Healthy Newborn Final Exam

What does an imbalance between the production and elimination of bilirubin cause? what is the primary cause of physiologic jaundice and what is its management? what are the other causes of physiologic jaundice (3)? how do you assess for jaundice? where does jaundice first appear? what is a prevention method (2)?

- Imbalance between the production and elimination of bilirubin - imbalance may cause acute bilirubin encephalopathy - In most infants, an increase in bilirubin production (e.g., due to hemolysis) is the primary cause of physiologic jaundice --> reducing bilirubin production is the approach for its management - Causes: increased bilirubin load bc of relative polycythemia, shortened erythrocyte life span (80 days instead of 120), & immature hepatic uptake and conjugation processes o How to assess: blanching of the skin w/ digital pressure on nose/sternum/forehead, revealing the underlying color of the skin and subQ tissue; if present the blanched area will appear yellow before the cap refill o Usually seen first in the face and progresses to the trunk & extremities o Prevention: expose newborn to natural sunlight for short periods of time, and avoid glucose water supplements

Formula preparation, what occurs if you mix too little water (1)? what occurs if you mix too much water (4)? what may occur with iron fortified formula and what is the intervention? what is the flow of drops per second with a bottle? what type of water should be used (2)? can you microwave formula? what should be kept nearby in case of choking?

- Mixing w/ too little water: lead to hypernatremia - Mixing w/ too much water: lead to failure to thrive, diminished nutrition, fluoride overdose, lack of weight gain · Constipation may occur with iron fortified formulas, so encourage infant to drink water in between feedings · When the bottle is filled and turned upside down, the flow from the nipple should be approximately one drop per second. · Make sure to use sterile water or bottled water · Never microwave formula, keep bulb syringe nearby in case of choking

Where are the identification bands placed on the infant (2)? who else is given matching identification bands (3)? when should banding occur (3)? what are other protection methods (6)?

- Placed on infant wrist and ankle - Identical identification bands on mother, father, and or other family member - Banding should occur before separation of mother and infant and the ID bracelets are checked by all nurses to validate that the correct newborn is brought to the right mother if separated · They also serve as the official newborn identification and should be checked before initiating any procedure on that newborn and on discharge from the unit · Other protection methods: taking a color picture, newborn footprints, alarm system, cord blood for DNA testing, facial biometric recognition, & live scans to capture digital prints

How often are vital signs taken on the newborn (3)? how is HR obtained? what is normal HR? how are respirations obtained (2)? what is normal RR? is BP assessed (2)? who will it be assessed? what is the usual range of BP?

- Vital Signs: obtained after birth, every 30mins for 2hrs, and then every 4-8hrs until discharge o HR, obtained by taking apical pulse (4th intercostal space) for 1 full minute, typically is 110 to 160 bpm. o Respirations assessed when newborn is quiet/sleeping - listen on right side of chest and count for 1min - Newborn respiratory rate is 30 to 60 breaths/min with symmetric chest movement - HR & RR assessed every 30 minutes until stable for 2 hrs after birth; once stable, every 8hrs o BP not assessed unless there is a clinical indication or low Apgar score - if assessed, oscillometer is used - Typical range is 50 to 75 mm Hg (systolic) and 30 to 45 mm Hg (diastolic)

What is the shape of the anterior fontanel and when does it close? what does it mean if it's bulging or depressed? what is the shape of the posterior fontanel and when does it close? how should both fontanels feel (3)? what can the zika virus cause (2)?

o 1. Anterior Fontanel: diamond shaped, 4-5 cm, closes 18-24 months - Bulging fontanel - increased intracranial pressure - Depressed - dehydration o 2. Posterior Fontanel: triangular shaped, 0.5-1cm, closes 8-12 weeks. - Both fontanels should be soft, flat and open - Zika - caused either the baby's brain to be small (microcephaly) or without a lot of brain cells (anencephaly)

What is the pH of the newborn stomach and what does it resembles? can bowel sounds be heard (2)? what is developed in the GI system to prevent penetration of harmful substances? how effective is the mucosal barrier in the newborn and for how long? what is colonization of bacteria depend on (2)? what is the physiologic capacity of the stomach first 4 days or life and then after? give an example?

o At birth, the pH of the stomach contents is mildly acidic, reflecting the pH of the amniotic fluid. o Bowel sounds are normally heard shortly after birth but may be hypoactive on the first day. o Development of a mucosal barrier to prevent the penetration of harmful substances (ex. bacteria, toxins, etc.) o Intestinal mucosal barrier remains immature for 4 to 6 months following birth o Colonization of bacteria is dependent on oral intake (occurs within 24hrs of age & is required for the production of vitamin K) o Physiologic capacity of the newborn's stomach is considerably less than anatomic capacity o First 4 days of life: rapid gain in physiologic capacity; after 4 days: anatomic & physiologic capacities are more closely approximate - Ex. when newborns are fed an ounce or two, most of it tends to come back up (bc the stomach stays firm, expels the extra milk rather than stretching to hold it) - never overfeed newborn!

What are the two auditory screening tests (2)? is this test mandated? what does delay in identification affect in the child (3)? explain the OAE and ABR test?

o Auditory screening - two tests: Otoacoustic emission (OAE) or automated auditory brainstem response (ABR) o Screening of all newborns is mandated by law in all states - Delays in identification and intervention may affect the child's language development, academic performance, and cognitive development o OAE: earphone is placed in infant's ear canal & sounds produced by the newborns inner ear are measured in response to certain tones or clicks presented through the earphone o ABR: earphone placed over ear canal, and a soft rapid tapping noise is presented. Electrodes placed around the newborn's head, neck and shoulders record neural activity from the infant's brainstem in response to the tapping noise (basically tests how well the ear and nerves leading to the brain work)

Before the newborn's lungs can maintain respiratory function, what events must occur (5)? what is initial breathing triggered by (3)? what are the central chemoreceptors triggered by (2)?

o Before the newborn's lungs can maintain respiratory function, certain events must occur: o Initiation of respiratory movement o Expansion of lungs o Establishment of functional residual capacity (ability to retain some air in the lungs on expiration - to help keep the alveoli from collapsing) o Increased pulmonary blood flow o Redistribution of cardiac output o Initial breathing is probably the result of a reflex triggered by pressure changes, noise, light, temperature changes, touching, compression of the fetal chest during the birthing process, and high carbon dioxide and low oxygen concentrations of the newborn's blood. o Central chemoreceptors stimulated by hypoxia and hypercapnia further increase the respiratory drive.

What is behavioral adaptation? what is it characterized by (2)? when does the first period of reactivity occur (2)? how does the infant behave (3)? how is the RR/HR? this period of alertness will allow the parents to?

o Behavioral Adaptation: defined progression of events triggered by stimuli from the extrauterine environment after birth. o Newborn usually demonstrates a predictable pattern of behavior during the first several hours after birth, characterized by two periods of reactivity separated by a sleep phase. o First period of reactivity o Begins at birth and may last from 30 minutes to 2 hours o Newborn is alert, moving, may appear hungry - Period is characterized by: myoclonic movements of the eyes, spontaneous Moro reflexes, sucking & rooting (good for breastfeeding), chewing and fine tremors of the extremities; muscle tone and motor activity is increased; RR and HR are elevated but begin to decline slowly - This period of alertness allows parents to interact with their newborns

What are the common behavioral responses to pain (1)? what are the physiologic responses to pain (2)? when are heel sticks performed (1)? What needs to be provided prior to circumcision? what is circumcision and when is it done and why (2)?

o Behavioral responses: Common signs: cry o Physiologic/autonomic responses - Changes in heart rate, HR, & oxygen saturation o Heel sticks: laboratory studies AND Circumcision o The policy suggests that an analgesia or subcutaneous ring block be used during the procedure to decrease pain - pain relief MUST be provided (to prevent pain and stress of the newborn) o Circumcision: is the surgical removal of all or part of the foreskin (prepuce) of the penis o Traditionally done for hygiene and medical reasons; performed in hospital before newborn is discharged

What are the benefits of circumcision (3)? how are circumcised newborns bathe (4)? what are the non-pharmacologic methods of pain relief (2)? what are the pharmacologic pain relief methods (3)?

o Benefits: UTI's, STIs, and penile cancer (1%) is less common to occur o Bathing Circumcised newborns o If the newborn has been circumcised, advise parents to wait until that area has also healed (usually 1 to 2 weeks) - Clean the penis with mild soap and water and apply a small amount of petroleum jelly to the tip to prevent the diaper from adhering to the penis o Non-pharmacologic: Swaddling & Non-nutritive sucking (ex. sucrose pacifier) o Pharmacologic: Local and topical anesthesia (EMLA cream, Doral penile nerve block w/ buffered lidocaine) and oral analgesia (Ex. acetaminophen)

What occurs to the fetal structures after birth? what causes the foramen ovale to close and what does it cause (2)?

o Changes in fetal structures: foramen Ovale, ductus arteriosus, ductus venosus, umbilical arteries and vein o Over a period of months, these fetal vessels form nonfunctional ligaments o The increased left atrial pressure (and decreased right atrial pressure) causes the foramen Ovale to close, thus allowing the output from the right ventricle to flow entirely to the lungs. - With closure of this fetal shunt, oxygenated blood is now separated from nonoxygenated blood

Who plays a role in bilirubin metabolism? what is bilirubin? where does bilirubin normally circulate and how is it conjugated? how much bilirubin does newborns produce and how does it compare to adults (2)? when does bilirubin production decline? what is unconjugated and conjugated bilirubin?

o Bilirubin metabolism: liver plays a major role o Bilirubin: a yellow-orange bile pigment formed from hemoglobin as a byproduct of RBC breakdown - Bilirubin normally circulates in plasma, is taken up by liver cells, and is changed to a water-soluble pigment that is excreted in the bile. o Newborns produce bilirubin at a rate of approximately 8 to 10 mg/kg/day. - This is more than twice the production rate in adults, primarily because of relative polycythemia and increased RBC turnover. o Bilirubin production typically declines to the adult level within 10 to 14 days after birth o Unconjugated (Indirect bilirubin): bilirubin (fat-soluble) bound to circulating albumin in the blood stream that has not yet been metabolized in the liver o Conjugated (Direct bilirubin): The bilirubin (now, water-soluble) that is excreted into the bile by the liver and stored in the gallbladder or transferred to the duodenum and is eventually excreted through feces

What occurs to the hormones after birth (2)? what increases the secretion of prolactin? what does prolactin promote production of and where does it occur? how does prolactin levels rise? when newborns suck what hormone is released and what does it cause? what is colostrum? what is the thickness? what does the fluid contain (4)? when does colostrum appear and what is it replaced by and when? what needs to be ensured to have successful breastfeeding (2)?

