newborn assessment

Erythema toxicum

'flea bite rash" appears during first 24-72 hours after birth and can last up to 3 weeks of age - lesions in different stages - macules, papules, small vesicles. - can appear suddenly anywhere on the body. thought to be an inflammatory response. esonophils are found in the vesicles. requires no treatment. goes away in couple weeks, papular rash. Raised. Looks like heat rash somewhat

Average for gestational age

(AGA): Weight between the 10th and 90th percentile for estimated weeks gestation

Large for gestational age

(LGA): Weight above the 90th percentile for estimated weeks gestation

Small for gestational age

(SGA): Weight below the 10th percentile for estimated weeks gestation

Telangiectatic nevi

(stork bites) angel kisses, salmon patches result of superficial capillary defect - small, flat and pink and easily blanch most common sites are upper eyelids, nose, upper lip, and nape of the neck tend to be symmetrical with lesions occurring on both eyelids or both sides of midlines normally fade over time, blood vessels dialate causing discoloration, blanches when press on it

signs of cold stress

-acrocyanosis=hands and feet turn blue, cool to touch, trunk may see purple reddish linear pattern, cry, if continues becomes flaccid from running out glucose and oxygen

interventions to prevent heat loss

-dry the infant quickly after bathing to prevent hypothermia - skin to skin contact with mother - place neonate under radiant warmer -place cap on babies fed

evaporation

-loss of heat through conversion of a liquid into a vapor (important immediately after delivery and bathing) -dry off as quickly as possible when getting them out of the bath.

radiation

-transfer of heat from body to cooler solid surface that is not in direct contact with the infant - cribs and examining table are placed away from outside windows.

conduction

-transfer of heat from the body to a cooler surface that is in direct contact with infant -placed on prewarmed bed under a radiant warmer to minimize heat loss - scales used for weighing the newborn should be covered

radiation

-transfer of heat from the infants body to a cooler solid surface that is not in direct contact with the infant. Going to be close by. *keep baby away from Old window units. keep way in the middle of the room instead of Placed. Windows can cause heat loss.

how long is a period of apnea okay for?

20 seconds if over 20 seconds indicate a pathologic process and should be evaluated.

preterm

20-37 weeks

brief gestational age assessment

28 weeks: No nipple bud Testes in inguinal canal Labia majora widely separated with prominent labia minora open Vernix (cheesy coating over entire body) preterm covered H-T Lanugo (fine, downy hair) over entire body H-T Full extension of extremities at rest. Flaccid not well flexed

term

38-40 weeks

brief gestational age assessment

40 Weeks: Raised nipple with tissue bud underneath. pocket of fat. Descended testes with rugae on scrotum. Labia major large and covering minora Vernix only in creases( neck, groin, behind the knees) Lanugo only on shoulders Hypertonic flexion of extremities at rest.

newborn care in the delivery room

APGAR scoring Obtain APGAR Scores at exactly 1(conditions of baby in utero) and 5 minutes(transition outside of utero). -Brief examination: -Cord-two arteries one vein (3vessels) Gestational age assessment Safety Identification Medication Administration

Nurses Responsibility

Assess, plan, and provide nursing intervention based on the outcomes of the individual newborn's assessment and examination

A normal newborn has erythromycin eye ointment ordered and the parent asks for an explanation. What is the nurse's best response? A. "It is ordered by the physician." B. "We give it to prevent eye infections which can be contracted with passage through the birth canal." C. "It will need to be given every 8 hours for the first week of life." D. "Don't worry. Your baby is fine and healthy.'

B. "We give it to prevent eye infections which can be contracted with passage through the birth canal."

safety for mom and baby

Before baby leaves delivery room make sure who the baby belongs to Band the baby, mother and someone else who is going to be present at discharge. Info on band- moms name goes on band. Medical record number. When you leave the room check bands, and when enter room, check bands Newborn foot prints Mothers index finger and thumb on right hand. Certificate with prints on them. Security tag gets placed on ankle of baby. Will put a lock down on unit if someone tries to kidnap baby Hug band

signs of respiratory distress

Bradypnea (< 30 breaths/min) Tachypnea (> 60 breaths/min) Abnormal breath sounds: coarse crackles, wheezing, grunting Respiratory distress: nasal flaring, retractions, stridor, gasping Skin color: cyanosis=central mouth, lips, tongue trunk, mottling Pulse ox reading < 95%

A newborn is sent home with the wrong mother from the newborn nursery. Who is legally liable? A. The nurse who applied the armbands B. The physician who performed the delivery C. The nurse discharging the infant D. The hospital who carries the malpractice insurance

