OB Cornell Notes Ch 18 & 19

APGAR scoring

Score	HR	Respiratory Effort	Muscle tone	Reflex irritability	Color
2	>100bpm	Strong, vigorous cry	Maintains a position of flexion with brisk movements	Cries or sneezes when stimulated	Body extremities pink
1	<100bpm	Weak cry, slow or difficult respirations	Minimal flexion of extremities	Grimaces when stimulated	Body pink, extremities blue
0	No HR	No respiratory effort	Limp and flaccid	No response to stimulation	Body and extremities blue (cyanosis) or completely pale (pallor)

Signs of respiratory Distress: 

Seesaw respirations, marked retractions, xyphoid retractions, nasal flaring, grunting, cyanosis, jaundice, head bobbing 

What area of newborn assessment has the highest priority: Good respiratory function 

Newborn Head to Toe Physical Assessment: 

Skin

• Color: Newborns may show generalized mottling, normal for their hands & feet to appear blue (acrocyanosis) for the first 24-48hr. Central cyanosis is concerning.

• Common Surface Findings:

  • vernix caseosa (cream cheese) lubricates and protects the skin.

  • Lanugo (peach fuzz on baby) rubs away in a few weeks.

  • Within 24-48hr, desquamation (dry, peeling skin) may appear, especially on the palms and soles.

• Rashes and Spots:

  • Milia are 1-2mm pinpoint white papules on the cheeks/nose, disappear by 3-4wks.

  • Erythema toxicum (or flea-bite rash) common erythematous rash with small papules, appears 1-4d postpartum and disappears shortly after.

• Jaundice:

  • On the 2nd or 3rd day: physiologic jaundice caused by fetal red blood cell breakdown.

  • First 24hrs: potential sign of pathologic jaundice and requires urgent examination.

Head

• Fontanelles and Sutures:

  • anterior fontanelle should be flat; indented = dehydration, bulging = inc ICP.

  • sutures may override from birth pressure, but should never be widely separated or fused (craniosynostosis).

• Swelling:

  • Caput succedaneum: harmless scalp edema that crosses suture lines and absorbs in a few days.

  • cephalohematoma is an egg-shaped collection of blood caused by a ruptured capillary that is strictly confined to a single skull bone and can take weeks to subside.

Face (Eyes, Ears, Nose, and Mouth)

• Eyes: Should be clear. Small red spots on the sclera are subconjunctival hemorrhages caused by pressure during birth; will absorb in 2 to 3 weeks.

• Ears: May have small skin tags, ear canals are often filled with vernix and amniotic fluid. All newborns should receive a hearing screening before discharge.

• Nose: Often has milia. Check for respiratory distress/nose patency by occluding one nostril.

• Mouth: should open evenly during crying. The tongue may be "tongue tied," palate must be palpated to ensure it is intact. May find tiny Ca⁺ cysts called Epstein pearls or occasionally 1-2 erupted natal teeth.

Neck and Chest

• Neck: short w creased skin folds, baby will exhibit a head lag.

• Chest: clavicles must feel smooth and straight. crepitus or separation suggests clavicle was fractured in delivery.

Abdomen

• Stomach: abdomen should be protuberant, bowel sounds present

• Umbilical Cord: Inspect cord clamp to ensure no bleeding at the base and that the cord isn’t wet.

Genitalia

• Female: vulva may appear swollen due to maternal hormones. Newborn girls may have mucus or blood-tinged vaginal discharge called pseudomenstruation.

• Male: scrotum is typically edematous with deep rugae, may be deeply pigmented in dark-skinned infants. Both testes must be palpable.

Back

• Spine flat in lumbar and sacral regions. Inspect base of the spine for pinpoint openings, dimples, or sinus tracts; could indicate dermal sinus or spina bifida occulta

Extremities and Hips

• Extremities:

  • Fingernails soft and smooth.

  • Muscle tone test: unflex baby's arms for about 5 seconds; should immediately return to a tightly flexed position

  • Inspect feet for missing/extra toes.

• Hips: routine hip examination is required to screen for developmental dysplasia of the hip (DDH); early detection is important for successful correction of instability.

How to assess a newborn has appropriate nutrition:

Cues of hunger:

• ask parents to identify restlessness, tense body posture, mouth movement. Waiting for baby to cry is a late sign of hunger.

• monitor voiding & stooling patterns

Nutritional education for infant feeding begins wehn prenatal period begins

um true yeah

Protein

• High amt necessary to provide for a rapid growth & maintenance of cells

• Human + commercial formulas provide all essential amino acids

 

• Unaltered cow’s milk not recommended (too rich solute load; leads to microscopic bleeding in GI, anemia) 

  • Introduce 9-12mo 

Fat

important for brain growth, so fat-free milk is not recommended

Carbs

lactose is easily digested

Minerals

• Calcium needed for newborn skeleton; tetany from low calcium occurs whether they are fed human milk or commercial formula 

• Iron AAP recommends formula-fed infants have iron-enriched formula for first year. Even breastfed advised to supplement to prevent iron-deficiency anemia 

• Fluoride is essential for building teeth & prev decay. Mom should drink fluoridated water + formulas prepared with fluoridated water.

Vitamins

• AAP recommends breastfed newborns be given 400 IU Vit D/day, beginning at first few days of life; fully or partially formula fed also benefit

Fluid

Sufficient neeeded cuz:

• metabolic rate is high 

• body surface area is large in relation to mass (baby loses water by evaporation more than adult

• kidneys cant fully concentrate urine yet

Advantages for breastfeeding for parent

• Release of oxytocin aids in uterine involution 

• may prevent breast & ovarian cancer 

• Return to prepregnant weight may occur sooner 

• Potential birth control (no menstration) 

• EMPOWERING 💪💪💪

• Reduces cost of feeding + prep time 

• Long-term: decreased risk of hip fractures and osteoporosis 

• Symbiotic bond 

Advantages of breastfeeding for newborns

• Anti-infective properties 

• Ideal electrolyte and mineral composition for growth 

• Easily digested (lactose) 

• Better balance of trace elements 

• Exclusive breastfeeding found to reduce allergy incidence 

• Formation of dental arch (best prep for forming common speech sounds)