Rachel Morgan 471 Test 2

Transition Period

6-8 hours after birth

First period of reactivity

Up to 30 minutes Increase in HR, RR - may see 160-180 bpm, 60-80 breaths

Alert

Optimal time for bonding/breastfeeding

Period of decreased responsiveness

30 minutes - 2 hours
Decreased in RR, HR to normal
Newborn begins to sleep

Second period of reactivity

2-8 hours after birth, brief periods of reactivity

Chemical stimuli

Chemoreceptors recognize fetal hypoxia
decrease in prostaglandins - surpasses fetal breathing

Mechanical stimuli

Squeezing through the birth canal

Thermal stimuli

Decreased environmental temperature stimulates respiratory center in medulle

Sensory stimuli

Drying, handling, pain, lights

Surfactant

Protein that lines the alveoli, reduces surfactant pressure

How long should apnea episodes last?

less than 20 seconds

How to babies breathe?

Obligatory nose breathers, can't breath out of mouth

Acrocynosis

24-48 hours present, perfusing core organs

Changes in respiratory before labor

Decreased production of fetal lung fluid prior and movement of fluid into pulmonary circulation

Targeted O2 sat after birth

1 minute - 60-65%
2 minute - 65-70%
3 minutes - 70-75%
4 minutes - 75-80%
5 minutes - 80-85%
10 minutes - 85-90%

Signs of respiratory distress

Apneic episode

Nasal flaring

Retractions

Grunting with expiration

Fetal blood circulation

Placenta - liver - ductus venosus - IVC - RA - foramen ovale - LA - LV- aorta

SVC - RA - RV - ducts arteriosis - aorta - Lower body

Foramen ovale

Closes after birth and the blood then travels from the lungs to the left atrium

Prostaglandins, oxygen

________ decrease and increase in ______ causes the ductus arteriosus to close

Apical HR

110-160 bpm

What causes a decreased pressure in the right atrium after birth?

Decreased pulmonary pressure

Average blood volume at term

80mL/kg

Delayed cord clamping

Increases RBC volume to fetus by 100mL

Benefits oxygenation but can have an increased risk of jaundice

Convection

loss of heat through ambient air

Radiation

loss of heat through object, not touching

Evaporation

loss of heat through wet skin

Conduction

loss of heat to direct touch

Vessels in the newborn

close to skin d/t low body fat

Thermogenesis

infant attempts to create heat through movement, flexion, metabolism of brown fat

Cold stress

RR increases, then apneic
Mottled skin, decreased activity
Hypoglycemic

Preterm babies

Decreased thermoregulation effectiveness d/t no brown fat

Unresolved cold stress

Anaerobic glycolysis
Fatty acid production
Metabolic acidosis
Respiratory acidosis

Circulation diverts from internal organs to skin in an attempt to warm it

How soon should an infant void after birth?

24 hours

Uric acid

causes pink tinged urine "brown dust"

Renal system in newborns

Inability to concentrate urine - risk for dehydration

Day 4: 6-8 per day voids, mom's milk is in

Sterile gut

lack of bacteria in GI tract at birth - cannot synthesize vitamin K

Meconium

First stool of the newborn - greenish tarry black

Lipase

Passed to the fetus through breast milk

Digestive enzymes

all present other than amylase and lipase

Newborn stomach size

small capacity

Increased bilirubin

Causes jaundice in the newborn

Glucose

drops at birth

Physiologic jaundice

24 hours after birth in term and 48 hours after birth in preterm infants

R/t breast feeding, lack of effective breastfeeding

Pathologic jaundice

Occurring before 24 hours of age

typically caused by hemolysis - maternal/newborn blood incompatability

Pathologic jaundice can lead to

Acute bilirubin encephalopathy or kernicterus

Immune system of newborn

Passive immunity from mother

IgG sufficient for 3 months

IgA

Immunoglobulins excreted through breastmilk

- specifically colostrum

IgM

produced in utero in small amounts

Vernix caseosa

Cheese-like, whitish substance that is a protective barrier

Milia

distended, small, white sebaceous glands; inability to sweat

Desquamation

peeling of the skin

Mongolian spot

bluish, black area, seen in darker pigmented skin, back and buttocks

Nevi "stork bites"

Pink, easily blanched

Nape of neck, upper eyelids, nose, forehead, upper lip

Disappear by 2 years

Nevus flammeus

Permanent purple birthmark; also called port-wine stain.