o Birth results in a drop in estrogen and progesterone. o Increase secretion of prolactin. o Prolactin promotes milk production (occurs in pituitary gland) o Prolactin level rises in response to the infant's sucking. o Newborn sucking stimulates release of oxytocin - and causes breast to release colostrum o Colostrum is a thick yellowish or creamy appearing fluid. o It is thicker than milk. o Contains more protein, fat-soluble vitamins and minerals and rich in immunoglobulins A (protects GI) o Begins early in pregnancy AND Replaced by transitional milk 2-4 days after birth. - Women has to be comfortable to be able to successfully breastfeed - production of milk will go down if she is stressed or dehydrated (important for women to drink fluids and keep hydrated)

What does the blood volume depend on after birth (2)? what is considered early and late clamping of the umbilical cord? what are the benefits of delayed clamping (6)? how long is it encouraged to wait to clamp the cord? what is the characteristics of the RBCs of a fetus (2)? what is the RBC lifespan?

o Blood volume - depends on the amount of blood transferred from the placenta at birth (also depends on when clamping of the umbilical cord occurs) o Early (before 30 to 40 seconds) or late (after 3 minutes) clamping of the umbilical cord changes circulatory dynamics during transition - Benefits of delayed clamping: improves cardiopulmonary adaptation, prevents iron-deficiency anemia, increases BP, and improves oxygen transport and increases RBC flow and increases iron - Its encouraged to delay cord clamping for 30-60seconds after birth o Blood components - Fetus has more RBCs than an adult, and they have greater affinity for oxygen (they are greater in size); after birth, RBC count gradually increases as cell size decreases; RBC lifespan 80-100 days

What is caput succedaneum? this occurs due to sustained pressure where? what does it cause (3)? how does the swelling appear? why does this occur (2)? when does it disappear?

o Caput Succedaneum: localized edema on the scalp that occurs from the pressure of the birth process o Sustained pressure of the presenting part against the cervix. o Increased tissue fluid, edematous swelling, and occasionally bleeding under the periosteum (petechiae & ecchymosis noted). o Appears as a poorly demarcated soft tissue swelling that crosses a suture line o Observed after prolonged labor or via vacuum extraction, Disappears in 12 hours to 3 days w/ no treatment

In the newborn, what is occurring to the cardiac sphincter and CNS control of the stomach (3)? what should be avoided in the newborn and what should be encouraged to do after feedings? are digestive enzymes present at birth (2)? what is the usual characteristic of stools of the newborn? how much calories does the newborn need to intake for weight gain? normally what occurs to the weight of the newborn (3)?

o Cardiac sphincter and nervous control of stomach are immature leading to regurgitation and uncoordinated peristaltic activity o Avoiding overfeeding and stimulating frequent burping may minimize regurgitation. o Most digestive enzymes are available at birth, allowing newborns to digest simple carbohydrates and protein. - They have limited ability to digest complex carbohydrates and fats, because amylase and lipase levels are low at birth - as a result, newborns excrete fair amount of lipids resulting in fatty stools o To gain weight the newborn requires an intake of 108 kcal/kg/day from birth to 6 months of age o Normally, term newborns lose 5% to 10% of their birth weight as a result of insufficient caloric intake within the 1stwk after birth, shifting of intracellular water to extracellular space, & insensible water loss.

What is cephalhematoma? how does it appear? why does this occur? does it cross the suture lines and what are its characteristics (2)? when does it appear and disappear? what other condition occurs following cephalhematoma?

o Cephalhematoma: Collection of blood resulting from ruptured blood vessels which is always confined by one cranial bone, between the surface of the cranial bone and periosteum. o Unilateral or bilateral; occurs due to pressure on the head & disruption of the vessels during birth (due to prolonged labor or use of obstetric interventions such as low forceps or vacuum extraction) o Do not cross suture lines, fluctuant swelling with no overlying skin discoloration, and is firm to touch - Appears on 2nd or 3rd day after birth, Disappears 2-3 weeks - Hyperbilirubinemia occurs following the breakdown of the red blood cells within the hematoma

How does the switch from fetal to newborn circulation occur? what does successful transition from fetal to postnatal circulation require (4)? what is the purpose? what causes the release of the catecholamines in the infant (4)?what dos epi and norepi do (3)?

o Change from placental to pulmonary gas exchange - Successful transition from fetal to postnatal circulation requires increased pulmonary blood flow, removal of the placenta, and closure of the intracardiac (foramen Ovale) and extracardiac shunts (ductus venosus and ductus arteriosus). · Purpose: to equalize the right ventricular output with the left o Physical forces of the contractions of labor and birth, mild asphyxia, increased intracranial pressure as a result of cord compression and uterine contractions, and the cold stress experienced immediately after birth --> lead to an increased release of catecholamines that is critical for the changes involved in the transition to extrauterine life. o Epi & Norepi stimulate increased CO and contractility, surfactant release & promote pulmonary fluid clearance

What do the characteristics of the skin depend on (1)? how should skin be (6)? What is tented skin? what is acrocyanosis (2)? what is mottling? what is jaundice and how is it evaluated and why does it occur (2)?

o Characteristics: varies with genetic background; Bright red, puffy, skin should be smooth and flexible o Small amount of lanugo (fine downy hair) may be observed over shoulder, sides of face and upper back - There may be some cracking and peeling of the skin, skin should be warm to touch & intact o "Tented" skin - after being pinched to assess skin turgor remains tented may indicate dehydration o Acrocyanosis - Bluish discoloration of the hands and feet and coldness; Poor peripheral circulation, common after birth (its normal & intermittent, may occur during first few wks in response to cold) o Mottling - Lacy pattern of dilated blood vessels under the skin - normal and common, it resolves alone o Jaundice - Yellow discoloration of the skin. Evaluated by blanching the tip of the nose, forehead, chest. - Occurs bc the liver is not fully functional yet, and may have not passed meconium yet

What is cold stress? what is the consequence (3)? which newborns are at risk (2)? what are the interventions to minimize cold stress (1)? what are the S/S of hyperthermia (6)?

o Cold stress: excessive heat loss that requires a newborn to use compensatory mechanisms (such as nonshivering thermogenesis and tachypnea) to maintain core body temperature o Consequences: newborn becomes less active, lethargic, hypotonic, and weaker o All newborns at risk (especially within 12hrs of life), preterm newborns are at greater risk (bc they have fewer fat stores, poorer vasomotor responses & less insulation) o Interventions to minimize cold stress - keep newborn warm to prevent heat loss o Heat stress - S/S of hyperthermia: tachycardia, tachypnea, apnea, warm to touch, flushed skin, lethargy, weak or absent cry, and CNS depression

What is cryptochidism and where may it be palpable? what is hydrocele and when does it disappear? what indicates patency of the anus? what will be done if meconium is not passed within 24hrs (2)?

o Cryptorchidism - undescended testes, might be palpated in the inguinal canal in preterm infants (bilateral or unilateral) o Hydrocele - type of swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding the testicle (usually disappears within 1yr) - Both male and female newborn anus - assess for position & patency; passage of meconium indicates patency o If meconium is not passed within 24hrs, a lubricated rectal thermometer can be inserted, or a digital examination can be performed to determine patency

Care of the newborn, when do you intervene in regards to cultural aspects? what is infant abduction? what are the security measures for infants (3)? in regards to temperature, what will be done prior examination of the newborn (2)? until when is the bathe delayed?

o Cultural aspects - important to take into consideration, only intervene if it hurts mother/baby o Infant security: o Infant abduction: someone who is not a family member takes a child less than 1yr old o Security measures: newborns must be transported in cribs, proper identification bands, cribs nearby mom o Temperature: Warm stethoscopes and hands before examining the baby or providing care. - Delay the initial bath until the baby's temperature has stabilized to prevent heat loss through evaporation.

What is the characteristic of the newborn chest (3)? what can be seen in the chest and when does it disappear? what may occur with the breast/nipples and why? what should be educated (2)? what are supernumerary nipples? what is normal respirations? what can be heard in the lungs? what is the normal HR and when do you auscultate? are murmurs common?

o Cylindrical, barrel shaped, equal AP diameter symmetric, ribs flexible. o Xiphoid cartilage frequently seen and more prominent at birth but becomes less apparent when fat accumulates o Engorged nipples/breast - may secrete white discharge, as a result of high levels of maternal estrogen in utero o Do not squeeze. Persist up to 2 weeks. o Supernumerary nipples - having an extra nipple (typically small, raised, pigmented areas vertical to main nipple line); 5 to 6cm below normal nipple, may be unilateral or bilateral, tend to be familial & does not contain tissue o Respirations - 30-60 bpm, diaphragmatic o Fine crackles can be heard on inspiration soon after birth as a result of amniotic fluid being cleared from the lungs o Heart rate 120-160 bpm. Auscultate rate, rhythm, intensity. o Auscultate when newborn sleeping or quiet; murmurs are common first few hours since the foramen Ovale is closing, should be evaluated if it persists

Newborn care, in regards to diapering how should parents use the diapers (2)? what are tips for diaper rash (3)? In regards to cord care, what will you ask the family? when does umbilical cord drying begin (3)? what assessments are important (2)? what can be applied to the cord stump to prevent infection (3)? when is the cord clamp removed (2)?

o Diapering Care o Instruct parents to keep the top edge of the diaper folded down below the umbilical cord area to prevent irritation and to allow air to help dry the cord. o For a male infant, point the penis down to prevent urine from wetting the top of the diaper where the umbilicus is located. o Tips for diaper rash: apply barrier cream after cleaning, expose butt to air, place butt in warm water o Cord care - ask family if they want to keep cord or if they want to discard it o Umbilical cord begins drying within hours after birth and is shriveled and blackened by the second or third day - Within 7 to 10 days, it sloughs off and the umbilicus heals - Frequent assessment is necessary to detect any bleeding (occur if cord clamp is loosened) or signs of infection (ex. drainage) - Apply triple dye, alcohol, or antimicrobial agent to cord stump to prevent ascending infection o Expect to remove the cord clamp approximately 24 hours after birth by using a cord-cutting clamp - If cord is still moist, keep clamp in place and refer home care nurse for removal after discharge

When is APGAR score performed (3)? explain what is assessed in APGAR? what will the assessment at 1 minute and 5 minute provide information about? what are the apgar score ranges (3)? how many points in each category?

o Documents the infant's response to birth at 1min and 5min after birth (each category can range from 0-2 points) o An additional Apgar assessment is done at 10 minutes if the 5-minute score is less than 7 points o A: Appearance (color) o P: Pulse (heart rate) - most important prognostic of the five signs o G: Grimace (reflex irritability) o A: Activity muscle tone o R: Respiration (respiratory effort) o Assessment of the newborn at 1 minute provides: data about the newborn's initial adaptation to extrauterine life. o Assessment at 5 minutes provides: a clearer indication of the newborn's overall central nervous system (CNS) status. o A score of 8 to 10 reflects normal adaptation. o A score of 4-7- moderate difficulty adjusting to extrauterine life --> Need for stimulation o A score of 0 to 3 - difficulty adjusting to extrauterine life and requires immediate intervention --> resuscitation

