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What are the immediate needs of the newborn?
- Address temp. then ABCs! (T A-B-C)
- Maintenance of body temperature to prevent cold stress and acidosis (drying, hat, warm blankets)
- Aspiration of airway mucus
- Evaluation by use of Apgar score 1 and 5 minutes following birth
- Constant observation of physical condition
- Eye care, Vitamin K, Hepatitis B (with consent)
- ID bands (one on wrist; one on ankle; one on each parent)
Describe thermoregulation: heat loss in the newborn.
occurs when the baby is wet and exposed to the air
occurs when the baby comes in contact with cold objects (hands/stethoscope)
occurs when the baby is exposed to cool objects that the baby is not in direct contact with (windows/walls)
occurs when the baby is exposed to the movement of cool air - for example air conditioning currents
Describe an apgar assessment
- Assesses the newborn’s cardiorespiratory adaptation at birth
- Score is determined at 1 and 5 minutes of life
- Total score ranges from 0-10
- Indicators scored are: heart rate, respiratory effort, muscle tone, reflex irritability and skin color
- A score of 8-10 is good; 5-7 requires stimulation and oxygen; 0-4 requires
What are the normal newborn lab values?
Describe the newborn senses
- Vision: term infant sees 9-12 inches away from eyes. Sees black and white
- Hearing: turn toward sound. Can discriminate parents’ voices. Mother’s preferred
- Taste: can taste. Prefers sweet over salty
- Smell: highly sensitive. Exhibit physiologic change when exposed to strong odors
- Touch: very sensitive to touch and pain
What is involved in teaching for circumcisions?
- Considered an elective procedure
- August 2012--American Academy of Pediatricians now recommends the procedure. Current research suggests that circumcisions decrease incidence of infections, cancers, HIV
Main complications are hemorrhage and infection
Important to comfort the infant during and after the procedure; glucose water on pacifier is soothing
A post-procedure intervention is to keep petroleum on the site. Keeps the diaper from sticking to incision
Yellow exudate that forms on the second day should not be removed. It is a sign of healing, not infection
Danger signs in the Newborn
Newborn genetic screening
State law; parents cannot refuse
- Done at discharge; repeated at 7-10 days of age
- Blood test that screens for multiple genetic/metabolic disorders including:
- PKU (phenylketonuria)
- Maple Syrup Urine Disease
- Sickle Cell Anemia
- Tay Sachs Disease
Results from a deficiency of the enzyme phenylaanine dehydrogenase
Unable to digest high protein foods
Without treatment, newborns become mentally retarded; eventual death
Treatment: Special diet low in phenylalanine
What is included in newborn discharge teaching?
- Follow-up with pediatrician in approx. 3 days
- Report any of the following:
- Poor feeding
- Temp. >38.0 C/100.4 F or < 36.6 C/97.8 F
- Projectile or frequent vomiting
- Lethargy, difficulty waking, listlessness
- Inconsolable infant or continuous high-pitched cry
- Cyanosis with or without crying
- Excessive, watery stools; abdominal distention
- No/insufficient wet diapers (>6/day after day 4)
- Jaundice or abnormal body rash
- umbilical cord or circumcision site
- Eye discharge
How is it treated?
50% of all infants affected
- Bilirubin is by-product of RBC breakdown
- Newborn liver is immature; inability to process and excrete from body
Circulates in blood causing yellow discoloration of skin, mucous membranes, sclera, internal organs
Pathological vs. physiological jaundice
Treatment: Phototherapy; hydration, increased nutritional intake
Seen in >50% of all neonates
Symptoms occur after first 24 hours of life
Cause: Inability to metabolize bilirubin related to immature liver
Less common but more serious condition
Infant is jaundiced at birth; or within first 24 hours of life
Cause: Hemolysis in-utero related to Rh factor or ABO incompatibilities
Describe Jaundice testing
Microbilirubin level (MBR
Levels greater than 12 g/dL usually require photopherapy
bilirubin plaque deposits in the brain
causes permanent brain damage
Describe ABO incompatibilities, what does it cause, and how is that condition treated?
