Thermoregulation
Large skin surface to body weight ratio
Head is 20% of body surface
Subcutaneous fat layers thin – depending on gestational age
Skin is thin and blood vessels are close to the surface
NB ***do not shiver; maintenance of temp is accomplished by brown fat metabolism
NB need about 4x more heat than we do.
Post term baby might not have as much fat, can lose weight.
Do not shiver: kick and cry instead, need to increase oxygenation, using up sugar stores when kicking and crying
Stores of brown fat are rapidly depleted with cold stress (Premies have less brown fat)
Heat is lost in several ways
Conduction: body’s heat is trying to heat up the bed. Cover any surfaces with warm blankets
Radiation: If there is a cold object somewhere, their heat will want to find the cold object and warm it up. Don’t have the baby next to a window or air conditioner
Evaporation: Wet so heat leaves the body. Dry, warm, stimulate
Convection: body producing heat but wind is taking it away
Effects of Cold Stress
Metabolism increases, ***increasing the O2 and glucose need, give asap!
- Rapid resp rate
- Low blood sugar (hypoglycemia)
Surfactant production decreased, impeding lung expansion
Metabolism of brown fat releasing fatty acids
- Leads to acidosis
- Interferes with transport of bilirubin
Heat Loss prevention
Dry NB immediately
Use warm blankets, radiant warmer, or skin-to-skin with Mom(most common, Mother is bare skin, baby is bare skin, next to each other, cover both with blanket)
Use cap on head(ALWAYS)
- Most heat lost thru head
- Insure head is dry and no dirt is left on the head before applying
DRY WARM STIMULATE
Vital statistics of NB
Temperature: 99.7-99.5
Pulse: 120-160, if crying will go up to 180, if asleep, as low as 90
Bradycardia: heart block of asphyxia, intracranial pressure release
***Tachycardia: usually because of TTN, fluid in the lungs, pneumonia, respiratory distress syndrome, too hot or too cold
RR: 30-60, count for one solid minute because it is irregular
Weight: Can lose up to 10% of body weight, if over 10% we need to report it
Length: if abnormal can be associated with some neurological problems
Head circumference: out of range it’s hypocephalus,
Chest: usually smaller than head, unless born from a gestational diabetic mother
If there are deviations in the height, weight, and head, look at the parents, if all 3 are off, it’s probably familial
Physiologic Function
Cardiovascular system- switching from fetal circulation
- Circulation to extremities poor at first- Will take about 24 hours for extremities to get pink
- Blue arms and legs for the first 24 hours is normal, if middle is blue, not normal, report
- Incomplete closure of shunts (?Murmur)
- Palpate femorals
- Cap refill
- **Know the fetal heart!
Blood values (To get accurate values warm foot)
- RBCs, H&H elevated due to fetal circulation
- Breakdown of extra RBC = Bili 1-4 OK
- Increased WBC – 15-30,000=normal, 40,000=Stressed. Increased WBC: always test for sepsis
- Blood coagulation (Decreased vitamin K)- Gut is sterile so cannot manufacture vitamin K- ***baby needs to start to eat. Will see enough germs by day 8
Keep vitamin K in the delivery room to prevent brain bleeds
- In ABQ, baby will produce extra RBC to feed the body, H&H will be super high
- If the bilirubin is super high- put the baby in the sun, helps the liver to break it down to water soluble
Physiologic Function: GI
Gastrointestinal system
Stomach holds 60-90cc but spits up easily due to immature cardiac sphincter
Intestines synthesize Vit K but needs bacterial flora to do so
Immature liver may lead to decreased glucose and protein, increased bilirubin
Stools- Black = meconeum,Ggreen = transitional, yellow,seedy =
- Meconeum – mucous, vernix, hormones, carbs, bile
- Must have – 24-48 hours –listen for bowel sounds
Conditions that Warrant Investigation: Abdominal distention Absence of bowel sounds Bowel sounds in chest cavity Discharge from the umbilicus Abdominal mass
Physiologic function: Respiratory system
Establishment:
- Initiated by cold receptors, increase CO2, decrease O2
- Lung fluid squeezed out, easing surface tension – C/S no squeezing
- Premies- little surfactant, alveola won’t stay open
- In 10 minutes, good volume attained, 10 hours, established
- If difficulty, need good cardiac assessment to check for patent cardiac structures (left over fetal circulation)
Look for resp distress
- Flare, grunt, retractions
- Unequal sounds, asymmetrical chest movement