C. the nurse discharging the infant

immediate care of the newborn- prevent hypoxia

Do a assessment of the babies lungs. Skin between rib bones suck in, retraction. Can have intercostal retractions Or abdominal retractions Right above abdomen, sucking in from the inside right above the xphoid Higher the score the worse the respiratory function. All the twos baby needs help.

new ballard scale

Done in the NICU setting. Not used as much in the nursery setting Use new ballard scale to do a thorough maturity assessment Look at the: Skin Lanugo Plantar surface bottom of feet Breast Eye-ear Genitals/ male Gentials female Get a score that helps to correlate the babies to their age Helps to determne how their neuromuscular system is developed. Posture Squrare windw-wrist Arm recoil Popliteal angle Scarf sign Heel to ear

immediate care of the newborn

Dry the infant (child cannot regulate temp) and place under warmer , or skin to skin with mother Suction mouth and nose with bulb syringe -squeeze out air, insert in mouth in sides, stimulates vagal nerve, look at color, presence of meconium could cause meconium and requires deep suction**Mouth first, then nose. Babies prefer to breath through nose=obligate breathers do not have reflex to breath through mouth if nose obstructed until 3weeks, keep nasal passage open Keep head slightly lower than body to promote drainage Assess for signs of respiratory distress Strong long lusty cry want to be heard immediately after birth

medications given at time of birth

Erythromycin eye ointment Vitamin K IM injection

APGAR score

Evaluates: Heart rate Respiratory rate Muscle tone Reflex irritability Color Score of 0 is bad Absent heart rate I bad. If don't have heart rate immediately start cpr 1-less than 100 bpm 2- hr above 100 Listen for full minute Put stethoscope at point of maximal impulse. Respiratory effort- looking for strong lusty cry-2 1-slow irregular weak cry 0-don't cry at all. Babies don't cry immedatiely. Do something to stimulate them, suction them. Hit bottom of their feet. If I suction and they cry or cough that is some type of response. If make a weird face- 1 No response to stimuli- 0 Fetal position- baby is flexion. If baby is in fetal position, well flexed posture- 2 Some flexion of extremeties-1 Flaccid or not bend- 0. Color- 2- normal skin coloring. Pink all over. 1- pink on face and trunk. Feet and hands are blue 0-totally cyanotic. 7-10 is good 4-6- may need some moderate resesitation Less than 4- need to go to NICU

Immediate transitional period

First 6 -8 hours of life- normally stay 2 days after vaginal birth C-section- 3 days hospital stay Transitional period is the first six to eight hours of life. Do assessments frequently on the normal newborn Can usually tell how that baby is transitioning from intrauterine to extrauterine life

How do babies promote heat?

Increase muscle activity, get very tense, cry, as they use up glucose, then we see signs of cold stress, burning brown fat, tensing up muscles, wasting oxygen and glucose, as a result get a metabolic acidosis. Can lead to a code. Keep depleting oxygen and glucose stores until someone does something -tense muscles, cry, cause cold stress from burning fat and oxygen and glucose, cause metabolic acidosis

rooting reflex

Infant turns toward stimulus when cheek or corner of lip is touched, feeding reflex Stroke one side and turn toward it Lasts until 3 - 4 months (possibly up to 1 year)

initiation of breathing

Intra to extra uterine life Breathe sounds- clear very loud breathe sounds in transition period. May hear fine rails. A little fluid your hearing. Last about 6 to 8 hours. Will cry it out. As they cry get rid of the fluid. C section baby- sometimes get transitient tachypnea of the newborn- fluid accumulation in theit lungs still. Causing some distress. See a pattern of repsirations up to 100 bpm. 24 to 48 hours. But doesn't mean if you see a tachypnea baby,It is a c section baby. may have to suction baby position to help with draining, can put baby in prone and pat on backs. Sleep on their back. But if nurse is watching closely, can put in prone. May have to give supplement oxygen. Blow-by oxygen. Blow over airway. Lay next to them. May stay in the nursery a little longer. Needs to be monitored a little longer. Signs of transient tachypnea- Nasal flaring, grunting when exhale, If see central cyanosis, respiratory rate less than 30. can give narcan

teaching for parents to prevent cold stress

Keep newborn warm and dry-dry thoroughly after bath Place stockinette cap on head (greatest heat loss through the scalp) Take newborn temperature on admission to nursery and every 4 hours If temp is below 97.6, place in radiant warmer and apply skin temperature probe(sticky electrode. normally put on abdomen, avoid boney prominence or ribs. Right over abdomen, little below xiphoid process) to regulate temperature. May also provide kangaroo care with mother to thermoregulate infant. Skin to skin on chest covered with blanket also helps with bonding Prevent cold stress, which can lead to hypoglycemia, ketoacidosis and shock!