More common than Rh incompatibility but less serious
Occurs when maternal blood type is O and fetal blood type is A, B, or AB
mothers naturally produce anti-A and anti-B antibodies which cross the placenta
Causes hyperbilirubinemia; phototherapy is the treatment
- These antibodies will cause red blood breakdown in the fetus with A, B, or AB blood
Direct Coombs test
- Performed on infant’s cord blood
- Determines if maternal antibodies are in the fetal blood
- Positive Coombs tests suggests increased risk of jaundice in neonate
Indirect Coombs Test
- Performed in antepartum period on mothers who are Rh negative
- Determines if mother has developed antibodies in response to a Rh+ fetus
What is transient tachypnea of the newborn, who is at risk, and what are the common S/S?
- Mild respiratory problem which lasts 24-72 hours
- Caused by the delayed absorption of fetal lung fluid after birth
- At risk: prematurity, SGA, smoker or diabetic mother
- Common signs: RR 60-90 BPM, labored breathing, grunting, flaring, retractions,
Treatment: oxygen, using mechanical ventilation if required, providing proper nutrition, medication use is minimal
What causes fluid in the lungs of a neonate?
During vaginal births, especially with full-term babies, the pressure of passing through the birth canal squeezes some of the fluid out of their lungs. Hormonal changes during labor may also lead to absorption of some of the fluid.
Babies who are small or premature or who are delivered via rapid vaginal deliveries or C-section don't undergo the usual squeezing and hormone changes of a vaginal birth. So they tend to have more fluid than normal in their lungs when they take their first breaths.
Respiratory Distress Syndrome
How does it happen, what are they at risk for, and what are the long term risks?
How is it treated?
Occurs when lungs are immature; lack of surfactant (facilitates gas exchange in the alveoli)
Risk of atelectasis if not treated
High risk of long-term respiratory neurologic complications
Treatment: Oxygen, surfactant. Curosurf (poractant alfa) administered via ET tube
Describe meconium aspiration syndrome, how is diagnosed, and how is it treated?
Usually related to fetal distress during labor. Also occurs in post-term infants
Hypoxia inutero causes relaxation of anal sphincter
Diagnosis: observe the vocal cords for meconium staining; ABG studies, X-ray
Treatment: Chest physiotherapy, antibiotics, oxygen therapy, mechanical ventilation if required
What is the normal range, how does it happen, and what can happen if it gets too bad, and what can be an "indicative cause"
Normal range 40-80 mg/dL
Infants of diabetics at greater risk
Because glucose crosses the placenta, fetus produces more insulin in response to these high glucose levels
After birth, maternal glucose supply stops abruptly but the baby is still producing insulin. This excess insulin causes hypoglycemia in the newborn
Severe hypoglycemia may result in seizures
Hypoglycemia and hypo/hyperthermia may also be indicative of infective process
What are the clinical signs of sepsis?
- Respiratory distress:
- Tachypnea,retractions, grunting, nasal flaring and apnea. Oxygen required
- Abnormal skin perfusion:
- Mottling, pale color, gray color, delayed cap refill
- Temperature instability:
- Hypothermia and rarely hyperthermia
- Feeding intolerance:
- Vomiting, abdominal distention, poor feeding pattern
- Abnormal vital signs:
- Tachycardia, bradycardia, hypotension
- Abnormal neurological status
- Lethargy, hypotonia, seizures
What are the labs associated with infection?
- Blood cultures
- CBC with differential
- Chest X-ray if respiratory distress is present
- Lumbar puncture
Group Beta Strep
Represents the leading cause of life-threatening perinatal infection in U.S.
Includes: chorioamnionitis, neonatal sepsis, pneumonia and meningitis
Mother screened at 35-37 weeks gestation. If positive, antibiotics given prophalactically in labor. Mother must receive 2 doses of IV antibiotics at least 4 hours before birth for infant to be considered safe. If not, CBC/ blood culture on infant to rule out infection
Large for gestational age: Skeletal injuries
- Skull fractures (molding)
- Clavicale fracture (most common #)
- Humerus/femur fractures
Facial Nerve: Usually unilateral. Permanent damage is rare
Brachial Nerve: Erb-Duchenne paralysis. Most common type. Involves upper arm.
- Phrenic Nerve: Usually associated with brachial
- plexus injury. May be unilateral or bilateral and results in diaphragmatic paralysis. Requires mechanical ventilatory support for first few days after birth