What occurs to the glucose levels of a newborn and explain? what is newborn hypoglycemia? what is the stable blood sugar level? which newborns are at risk for hypoglycemia (2)? what are the S/S of hypoglycemia (6)? what are the interventions (2)? what should be implemented (3)?

o During first 24-48hrs of life, newborn plasma glucose levels are typically lower than later in life o Because the source of maternal glucose is removed when the placenta is expelled o Newborn Hypoglycemia: blood glucose level of less than 30 mg/dL or a plasma concentration of less than 45 mg/dL in the first 72 hours of life o Hypoglycemia: BS stable at 60-70mg/dl; does not accept < 40mg/dl o Newborn at risk: SGS, LGA o Risk factors: mothers who are diabetics, preterm, newborns w/ intrauterine growth restriction, inadequate caloric intake, sepsis, hypothermia, polycythemia, endocrine or glycogen storage disorders o Symptoms: Most asymptomatic, Jitteriness, lethargy, cyanosis, apnea, seizures, high pitch cry or weak cry, hypothermia, and poor feeding, hypotonia, respiratory distress, vomiting o Interventions: o Oral feedings - administration of a rapid-acting source of glucose such as dextrose gel, breastfeeding or early formula feeding o Intravenous therapy (severe cases) - IV of glucose and continuous monitoring of glucose levels o Prevention - Minimized stress, maintain normal body temperature & Feeding as soon as stable

What are the characteristics of the ears (3)? what should the top of the ear be parallel with? what does low-set ears mean (2)? if the sinuses or preauricular tags are found what does that mean? will an otoscopic examination be performed? when is hearing test performed? what is the characteristics of the neck (4)?

o Ears: Soft, pliable, recoil readily when folded and released. Inspect for shape size, position, firmness. Top of ear (pinna) parallel to the outer cantus of the eye. o Low-set ears or abnormally shaped ears - associated w/ chromosomal, renal abnormalities o Findings of sinuses or Preauricular tags should prompt further evaluation of renal abnormalities o Otoscopic examination not done bc ear canals are filled w/ amniotic fluid & vernix caseosa, makes it hard to visualize; assessment for hearing loss performed (treatments: cochlear implants, hearing augmentation) o Neck: Short, creased with skin folds. Should move freely & midline position, Poorly developed muscle tone.

What is erythema toxicum and who does it affect and what is it caused by? what is milia? what is epstein pearls? what is vernix caseosa and what is it formed of? who does vernix and lanugo occur more in and what should be educated to the mother? and when does lanugo usually disappear?

o Erythema Toxicum (newborn rash) - Perifollicular eruption of lesions (No treatment) - Benign, idiopathic, generalized, transient rash that occurs in up to 70% of newborns during 1st wk of life; it consists of small papules resembling flea bites (on face, chest, & back) - Caused by abundance of eosinophils (reacting to environment as immune system matures) o Milia - Multiple pearly white or pale yellow exposed sebaceous glands on the nose, chin, forehead - Epstein pearls: when milia appears in the newborns mouth or gums o Vernix Caseosa - thick white substance, cheesy, odorless (Lubricates the newborn skin) - It is formed by secretions from the fetus's oil glands and is found during the first 2 or 3 days after birth in body creases and the hair. - The vernix and lanugo is seen more in preterm babies, takes a while for it to fall off (Tell mother not to rub it off); this protects skin - Lanugo usually disappears while in utero

What is the medication used for prevention of ophthalmia neonatorum? when is it administered and where? what can ophthalmia neonatorum cause? how is it usually transmitted? how may both eyes present (2)?

o Erythromycin (Prophylactic eye treatment) - administered within 1-2hrs of birth to prevent ophthalmia neonatorum (causes neonatal blindness, occurring during first 10days of life); applied on lower conjunctival sac o Usually contracted during birth when the baby comes in contact with vaginal discharge of the mother infected with gonorrhea and chlamydia (Both eyelids become swollen and red with purulent discharge)

What is evaporation? what is insensible? what is sensible? what is water converted to? give an example? what is important to do to newborns after bathing? what is conduction? give an example? what can done to prevent this?

o Evaporation - involves the loss of heat when a liquid is converted to vapor (may be insensible or sensible) - Insensible: such as from skin & respirations; sensible: such as from sweating (is noticeable) - Water is converted to vapor --> ex. amniotic fluid evaporation after birth; and bathing newborn · Drying newborn after baths helps prevent heat loss through evaporation o Conduction - the transfer of heat from one object to another when the two objects are in DIRECT CONTACT with each other (heat loss to cooler surface) - Such as a cold mattress/blanket, scale, circumcision restraining board, chilled hands - Using warm cloth diaper or blanket to cover any cold surface touching the newborn directly helps prevent heat loss through conduction (also skin-to-skin contact)

How may the female genitalia present (2)? what is psuedomenstruation and why does that occur? what is smegma and why does it occur?

o Examine labia majora and minora, clitoris - female genitalia will be engorged and edematous o Vaginal tag o Vaginal discharge composed of mucus mixed w/ blood may also be present during first few weeks of life - This discharge is called --> Pseudomensturation - withdrawal of maternal hormones. o Smegma: whitish cheese-like substance - occurs from breakdown of skin

In Ballard Gestational Age Tool, when are the external physical characteristics assessed? what is assessed (6)? when is the neuromuscular development assessed? what is assessed for that (6)?

o External Physical Characteristics (Examination done during the first 2 hours after birth): - Sole creases of the feet - Breast tissue - Ear Cartilage & Eyes - Lanugo - Testicular descent & Scrotal Rugae - Labial development o Neuromuscular Development (Examination completed within 24 hours after birth) - Scores 0-5: - Posture - Square window sign - Arm recoil - Popliteal angle - Scarf sign - Head lag (Heel to ear)

Mechanism of respirations, explain mechanical, chemical, thermal and sensory?

o Mechanical: fetal chest is compressed during the birth process removing lung fluid (CO2 elevates and stimulates respiratory system to start breathing in response to increase in CO2) o Chemical: transitory asphyxia is a chemical stimulator that contributes to the onset of breathing o Thermal: decrease in ambient temperature - via evaporation (be mindful, keep baby warm) o Sensory: tactile, auditory, verbal

How is the face designed for newborns (4)? what may be present if forceps were used (2)? what can forceps cause to the face and how long is the recovery? When is the eye color established? what kind of vision does the newborn have (2)? what is the blink reflex? what is pupillary reflex? gaze? subconjunctival hemorrhages? transient strabismus (2)? what is nystagmus? what is red retinal reflex (3) and what if there is absence?

o Face: Well designed to help the infant suckle. Sucking pads on cheeks. Recessed chin, flattened nose. o Assess facial symmetry and fullness of checks; may have bruising or redness if forceps were used - Facial nerve paralysis caused by forceps can occur, recovery may require weeks to months - Eyes:Color established by 3 months. Check eyes for size, edema of eyelids & subconjunctival hemorrhages due to pressure during birth, inflammation o Peripheral Vision. Can fixate on near objects. - Blink reflex: bring object close to eye, newborn should respond quickly by blinking - Pupillary reflex: pupils should be equal, round & reactive to light bilaterally - Gaze: newborn should be able to track objects to the midline o Subconjunctival hemorrhages - from popped blood vessels after being pushing in the birth canal o Transient strabismus: Squinting; deviation or wandering of eyes independently (resolves 3months) o Nystagmus: involuntary repetitive eye movement caused by immature muscular control (first 3-6months) o Red retinal reflex: luminous red appearance seen on the retina, should be seen bilaterally; should show no dullness or irregularities (Absence associated with cataracts)

Explain how fetal circulation differs from neonatal circulation (3)?

o Fetal circulation differs from neonatal circulation in three areas: o The process of gas exchange o The pressures within the systemic and pulmonary circulations (once the pressure changes, the shunts should naturally close - sometimes they may not close and cause issues later on in life) o The existence of anatomic structures (shunts) that assist in the delivery of oxygen-rich blood to vital organ systems.

When does the first bath usually occur? until when is bathing postponed (2)? when is best to bathe after birth and why? what will be assessed post bath (2)? what is important to ensure of the water? what should not be used on the infants skin? IF lotion were to be used, how will it be applied? how often should infants be bathed? how should parents bathe their infants for first two weeks?

o First bath within 2-4 hours - Bathing is postponed until thermal and cardiorespiratory stability is ensured - Waiting 48hrs after birth is more effective in preserving the body temperature of the newborn o Reassess vital signs especially temperature post bath (within 1hr) - At least 2 normal temperatures - Always implement measures to keep baby WARM after bath - Use of lotions, baby oil, and powders is not recommended because oils and lotions can lead to skin irritation and can cause rashes; & power can cause respiratory distress if inhaled · If using lotion, apply onto hands and warm it before applying to newborn o Instruct parents that a bath two or three times weekly is sufficient for the first year o Parents should not fully immerse the newborn into water until the umbilical cord area has healed (do sponge bath instead)—up to 2 weeks after birth

What is the normal heart rate after birth? what is the average HR? what is the resting HR? what is the HR when crying? how long do you listen/count HR? when is the BP highest and lowest? what is the BP ranges? when do heart murmurs usually disappear? what can increase HR/BP (4)?

o First few minutes after birth - HR is 110 to 160bpm; after it decreases to an average of 120 to 130bmp - Resting heart rate 120-160. May decrease to 80 in full-term newborns. May be up to 180 or above when crying - always listen for a full minute o Blood pressure is highest after birth and lowest at around three hours of age - SBP 60-80; DBP 40-50 in full-term newborns o 90% of heart murmurs are transient and not associated with anomalies - disappear within 1 yr usually o Increase in activity, crying, movement, wakefulness --> corresponds to increase in HR & BP

When the newborn experiences physiologic depression, the Apgar score characteristics disappear in a predictable manner, what is the order (5)?

o First the pink coloration is lost, o Next the respiratory effort, o Then the tone, o Followed by the reflex irritability o Finally, heart rate

Breast feeding positions, what is the football hold? cross- cradling position? across the lab position? and side lying position?

o Football hold: mother holds infant's back and shoulders in her palm and tucks the infant under her arm - The mother supports the breast with her hand and brings it to the infant's lips to latch on o Cross-cradling position: mother holds the baby in the crook of her arm, with the infant facing the mother. The mother supports the breast with her opposite hand. o Across the lap position: mother places a pillow across her lap, with the infant facing the mother. - The mother supports the infant's back and shoulders with her palm and supports her breast from underneath. o Side-lying position: mother lies on her side with a pillow supporting her back and another pillow supporting the newborn in the front. - To start, the mother props herself up on an elbow and supports the newborn with that arm, while holding her breast with the opposite hand.

