OB: Newborn Assessment & Nursing Care

What Respiratory transition does the newborn infant go through?

Go from a fluid filled environment to air filled

What is Surfactant?

a surface-active phospholipid critical for alveolar stability

What are some Reflex Breathing Triggers in the newborn?

• Low blood oxygen levels​

• Increase blood carbon dioxide ​

• Low blood pH​

• Temperature Changes ​

• Drying

What is the normal respiratory rate of a newborn?

30-60/min

While apnea can be common in the newborn, how long is considered abnormal?

More than 20 seconds

What is the normal heart rate of the newborn?

110-160

What is the typical BP of a newborn?

50-75 mmHg systolic & 30-45 mmHg diastolic

What is the newborns typical temp range?

97.7-99.5

What is Thermogenesis?

physiological process of heat production in the body, crucial for maintaining body temperature and contributing to energy balance

How does the newborn produce heat?

• Shivering ​

• Non-shivering​

• brown fat ​

What is Brown fat?

a process in which brown adipose tissue (BAT) burns calories to generate heat

What are the sites of brown fat?

• Midscapular area​

• Around Neck​

• Axilla​

• Around Trachea ​

• Esophagus ​

• Abdominal Aorta ​

• Kidneys ​

• Adrenal Gland

What is Convection heat loss in newborns?

Exposure to cool air currents

What is Radiation heat loss in the newborn infant?

Exposure to cool objects near infant

What is Evaporation Heat Loss in the newborn infant?

Wet body surface

What is Conduction heat loss in the newborn infant?

Cool surface exposure on infant (cold clothes, towels, stethoscope)

What is Cold Stress?

Excessive heat loss resulting in compensatory mechanisms (increased respirations and nonshivering thermogenesis) to maintain core body temperature. ​

What are the stools like for breastfed babies?

6-10 small, semi liquid yellow stools per day by 3rd or 4th day after milk production is established

What are the stools like for Formula-fed babies?

1-2 stools per day, more formed, yellow or yellow brown

How often should a healthy newborn urinate?

• 6-8 wet diapers per day ​

• Should have first urination in first 24 hours of life

What is Unconjugated (indirect) bilirubin?

• breakdown of hemoglobin from RBCs​

  • Not an excretable form and a potential toxin

What is Conjugated (direct) bilirubin?

conversion of yellow pigmented fluid into a water-soluble pigment

How do you calculate the total bilirubin?

Take the sum of both Conjugated and Unconjugated bilirubin

Normal range: < 3 mg/dl

What is the risk of Jaundice buildup?

Bilirubin deposits in tissues & brain if unable to get rid of buildup can cause irreversible brain damage

What is Physiologic Jaundice?

Most common

acceleration of destruction of RBCs impaired conjugation of bilirubin; not pathological normal variation of newborn ​

• “imbalance between the production and elimination of bilirubin” ​

• 60% of FT and 80% pre-term babies on 2-3 day ​

What is Pathologic Jaundice?

More concerning

• occurs within first 24 hours ​

• Needs hydration, warmth, monitor for adequate stools, early feedings, phototherapy ​

What is Breastfeeding Jaundice?

rise after the first 24 hours. Need to increase number of feedings.

What does Phototherapy do to treat Jaundice?

Changes bilirubin into a form that can be excreted

What Integumentary coloring of the skin will you likely see in the newborn?

• Pallor ​

• Pink ​

• Jaundice​

• Cyanosis ​

• Acrocyanosis

What is Lanugo in the newborn?

The fine, soft, downy hair that covers the body of a fetus during pregnancy. It typically appears around the 16th week of gestation and covers the entire body except for the palms, soles, lips, and genitals​

Is Temporary

What is Milia in the newborn?

tiny, white bumps that commonly appear on newborns' skin. They are caused by trapped keratin, a protein found in skin cells​

Temporary

What is Telangiectatic Nevi in the newborn?

 flat, pink spots on their skin often referred to as “stork bites”

Fade by age 2

What is Erythema Toxicum in the newborn?

a common, benign skin rash that typically appears in newborns within the first few days of life​

What are Mongolian spots on newborns?

also known as congenital dermal melanocytosis or slate gray nevi, are harmless, flat, bluish-gray birthmarks that commonly appear on the lower back or buttocks of newborns, especially those of Asian, African, or Native American descent​

What is Vernix Caseosa?

a greasy deposit covering the skin of a baby at birth.

Protects baby’s skin while in womb & has Antimicrobial properties

What is the Tonic Neck reflex?

causes the baby to assume a fencing-like posture when their head is turned to one side

What is the Palmar Grasp reflex?

a newborn reflex where touching a baby's palm causes them to grasp tightly, and typically disappears around 5-6 months of age

What is the Plantar Grasp Reflex?

an involuntary reflex present in infants that causes them to curl their toes when the sole of their foot is stimulated

What is the Moro Reflex?

a normal, involuntary response in newborns where they throw their arms and legs outward and cry when startled or feel like they are falling, usually disappearing by 3-4 months

What is the root reflex?

newborn reflex triggered by touching a baby's cheek or mouth, causing them to instinctively turn their head and open their mouth, helping them find and latch onto a nipple for feeding

What is the Step Reflex?

a newborn reflex where a baby appears to take steps or dance when held upright with their feet touching a solid surface

What is the Babinski Reflex?

neurological reflex where stroking the sole of the foot causes the big toe to extend upwards (dorsiflexion), and the other toes to fan out.

What does the APGAR test look for?

• A: appearance (color)​

• P: pulse (heart rate)​

• G: grimace (reflex irritability)​

• A: activity (muscle tone)​

• R: respiratory (respiratory effort)​

What is being looked for with appearance for the APGAR test?

