Family Exam III

What is the difference in dependency between a fetus and a neonate?

A fetus is totally dependent on its mother but at the moment of birth, the neonate is independent.

When is the neonatal period?

Birth to the first 28 days of life.

During the first ____ hours after birth, major adaptations occur in neonates.

6 to 8

What are the 6 primary tasks for neonates?

1. Establish and maintain respirations

2. Adjust to circulatory changes

3. Thermoregulation

4. Ingestion and digestion of nutrients

5. Eliminate waste

6. Regulate weight

After a baby is born, how much time do they have to maintain respirations and adjust to circulatory changes?

Within a few minutes.

After how many days of life should babies be back to their birth weight?

10-14 days.

What is the most critical adaptation to extrauterine life for a newborn?

Breathing.

What four factors combine to stimulate the initial onset of breathing in a neonate?

1. Chemical

2. Mechanical

3. Thermal

4. Sensory

What chemical factor stimulates the newborn's respiratory center at birth?

Chemoreceptors in the aorta and carotid arteries.

What are the 2 mechanical factors involved in initiating neonatal respiration?

1. Negative intrathoracic pressure caused by compression of the chest during vaginal birth.

2. Positive pressure caused by crying keep the alveoli open

How do thermal and sensory factors contribute to a newborn's first breath?

1. Thermal → Expose them to the colder external environment

2. Sensory → Drying and handling of the baby as well as lights, smells, and sounds

What two main factors does lung expansion depend on in a newborn?

1. Chest wall contraction

2. Adequate surfactant secretion

What happens to a neonate's blood pressure, circulation, and lung perfusion when the umbilical cord is clamped?

1. BP increases

2. Circulation increases

3. Lung perfusion occurs as the lungs take over.

What is surfactant, and what are its 3 functions?

Surfactant is a phospholipid created towards the end of pregnancy.
3 functions
1. Decreases surface tension
2. Keeps alveoli open
3. Accelerates lung maturity.

What type of posture do babies typically exhibit following a vaginal delivery?

A tightened posture.

How do newborns primarily breathe, and what type of breathers are they structurally?

Newborns are nose and abdominal breathers.

What is the duration threshold for normal periodic apnea in newborns versus what requires concern?

They are prone to apnea LESS THAN 20 seconds.

How long after birth are newborns commonly prone to acrocyanosis?

First 24 hours.

What is acrocyanosis?

Bluish/purple coloring to the extremities.

What are the 3 classic signs and symptoms of respiratory distress in a newborn?

1. Nasal flaring

2. Intercostal or subcostal retractions

3. Grunting with respirations

What should "stridor" immediately make you think of in a newborn?

An airway obstruction.

What respiratory rate (RR) range indicates potential respiratory distress in a neonate, and what can tachypnea be the first sign of?

1. RR <30/minute

2. RR >60/minute

3. Tachypnea is the first sign of many illnesses

Is central cyanosis considered a normal finding in a newborn?

NO.

What type of infant issues can directly lead to feeding difficulties?

Nasal issues.

While a neonates respiratory rate can be irregular, what normal range should it still fall within?

30 - 60 breaths per minute.

For how long should you count when assessing a baby's heart rate (HR) and respiratory rate (RR)?

One full minute.

When does Transient Tachypnea of the Newborn (TTN) typically develop and when does it usually resolve?

1. Develops → As the newborn transitions over the first 1-2 hours of birth.

2. Resolves → within 48-72 hours.

At what respiratory rate (RR) over time can Transient Tachypnea of the Newborn (TTN) progress to grunting, nasal flaring, and retractions, requiring oxygen application?

A respiratory rate greater than 100 bpm.

What are the 2 standard nursing interventions for a newborn with Transient Tachypnea of the Newborn (TTN) showing signs of respiratory distress?

1. Apply oxygen

2. Monitor vital signs

What 6 associated conditions indicate that a newborn's respiratory status is not normal?

1. Respiratory Distress Syndrome

2. Meconium

3. Aspiration

4. Pneumonia

5. Persistent pulmonary HTN of newborn (PPHN)

6. Congenital defects

What 8 clinical signs and laboratory findings indicate that a newborn's respiratory status is not normal?

1. Moderate to severe grunting

2. Retractions

3. Pallor

4. Central cyanosis

5. Hypotension

6. Temperature instability

7. Hypoglycemia

8. Acidosis

What do blood vessels around the alveoli do?

Drop off O2 and take CO2 away.

How many shunts does the fetal circulatory system use, and what is their primary purpose?