How often do formula fed newborns feed and how long does it take for them to finish a bottle? which infants grow quicker bottle fed or breast fed? what are the advantages of formula feeding (2)? what are the disadvantages (2)? what are the potential contraindications to formula feeding (3)? formula products (read over)

o Formula-fed newborns usually feed every 3-4 hours, finishing a bottle in 30minutes or less o Formula fed infants grow more rapidly than breastfed infants o Advantages: o Both parents can share in this naturing and caring experience. o Commercially prepared formula meets the need of the infant. o Disadvantages: o Contains less Taurine o Increased risk for allergy to cow's milk. - Potential Contraindications to Formula Feeding: o Improperly prepared formula can be detrimental to infant's kidneys. o Allergic reaction to cow-based milk. o Iron deficiency. - Formula Products: o Cow's Milk Based- Similac, Enfamil, Gerber, Good Start. o Soy Based- Isomil, Prosobee, Gerber Soy. o Specialized Formulas- Nutramigen, Pregestimil, Alimentum

How frequent should you breastfeed / feed the newborn (3)? what is the average length of feeding? how should feeding be alternated? what are signs the infant is getting proper nutrition (2)? how long is breastfeeding recommended? what does increasing fluid intake cause?

o Frequency: 8-12 feedings in 24 hours; basically every 2-4hrs during the day and at night when newborn wakes o Length of feeding - Average 30 minutes (15 minutes per breast) - One feeding one breast, then next feeding the other breast - to get foremilk and hindmilk from each breast; signs infant is getting proper nutrition: curl toes and gurgling o Recommended during the first 6 months to year of life o Monitor progress - increasing fluid intake encourages greater milk production

What is the general appearance of the newborn? when are basic measurements obtained (2)? what is the average weight? when are they weighed (2)? what occurs to their weight after birth (2)? what is the average length? how is length measured? what is the average head length and what should it be? what is chest measurement and how is it measured? and what is abdomen measurement?

o General Appearance - Head is disproportionately large for the body. o Basic Measurements (obtained within first 24hrs after birth, and when newborn is calm; start from least invasive) o Weight: Average 2,500-4,000g (5 lb, 8 oz to 8 lb, 14 oz; average: 7lb 8oz) - Weighed immediately after birth and then daily (keep a hand above newborn for safety) - Newborns can lose up to 10% of their initial birth weight by 3 to 4 days of age secondary to loss of meconium, extracellular fluid, and limited food intake. · This weight loss is usually regained by the 10th day of life o Length: 45-55 cm (18-22 in) - Measured from the head of the newborn to the heel with the newborn unclothed (supine w/ legs extended position) o Head: 32-37 cm (12.5-14.5 in) - use occipitofrontal circumference - Should be 1/4th of newborns length or half of length +10cm o Chest: 30-33cm (12.5 in) - measured below nipple line o Abdomen: 30-33cm

What is the general appearance of the head (2)? what is plagiocephaly? what is molding and does it resolve? what are the characteristics of the sutures (2)? what is Craniosynostosis and is this emergency?

o General Appearance: Large with pliable skull bones (changes can occur due to the pressure of the birth canal) o Plagiocephaly: Asymmetry of head o Molding: Elongated shaping of the fetal head to accommodate passage through the birth canal (occurs w/ vaginal birth, typically resolves within a week, no interventions); overriding skull bones o Sutures: Palpable and separated (spongy spaces, and allows the skull to expand as the head develops) o Craniosynostosis: Premature closure of cranial sutures w/ inhibition of perpendicular cranial bone growth & are associated with a small fontanel or early fontanel closure associated with microcephaly o May be an emergency bc the babys brain is trying to develop and wont have the space to expand

What is used to determine the gestational age? what does it determine? what are the point ranges? what is LGA classification? APA classification? SGA classification?

o Gestational Age is determined by using the Ballard gestational age assessment of Ballard scale o Determines a newborn's gestational age between 20 and 44 weeks o Points are given for each assessment parameter, with a low score of -1 point or -2 points for extreme immaturity to 4 or 5 points for postmaturity o Newborn classification by gestation age: o Large for gestational age (LGA): weight above 90th percentile (usually >9lb) o Appropriate for gestational age (APA): weight between 10th and 90th percentiles o Small for gestational age (SGA): weight below 10th percentile (usually >5.5lb)

What is habituation and when does it usually occur? what does motor maturity depend on and what is it? how should the infants movement be (3)?

o Habituation: newborn's ability to process and respond to auditory and visual stimuli AND the ability to block out external stimuli after newborn has become used to the activity o During the first 24 hours after birth, newborns should increase their ability to habituate to environmental stimuli and sleep. o Motor maturity: depends on gestational age and involves evaluation of posture, tone, coordination, and movements (These activities enable newborns to control and coordinate movement) o When stimulated, newborns with good motor organization demonstrate movements that are rhythmic and spontaneous - over time smoother movements should be observed o Bringing the hand up to the mouth is an example of good motor organization.

What are the four ways the newborn has heat loss? Explain convection, what is an example? what is the prevention (3)? what is radiation, what is an example? what is the prevention (2)?

o Heat loss in the newborn occurs in fours ways: convection, conduction, radiation, evaporation o Convection - involves the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface. - Loss of heat from warm body surface to cooler air currents - air-conditioned room - Examples: cool breeze that flows over the newborn, a cool room/corridor/outside air current - Prevention: keep newborn out of direct open doors/windows/fans/ACs, minimize opening portholes that allow cold air to flow inside & warm any oxygen or humidified air for newborn o Radiation - involves the loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact with the newborn (Transfer of heat from heated body to cooler surfaces - ex. walls) - For example, when a newborn is placed in a single wall isolette next to a cold window, heat loss from radiation occurs. - To reduce heat loss by radiation, keep cribs and isolettes away from outside walls, cold windows, and air conditioners; use radiant warmers for transporting newborns & when performing procedures

What are the hemoglobin levels after birth, when do they peak and when do they decrease? what are the WBC levels? what are the newborn hematologic values affected by (3)? What does the onset of respirations trigger? what does the greater blood volume to the lungs contribute to? What are the pressure of the aorta, venous pressure, systemic pressure and pulmonary artery pressure? what fetal structures close (3)?

o Hemoglobin levels are higher in newborns in first few hrs after birth, peaking at 4-6hrs, and then slowly decreases over the next 12-18hrs - decreases as a result of a decrease in neonatal red cell mass (physiologic anemia of infancy) o Leukocytosis (elevated white blood cells) is present as a result of birth trauma soon after birth. o Newborn hematologic values are affected by: site of the blood sample, placental transfusion, and gestational age o The onset of respirations triggers increased blood flow to the lungs after birth o This greater blood volume contributes to the conversion from fetal circulation to neonatal circulation o Increase aortic pressure and decreased venous pressure (what causes the shunts to close) o Increased systemic pressure and decreased pulmonary artery pressure o Closure of the foramen Ovale, ductus arteriosus, ductus venosus

In regards to the newborns immune system, are they susceptible to infections? what can cause delayed or decreased immunity? which infants are at greatest risk? what do term newborns have? what are infection prevention methods (3)?

o Immature immunologic responses make the newborn susceptible to infection for months o Lack of exposure to common organisms result in delayed or decreased immunity o Premature infants are at greater risk o Term newborns have temporary passive immunity o Infection prevention: Handwashing, avoid taking newborn into crowds, minimize exposure of organisms

In fetal circulation, how does gas exchange occur? are the lungs functional in utero? what does the placenta provide (3)? does the mother and fetus blood intertwine? how does the exchange of oxygen/nutrients/waste products occur? what is the placenta attached to? how many arteries and veins does the umbilical cord have? how does oxygenated blood flow and how does deoxygenated blood flow back to the placenta? what is important to assess after birth?

o In fetal circulation, gas exchange occurs in the placenta o The lungs are nonfunctional with very little blood flow o The placenta provides oxygen and nutrients for the fetus, and removes carbon dioxide and other waste products o The mother and fetus' blood vessels intertwine but do not join (no mixture of blood) o The exchange of oxygen, nutrients, and waste materials between the mother and fetus occurs by diffusion. o The umbilical cord connects the fetus to the placenta, and contains two small arteries and one large vein, providing for the transport of blood to and from the fetus and placenta o Oxygenated blood from the placenta flows by way of the umbilical vein to the inferior vena cava o Deoxygenated blood flows back to the placenta by way of the two umbilical arteries (arteries always carry blood "away" from heart). - Important to assess cord - if they are not present, then the baby may have a congenital defect (this is examined after baby is delivered)

What is the characteristic of the newborns liver that leads to unconjugated bilirubin? failure of the liver to excrete bilirubin will cause (2)? what is jaundice? how does jaundice progress? who may this occur to (2)? what is physiologic jaundice levels and explain?

o In the newborn, the metabolic pathways of the liver are relatively immature & cannot conjugate bilirubin as quickly as needed. o Failure of the liver cells to break down and excrete bilirubin can cause an increased amount of bilirubin in the bloodstream, leading to jaundice (bilirubin is toxic to the body and MUST be excreted) o Jaundice: When unconjugated bilirubin pigment is deposited in the skin and mucous membranes as a result of increased bilirubin levels, icterus develops with a yellowing of the skin, sclera & mucous membranes o Progress from head to toe (basically the visible manifestations of hyperbilirubinemia) o May be more evident in dark-skinned babies; and occurs in more than half of healthy newborns o Physiologic jaundice: level of 5-7mg/dl in the first few days after birth; normal event · Occurs in 45%-60% of termed newborns within the first 3 days of life

What is the infants weight at 6 months and then at a year? what is the newborns caloric need kcal? how much calories does breast milk and formula contain? what is the recommendation if breastfeeding is not done (formula wise)? what type of foods at 6 months? what daily supplement is recommended and why (2)?

o Infant's birth weight doubles in the first 4 to 6 months of life and triples within the first year o Newborn's caloric needs range from 110 to 120 cal/kg body weight o Breast milk and formulas contain approximately 20 cal/oz, so the caloric needs of young infants can be met if several feedings are given o Recommendation that iron-fortified formula be used for all infants who are not breastfed from birth to 1yr of age; needs of iron-rich foods or supplements added at 6 months of age o Recommendation for all infants to receive daily supplement of 400 IU vitamin D - to prevent rickets and vitamin D deficiency

When is the initial newborn screening conducted and what will it determine (2)? what is RAPP assessment? when is the second and third assessment performed? what will be assessed when the baby emerges (4)?

