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What 4 things is the newborn’s first breath triggered by?
light
cold
noise
decreased pO2 / increased pCO2
What does an APGAR score tell us?
an assessment of how a newborn is doing as they transition to the extrauterine environment
What are the 5 things we assess for in APGAR?
activity (muscle tone)
pulse
grimace
appearance
respirations
What are the three scores for activity (muscle tone)?
0: Flaccid
1: some flexion
2: well flexed
How does crying help help the transition to extrauterine life?
increased positive pressure
air to the lungs
inflation of alveoli
What are the 4 factors that help stimulate the initiation of breathing?
mechanical
sensory
thermal
chemical
What does surfactant do?
decrease surface tension and maintain alveolar stability
Why is the patency of the baby’s nares significant?
newborns are obligate nose breathers
What causes cardiovascular adaptations to begin?
cord clamping and first breath
What 3 structures close with cord clamping?
ductus arteriosus
ductus venosus
foramen ovale
Name 2 other cardiovascular adaptations.
increased blood flow to lungs and liver
increased O2 to periphery
The transition to extrauterine life is characterized by ____________.
predictable periods of instability
Describe what happens during the first period of reactivity.
quiet alert state
HR decreased from 160-180 to consistent baseline of 100-160 bpm
RR irregular and there may be audible fine crackles, grunting, nasal flaring, and retraction of the chest (should cease by 1 hour of life)
Describe what happens during the second period of reactivity.
HR, RR, muscle tone, GI activity all increase
What happens between the first and second periods of reactivity.
sleep period
What are the sleep states?
deep sleep
light sleep
What are the wake states?
drowsy
quiet alert
active alert
crying
What is the optimal state of arousal?
quiet alert state
Describe vision at birth.
eye is structurally incomplete
muscles are immature
What happens to vision accommodation over the first 3 months of life?
improves
How is vision at 6 months?
as acute as in adults
Describe hearing at birth.
similar to an adult as soon as he amniotic fluid drains from the ears
infants respond readily to the mother’s voice
Smell at birth in response to breastmilk?
breastfed infants can smell breast milk and can differentiate their mother from other lactating women based on the smell
How do children react to different tastes?
facial expressions
What tastes do newborns favour?
sweet tastes
What parts of newborns are the most sensitive?
face
hands
soles of the feet
What is erythromycin administered to prevent?
ophthalmia neonatorum
What is ophthalmia neonatorum?
inflammation of the eyes caused by a gonorrhea and chlamydia infection
How soon is erythromycin administered?
within 2 hours of birth
What is vitamin K administered to prevent?
hemorrhagic disease of the newborn
Why is the administration of vitamin K important?
newborns do not have the intestinal flora to produce vitamin K in the first week after birth and it promotes the formation of clotting factors in the liver
How much vitamin K is administered for babies >1500 g?
1 mg
How much vitamin K is administered for babies <1500 g?
0.5 mg
What 5 things should you assess for in the general appearance of a newborn?
posture
activity
anomalies
bruising
state of alertness
What pulse should be obtained on all newborns? How?
apical pulse; auscultation for a full minute
What state should a newborn be in when auscultating the apical pulse?
quiet alert state
Normal newborn heart rate?
110 - 160 bpm
Normal newborn respiratory rate?
30 - 60 breaths per minute
Where are respirations found? How are they counted?
abdominal; observing
Normal newborn temperature?
36.5 - 37.5 degrees celsius
What does newborn bradycardia often indicate?
congenital heart block
What does newborn tachycardia often indicate?
RDS
pneumonia
fever
What does newborn bradypnea often indicate?
birth trauma
maternal narcosis from analgesics or anesthetics
What does newborn tachypnea often indicate?
RDS
TTN
CDH
What does newborn subnormal temperature often indicate?
infection
dehydration
What does newborn increased temperature often indicate?
infection
chemical dependence
diarrhea
dehydration
Thermogenesis in infants?
fetal position
brown fat
protects the organs and structures
breakdown increases heat production
glycogen stores
What is convection?
heat loss to air
What is radiation?
heat loss to cold solid surface nearby
What is evaporation?
heat loss to vaporization of moisture from skin
What is conduction?
heat loss directly to a cold surface
Name 5 reasons why newborns are at higher risk of getting cold.
unable to shiver
large surface area to comparison to weight
born wet into a cold room
blood vessels are superficial
low energy stores
What can result from cold stress in newborns?
hypoglycemia
decreased pulmonary perfusion
respiratory distress
return to fetal circulation
hyperbilirubinemia
How does cold stress cause hypoglycemia?
increased energy expenditure
How does cold stress cause decreased pulmonary perfusion, respiratory distress, and return to fetal circulation?
increased oxygen consumption
How does cold stress cause hyperbilirubinemia?
increased metabolic rate which results in glycolysis and acidosis
Interventions to prevent heat loss in newborns?
place baby skin-to-skin uninterrupted with mom or dad/other parent/family member
dry baby immediately and thoroughly at birth
place a warm hat on baby
minimize skin exposure
loosely swaddle baby in warm blankets if not skin-to-skin
When do most newborns need to be weighed?
at birth and at discharge
When may a newborn need to be weighed more often? How much more often?
newborns who are small for gestational age; daily weights
What is the birth weight of term newborns?
