Describe causes of initial neonatal respiration after delivery and what is needed to promote continued respiration
- Breathing is initiated by chemical, mechanical, thermal, and sensory factors to stimulate respiratory center of medulla.
- Chemical: changes in blood chemistry caused by hypoxia stimulate medulla to cause forceful contraction of diaphragm, which causes air to enter lungs
- Mechanical: fetal chest is compressed during vaginal birth and cause chest recoil which draws air into lungs
- Thermal: sudden change in surrounding temperature sends impulses to stimulate medulla
- Sensory: stimulation of sound, light, smell, pain, and delivery may aide in initiating respiration
Four methods of heat loss
Evaporation:air drying of skin that results in cooling. drying off infant lowers this
Conduction: Movement of heat away from infant to cooler object that infant comes into contact with.
Convection: transfer of heat from infant to cooler surrounding air. Incubators have circulation warm air that helps keep infant warm by convection
Radiation:transfer of heat to cooler objects that are not direct contact with infant. Place crib away from windows and outside walls.
List common s/s of effects of cold stress on neonate
- brown fat metabolism can increase oxygen demands
- cold diminishes surfactant production
- glucose demand is increased with brown fat metabolism
- metabolism of brown fat releases fatty acids and interfere with jaundice levels
Hyperthermia effects on newborn
- with elevated temperature, metabolism rate increases which increases need for oxygen and glucose
- peripheral dilation leads to insensible fluid loss
Meconium
- sticky, dark green/black, tarry
- should be within 12-48 hours
Transitional stool
- follows meconium
- combination of meconium and milk
- greenish brown, looser consistency
BreastFed stool
- seedy
- mustard color
- sweet sour smell
Formula Fed Stool
- pale yellow, light brown
- firmer
- strong fecal odor
- once or twice a day
Normal newborn glucose levels
40-60 mg/dL
Physiologic jaundice
- nonpathologic, considered normal
- appears 2nd-3rd day
- jaundice becomes visible when bilirubin levels are around 5-6 mg/dL, bilirubin peaks at 5-6 between 2nd-4th day
Nonphysiologic Jaundice
- jaundice appears within first 48 hours and bilirubin rises higher, quicker, sooner, longer
- result of abnormalities causing excessive destruction of RBCs, problem in bilirubin conjugation such as incompatibilities between maternal and fetal blood types, infection, and metabolic disorders.
- treated with phototherapy
Jaundice associated with Breastfeeding
- bilirubin levels greater than 12 mg/dL develop in 13% of infants
- most common cause is insufficient intake and can reach toxic levels if intake not increased
- colostrum works as laxative for meconium which has levels of bilirubin in it.
- treatment is closely monitoring patient and increasing feeds to 8-12 in 24 hours
What is the normal output for a newborn? Specific gravity range?
- output is 2-5 mL/kg/hr
- 1.002-1.01
Normal Vital Range: Temperature Heart Rate Respirations BP Cap Refill
-temp: 36.5-37.5
-HR: 120-160 bpm
-Respiration’s 30-60
BP: varries with gestational age, average is systolic 65-95, diastolic 30-60
Cap: 3-4 seconds
Molding
change in shape of head caused by overriding cranial bones at sutures
- palpate sutures
- note overlapping, wide gaps, premature closing of sutures
Fontanels
- Palpate, should be soft and flat
- Anterior: diamond shape, 4-5 cm, closes by 18mo
- Posterior: triangular shape, 0.5-1cm, closes by 2-4 mo
Caput Succedaneum
- Area of localized edema as a result of pressure against mothers cervix during labor
- may correspond with VBAC
- bilateral
- may cross suture lines
Cephalhematoma
- results when there is bleeding between periosteum and skull from pressure during birth
- develops within 24-48 hours
- palpate area to differentiate from caput succedaneum
- clear edges that end at suture lines
- reabsorbs within 2-3 weeks
Cord
-should contain 2 arteries and 1 vein yellow/brown means meconium was released
-redness should be noted.
-note amount of wartons jelly
-if cord is thin, means baby is malnourished
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Simian crease
- 2 transverse crease that extend most of way across palm, simian line is small line that crosses theses lines
- indicative of down syndrome but not diagnostic
Harlequin Sign
- distinct color diversion with one side of body pink/red to the other side pale
- occurs with low birth weight infants
- transient and benign
Mottling
- lacy, red/blue marbling of skin
- seen infants who are cold, stressed, or over stimulated
Vernix Caeseosa
- thick white cream cheese substance
- protects fetus in utereo
- may be present at birth
Lanugo
-fine soft hair that covers fetus in intrauterine life
