The Normal Newborn
What initiates breathing for a newborn at delivery?
Hint: mechanical, chemical, and sensory
Mechanical
-coming through the birth canal due to the pressure
Chemical
-stress hormones
Sensory
-temperature change
-blanket rubs
-skin to skin
-noise, smell, light
Name the complication
The baby is grunting and you notice both nasal flaring and subcostal retraction. You also notice some cyanosis present.
Respiratory distress
Name the complication
This complication is due to the insufficiency of surfactant which could lead to alveolar collapse and atelectasis and respiratory failure.
The treatment is endotracheal intubation and an artificial surfactant into the lungs via ET
Respiratory Distress Syndrome(RDS)
What are post-term babies at risk for?
-macrosomia
-lack of brown fat
-meconium aspiration syndrome(MAS)
-hypoglycemia
-polycythemia
-asphyxia
What does the APGAR score indicate and what are the components?
A low score indicates poor transition to extrauterine life while a high score indicates a good transition to extrauterine life.
There are 5 components which include: color, heart rate, reflexes, muscle tone, and respiration
This test is done a 1 and 5 minutes after birth
Why is there edema of the genitals in male and female babies?
Name the complication
This complication is common in term and late preterm babies and is more common in c-section babies. This complication is not because of a lack of surfactant but rather due to retained fetal lung fluid(not aspiration of amniotic fluid). This complication often resolves in 72 hours.
Transient Tachypnea of Newborn(TTN)
What are some nursing interventions for respiratory distress syndrome?
-ensure warmed air-positioning
-gentle suctioning
-monitor O2 delivery and SaO2
-VS
-neutral thermal environment
What are the problems of post-term infants related to?
-placental aging and insufficiency
-stress during labor and delivery
Calculate the APGAR score for the baby below
Color: peripheral cyanosis only
Heart rate: 120 bpm
Reflexes: cry when stimulated
Tone: some flexion
Respirations: strong cry
8
Color: peripheral cyanosis only(1)
Heart rate: 120 bpm(2)
Reflexes: cry when stimulated(2)
Tone: some flexion(1)
Respirations: strong cry(2)
How many voids and stools should a newborn have?
1 void and 1 stool per day of age
Ex: 3 day old baby should should 3 voids and 3 stools
What are some risks of sepsis in the newborn?
-PROM
-Premature labor/birth
-ROM >18 hours
-Chorioamnionitis
-perinatal asphyxia
-procedures prior to birth, at delivery/instrumentation, after delivery(IV and central lines, intubation)
Name the complication
This complication is more common in preterm babies and it is the acute inflammation disease of the bowel. This is a life-threatening disease that usually presents in the 2nd week of life. The treatment for this complication is bowel rest or decompression, broad spectrum antibiotics, or surgery for drain placement for perforation
Risk factors for this complication includes the following:
-asphyxia/shock
-RDS
-IUGR
-polycythemia
-patent ductus arteriosus
-early formula feedings
-blood transfusion/anemia
Necrotizing Enterocolitis(NEC)
Name the complication
This complication is common in post-term babies. Oxygen cannot get in to the lungs and carbon dioxide cannot be removed due to this thick substance blocking the small airways. The treatment is mechanical ventilation and inhaled nitric oxide.
Meconium Aspiration Syndrome(MAS)
What is PKU testing for?
This is a test for newborns between 1 and 3 days after birth to test for a metabolic disorder. This disorder prevents the body from breaking down a part of proteins known as phenylalanine.
What are the goal glucose levels of a newborn?
>40 ml/dl on 1st day
>50 ml/dl after 1st day
Excessive secretions are indicative of x complication while aspiration is indicative of y complication
x= esophageal atresia
y= tracheoesophageal fistula
Name the complication
This is when there is free oxygen radical damage to the retina of the eyes that are <32 wga. There is a risk for retinal detachment if progressive. If it is severe, it can be treated with Avastin or laser surgery
Retinopathy of Prematurity(ROP)
Why are post-term babies at risk for hypoglycemia?
The baby has used up most of their glucose stores
When the cord is cut, shunts off the supply of glucose from the placenta
What are 3 tests that babies must have before getting discharged?
-hearing screen
-congenital heart screening
-car seat test
Which type of jaundice is normal: pathologic or physiologic?
Physiologic jaundice is a normal phenomenon during transition
Name the complication
Signs and symptoms of this complication includes:
-abdominal distention
-failure to pass stool or bloody stools
-vomiting
-pain/tender abdomen
GI Obstruction
Name the complication
Signs and symptoms of this complication includes:
-feeding intolerance, emesis
-bloody stools
-abdominal distention/tenderness
-hypotension/shock
-respiratory distress
-lethargy
Necrotizing Enterocolitis(NEC)
The following signs and symptoms are consistent with what?
-abnormal cry
-poor feeding
-hypothermia
-diaphoresis
-tremors or jitteriness
-irritability
-hypotonia
-lethargy
-seizures
-tachypnea
-apnea
-respiratory depression
-cyanosis
Hypoglycemia
What is a congenital heart screening for?
Checks the amount of oxygen in the baby's blood