Infantile hemangioma

most common tumor of infancy
classified as superficial, deep, cavernous, or with descriptive terms (strawberry)

Erythema toxicum

transient dermatitis

Baby girl reproductive system

Discharge or pseudomenstration d/t maternal hormones

Swollen labia, vaginal tags

Hydrocele

accumulation of fluid around testes, sometimes normal

Hypospadias

urethra on ventral side (bottom) - not normal

Epispadias

Urethra on Doral side (top) - not normal

Undescended testes

failure of one or both testes to move from the abdomen to the scrotum during fetal development

Molding

Shaping of the fetal head during movement through the birth canal

Caput succedaneum

fluid filled, crosses suture lines

Cephalahematoma

Blood filled, does not cross suture lines

Risk for jaundice

Subgaleal hemorrhage

bleeding in the connective tissue as a result of traction on the head (not okay)

Sucking/rooting reflex

Stroke baby's cheek and they turn toward that side and look for nipple

Present from birth-4 months

Palmar/plantar grasp

infant grasps examiner's finger when stroked against palm/plantar surface of infant

Tonic neck

In response to head being turned baby stretches its arm on same side and opposite arm bends up at the eblow

Moro reflex

Infant reflex where a baby will startle in response to a loud sound or sudden movement.

Babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched

Habituation

infants become accustomed to environmental stimuli by repeated exposure

Senses in the newborn

highly developed sense of smell, prefer sweet tastes, see best at 20 cm

Newborn sleep-wake cycle

20 minute wake periods

APGAR

appearance, pulse, grimace, activity, respiration

Vital signs in newborn

temp 97.8 to 98F, apical rate 110 to 160 beats/min, respirations 30 -60

Skin to skin

The naked baby is immediately placed upon mother's skin after birth for emotional/psychological benefits.

Newborn stimulation

Important immediately following birth to attempt in drying the newborn to prevent hypothermia and assisting in clearing the newborns airway

APGAR chart

Gestational age assessment

20 weeks or greater
6 neuromuscular, 6 physical
Should be performed within 48 hours following delivery

AGA

Appropriate for gestational age
10-90th percentile

SGA

Small for gestational age
below 10th percentile

LGA

Large for gestational age

Above 90th percentile

Newborn medications

Vitamin K

Hep B vaccine

Erythromycin eye ointment

Erythromycin eye ointment

For prophylaxis of ophthalmia; generally for newborns of moms with Chlamydia or Gonorrhea

Preterm infant

Born between 20 0/7 - 36 6/7

VLBW (Very low birth weight)

Less than 1500 gms (3.3 lbs)

ELBW (extremely low birth weight)

Less than 1000gms (2.2 lbs)

Post term

Born after 42 weeks

Age of viability in LA

23 weeks

Preterm respiratory

Decreased in functional alveoli

Deficient surfactant

Smaller lumen of respiratory tract

Immature, friable capillaries in lungs Insufficient calcification of bony thorax

Absent/weak gag reflex

Preterm cardiac

Developed but may not be mature enough to sustain extrauterine life

Preterm thermoregulation

Large surface area to weight

Decreased SubQ fat or brown fat

Inadequate muscle tone/mass

Immature temperature regulation center in the brain

Preterm CNS

Fragile capillaries in the brain

Impaired coagulation

Preterm nutrition

Absent suck, swallow, breathe (appears at 37 wks)

Small stomach, weak muscles

Preterm renal

Inability to excrete toxins

Inability to concentrate urine

Preterm hematologic

Slowed production of RBCs

Decreased survival of RBCs Risk for anemia

Tendency to bleed - prolonged PT/PTT

Risk for infection

Decreased IgG

Corrected gestational age

Gestational age that a preterm infant would be if still in utero. May also be called developmental age.

Not used once the baby reaches 2-2.5 years

Actual gestational age

Age of the baby using the time spent out of utero

Respiratory care preterm

Establish airway
O2 administration (possibly mechanically)
Administer surfactant

Cardiac care preterm

Continuous vital signs

Thermoregulation care preterm

Neutral thermal environment - decrease O2 consumption

Humidified air (isolates)

Kangaroo care