o Initial newborn assessment is completed in the birthing area to determine whether the newborn is stable enough to stay with the parents or whether resuscitation or other immediate interventions are necessary - RAPP assessment: (Respiratory Activity, Perfusion/color, and Position/tone) o Second assessment may be performed within the first 2 to 4 hours (when admitted to nursery/ room) o Third assessment is usually completed before discharge o Begin assessment as soon as the baby emerges: o Check for meconium - ensure to suction meconium so the infant doesn't aspirate o Breathing or crying - are they crying vigorously or slowly? o Displaying muscle tone o Gestational age (38-42 weeks)

Explain the adjustment needed in the respiratory system at birth (2)? what occurs at birth that is important for the respiratory system? what occurs if the fluid is removed too slowly or incompletely? when does it occur (2)? what is transient tachypnea S/S (4)? what is the treatment (2)? when does it resolve by (2)? what may be present at birth or occur within 6 hrs (1)?

o Initiation of respirations: adjusting from a fluid-filled intrauterine environment to gaseous extrauterine environment (which occurs during the passage of the birth canal that compresses the chest, and eliminates the fluids) o If fluid is removed too slowly or incompletely --> transient tachypnea (RR above 60bmp) occurs - For example, may occur in cesarean births and sedation in newborns (diminished respiratory effort) - Transient tachypnea is accompanied by retractions; expiratory grunting or cyanosis · Relieved by low-dose oxygen therapy & allowing time for the pulmonary capillaries & lymphatics to remove the remaining fluid. (usually resolves over a 24-72hr period) - Mild or moderate respiratory distress typically is present at birth or within 6hrs of birth

What should the newborns penis be inspected for? how will the circumcised penis appear? how will the uncircumcised penis appear? what is hypospadias? what is epispadis? what should be avoided for both? what is phimosis? how should the scrotum appear (3)?

o Inspect Penis- correct position of urinary orifice (should be in the middle) - Circumcised male: glans should be smooth w/ meatus centered at the tip, may be red until healed - Uncircumcised male: foreskin should cover the glans o Hypospadias: urinary meatus is on the ventral surface of the penis; Epispadias: if it is on the dorsal surface of the penis (for both, circumcision should be avoided until further evaluation) o Phimosis - inability to retract the foreskin or prepuce covering the glans of the penis o Inspect Scrotum: size, symmetry, rugae & location of testes - Usually appears relatively large w/ well-formed rugae and should cover the scrotal sac - Testes should feel firm and smooth and should be of equal size on both sides of the scrotal sac

What will be inspected in the upper extremities (5)? what is polydactyl? what is syndactyly? what is simian line? what is brachial palsy and how long is the recovery time and what does it result from? how does the affected arm look like (3)? what reflex may be absent on the affected side? what is Erb's palsy? what is Klumpke palsies?

o Inspect arms, hands, fingers (counted), palmar creases, ability to move through ROM without hesitation - Polydactyl: extra digits / Syndactyly: fusion (webbing) of fingers or toes (can have surgery) o SIMIAN LINE: single palmar crease frequently present in children with Down's Syndrome. o Brachial Palsy: partial or complete paralysis of the arm (recovery 6months or longer) - Results from excessive lateral traction on the head away from the shoulder (damages nerves) - The affected arm hangs limp alongside the body, and the affected shoulder and arm are adducted, extended, and internally rotated with a pronated wrist; Moro reflex absent on affected side o Erb-Duchenne Paralysis (Erb's Palsy): unable to move arm; injury resulting from damage to upper plexus - Klumpke palsies: palsies associated with the lower brachial plexus

What do you want to inspect the umbilical cord for and what may be associated with renal or GI abnormalities? what are the characteristics of the umbilical cord (2)? why can umbilical infections occur (2)? where can umbilical cord infection spread (4)? when does drying begin? when is cord separation time? when the the removal of the cord clamp within?

o Inspect the umbilical cord area for the correct amount of blood vessels (two arteries and one vein). o Evidence of only a single umbilical artery is associated with renal and gastrointestinal anomalies. o White and gelatinous o Check for bleeding, foul-smelling. o Umbilical infections can occur because of an embryologic remnant or poor hygiene o Umbilical cord infection (omphalitis) can spread to adjacent tissue, causing peritonitis, hepatic vein thrombosis, and hepatic abscess (medical emergency) o Drying begins 1-2 hours after birth; cord separation time 7-14 days. o Remove cord clamp within 24 hours.

To promote latching on, what will you instruct the mother to shape her fingers (3)? what is C hold? what is V hold? how do you want to position the baby? what can be used (2)?

o Instruct mother to make C or V shape with her fingers to support breast or scissor hold - C hold: mother places her thumb well above the areola and the other four fingers below the areola and under the breast. - V hold: mother places her index finger above the areola and her other three fingers below the areola and under the breast. o Position baby - so that latching on is effective and not painful for mother - Placing pillows or a folded blanket under the mother's head may help, or rolling her to one side and tucking the newborn next to her

What determines the iron status of the newborn (3)? how is iron released and where is it stored and for long how? does the newborn have sufficient iron stores why or why not? what causes the glucose levels to decline immediately after birth? what must newborns learn how to regulate/adjust (2)? what does the liver release immediately after birth and why? what helps stabilize blood glucose levels?

o Iron storage: o Maturity, birth weight, and hemoglobin level determine the iron status of the newborn. o RBCs are destroyed after birth - iron is released and stored in liver until new RBCs are produced o Newborn has sufficient iron stores during first 6months (if mother had adequate iron during pregnancy) o Carbohydrate metabolism: o Placenta is cut at birth; the maternal glucose supply is cut off - therefore newborns glucose levels decline o Newborns must learn to regulate their blood glucose concentration and adjust to an intermittent feeding schedule - With the newborn's increased energy needs after birth, the liver releases glucose from glycogen stores for the first 24 hours. · Initiating early breastfeeding or bottle-feeding helps stabilize blood glucose levels.

What are the lower extremities assessed for (5)? what is ortholani's maneuver? what is barlow's maneuver? what is Talipes deformity and what can the infant wear? how can hip deformity be corrected?

o Legs and Feet: equal length with symmetrical skin folds; toes counted; ROM; evaluate for hip dislocation or instability. o Ortholani's Maneuver: flex hip/knees to 90 degrees at the hip and apply downward pressure on the hip and inward rotation; performed by a trained clinician - used to identify congenital hip dislocation - Usually corrected with the pelvic harness to try to straighten out hips o Barolow Maneuver: grasp inner aspect of thighs, adduct the thighs while applying outward and downward pressure on the thighs (also listen for a click sound) o Talipes Deformity: clubfoot (a turning-inward position) - they can wear a special boot

What ability are the kidneys limited and for how long? what is important to properly do (2)? what is the GFR and what may it lead to (2)? even tho the kidneys are immature, can they perform their duty (2)? how often do newborns void a day? what other capabilities are limited (2) and it affects the newborns ability to excrete (3)? when should newborns void by?

o Limited ability to concentrate urine until about 3 months of age (urine has a low specific gravity & more frequent urination occurs until 3months) - important to mix formula properly bc excess waste may not be removed and it may be damaging to the newborn; ensure medications are proper dosage o Limited ability to concentrate urine & reduced GFR - lead to dehydration and fluid overload in newborn o Kidneys are described as immature, but they can carry out their responsibilities (excretion & acid-base balance) o Six to eight voiding's per day considered normal - most term newborns void immediately after birth o Low glomerular filtration rate and limited excretion and conservation capability o Affects newborn's ability to excrete salt, water loads, and drugs o All newborns should have void by 48 hours o If newborn does not void within 48 hours, the nurse should assess adequacy of fluid intake, bladder distention, restlessness, pain; notify HCP

What is the main purpose of the integumentary system in newborns? what are the characteristics of the newborn skin (6)? what is the function of the skin (4)? how is the epidermal development accelerated?

o MAIN purpose: provides a protective barrier between body and environment o It is sensitive, fragile, with a neutral pH on the surface, lower lipid content, and higher water content when compared with adults (skin development is not complete at birth) - Because of these characteristics, newborn skin is vulnerable to injury and infections o Functions: limits loss of water, prevents absorption of harmful agents, protects thermoregulation and fat storage, and protects against physical trauma (bc may bruise/breaks in the skin easily) o Accelerated epidermal development with exposure to air for all newborns

How is the circumcision procedure performed? explain the plastibell procedure (4)? what should be applied to the circumcised area after the procedure if done with the gomco or mogen clamp (1)? what is the preoperative requirements for surgery (4)?

o Methods - Part of the foreskin is removed by clamping and cutting with a scalpel (Gomco or Mogen clamp) or by using a Plastibell. o The Plastibell is fitted over the glans, and the excess foreskin is pulled over the plastic ring. - A suture is tied around the rim to apply pressure to the blood vessels, creating hemostasis. - The excess foreskin is cut away. The plastic rim remains in place until healing occurs. - The plastic ring typically loosens and falls off in approximately 1 week. o Petroleum jelly should be applied to the circumcised area after the procedure is done with the Gomco or Mogen clamp o Preoperative preparation: infant is at least 12hrs old, received vitamin K prophylaxis, has voided once since birth, & has not eaten in the past hour, and obtain consent

What is natural immunity? what are some explains of natural immunity (3)? what is the basic host defense response? what is acquired immunity? which are the most important immunoglobulins (3)? do young children wear masks? what should be encouraged of visitors?

o Natural immunity: includes responses or mechanisms that do not require previous exposure to the microorganism or antigen to operate efficiently. o Includes: physical (ex. skin) and chemical barriers (ex. gastric acid), & resident nonpathologic organisms o Basic host defense response: ingestion and killing of microorganisms by phagocytic cells o Acquired immunity: o (1) Development of circulating antibodies or immunoglobulins capable of targeting specific invading agents for destruction and (2) formation of activated lymphocytes designed to destroy foreign invaders o Absent until after first invasion by foreign organism or toxin o Newborn primarily dependent on three immunoglobulins: IgG, IgA, and IgM - Child under 2 don't wear masks; encourage visitors wash hands before touching infant

What is neurobehavioral response and this may be a reflection of the dynamic relationship between (2)? what is orientation? how does the infant display this? what do newborns prefer (2)?

o Neurobehavioral response: how the newborn reacts to the world around them o Newborn development is a reflection of the dynamic relationship between endowment and environment. o Orientation: response of newborns to stimuli o They become more alert when they sense a new stimulus in their environment o Orientation reflects newborns' response to auditory and visual stimuli, demonstrated by their movement of head and eyes to focus on that stimulus. - Newborns prefer the human face and bright shiny objects.