second period of reactivity

Lasts 2 - 5 hours Occurs when infant wakes from deep sleep Infant is alert again, brief periods of tachycardia and tachypnea increases muscle tone changes in skin color and mucus production. *meconium is commonly passed at this time. shows hunger cues=rooting, sucking on hands, become restless, irritable, agitated, crying, good time breast feeding, first meconium pass

deep sleep period of reactivity

Occurs after first period of reactivity, Lasts 2 - 4 hours (60-100 minutes) Complete physical exam before this time infant is pink, respirations are rapid and shallow but unlabored -bowel sounds audible - peristaltic waves may be noted.

physiologic jaundice

Occurs at 2 to 3 days of life Due to the immature liver's normal inability to keep up with RBC destruction Unable to bind bilirubin Unconjugated bilirubin is the problem! Promote early and frequent feedings of milk(milk comes in on day 3) (protein binds bilirubin for excretion) the sooner and more frequent the better. Bilirubin excreted through feces. Breast fed takes longer to get rid of jaundice than Formula fed. Formula fed will get rid of bilirubin. Monitor bilirubin levels 5-7, peaks at about 12-15 on day 3 if above 15 receive phototherapy with only diaper and eye protection usually 24hrs, maybe longer if not improved. Also available biliblanket, alternative. Assist with phototherapy if needed Assess jaundice in skin color, sclera and mucous membranes (proceeds cephalocaudally) Pathologic jaundice if occurs within 24 hrs-not normal something wrong

initiation of breathing

Passage through birth canal squeezes fluid from the lungs. Vaginal birth don't sound as wet as a c section birth does. Vag birth gets rid of 2/3 of the fluid. Cord clamping causes pCO2/pH to increase and vascular chemoreceptors to stimulate breathing. Signifies the babies need to take first breathe. Lungs expand with first breath, and fetal shunts functionally close due to pressure changes. Subsequent breathing requires surfactant or respiratory distress will ensue Normal respirations: 30-60bpm Breath sounds within the first 1-2 hours: clear loud BS in transition period 6-8hrs after delivery may hear faint rails; c-section can get transiate(short period of time 24-48hrs) tachypnea may resolve 80-100bpms- reposition to promote drainage, suction, if under nurses watch prone, pat on back-if doesn't resolve blow by O2, lay close to face may need a longer nursery stay-nasal flaring may be seen, grunting usually upon exhale **Narcan used to reverse narcotic induced resp. depression

palmar grasp reflex

Press firmly with index finger, baby grasps finger 3-4 months

erythromycin eye ointment

Provides eye prophylaxis: prevents opthalmia neonatorum and Chlamydia conjunctivitis. * wipe away excess after a minute or so - is mandatory no matter route of birth. Prevents herpes, chlamydia, gonorrhea * must be applied within one hour of delivery. May use silver nitrate-very rarely used

negative bonding behaviors

Refusing to hold child Don't want to see baby Baby in nursery all the time. Calling baby an it. Excessively worrying about baby.

nursing assessment once out of delivery room

Review L&D report and history to determine risks to the newborn caused by medications and anesthesia during labor and delivery Magnesium sulfate- Hypermagnesemia of the newborn- depressed respirations, hypocalcemia, hypotonia, particularly in next 12hrs Narcosis- Late administration of narcotics during labor/delivery- decreased respirations and hypotonia

nursing assessment (full assessment)

Review Labor and delivery report of neonatal history to determine newborn risks during transition that may result from medical or obstetrical complications. -Cesarean delivery- missing vaginal squeeze -Prematurity -Post-maturity -Diabetic mother-more thorough assessment -Prolonged ROM (>24 hours): sepsis work-up -Rh+ isoimmunization (+ direct Coombs test) -Traumatic birth: forceps, vacuum suction **If mother is RH- concerned if infant is RH+=if the blood cells mix, mothers blood cells will attack babies, shows signs of jaundice,anemia particularly within first 24hrs, not normal occurrence of jaundice

nursing assessment continued

Review newborn risks related to birth asphyxia (severely deficient supply of oxygen to the body) Review documentation during labor for evidence of late decelerations, decreased variability, severe variable decelerations APGAR scores at 1 and 5 minutes

