Care of a Newborn (Part 3)

What are some normal neuromuscular symptoms in the newborn?

• good flexion of arms at elbows and legs at knees

• transient tremors of the mouth and chin while crying

• newborns can feel pain and will respond with physical behaviors and vitals

When is sucking and rotting present?

it is present at birth

When does sucking and rotting go away?

it is usually gone by 3-4 months but can last up to a year

What is plantar (Babinski) reflex and when does it go away?

• it is when you rub their foot and the toes should flare

• usually gone by a year

What is tonic neck (fencing)?

it is when you turn the infants head, the arm extends like a fencer

When does tonic neck (fencing) go away? 

it usually goes away by 3-4 months, and if they have a persistent response it can take up to 6 months

What is the moro (startle) reflex?

it is if you make a loud noise, the arms and legs will shoot out

• goes away within 6 months

Babies of moms who have taken heroin will show signs of withdrawal within how many hours? 

they will show signs of withdrawal within 12hrs

When do babies start withdrawing from methadone?

they start withdrawing from methadone within 1-2 days 

What can be given to help with pain and weaning from withdrawals?

morphine can be given

What happens if a baby is withdrawing from methamphetamine?

• agitated

• throwing up

• tachypnea

• bad feeders

What is marijuana associated with?

• low birth weight

• little babies (SGA)

What are the vernal signs and symptoms of withdrawal from SSRIs?

• tremors

• hyper alert

• bad feeders

What are the interventions for drug-exposed infants?

• decrease stimuli

• swaddle infant

• provide adequate nutrition and promote bonding

What drugs warrant a social work call?

• heroin

• methadone

• methamphetamine

• marijuana

• SSRIs if taken legally do not, but illegally yes

What is a key physical identification of fetal alcohol syndrome?

• smooth philtrum

• low nasal bridge

• epicentral folds

• thin upper lip

• flat mid face and short nose

• big forehead

What are the withdrawal symptoms from alcohol in newborns?

• jitteriness

• increased tone and reflex responses

• irritability

• seizures

• may have learning disabilities and growth abnormalities when they get older and may need more help

How do we measure I/O in the NICU?

weight diapers

What is a touch time?

it is when NICU babies are on minimal stimulation protocols and can only be touched every so hours to not stress out the babies

Why are NICU babies at an increased risk for aspiration?

they are at an increased risk for aspiration b/c their coordination of breathing and feeding are not aligned and develops between 34 and 36 weeks

• these babies will have NG tube to decrease this risk

What three things are we looking for once the baby is immediately born?

• term

• tone

• crying

If baby is having apnea/gasping or HR is below 100 what is done?

you as the nurse will look for labor breathing and persistent cyanosis (grunting, flaring, retractions) and administer blow by oxygen

• PPV

• SpO₂

• ECG

What happens if baby’s HR is still below 100bpm after PPV?

• MR. SOPA

• mask readjustment

• reposition airway

• suction w/ delee

• open mouth

• pressure (PEEP & PIP)

• artificial airway

When happens if baby’s HR is below 60bpm?

• chest compressions

• PPV

What happens if baby’s HR is below 60 bpm after bringing in chest compression with PPV?

IV epinephrine
- consider hypovolemia
- consider pneumothorax

What are the targeted pre-ductal spo2 ranges after birth for 1 minute? 

60-65

What are the targeted pre-ductal spo2 ranges after birth for 2 minutes? 

65-70

What are the targeted pre-ductal spo2 ranges after birth for 3 minutes? 

70-75

What are the targeted pre-ductal spo2 ranges after birth for 4 minutes? 

75-80

What are the targeted pre-ductal spo2 ranges after birth for 5 minutes? 

80-85

What are the targeted pre-ductal spo2 ranges after birth for 10 minutes? 

85-95