What is nevus flemus? does it fade and when is treatment optimal? what are the characteristics (3)? what may it be associated with (3)? What is Nevus Vasculosis? how do they first appear (2)? when does it tend to resolve by (2)?

o Nevus Flemus (Port-wine stain): capillary angioma located below the dermis (appears on face/neck or other) o Permanent and will not fade; optimal time for treatment is before 1yr of age o Characteristics: flat w/ sharp demarcations, purple red, mature capillaries that are congested & dilated o May be associated with structural malformations, bony or muscular overgrowth, and certain cancers o Nevus Vasculosis (strawberry mark or strawberry hemangioma): benign capillary hemangioma in dermal and subdermal layers, commonly found on the head & can increase in size/number o These hemangiomas are subtle or even absent at first, but they proliferate in the first few months o Tend to resolve by age 3 without any treatment (about 90% resolves in 10yrs) - some can have surgery

In regards to temperature, what are newborns prone to? what is the predisposition to overheating (3)? how does control of body temperature occur (2) and what balance does it create (3)? what is the consequence of the newborns CNS still being immature? when is skin to skin allowed?

o Newborn is prone to --> Overheating o Predisposition to overheating: - Large body surface area - Limited insulation & Limited sweating ability o Control of body temp achieved via negative feedback system that creates a balance between heat production, heat gain and heat loss (heat regulator located in hypothalamus and CNS) o Bc the newborns CNS is still immature, they become overheated easily bc they have difficulty to create and maintain the balance - Skin to skin care to keep the infant warm usually done after delivery, as long as the baby is okay

What are the newborn (4) and maternal advantages (5) of breastfeeding? What are the disadvantages (3)? what are the contraindications to breastfeed (2)?

o Newborn: strong immune system, reduces upset stomach, promotes bonding, protection against food allergies o Mother: facilitates postpartum weight loss, stimulates uterine contractions, lowers ovarian, endometrial, breast cancers and osteoporosis, lowers risk for type 2 DM, reduces postpartum depression, promotes uterine involution o Inconvenience, Exclusion of father (have them burp baby), time consuming o Contraindications: Medical conditions - Breast cancer, HIV

What are the abilities for the newborns to regulate temperature? how do newborns produce heat? what is thermoregulation? what are the ways newborns conserve heat (5)? what is neutral thermal environment (NTE)? how is internal body temperature maintained? how do newborns maintain a neutral thermal environment? what is the neutral thermal environment temperature?

o Newborns have a decreased ability to regulate body temp - producing heat through nonshivering thermogenesis. o Thermoregulation, the balance between heat loss and heat production, is related to the newborn's rate of metabolism and oxygen consumption. - Ways newborn conserves heat: increasing metabolic rate, nonshivering, muscular activity through movement, peripheral vasoconstriction, assuming fetal position to hold in heat o Neutral thermal environment (NTE) An environment in which body temperature is maintained without an increase in metabolic rate or oxygen use o Within a neutral thermal environment, the rates of oxygen consumption and metabolism are minimal, and internal body temperature is maintained because of thermal balance. o Newborns need a higher environmental temperature to maintain a neutral thermal environment - Neutral Thermal Environment: 32-34 degrees Celsius

What is nonshivering thermogenesis? explain the process (3)? when is brown fat produced and when does it reduce? what does the brown color derive from (2)? where is brown fat found (5)? when the newborn experiences cold, what does it stimulate (3)?

o Nonshivering thermogenesis (NST) - Primary method of newborns heat production o Process in which brown fat (adipose fat) is oxidized in response to cold exposure o Brown fat is able to convert chemical energy directly into heat when activated by SNS - Skin receptors o Produced during 3rd trimester, and reduced by 3-5wks after birth - Brown color derives from fats rich supply of blood vessels/nerve endings - Found between scapulae, axillae, nape of neck, mediastinum, kidneys o When newborn experiences cold - Norepi is released and stimulates brown fat metabolism by breaking down triglycerides, CO increases, blood flow through brown fat issue is increased, and essentially blood becomes warmed as a result of the increased activity. - Unique to the newborn

What are the characteristics of the newborn nose (4)? how do infants breath and what will they do to clear their nose? after the nasal passages are clear, what can they do? what are the characteristics of the mouth (4)? what are epstein pearls? how does thrush appear? can the infant be tongue tied? what is cleft lip? how does the lips of fetal alcohol syndrome appear?

o Nose: Nose is small & narrow that is midline w/ patent nares & intact septum o Newborn is a nose-breather and will sneeze too clear nose if needed; can smell after nasal passages clear o Mouth: Pink lips that has moisture or cracking, scant saliva, taste buds and sucking reflexes are developed o Epstein's pearls (small, white epidermal cysts on gyms/hard palate), Thrush (white plaque), Tongue-tied. o Cleft upper lip (separation extending up to the nose); fetal alcohol syndrome (thin upper lip)

Where is the apical pulse located in the newborn? what is the characteristic of the abdomen (3)? where is the liver located? where is the kidneys located (2)?

o Obtain apical pulse for a full minute --> located: lateral to midclavicular line located at 4th intercostal space o Assess Peripheral pulses - brachial, femoral; and assess Blood pressure o Usually cylindrical, protrude slightly but NOT distended, moves with respirations (bc their abdominal breathers) o Auscultate bowel sounds in four quadrants; monitor bowel movements as well o Palpate - softness, masses. o Liver: 1 to 3cm below costal margin in the midclavicular line; Kidneys: 1 to 2 cm above & to both sides of umbilicus

What is one of the most important elements in a newborns survival? what is an initial method for maintain newborn body temperature (1) and what else does it help with? what is thermoregulation? what are newborns sensitive to? what may occur to the newborns temperature after birth and why (2)? how is heat production achieved? and how is heat loss occur (4)?

o One of the most important elements in a newborn's survival is obtaining a stable body temperature to promote an optimal transition to extrauterine life (temp can range from 97.9-99.7 F) o Skin to skin w/ mother is recommended as initial method for maintaining newborn body temp - First line treatment for hypothermia & establishes successful breastfeeding o Thermoregulation: process of maintaining the balance between heat loss and heat production in order to maintain the body's core internal temperature. o Newborns tolerate a narrower range of environmental temperatures and are extremely vulnerable to both underheating and overheating - Newborn temp may decrease 3-5 degrees within minutes after birth due to drying of amniotic fluid and cool air o Heat production: primarily through nonshivering thermogenesis o Heat loss: via four mechanisms leading to cold stress - Conduction, convection, evaporation, radiation

What is critical in the development of GI function? which type of nutrition is preferred? when should formula be given (2)? what is the stomach capacity of the born? what is the diet? what is the infant at high risk for when under 6months? when can the infant not digest cereal? how much water do infants need (2)? what occurs if too much protein is consumed? what occurs between 4-6 months in regards to development and nutrition?

o Oral feeding: critical in the development of immature gastrointestinal function o Human milk: preferred (gives baby immunity and most nutritious) o Formula: should eat as soon as possible or within 6-8 hours of birth o Stomach capacity: 6ml/kg --> therefore, small frequent feedings are necessary (don't overfeed) - Baby is at high risk for food allergies during first 4-6months of life, introducing solid foods during that time increases the risk - Pancreatic enzymes & bile are limited from 3-6months, infant cannot digest cereal at that time - Higher consumption of water needed due to kidneys being immature and inability to concentrate urine from 4-6wks of age, excess protein/mineral intake can play strain on kidney function o At about 4 to 6 months, inborn reflexes disappear, head control develops, and the infant can sit to be fed, making spoon-feeding possible

What is PKU? when should PKU screening be performed (2)? how is screening for PKU done? what may the child react in response to certain proteins? what will these individuals be on a lifetime diet of?

o PKU: autosomal recessive inherited deficiency in one of the enzymes necessary for the metabolism of phenylalanine to tyrosine - essential amino acids found in most foods - The newborn needs to ingest enough breast milk or formula to elevate phenylalanine levels for the screening test to identify PKU accurately, so newborn screening for PKU testing should not be performed before 24 hours of age o Screening for PKU: performing a heel stick and applying the blood specimen to the card for screening - The child may vomit the feedings that contain certain proteins; these children will be on a lifetime diet of food low in phenylalanine

Behavioral Pattern of the newborn, when does the period of decreased responsiveness begin? what is the characteristic of this stage (5)? when does the second period of reactivity begin/last? what is it characterized by (4)?

o Period of decreased responsiveness: o Begins at 30 to 120 minutes old (second stage - the sleep period or decrease in activity) o This phase is referred to as a period of decreased responsiveness - It is difficult to arouse or interact with the newborn (no interest in sucking is shown) o Characterized by: less movement, HR and RR decline, muscles are relaxed o Second period of reactivity: o Begins as the newborn awakens and shows an interest in environmental stimuli. o This period lasts 2 to 8 hours in the normal newborn o Characterized by: HR and RR increase, peristalsis increases (can pass meconium or void during this period), motor activity and coordination/tone are increased - Newborn awakens and shows an interest in stimuli

Explain the transfer of gas exchange from fetus to infant? what does the transition include (3)? what is surfactant? if the infant is premature, what medication can be given to increase surfactant?

o Physiologic responsibility for gas exchange is transferred from the placenta to the newborn's lungs and pulmonary system at birth. o Transition includes: aeration of the lungs, establishment of pulmonary gas exchange, change to adult circulation o Surfactant: is a surface tension-reducing lipoprotein found in the newborn's lungs that prevents alveolar collapse at the end of expiration and loss of lung volume (if premature, give dexamethasone) o It lines the alveoli to enhance aeration of gas-free lungs, thus reducing surface tension and lowering the pressure required to open the alveoli (basically provides the lung stability needed for gas exchange) o Permits a decrease in surface tension at end expiration (to prevent atelectasis) & an increase in surface tension during lung expansion (to facilitate elastic recoil on inspiration).

What are the post discharge follow up appointment schedule (7)?

o Post discharge follow-ups - normally 6 weeks if infant is healthy; if something is wrong, then sooner o First health follow-up appointment within 2 to 4 days after discharge o Typical schedule of health care visits is as follows: 2 to 4 weeks of age; 2, 4, and 6 months of age for checkups and vaccines; 9 months of age for a check-up; 12 months for a check-up and tuberculosis testing; 15 and 18 months for check-ups and vaccines; and 2 years of age for a check-up.