• Cyanotic or pale (0)

• Appropriate body color, blue extremities (1)

• Complete Appropriate color (2)

What is being looked for with HR for the APGAR test?

• Absent (0)

• Slow <100 (1)

• >100 (2)

What is being looked for with reflex irritibility for the APGAR test?

• None (no response) (0)

• Grimace or frown when irritated (1)

• Sneeze, cough, or Vigorous cry (2)

What is being looked for with Muscle tone for the APGAR test?

• Limp, Flaccid (0)

• Some flexion of extremities (1)

• Active motion. Tight flexion (2)

What is being looked for with Respiratory effort for the APGAR test?

• Apneic (0)

• Slow-irregular, shallow (1)

• Regular Respirations (30-60 min), Strong good cry (2)

What is the average weight for the newborn?

• Average 3405g (7lb 8oz)​

• Range 2500-4000g (5lb 8oz – 8lb 14oz)

What is the typical length of a newborn?

50 cm (20 in)

What is the average head circumference of a newborn?

33-35 cm (13-14 in)

What is the average chest circumference of a newborn?

Average 32 cm (12.5 in)

What is molding of the neck/head in newborns?

pressure of the birth canal causes the baby's skull bones to shift and overlap, temporarily making the head appear elongated or pointed, but usually resolves within a few days​

What is Cephalhematoma in the newborn?

a collection of blood that accumulates between the scalp and the skull of a newborn baby. It is a common birth injury that occurs when pressure is applied to the baby's head during delivery​

Resolves on own

What is Caput Succedaneum in the newborn?

a common, benign condition in newborns characterized by swelling or edema of the scalp, caused by pressure on the baby's head during labor and delivery​

What Assessment are you looking for with the eyes of a newborn?

• Symmetry​

• Eye color established approx. 3 months ​

• Eyelids edematous during first few days of life

What Assessment are you looking for with the nose of a newborn?

small and narrow

What Assessment are you looking for with the mouth of a newborn?

• lips should be pink ​

• Saliva normally scant ​

• Epstein’s Pearls ​

• Thrush

What Assessment are you looking for with the Ears of a newborn?

top of ears (pinna) should be parallel to the outer and inner canthus of the eye

What Assessment is needed for the Abdomen of a newborn?

• Should be cylindrical, protrude slightly, and move with respiration ​

• Auscultate bowel sounds before palpate ​

What should you look for with the Umbilical Cord on the newborn?

• White and gelatinous ​

• Cord bleeding is abnormal ​

• Assess for infection ​

• Umbilical Hernia ​

• Cord begins drying 1-2 hours after birth (shrivels and blackens by 2nd or 3rd day) ​

When should you first bathe baby in water?

After the umbilical cord falls off, typically in 1-2 weeks

What should you assess for with male genitalia in the newborn?

• Hypospadias ​(urethral opening located posterior or distal to proper opening)

• Cryptorchidism ​(balls don’t decend)

  • Increase risk of infertility

• Hydrocele (fluid-filled sac surrounding testicles)

What should you assess for with female genitalia in the newborn?

• Pseudomenstruation​

• Smegma

What is Hyperspadias in the male newborn?

opening of the urethra is located on the upper part of the penis, instead of on the tip

What is Cryptochordism in the male newborn?

a condition where one or both testes fail to descend into the scrotum before birth

What is Hydrocele in the newborn?

a collection of fluid in the scrotum, the sac that contains the testicles

What is Pseudomenstruation in the female newborn?

A temporary, false menstration. It is caused by the withdrawal of maternal hormones, such as estrogen, from the baby's body after birth

What does the Physical Maturity Assessment do?

determines a newborn’s gestational age between 20 and 44 weeks​

What are Plantar creases in the newborn?

creases on the soles of the feet, which range from absent to covering the entire foot, depending on maturity (the greater the number of creases, the greater the newborn’s maturity).​

What does a Neuromuscular Maturity Assessment test?

• Posture

• Square window

• Arm recoil

• Popliteal angle

• Scarf sign

• Heel to ear

Scoring of 0 (Preterm) to 4 (term)

What does it mean by SGA?

Small for gestation age, weight less than the 10th percentile (usually <5.5lb)​

What does it mean by AGA?

Appropriate for gestational age, between 10th and 90th percentile

What does it mean by LGA

Large for gestational age, more than the 90th percentile (usually >9lbs or anything greater than 4000g​

What immediate care is needed for newborn?

• Maintain clear airway ​

• Thermoregulation ​

• Medications ​

  • Vitamin K (AquaMephyton) IM

  • Erythromcyin

    • Antibiotic ophthalmic ointment

• Hepatitis B Vaccine ​

• Initiation of first feeding ​

• Parent-newborn attachment

Where is the IM injection site on a newborn? (Vastus lateralis)

Divide outer thigh into thirds b/w hip and knee.

Shot goes in junction of middle and upper third

What are the signs of Neonatal Distress?

• Retractions

• Nasal Flaring

• Grunting

• Facial Grimacing

• Cyanosis

• Abdominal Distention

• Vomiting

• Jitteriness (Glucose less than 40)

What is some ongoing Newborn care the nurse needs to insure?

• Thermoregulation ​

• Nutrition ​

• Suctioning ​

• Safety ​

• Circumcision ​

• Bonding ​

• Care of Baby ​

• Newborn Screening and Immunizations ​

• Sleep

When can a newborn get a metabolic screen?

Has to be at least 24 hours old

What safety measures does the nurse need to educate the parents about the baby?

• General safety

• Hospital safety

• Car seat

• SIDS (Sudden Infant Death Syndrome)