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Study Notes on Normal Newborn (Chapters 17+18)

OB MODULE 1: NORMAL NEWBORN (CHAPTERS 17 + 18)

TOPICS

  • Newborn System Adaptations

  • Immediate Newborn Management

  • Newborn Medications

  • Nursing Management of the Newborn

  • Newborn Skin Variations

  • Newborn Head Variations

  • General Newborn Care

  • Feeding the Newborn

NEWBORN SYSTEM ADAPTATIONS: NEWBORN TRANSITIONING

Respiratory System

  • Surfactant: A substance that reduces surface tension within the alveoli, aiding in lung expansion.

  • Respirations: Newborns typically exhibit respiratory rates of 30-60 breaths per minute, characterized by irregular shallow breathing.

Cardiovascular System (Pages 528-529)

  • Fetal to Neonatal Circulation Changes: Transition changes involves closure of fetal shunts (e.g., ductus arteriosus, foramen ovale).

  • Heart Rate: Normal heart rate ranges between 110-160 beats per minute.

Hepatic System

  • Iron Storage: Newborns have iron reserves from maternal stores, sufficient for the first 4-6 months.

  • Carbohydrate Metabolism: Glucose is crucial; hypoglycemia may occur if not adequately nourished post-birth.

  • Bilirubin Conjugation: Newborns are at risk for hyperbilirubinemia due to immature liver function.

Gastrointestinal System

  • Bowel Elimination: The first stool (meconium) should be passed within the first 24-48 hours post-delivery.

Renal System

  • Concentration of Urine: Newborns' kidneys are immature and typically can concentrate urine moderately.

  • Voiding: Newborns should void within the first 24 hours, with normal frequency thereafter.

Immune System

  • Immune responses are naive; newborns rely on maternal antibodies transferred during pregnancy.

Integumentary System

  • Adaptations include changes in skin texture and color.

Neurological System

  • Senses: Newborns can hear and respond to noises and have limited sight.

  • Reflexes: Important reflexes include the Moro reflex, rooting reflex, and grasp reflex.

BODY TEMPERATURE REGULATION

  • Thermoregulation: The balance between heat loss and production impacting core body temperature.

  • Overheating: Can lead to hyperthermia; monitoring environmental conditions is crucial.

  • Neutral Thermal Environment: The ambient temperature (between 24-26°C or 75-78°F) where the newborn can maintain a normal body temperature without metabolic changes.

  • Cold Stress: Occurs when excessive heat loss leads to compensatory mechanisms to maintain body temperature.

MECHANISMS OF HEAT LOSS

  • Conduction: Heat transfer via direct contact; e.g., placing a newborn on a cold surface.

  • Convection: Heat loss via air movement; warm air moving away from the body. (Pushing through halls uncovered)

  • Radiation: Heat loss to nearby solid surfaces (e.g., walls) without direct contact.

  • Evaporation: Heat loss when moisture on the skin evaporates, contributing to cooling. (don’t let them sit wet)

IMMEDIATE NEWBORN MANAGEMENT

ABC’s Newborn Resuscitation

  • APGAR Scoring: Assessed at 1 and 5 minutes after birth to evaluate the newborn's condition.

    • Parameters:

    • Appearance/Skin Color (0-2 Points):

      • 0: Cyanotic or pale

      • 1: Appropriate body color; blue extremities (acrocyanosis)

      • 2: Completely appropriate color (pink on trunk & extremities)

    • Pulse/Heart Rate (0-2 Points):

      • 0: Absent

      • 1: Slow (< 100 bpm)

      • 2: > 100 bpm

    • Grimace/ Reflex Irritability (0-2 Points):

      • 0: No response

      • 1: Grimace or frown

      • 2: Sneeze, cough, or vigorous cry

    • Activity/Muscle Tone (0-2 Points):

      • 0: Limp, flaccid

      • 1: Some flexion

      • 2: Tight flexion with good resistance to extension

    • Respiratory Effort (0-2 Points):

      • 0: Apneic

      • 1: Slow, irregular, shallow

      • 2: Regular respirations (30-60 breaths/min), strong cry

Initial Assessment/Interventions

  • Identify if the newborn is term, assess tone, and observe for breathing/crying.