Who are reflexes present in? Explain the reflex and when it should go away: tonic neck reflex (fencer position), palmar grasp, planter grasp, moro reflex

o Reflexes are present in all newborns, if absent past a certain time period - may indicate CNS problem o Tonic Neck Reflex (fencer position): 4-6 months; brain damage o Newborn lie on the back. Turn the baby's head to one side. The arm toward which the baby is facing should extend straight away from the body with the hand partially open, whereas the arm on the side away from the face is flexed and the fist is clenched tightly o Palmar Grasp: 3- 6 months; placing a finger on the newborn's open palm. The baby's hand will close around the finger. Attempting to remove the finger causes the grip to tighten (should be seen bilaterally) o Planter Grasp: 10 months; place finger below the newborn's toes, the toes typically curl over the finger o Moro: 4-6 months, occurs when neonate is startled o Place the newborn on his or her back & support the upper body weight of the supine newborn by the arms, using a lifting motion, without lifting the newborn off the surface. § Then release the arms suddenly. The newborn will throw the arms outward and flex the knees; the arms then return to the chest. The fingers also spread to form a C shape

Explain the reflex and when it should go away: rooting reflex, sucking reflex, babinski reflex, galant reflex, stepping reflex, and head righting? which reflexes dont go away?

o Rooting: 3-4 months, stroke the newborns check and newborn should turn toward the side & begin sucking o Sucking: 3-4 months, elicited by gently stimulating the newborn's lips by touching them and newborn will open mouth and begin at sucking motion o Babinski: 12 mths, stroke the lateral sole of the newborns foot from the heel toward and across the ball of the foot, the toes should fan outwards o Trunk Incurvation (Galant) - truncal incurvation; newborn in prone position or in ventral suspension, apply firm pressure and run a finger down either side of the spine; stroking will cause pelvis to flex toward the stimulated side o Stepping: 6-8 weeks, hold newborn upright & inclined forward w/ the soles of the feet touching a flat surface, newborn will make stepping motion o Head Righting - corrects the orientation of the body when is taken out of its normal upright position o In addition, newborns can blink, yawn, cough, gag, sneeze, and draw away from pain. o The ways newborns blink, move their limbs, focus on a caregiver's face, turn toward sound, suck, swallow, and respond to the environment are all indications of their neurologic abilities.

Newborn care, in regards to safety what will be ensured of the cribs (2)? how should infants be put to sleep? what should be applied to the skin when outside? in regards to clothing, what should it be appropriate to (2)? are onesies recommended? how do you hold an infant? can newborns console themselves and what needs to be done if not?

o Safety o Make sure the crib or changing table is sturdy, without any loose hardware, and is painted with lead-free paint. o Place all infants on their backs to sleep to prevent sudden infant death syndrome. o Use sun shields on strollers and hats to avoid overexposing the newborn to the sun. o Clothing - ensure proper clothing is maintained depending on body temperature and weather o Wrapping - onesies aren't recommended bc we want umbilical cord to be exposed until it dries up o Holding - educate new parents how to hold baby, support head and neck o Comforting - some babies can console themselves, some need to be held and comforted (develops security)

What is self-soothing ability? what is "Consolability"? what are the five S's to calm fussy infant? what do social behaviors involve (2)?

o Self-quieting (Self-soothing) ability: refers to newborns' ability to quiet and comfort themselves. o "Consolability": is how newborns are able to change from the crying state to an active alert, quiet alert, drowsy, or sleep state. o Five S's to calm fussy infant: swaddling, side/stomach position on lap, shushing loudly, swinging using any rhythmic movement, & sucking o Social behaviors: include cuddling and snuggling (newborns are sensitive to being touched, cuddled, & held)

Newborn care, what are some signs of illness (8)? In regards to car seat safety, what needs to be ensured prior to parents being discharged? what car seat must they use? what needs to be ensured of the harness? what may occur if pets are at home (2)?

o Signs of illness: Fever (> 101 F), vomiting, refusal of feedings, 2-3 green diarrheal stools, infrequent wet diapers or change in bowel movements, lethargic, excessive sleepiness, inconsolable crying or fussiness, abdominal distention, and difficult or labored breathing, change of eye color, rash o Car Seat Safety: o Do not release any newborn unless the parents have a car seat in place for their newborn's ride home (ensure parents understand the importance of safely transporting newborn in car seat) - Use rear-facing car safety seats for most infants up to 2 years of age or until they reach the highest weight or height allowed by the manufacturer of their CSS. - Make sure the harness (most seats have a three- to five-point harness) is in the slots at or below the shoulders o Pet safety - pet jealousy may develop when infant is first brought home (aggression may occur); infant may be allergic if pet is not hypoallergenic

Newborn care, How long do newborns sleep (2)? where is the safest place for infants to sleep? what should the crib look like? how should infants be put to sleep? what is tummy time (2)? when may side to side be taught? what should be avoided in the infants room/position (4)? what immunization is given at birth?

o Sleep positions and SIDS: o Newborns sleep up to 15 hours daily - They sleep for 2 to 4 hours at a time o Safest place for a newborn to sleep is in a crib in the same room with their parents for at least 6 months, and without any movable objects in the crib and placed on their back to sleep - Babies' tummy time is supervised, not during sleep; side to side may be taught by hospitals o Avoid: placing newborn in prone position, loose window cords, blankets or pillows, high temperatures o Immunizations: o Newborns first Hep B vaccine and Hep B immunoglobulin is received in hospital soon after birth within 12hrs of birth, if mother HbsAg positive (can be given at 2 months if mother is HbsAg negative)

Breastfeeding common problems, why does sore or cracked nipples occur? what should be reinforced (2)? should breastfeeding be painful? what is engorged breasts and how is it relieved? what are interventions to help with discomfort (4)? what is mastitis? what are the S/S (1)? what is the treatment (4)?

o Sore or cracked nipples (breastfeeding should not be painful): finding the cause is important - Sore nipples are caused by improper infant attachment, which traumatizes the tissue - Reinforce latching on techniques & the need to break the suction before removing infant o Engorgement: may occur as milk comes in around day 3-4 after birth, resolves w/ infant nursing - Take warm showers, express milk before feeding, wear supportive bra, massage breast o Mastitis: inflammation of one breast, S/S are flu like symptoms, caused by bacteria infecting breast - Treatment: rest, warm compress, antibiotics, breast support, continued breastfeeding o Inadequate milk

How should the newborns infant be (2)? when do the curvatures develop? what is nevus pilosus? what is pilonidal dimple?

o Spine straight and Flat; lumbar and sacral curves does not develop until infant begins to sit-up o Neveus Pilosus (hairy nevus): found at the base of the spine, associate with spina bifida (take prenatal folic acid) o Pilonidal Dimple - cyst in the lower sacral area, usually doesn't cause issues but is removed surgically

What will you assess in the neurologic status of the newborn (4)? how should the newborn present (2)? what is the newborns normal position (3)? what is their movement (2)? how do you assess muscle tone in the newborn and what are the result (2)? when may tremors or jitteriness be present?

o State of alertness, resting posture, cry, quality of muscle tone, and motor activity o Newborn should be alert & not persistently lethargic o Normal Position: partially flexed extremities with legs abducted on abdomen & arms are adducted, fists are clenched with fingers covering the thumb o Movement: purposeless, uncoordinated o Assess Muscle tone - support newborn w/ one hand under the chest, observe how neck muscles hold the head o Neck extensors should be able to hold head in line briefly, & only slight head lag when moving from a supine position to a sitting one o Tremors and jitteriness o Jitteriness: hypoglycemia (may need to feed infant)

What is the order of stools (3)? what is meconium and when should it be passed? failure to pass meconium may indicate (2)? what is transitional stool (4)? what is milk stool? what are the stools characteristics of breast fed (4) and formula fed newborns (3)?

o Stools: meconium, then transitional stool, then milk stool o Meconium: newborn first stool; greenish-black, tarry; passed within 24-48 hours of life o Failure to pass may indicate intestinal obstruction and places the newborn at risk for hyperbilirubinemia o Transitional stool: after feedings are initiated, is greenish brown to yellowish brown, thinner in consistency and seedy in appearance o Milk Stool - characteristics differ in breastfed and formula-fed newborns o Breast-fed newborns: Yellow-gold with seed like particles, loose, stringy to pasty consistency, sour smelling o Formula-fed newborns: tan, yellow, or yellow-green and firmer, loose, pasty, or formed in consistency, unpleasant odor

When is surfactant produced and function? what phospholipids are important for alveolar activity (2)? what should the LS ratio be? what occurs if it's not? what is LS ratio and what may the infant require?

o Surfactant: 28-32 weeks - Prevents alveoli from collapsing & Promotes lung compliance. o Phospholipids - Lecithin and Sphingomeyelin are critical for alveolar activity. o LS Ratio -2:1: Infants born before the LS ratio is 2:1 will have varying degrees of respiratory distress. o Test done in the amniotic fluid to test how mature the lungs are or not - may require respiratory support

What are telangiectatic nevi and when does it usually disappear? what is it caused by and when is it most seen? What are Mongolian spots? who is it common in (2)? when does it fade and what causes it?

o Telangiectatic Nevi: Stork bites, pale pink or red spots found on eyelids, and neck. Fades in 2 years. o Stork Bites or salmon patches -superficial vascular areas found on the nape of the neck, on the eyelids, and between the eyes and upper lip - Caused by a concentration of immature blood vessels and are most visible when the newborn is crying (considered normal, most fade completely within the first yr) o Mongolian Spots: Macular areas of bluish or purple/black pigmentation that appear solitary on the lower back and buttocks (also may occur over the legs or shoulders) o Found in Asian, African and dark-skinned races. Fades 1-2 yrs, caused by concentrated of pigmented cells

In the newborn, when does temperature stabilize? when are temperatures taken (3)? how often (2)? what are the modes of taking temperature in the newborn (4)? what is the normal temperature? where is the probe taped to?

o Temperature stabilizes within 8-12 hours (Monitor temperature) o Temps are taken immediately after the Apgar score has been taken to allow for identification of hypothermia, which then requires a glucose check (every 30mins first 2hrs, then every 8hrs) o Mode - axillary skin mode, skin probe, rectal, tympanic; axillary temp range 36.5˚-- 37.2˚C (97.7˚-- 98.6˚ F) o The probe is taped to the newborn's abdomen, usually in the right upper quadrant

How is the newborns neurological system at first and how long until its mostly developed? what pattern does the neurological development follows (2)? Where does myelin develop early (3)? what can infants recognize (2)? What will indicate the the infant had successful transition from fetal to extrauterine life (2)?

o The nervous system is immature and continues to develop to achieve a full complement of cortical and brain stem cells by 1 year of age. o Neurologic development follows cephalocaudal (head-to-toe) and proximal-distal (center-to-outside) patterns. o Myelin develops early on in sensory impulse transmitters - Thus, the newborn has an acute sense of hearing, smell, and taste - infant will recognize their caregivers voices if they were exposed while in utero or even certain sounds and may continue to console the baby o Congenital Reflexes o Successful adaptations demonstrated by the respiratory, circulatory, thermoregulatory, and musculoskeletal systems indirectly indicate CNS's successful transition from fetal to extrauterine life o Congenital reflexes are the hallmark of maturity of the CNS, viability and adaption to extrauterine life

