"Normal"
This is the newborn’s primary method of heat production.
Nonshivering thermogenesis. This is a process in which brown fat (adipose tissue) is oxidized in response to cold exposure
Brown adipose tissue = unique tissue that can convert chemical energy directly into heat when activated by the sympathetic nervous system. When the newborn experiences a cold environment, norepinephrine is released. This in turn stimulates brown fat metabolism by breaking down triglycerides. Cardiac output increases, increasing blood flow through the brown fat tissue. Subsequently, this blood becomes warmed as a result of the increased metabolic activity of the brown fat
An infant who's birth weight is appropriate for gestational age falls between these percentiles on the growth chart.
birth weight between the 10th and 90th percentile for gestational age on the growth chart
Define hyperbilirubinemia
total serum bilirubin (TSB) level above 5 mg/dL, resulting in jaundice
This tool can be used to determine the degree of respiratory distress in an infant.
Silverman–Anderson index assessment tool
True or false: infants of mothers with diabetes frequently display hyperglycemia after birth due to residual maternal hyperglycemia
False - IMDs experience fetal hyperinsulinism and increased peripheral glucose utilization, placing them at risk for hypoglycemia in the immediate postnatal period
Newborns lose a notable amount of weight within the first 3-4 days of life - how much is typical?
Newborns usually lose 7% to 10% of their birth weight within the first 3 to 4 days of life due to loss of meconium, extracellular fluid, and limited food intake. The infant then gains weight, returning to the birth weight by 2 weeks of age
Describe fetal growth restriction.
Birth weight below 3rd percentile
OR
3 or more of these: Birth weight below 10%, length below 10%, head circ below 10%, prenatal history of condition strongly associated with FGR, OR a prenatal diagnosis of FGR
These are the two forms of bilirubin.
Unconjugated bilirubin: fat soluble and toxic to body tissues; normally cleared by placenta and mom’s liver so total bilirubin in newborn is low normally. After cord cut, infant need to conjugate bilirubin on their own.
Conjugated bilirubin: water soluble and non-toxic to body tissues
This condition involves soft tissue swelling caused by pressure of head against dilating cervix during birth process, is not limited by suture lines, and usually resolves over the first few days without treatment.
Caput succedaneum
When diagnosing NOWS, the gold standard to ID substances newborn was exposed to is toxicology screening of what?
Newborn's meconium (but can also test urine or umbilical cord blood)
Intramuscular injection of this drug at birth for all newborns reduces the risk of bleeding in the newborn.
Vitamin K
Newborns are at risk for VKDB because they have not yet established an efficient gastrointestinal microbiome (for ongoing vitamin K synthesis), they have relative vitamin K deficiency at birth, and breast milk contains low levels of vitamin K. Infants with VKDB bleed more and for longer periods than other newborns, and they are at risk for hemorrhage.
Describe gestational age variation.
Preterm: Less than 37 weeks gestation
Full term: 39 weeks – 40 weeks 6 days
Post term: More than 42 weeks gestation
This intervention may be performed if phototherapy is not effective in hyperbilirubinemia or if hemolytic disease is present.
Exchange transfusion
List two assessment findings a nurse might expect to find with meconium aspiration syndrome.
Barrel-shaped chest; progressive respiratory distress including cyanosis; tachypnea, which progresses to significant respiratory distress; intercostal and subxiphoid retractions; end-expiratory grunting, coarse crackles and rhonchi
A newborn is considered hypoglycemic if their blood glucose drops below which point?
Newborns frequency hypoglycemic in first few hours after birth (BG<30-50 mg/dL)
List each component of APGAR.
Appearance
Pulse
Grimace
Activity
Respiratory
Describe the difference between symmetric and asymmetric FGR.
Symmetric fetal growth restriction = fetuses whose head, body, and length are equally affected. (20% to 30% of cases).
Asymmetric FGR = fetuses whose weight is negatively impacted significantly, whose length may be somewhat impacted, and whose head circumference is spared. (70% to 80%) Usually have a better prognosis than symmetric FGR. Once the infant born, optimal nutrition usually restores normal growth potential.
This term refers to the development of jaundice within the first 24 hours of life.
Significant hyperbilirubinemia (formerly known as pathologic jaundice)
An infant with RDS may require supportive care - list the collaborative interventions the nurse might expect to see used.
giving exogenous surfactant, CPAP/PEEP, mechanical ventilation in NICU
List two interventions that may be implemented to prevent / manage hypoglycemia in an infant.
Provide early oral feedings with breast milk (preferred) or formula at frequent intervals (q2-3h). Maintain a neutral thermal environment to avoid cold stress. Provide rest periods to decrease energy demand and expenditure.
This the expected HR range of a newborn.
120–140 bpm (as low as 70 with sleep, as high as 170+ with activity or crying)
see Ricci - table 18.2 / p. 557
You are caring for an infant who is LGA. List at least three potential signs of hypoglycemia.
listlessness, hypotonia, apathy, poor feeding, apneic episodes with a drop in oxygen saturation, weak or high-pitched cry, cyanosis, temperature instability, pallor and sweating, tremors, irritability, and seizures
This test can be performed to identify hemolytic disease of the newborn
Direct Coomb's: done on newborn's blood - to identify hemolytic disease of the newborn; positive results indicate that the newborn’s red blood cells have been coated with antibodies
In a pre-term infant, respiratory distress, central cyanosis, hypoglycemia, lethargy, weak cry, apnea, bradycardia can all serve as cues for...
cold stress
List three potential nonpharmacologic interventions that may be implemented when caring for an infant with NOWS.
Limit stimulation and promote quiet environment, feed frequently and on demand, provide nonnutritive sucking, encourage skin-to-skin contact with the parent/caregiver, hold the infant often, safely swaddle in a flexed position, cluster nursing care, swaying or vertical rocking