moist lips and mucosa

• sucking blisters

  • from breastfeeding latch

• saliva not excessive

• intact hard and soft palate, freely moving tongue 

• tongue not protuding; freely movable; symmetrical movement

• sucking pads inside cheeks

• uvula in midline

• It’s a natural groove on the roof of the mouth (palate) that helps the baby hold and suck the nipple during feeding.

  • disappears by 3–4 years of age as the mouth and teeth develop.

what is epstein pearls

• small, firm white cyst on gum, resolves on own during 1st weeks

what are common conditions to do with the mouth

• thrush

• precocious

• cleft lip/palate

what is thrush?

• white plaque, similar to milk curds, does not easily scrape off

what is precocious

• presence of teeth at birth 

• hereditary

what is cleft lip/palate?

• cyanosis, circumoral pallor (resp distressm hypothermia)

• asymmetry in movement of lips (seventh cranial nerve paralysis)

• short lingual frenulum (ankyloglossia- tongue tie)

• difficult with breast feeding, central cyanosis; cardiac problems

what would u assess in female genitalia?

• labia

  • size?

• labia majora

  • develops close to term 

• assess to ensure labia not fused 

• assess ambiguous genitalia

  • unclear sex at birth

• milky vaginal discharge

  • circulating  maternal hormones

what is pseduomenses?

• blood tinged mucous- d/t hormones of pregnancy

  • imbalances

what is a vaginal tag (hymenal tag)

• usually disappears first few weeks after birth

why do some newborns have swelling of breast tissues

• both sexes may have swelling of breast tissue due to hyperestrogensim in utero

  • high levels of estrogen in mother when baby was in womb

• few newborns can have a thin milky discharge 

male genitalia; what is hypospadias?

• The urinary opening (meatus) is on the underside (ventral surface) of the penis instead of the tip.

• Do not circumcise — the foreskin is needed for surgical repair.

what is epispadias?

• The urinary opening is on the top (dorsal surface) of the penis.

• Circumcision is also avoided — foreskin may be needed for repair.

what is phimosis

• The foreskin cannot be fully pulled back over the tip of the penis.

• A tight foreskin is normal in newborns — it usually loosens with time.

what is hydrocele?

• A collection of fluid around one or both testes.

• It may make the scrotum look swollen, but it usually goes away on its own.

what should you assess for discolouration of testes?

• assess for testicular torsion?

what does crepitus in the groin or scrotal sac?

• indicates hernia

What is cryptorchidism (undescended testes)?

• One or both testes haven’t moved down into the scrotum.

• Normally, they should be in the scrotal sac at birth in full-term infants.

• want to palpate testes to make sure they both descend down

what is normal on the skin to see for an infant?

• pink varying with ethnic group, well perfused

• perfusion assessed by cap refill of 2 secs or less

• skin should spring back when pinched

• if fold of skin is persisting after release of pinch= dehydration

• skin is soft, dry

• acrocyanosis; blueish discolouration of hands and feet 6-8hrs post birth

  • from cardiovascular immaturity

what would u see in post-mature infants

• dry skin, cracking on feet and hanfs

what skin would indicate prematurity?

• loose wrinkled skin

what is mottling

• Mottling = a lace-like, bluish or reddish pattern on the skin

• due to temp instability; overstimulation of ANS

What does tense, tight, shiny skin in a newborn indicate?

• Can be a sign of swelling (edema), infection, shock, or exposure to extreme cold.

• Skin may look stretched and glossy.

what should be seen in extremities?

• full range of motion of arms and shoulders

• assess leg length; equal with symmetrical gluteal creases

• assess for club foot; talipes, equinovarus

• back should be straight and flexible 

• pilonidal dimple

  • cleft at base of sacrum generally benign 

  • if it goes on snd on can be indicated spine issue

what does ploydactyly mean

• extra digits

what does syndactlyly mean

• webbing 

• 2 fingers merged together

what are the newboen reflexes?

• sucking

• rooting

• moro

• babinski

what is the sucking reflexes?

• when anything is placed in mouth or touches lips 

  • should be able to suck

what is rooting reflexes?

• infant turns head when side of mouth/cheek is stimulated. present for 3-4 months 

  • aids in latching

what is moro reflex?

• starling infant 

• response by symmetrically extending arms outward while knees reflex. can last up to 6 months 

• most sensitive assessment for infants neurological system

• pretend ur gonna throw them, need reflex

what ia babinski reflex?

• plantar reflex

• hyperextension of toes when the sole is stroked from heel up to ball of foot

• disappears by 1 year o

Why is Erythromycin eye ointment given after birth?

• Given within 1 hour of birth.

• Prevents eye infection from maternal gonorrhea (and sometimes chlamydia).

• Protects against blindness caused by infection

Why is Vitamin K given after birth?

• Given within 1 hour of birth by injection.

• Newborns can’t make enough Vitamin K yet.

• Prevents bleeding (hemorrhage) by helping blood to clot.

Why is the Hepatitis B vaccine given at birth?

• Protects against Hepatitis B virus (all types).

• If the mother’s Hep B surface antigen is positive or unknown, give HBIG (Hepatitis B immune globulin) within 12 hours after birth for extra protection.

When and why is blood glucose monitoring done in newborns?

• Check at 2 hours after birth for babies who are:

  • Born to moms with gestational diabetes

  • Large (LGA) or small (SGA) for their age

• Check sooner (½–1 hour) if the baby shows symptoms of low blood sugar (hypoglycemia).

• If baby is above 90th or below 10th percentile for weight → monitor more often

What is the heel prick test for?

• Done to screen for metabolic and genetic disorders, such as:

  • Bilirubin levels (jaundice)

  • PKU (phenylketonuria)

  • Congenital hypothyroidism (can cause intellectual disability if untreated)

  • Sickle cell disease

• Usually done within the first 24–48 hours after birth.

is screening for congenital heart disease done?

• Measure oxygen saturation in:

  • Right hand (pre-ductal)

  • Any foot (post-ductal)

• Normal: both readings similar and ≥ 95%.

• Abnormal:

  • Difference >3% between hand and foot, or

  • O₂ < 94% in either → repeat test or report.

Why is hearing screening done for newborns

• Detects hearing loss early so treatment or support can start quickly

what is the goal of newborn pain managment

• minimize intensity, duration, and physiological cost of pain 

• maximize newborn ability to cope with and recover from pain

what would you see in vital signs when in pain?

• increase HR

• increase BP

• rapid, shallow resps

what would u see in oxyegnation when in pain

• increased oxygen sat (tcPo2)

• decreased arterial oxygen saturation

what would u see in their skin pain?

• pallor, flushing, diaphoresis, palmar sweating

what would u see in vocalization when in pain?

• crying, whimpering, groaning 

what would you see in facial expressions when in pain?

• grimaaces, brow furrowed, chin quivering, eyes tight closed, mouth open and squarish

what would u see in body movments and posture?

• limb withdrawl, thrashing, rigidity, flaccidity, fist clenching

what changes in state would u see in pain

• changes in sleep-wake cycles, feeding behaviour, activity level, fussiness,irritability, listlessness