Newborn IRAT

kernicterus

bilirubin stain brain tissue and causes irreversible brain damage

unconjugated bilirubin

indirect, fat-soluble, toxic to tissues

conjugated

direct, water soluble, not toxic to tissues

physiologic hyperbilirubinemia

appears day 3-7, max is 13, and mostly preterm babies

pathologic hyperbilirubinemia

considered normal, occurs in the 1st 24 hours, associated with hemolytic disease, infection, metabolic disorders, strict breastfeeding

treatment for hyperbilirubinemia

increase intake, phototherapy, exchange transfusion if necessary

20

toxic levels of bilirubin

IgG

crosses placenta, protective, lasts 6-8 months

IgM

first immunoglobin produced when newborn is challenged

IgA

produced by the infant, protective for the GI and respiratory systems, a form can be found in colostrum and breast milk

transplacental, intrapartum, and nursery

three common sources of infection in newborns

plethora

an abundance of RBC in the newborn creating a very red skin appearance

the 5 newborn cranial bones

2 frontal, 2 parietal, and 1 occipital

first period of reactivity

birth to 30 minutes

second period: deep sleep

2-4 hours

third period: 2nd reactivity

2-5 hours

16-18hr

newborn sleep requirement

2-3 months

when their circadian rhythm develops

habituation

process, respond to stimuli, ignore disturbances

orientation

alert, pay attention, focus on interesting stimuli

self-quieting

console themselves

visual senses

can see objects 8-10 inches away, can detect light and dark, but not color, pupils respond to light, will trace a short distance

auditory senses

can hear once amniotic fluid is cleared from the ears, recognize sounds, calm to familiar sounds, respond to noise, but cannot locate the source

olfactory

can smell once amniotic fluid is cleared, highly responsive to subtle odors from alveolar glands and breastmilk

taste senses

taste buds fully formed before birth, facial expression changes in response to sweet and bitter (prefer sweet)

touch senses

feel pain and cry in response, comfort: gentle touch, touch elicits rooting, sucking, and grasp reflexes

approach behavior

mouthing, tongue extension, coos, hand hold, or toe grasp

withdrawal behavior

spits up, gags, hiccups, frowns

breast feeding

every 2-3 hours, document time

formula feeds

every 3-4 hours and document volume

12 hours

first void should be within…

24 hours

first stool should be within…

weight gain for first 6 months

1oz a day

hemoglobin range

14-24

hematocrit range

44-64

wbc range

9,000-30,000

respiratory distress

grunting, nasal flaring, retractions, cyanosis, tachypnea, low O2 sat

periodic breathing

5-10 second

chemoreceptors are affected by…

decreased O2, increased CO2, and increased pH

<1000

extremely low birth weight

<1500

very low birth weight

<2500

low birth weight

weight range

2500-4000g

length

45-55cm

head

33-35cm

chest

30-33

acceptable weight loss

10% of their birth weight