3; their primary purpose is to bypass the lungs and liver to direct blood to areas that need oxygen.

What are the 3 fetal shunts?

1. Foramen ovale

2. Ductus venosus

3. Ductus arteriosus

After oxygen crosses the placenta and enters the umbilical vein, where does it go first?

The ductus venosus.

What organ does the ductus venosus bypass?

The liver.

What is the pathway and function of the foramen ovale?

1. Pathway → runs from the right atrium to the left atrium

2. Function → sends some blood to the right ventricle and pulmonary system

Where is the highest concentration of blood oxygen found in the fetus?

The right atrium.

Where does the ductus arteriosus move blood?

Into the aorta and the rest of the body.

Where is the lowest concentration of blood oxygen found in the fetus?

In the umbilical arteries.

Why are the liver and lungs bypassed in utero?

These organs do not need to function in utero.

What action functionally closes the umbilical arteries, vein, and ductus venosus (DV)?

Cord clamping and cutting.

What do the umbilical vessels and ductus venosus convert into over time, and how long does it take?

1. Converted into ligaments

2. Takes 2-3 months

What causes the ductus arteriosus (DA) to constrict after birth?

An increase in PO2 levels in response to increased oxygenation.

Besides increased oxygenation, what substance in the blood contributes to the closure of the ductus arteriosus?

Prostaglandins.

What is the timeline for functional versus permanent closure of the ductus arteriosus in term babies?

1. Functional closure → Within 24 hours of birth

2. Permanent closure → Within 2-3 months

What risk is increased in preterm babies regarding the ductus arteriosus?

A delay in closure which could lead to respiratory distress.

What 2 physiological changes in the lungs trigger the functional closure of the foramen ovale?

1. First breaths inflate the lungs

2. Pulmonary vascular resistance is decreased

What is the timeline for the functional and permanent closure of the foramen ovale?

1. Functional → Over the first few days of life.

2. Permanent → 3 months

What is the recommended timing and 4 physiological benefits of delayed cord clamping?

1. Timing → by at least 30-60 seconds

2. Increases blood volume to the baby by 100 mL

3. Increases baby’s blood pressure

4. Reduces intravascular hemorrhage

5. Reduces necrotizing enterocolitis

What skin findings may be exhibited by an infant with an open ductus arteriosus?

Pallor and acrocyanosis.

Why might heart murmurs be heard during the first 24 hours of a baby's life, and at what point does hearing a murmur become a warning sign?

Murmurs may be heard due to shunts closing. If it is heard after 72 hours, this is a warning sign.

What heart rate threshold defines persistent tachycardia as a sign of cardiovascular problems in a newborn?

Greater than 160 bpm.

What pulse and blood pressure abnormalities indicate potential cardiovascular issues in a newborn?

1. Unequal/absent or bounding pulses

2. Decreased or elevated BP

Which skin color findings can serve as signs of cardiovascular problems in an infant?

1. Pallor

2. Central cyanosis

3. Jaundice

What are the most common types of congenital malformations?

Congenital heart defects.

What is thermoregulation in a newborn?

Maintenance of balance between heat loss and heat production.

Why do cold babies assume a flexion position, and what physiological mechanism do they lack to generate heat instead?

They assume a flexion position because they lack the ability to shiver.

At what temperature drop does a newborn begin metabolizing brown fat?

Below 95 F or 35 C

What are the three major consequences of cold stress in a newborn?

1. Respiratory distress

2. Metabolic acidosis

3. Hypoglycemia

What temperature defines a "hot baby”?

Greater than 37.5 C

What are 3 causes of a “hot baby”?

1. Excess heat production

2. Environment temp is too high

3. Too many layers

Why are hot babies at an increased risk for seizures?

Their sweat glands do not function well.

What 3 anatomical and physiological (A&P) factors contribute to temperature dysregulation in newborns?

1. Thin layer of subcutaneous fat

2. Vessels close to the surface of the skin (they lose more heat)

3. Greater body surface area to body weight ratio

What is the definition of convection regarding environmental heat loss?

Body heat lost to a cooler environment.

What is the definition of radiation regarding environmental heat loss?

Body heat lost to close proximity to a cooler surface (such as air drafts)

What is the definition of evaporation regarding environmental heat loss?

Body heat lost to wet skin and insensible water loss.

What is the definition of conduction regarding environmental heat loss?

Body heat lost by direct contact with a cooler surface.

Where is brown fat located, when is it deposited during pregnancy?