2500 - 4000 g
Normal skin variations (10).
mottling
Harlequin sign
plethora
acrocyanosis
Nevus simplex
Erythema toxicum neonatorum
Congenital dermal melanocytosis
milia
petechiae
ecchymoses
Name the 5 steps to assessing the neck.
palpate the head
inspect the shape and size
palpate, inspect, and note status of fontanels
palpate sutures
inspect and palpate the neck for movement, flexibility, masses, bruising
What is caput succedaneum?
generalized and identifiable edematous area of the scalp
present at birth
extends across the suture lines of the skull
disappears spontaneously within 3 to 4 days
How is caput succedameum caused?
compression of local vessels resulting in slowed venous return which causes an increase in tissue fluids within the skin of the scalp
What kinds of infants commonly have caput succedaneum?
vacuum-assisted delivery infants
What is a cephalohematoma?
collection of blood between a skull bone and its periosteum
soft, fluctuating, irreducible fullness
does not bulge when the newborn cries
How quickly does a cephalohematoma resolve?
3 - 6 weeks
How are cephalohematomas caused?
pressure against the maternal bony pelvis or forceps extraction
Main differentiating factor between cephalohematoma vs. caput succedaneum?
cephalohematoma does not cross cranial suture lines
What is a subgaleal hemorrhage?
bleeding into the subgaleal compartment
What are subgaleal hemorrhages associated with?
difficult operative vaginal births (ex. vacuum-assisted)
Signs of subgaleal hemorrhage?
boggy scalp
pallor
tachycardia
increased head circumference
What 3 assessments do we do for the eyes?
check placement on face
check for symmetry in size of shape
assess for discharge from the eyes
What assessments do we do for the nose?
observe for shape, placement, patency, configuration
midline
preferential nose breathers
sneezing to clear nose
What 3 assessments do we do for the ears?
observe size, placement on head, amount of cartilage, and open auditory canal
assess hearing; wake state influences response
ensure newborn hearing screening is completed to identify defiicts
What 3 assessments do we do for the face and mouth?
observe overall appearance and symmetry of face
rounded and symmetrical; influenced by birth type or moulding
positional deformities associated with intrauterine positioning and cranial moulding may be noted
assess mouth and palate to ensure they are intact
assess for reflexes (rooting and sucking)
What 4 assessments do we do for the chest?
inspect and palpate; circular/barrel shaped
observe respiratory movements
evaluate clavicles to ensure they are intact
assess the rib cage; should by symmetrical, intact, and move with respirations
Signs of respiratory distress.
nasal flaring
head bobbing
tracheal tug
intercostal or subcostal retractions
grunting
stridor
tachypnea
centralized cyanosis and duskiness
What is mild transient tachypnea of the newborn?
signs of respiratory distress during the first 1 to 2 hours after birth as baby transitions
Signs of TTN?
grunting
nasal flaring
mild retractions
Treatments for TTN?
supplemental oxygen and/or noninvasive ventilator support
Serious respiratory problems signs/symptoms?
more pronounced and last beyond the first 2 hours after birth
RR may exceed 120 breaths per minute
retractions, grunting, pallor, central cyanosis may occur
hypotension, temperature instability, hypoglycemia, acidosis, and signs of cardiac problems
Name 4 examples of respiratory complications.
respiratory distress syndrome
meconium aspirate syndrome
pneumonia
persistent pulmonary hypertension of the newborn
What assessments do we do for the abdomen?
inspect and palpate the umbilical cord
two arteries, one vein
inspect the size of the abdomen and palpate the contour
rounded, prominent, and dome-shaped
assess colour and observe movement with respirations
auscultate bowel sounds and note number, amount, character of stools
How soon should bowel sounds be heard after birth?
minutes
How soon does meconium stool pass after birth?
24 - 48 hours
What assessments do we do for the genitalia/GU system?
inspect and assess for general appearance
female genitalia may be edematous
male testes should be palpable on each side
voiding within 24 hours of birth
How often should voids happen after birth?
1 time per day for each day of life
What assessments do we do for the extremities?
inspect and palpate for
attitude of general flexion
full range of motion and spontaneous movements
muscle tone
colour
intactness
appropriate placement
count number of fingers and toes
evaluate joints for full range of motion
assess reflexes (palmar and plantar)
What assessments do we do for the back?
assess anatomy
inspect and palpate the spine, shoulders, scapulae, and iliac crests
assess base of spine
What should the spine look like at birth?
spine straight and easily flexed
What 3 assessments do we do for the anus and stools?
inspect and palpate placement and patency of anus
passage of meconium within 24-48 hours after birth
observe the frequency. colour, and consistency of stools
meconium is followed by transitional and soft yellow stool
What is biliary atresia?
condition where bile from liver does not get to the gallbladder/intestines
Signs and symptoms of biliary atresia?
pale stool, dark urine
jaundice lasting >2 weeks
irritability
weight loss
abdominal distension
Treatment for biliary atresia?
surgical
What assessments do we do for the neurological system?
assesses newborn reflexes
provides information about the newborn’s nervous system and state of the neurological maturation
Tests done prior to discharge?
bilirubin level
newborn screening
critical congenital heart disease screening
teaching (ex. feeding, SIDS, tummy time, etc.)
When does discharge teaching begin?
at admission
Name 4 elements of discharge teaching.
self care and signs of complications
sexual activity and contraception
prescribed medications
coping with visitors