Is the newborn protected from certain infections, why and for how long? when do newborns produce their own antibodies? where do breastfed newborns receive their antibodies? are newborns at risk for acquiring infection (2)? what are the 3 responses of the immune system (3)?

o The newborn is protected from certain infections, in part because of maternal antibodies circulating in their systems until about 6 months of age - newborns produce their own antibodies starting at 2-3months of age o Newborns who are breastfed receive antibodies from the breast milk, which includes IgE, IgA, IgM, and IgG o The risk of acquiring an infection is great because a newborn's immune system is immature and is not able to respond for long periods of time to fight infections. o Responses of the immune system: defense (protection), homeostasis (elimination of worn-out host cells), & surveillance (recognition & removal of enemy cells)

What are the interventions if the newborn is breathing but not pink? what if they are in respiratory distress? what if they are apneic?

o The nurse should: o Assess risk o Assess family preferences o Family desires o Assessment o Planning/intervention for infants: - Breathing but not pink: free-flow oxygen - Respiratory distress/limp: more thorough assessment and possible ventilation - Apneic: stimulation; bag and mask ventilation

What is an important indication of neurologic development and function? what is a reflex? what may congenital defects reveal (3)? what is an indication of neurologic pathology (3)?

o The presence and strength of a reflex is an important indication of neurologic development and function. o Reflex: is an involuntary muscular response to a sensory stimulus. o Congenital defects within the CNS are frequently not overt but may be revealed in abnormalities in tone, posture, or behavior - Indication of neurologic pathology: absent or abnormal reflexes in newborn, persistence of a reflex past the age when it's normally lost, or redevelopment of an infantile reflex in an older child or adult

What are the characteristics of the newborn and heat loss (10)?

o Thin skin with blood vessels close to the surface (babies normally have brown fat - metabolism of their food generates heat) o Lack of shivering ability to produce heat (until 3m); limited stores of metabolic substrates (glucose, glycogen, fat) o Limited use of voluntary muscle activity or movement to produce heat o Large body surface area relative to body weight o Lack of subcutaneous fat; little ability to conserve heat by changing posture (fetal position) o Flexed posture decreases the surface area exposed o No ability to adjust own clothing or blankets to achieve warmth o Infants cannot communicate that they are too cold or too warm - be mindful, keep them in neutral environment

What does the cord clamping depend on (2) and when might it be clamped (2)? where is blood sampling done? At birth, what does the newborns liver have to assume? when does the liver become fully functional? what does glycogen provide and what may cause the levels to drop (2)?

o Timing of cord clamping (dependent on the physician and hospital - may be clamped after pulsation or immediate o Blood components, WBC's, Platelets, Blood sampling (may be done at the heel of the foot for blood sugar) o At birth, the newborn's liver slowly assumes the functions that the placenta handled during fetal life. o Most enzymatic pathways in the newborn become fully active at 3months of age o Glycogen reserves provide energy & may become depleted if metabolic needs of newborn increase (ex. during cold or respiratory stress)

What is transitional milk (3)? when is transitional milk replaced? what is mature milk (3)? what should be determined before feeding (4)? what are signs the newborn is hungry (4)? what do infants do during feedings and what is important to do? what is a breastfeeding room?

o Transitional milk: occurs between colostrum and mature milk, contains all nutrients in colostrum but is thinner and less yellow; replaced by true or mature milk around day 10 after birth o Mature milk: appears bluish and is not as thick as colostrum; contains protein, fat, carbs, water, minerals, vitamins and enzymes o Before feeding: determine newborn ability to suck and swallow, clear any mucus from nares, auscultate bowel sounds, inspect anus for patency o Signs newborn is hungry - crying, placing their fingers or fist in their mouth, rooting around, and sucking o Infants swallow air during feedings, so burping is important o Provide privacy - breastfeeding rooms, must have a wash basin and comfortable chair

Explain the two main treatments for jaundice (2)? what happens if the baby is constipated? explain the procedure of phototherapy? when is phototherapy begun? what does this therapy aim to do (2)? how must the infant be and what must be protected (2)? what are the side effects of phototherapy (5)?

o Treatment o Hydration - ensure frequent breastfeeding to ensure hydration & promote stooling *** - If baby is constipated, jaundice may occur bc they are not excreting the bilirubin in the stools as they should o Phototherapy: exposing the newborn to ultraviolet light, which converts unconjugated bilirubin into products that can be excreted through feces and urine - Begun when bilirubin levels reach 12 to 15 mg/dL in the first 48 hours of life in a term newborn - Aims to curtail the increase in bilirubin blood levels; thereby preventing kernicterus, a condition in which unconjugated bilirubin enters the brain (can lead to brain damage & death) - Procedure: phototherapy administered w/ banks of fluorescent lights or spotlight · Rays must penetrate the skin, newborn must be naked and turned frequently to ensure maximum exposure, put eye protection (monitor newborn body temp, hydration status, stools) - Side effects: frequent loose stools, increased insensible water loss, transient rash, retinal damage · Stools may be dark and tarry - due to excessive bilirubin coming out of the baby

Newborn care, why is a bulb syringe used? what type of breathers are infants? what else can be used to wipe secretions? explain how to use a bulb syringe (3)? in regards to voiding and stooling, how many diapers do newborns soil in a day? when is meconium passed and what is the characteristic? when do transitional stools appear? breastfed/bottlefed stools?

o Use of bulb syringe - infants are nose breathers, so we have to make sure it is clear for them to breath o Newborn is suctioned to remove fluids and mucus from the mouth (first) and nose (second) - To prevent aspiration of fluids into the lungs by an unexpected gasp - can also use a towel to wipe secretions for stable newborns o Process: compress the bulb before placing it into oral/nasal cavity, release bulb compression slowing (making sure tip is placed away from mucous membranes to draw up the excess secretions) o Remove the bulb syringe from the mouth or nose & compress the bulb to expel the secretions in a basin o Voiding and stooling: o Soaking six to 12 diapers a day indicates adequate hydration o Meconium is passed for the first 48 hours after birth; the stools appear thick, tarry, sticky, and dark green. o Transitional stools (thin, brown to green, less sticky than meconium) typically appear by day 3 after initiation of feeding (stool characteristics depends on if newborn is bottle-fed or breastfed) - Breastfed newborns typically pass mustard-colored, soft stool with a seedy consistency; formula-fed newborns pass yellow to brown, soft stools with a pasty consistency.

What are the vision capabilities are birth and what does maturation depend on (2)? what can newborns see (2)? visual acuity? which sense is least mature at birth? what are the hearing capabilities are birth? what are the smell capabilities? what are the touch capabilities (2)? what is the taste ability?

o Vision: incomplete at birth; maturation is dependent on nutrition and visual stimulation. o Newborns have the ability to focus only on close objects (8 to 10 in away) with a visual acuity of 20/140; they can track objects in midline or beyond (90 in). o This is the least mature sense at birth - ability to fix, follow, and be alert is indicative of an intact CNS o Hearing: well developed at birth, responds to noise by turning to sound o Smell: ability to distinguish between mother's breast milk and breast milk from others o Touch: sensitivity to pain, responds to tactile stimuli o Taste: ability to distinguish between sweet and sour by 72 hours old

What injection will be provided to the newborn and where/dosage? what does vitamin K promote? what is an acquired coagulopathy in newborns and why? where in the body is vitamin K produced and when does the infant produce it?

o Vitamin K injection (Aquamephyton): Vastas lateralis muscle (IM dose of 0.5mg to 1mg) o Vitamin K, a fat-soluble vitamin, promotes blood clotting by increasing the synthesis of prothrombin by the liver (deficiency can lead to delayed clotting & hemorrhage) o Vitamin K deficiency is an acquired coagulopathy in newborn infants because of an accumulation of inactive vitamin K coagulation factors, which leads to an increased bleeding tendency. - Bacteria of the intestine produce vitamin K - However, the newborn's bowel is sterile, so vitamin K is not produced in the intestine until after microorganisms have been introduce (takes 1 wk to produce enough vitamin K to prevent bleeding in the newborn)

After a vaginal or cesarean birth, what will be done (3)? what does drying stimulate? what is encouraged from the parent? what will occur to the infant if skin-to-skin is unable to be done? what will you educate the parents on (3)? what opportunity will you offer the parents?

o Warmth, Clear airway and Dry baby (when drying baby, it causes stimulation - turns blue to pink) o Bonding - encourage skin to skin if healthy, if not then infant can be put in the radiate warmer - Enhance parent-newborn interaction by involving both parents with the baby (use soothing voice) - Tell parents what you are doing, why you are doing it, and how they can duplicate what you are doing at home. - Offer the opportunity for parents to perform care while you observe them. Support their efforts to soothe the newborn throughout the care process

What is the neonatal period? what is the environment that the fetus is in and explain the environment the infant is in (2)? what is the golden hour of life? what changes will occur (3)? what are the primary challenges faced by the newborn (3)?

· Neonatal Period: defined as the first 28 days of life o The newborn, previously confined to the warm, dark, wet intrauterine environment, is now thrust into an environment that is much brighter and cooler o "Golden hour of life" - first hour in recognition of the fact that the newborn's intrauterine to extrauterine transition is dramatic and critical · Respiratory gas exchange, Circulatory modifications, Changes in organ systems · System-wide changes, Neutral thermal environment, Prevent cold stress & Problems bilirubin conjugation and jaundice

What is the normal respiratory rate for newborns? what are the characteristics of the breaths (4)? what is periodic breathing (2)? what is apnea? what is normal to see for several hours after birth (2) and why does it occur? how do newborns breath and what is an important intervention?

· Respirations: 30 to 60 breaths per minute; irregular, shallow, unlabored; with short periods of apnea (<15 seconds); symmetrical chest movements o Initial breathing is largely diaphragmatic, but synchronous w/ abdominal movements o Periodic breathing: cessation of breathing lasting 5-15 seconds; No color or heart rate changes o Apnea - cessation of breathing lasting more than 20 seconds. o Cyanosis and acrocyanosis are normal for several hours after birth - bc baby is trying to supply oxygen to vital organs first, so extremities may be bluish color (important that it's not central cyanosis- emergency!) o The newborn is an obligatory nose breather (unless they are crying) - bulb syringes used to clear nares

Why may accumulation of jaundice occur (3)?

· Three groups of jaundice based on mechanism of accumulation of bilirubin: - Bilirubin overproduction (ex. from blood incompatibility, polycythemia, delayed clamping) - Decreased bilirubin conjugation (ex. from physiologic jaundice, hypothyroidism, breastfeeding) - Impaired bilirubin excretion (ex. from biliary obstruction, sepsis, hepatitis)