  • If respiratory distress is present: Dry, stimulate, and suction if necessary.

  • Perform assessments for large for gestational age (LGA) or small for gestational age (SGA).

  • Check fontanelles for signs of dehydration or increased intracranial pressure.

  • Ensure proper identification (ID bands, footprints, picture).

NEWBORN MEDICATIONS

  • Erythromycin: Used as a prophylactic eye ointment to prevent gonococcal ophthalmia.

  • Vitamin K (phytonadione): Administered to prevent hemorrhagic disease in newborns.

    • NDC: 0676-4024-35

  • Hepatitis B Vaccine: Prevents Hepatitis B virus infection; NDC: specific to product.

  • RSV Vaccine: Administered to mitigate the risk of Respiratory Syncytial Virus infection.

NURSING MANAGEMENT OF THE NEWBORN

Prenatal & Perinatal History

  • Important factors influencing newborn health include maternal health, pregnancy complications, and delivery conditions.

Newborn Vital Sign Range of Values

  • Temperature: 36.5-37.5°C (97.7-99.5°F)

  • Heart Rate: 110-160 bpm (as low as 70 during sleep, as high as 170+ with activity or crying)

  • Respiratory Rate: 30-60 breaths/min at rest; increases with crying

  • Labor + Birth: Documentation of labor progression and delivery details is essential.

NEWBORN SKIN VARIATIONS

  • Vernix Caseosa: A protective coating on the skin formed during gestation.

  • Stork Bite: Nevi are flat, pink marks usually seen on the nape of the neck or eyelids.

  • Milia: Small cysts that appear on the face, often mistaken for acne.

  • Epstein Pearls: Small, white cysts found on the gums or roof of the mouth.

NEWBORN SKIN (CONTINUED)

Dermatoses

  • Congenital Dermal Malanocytosis: Variations in skin pigmentation and anatomy. (Looks like bruises on the butt)

  • Erythema Toxicum: Common rash seen in newborns, usually self-resolving.

  • Harlequin Sign: A condition where half the body is red while the other half is pale.

  • Nevus Flammeus: A capillary malformation (port-wine stain). (Becomes thicker and darker with age and can indicate cancer)

  • Nevus Vasculosus: A raised, centrally pink lesion (strawberry mark). (Decreases, lightens, and flattens with age)

  • Melanocytosis: Birthmarks that appear darker due to increased melanin.

NEWBORN HEAD VARIATIONS

  • Caput Succedaneum: Localized swelling on the scalp, which crosses suture lines and is due to pressure during delivery.

  • Cephalhematoma: A collection of blood beneath the cranial bone that does NOT cross suture lines.

  • Molding: The elongation of the fetal head shape to accommodate passage through the birth canal; resolves naturally over time.

GENERAL NEWBORN CARE

  • Bathing + Hygiene: Bath is typically delayed for 6+ hours post-delivery to promote bonding and thermal stability.

  • Cord Care: Clean and dry application of antiseptic; monitor for signs of infection.

  • Circumcision Care: Pre-operative care includes ensuring the infant is at least 12 hours old, has voided, has received Vitamin K, and informed consent has been documented. Post-operative care should include application of Vaseline to the area, monitoring for bleeding, edema, and voiding.

FEEDING THE NEWBORN

Breastfeeding

  • Frequency: Every 2-3 hours with sessions lasting approximately 10-20 minutes on each breast.

  • Emphasize proper positioning during feeding and education for successful breastfeeding, including recognizing hunger cues and maintaining latch.

Formula Feeding

  • Frequency: Every 3-4 hours; ensure feeding is completed within 30 minutes to prevent risk of aspiration.

  • Emphasize education on formula preparation and management, along with promoting nutritional needs considering limited stomach capacity and immature systems.

  • Address the immaturity of the immune system and limitations in the supply of pancreatic enzymes and bile, and manage fluid load considering immature kidneys.