It is located at the base of the neck, around organs, and in the abdomen; it is deposited during the last 2-3 months of pregnancy

Why do preterm babies struggle with brown fat?

They don’t have much of it.

What is the general rule of thumb for dressing a baby compared to an average adult?

1 layer more than normal of what an average person would need.

What three functions must a newborn be able to coordinate for feeding, and what influences this capability?

1. Sucking

2. Swallowing

3. Breathing

4. Influenced by neuromuscular maturity and EGA

When is the mucosal barrier fully established in an infant?

4-6 months

Why is Vitamin K administered at birth in relation to a newborn's intestinal flora?

Intestinal flora in the digestive system are not well established and are the primary creators of Vitamin K and folate.

How do birth method and feeding type affect a newborn's microbes?

Cesarean babies guts are colonized by skin bacteria. Vaginal babies guts are colonized by rectal bacteria. Breastfeeding contains microbes.

What is the approximate stomach capacity of a newborn on day 1 versus day 3?

1. Day 1: 10 mL

2. Day 3: 30 mL

What causes gastroesophageal reflux (GER) in newborns, and what 3 interventions can minimize it?

Lower esophageal sphincter tone (backflow); minimized by:
1. Not overfeeding
2. Burping the baby
3. Position the baby with their head elevated

What 6 key GI assessments should be performed on a newborn?

1. Feeding and stooling patterns

2. GER

3. Formula intolerance

4. Bowel sounds

5. Absence of stool

6. Abdominal distention

What status of reflexes do very preterm infants typically have regarding feeding?

An absent sucking, swallowing, and rooting reflex.

What position are most babies born in during a vaginal delivery?

Head down with their heads facing the rectum.

What feeding style is best for newborns?

Small, frequent feedings.

What is the normal voiding frequency for a newborn in the first 2 days, and when must a provider be notified?

A baby should void 2-6 times within the first 2 days of life. Notify the provider if there is NO VOID within the first 24 hours of life.

What are the minimum expected void counts within the first 24, 48, and 72 hours of life?

1. 24 hours → At least one void

2. 48 hours → At least two voids

3. 72 hours → At least three voids

What is "brick dust" in a newborn's diaper, what causes it, and is it harmful?

Brick dust is uric acid crystals seen during the first week of life. It is more common in boys and it is harmless.

Why might newborn girls have a scant amount of blood in their diaper?

Decreased maternal estrogen and progesterone.

What are the 6 key functions of the hepatic system in a newborn?

1. Iron storage

2. Glucose homeostasis

3. Fatty acid metabolism

4. Bilirubin synthesis

5. Coagulation

6. Drug metabolism

What is bilirubin, what form is insoluble, and how is it processed for excretion?

Bilirubin is a biproduct of RBC breakdown; unconjugated bilirubin is insoluble and must be conjugated by the liver to be excreted via stool or urine.

How does stooling frequency affect bilirubin excretion?

More stools → faster excretion.

How long do term babies have iron stores at birth, and what can low iron lead to?

Term babies have 4 months of iron stores at birth. Low iron can lead to impaired neurological development.

What are the recommended feeding frequencies for breastfed versus formula-fed babies due to liver glucose stores?

1. Breastfed babies → Every 2-3 hours

2. Formula babies → Every 3-4 hours

Why must clinicians be cautious when calculating medication dosages for babies regarding the liver?

Medications are cleared slower in a babies body.

Are routine blood sugar checks standard for all newborns?

No; only when risk factors are present.

What is another name for unconjugated bilirubin?

Indirect bilirubin.

What is another name for conjugated bilirubin?

Direct bilirubin.

How is unconjugated bilirubin (UB) transported in the blood after heme is broken down from RBCs?

Most UB binds to the albumin in the blood, but some remains as free UB.

Why is free unconjugated bilirubin (UB) dangerous, and what condition can high levels cause?

Free UB can easily cross the blood-brain barrier and can cause: pathologic jaundice and kernicterus.

What are the 5 key signs of hepatic system immaturity or problems in a newborn?

1. Hypoglycemia

2. Jaundice

3. Anemia

4. Blood loss

5. Lethargy

What is the most significant risk factor for problems in the hepatic system?

Premature birth.

Why is the risk for infection higher in newborns?

They have an immature immune system.

What are 8 major risk factors for infection in newborns?

1. Prematurity

2. Pre-labor rupture of membranes

3. Chorioamnionitis

4. Maternal fever

5. Antenatal or intrapartum asphyxia

6. Invasive procedures

7. Stress

8. Congenital anomalies