nursing assessment- continue

Review social history of mother for history of STDs, socioeconomic status (single mother), substance abuse, support system Assess vital signs every 30 minutes for 2 hours, then every hour for 5 hours Respirations: 30 - 60 breaths/min ;irregular at first, may have fine rhales (one full minute) up to 20secs can have apneic periods and still be normal, apnea greater than 20 secs not normal Heart rate: 110-160 bpm (may be 100 while sleeping, 180 when crying) Temperature: 97.7 -99.4 o F (36.5 -37.5 o C) Routes: Axillary or Rectally(not normally used) lubricate tip ¼ inch Blood pressure: 80/50 mm Hg (not commonly measured) unless worries of heart defect **Respirations for one full minute Keep in mind babies breathing pattern are irregular. Can get apnea for up to 20 seconds. This is normal If beyond 20 seconds it is not normal should not be over 20 seconds

immediate care- newborn

Right after delivery Hope to hear a long, lusty cry. Strong, don't head fluid behind the vocal quality. Tells us airway is clear and able to protect their airway. Nurses priority- first thing to do is Dry the infant off and put under radiant warmer or skin to skin with mom. Cannot control boy temp. loss heat rapidly. Compress air before you put into babies mouth, to the side of babies mouth so you do not stimulate the vagus nerve, cranial nerve 10, causes bradycardia, Color is important. If have meconium aspiration, first stool of newborn, black tarry thick stool, if baby aspirates that, its in their mouth airway can lead to pneumonia. Deep suction if meconium is present. Monitor baby for respiratory issues. Always do nose first then the nose Keep nasal passages open. Babies prefer to breathe through their nose. If nasal passages blocked at risk for aphasia or oxygenation problems Dry baby off, make sure don't get cold stress

safety

SAFETY: Identify mother and baby with bracelet and required prints before maternal separation and any time mother and infant are apart= ID band baby, mother, one other person(dad) mothers name goes on all three bands and medical record number, DOB, HCP, when leaving and coming must check bands. Mothers index finger and thumb, babies footprint. Other foot has security band in case of abduction(code pink). Go to all exits, don't let anyone leave or enter, check bags, and heavy coats

positive bonding behaviors

Skin to skin contact-kangaroo care Breast feeding Looking at baby Looking at babies toes and fingers Admiring the infant, positive comments, rooming in with parents Using the name of the baby Holding the baby Looking inface position. Making eye contact. Holding to where can see babies eyes. Paying attention to babies cries.

what do you want to hear immediately after birth?

Strong long lusty cry

assessment of umbilical cord

Veins carry oxygenated blood Look at after cut and clamped. Cord blood for Rh- tells if blood is positive or negative Determine blood type from cord blood Can check hemocrit level from cord blood Cord blood gases Cord blood for drug screen- not always sent off. If negative while pregnancy. Wont send off. If not a documented drug screen on record during pregnancy

VItamin k injection ( phytonadione, AquaMEPHYTON)

Vitamin K- Give to help with clotting. Synthesized in the gut. Babies are born with a sterile gi tract Cannot synthesize vitamin k Have to be given vastus lateralis Hold the knee secure. Or bend and extend the leg before you administer. Then bend the knee. Give in meaty part of leg. Give within one hour of delivery. To prevent an type of hemorrhage. Administer appropriate medication, if applicable. Prevents hemorrhage, given IM vastus lateralis

physical measurements of the newborn

Weight:Average: 7 lb. 8 oz. 2700 - 4000 g (6-9 lbs) Length: Average: 18 - 21 inches 46 52.5 cm Head circumferenceAverage: 33 -35 cm Normally 2 cm larger than chest circumference Frontal-occipital circumference Chest circumference-nipple line Average: 31 -33 cm

tonic neck

When neck is turned to side, baby assumes fencing posture Lasts until 3 - 4 months

babinski reflex

When sole of foot is stroked from heel to ball, toes hyperextend and fan apart from big toe (abnormal in adult ,could be sign of neurologic problem) See positive reflex. Toes fan out and spread apart from big toe. -1 year - 18 months

vernix

a cheeselike, whitish substance that is fused with the epidermis and serves as protective covering. contains subaceous gland secretions. prevent fluid loss through the skin. if everywhere signifies preterm, wipes away with towel or bath

what kind of breathers are newborns?

abdominal breathers

signs of cold stress

acrocyanosis- hands and feet turn blue. central parts of their body still pink. Cool to the touch Mottled skin on the trunk- purplish red linear pattern Cry at first, strong cry until the use up oxygen and glucose, get weaker and weaker Restless, real tense as it continues, get flaccid, Blood glucose level low Oxygen sats low Respiratory rate real high

physiologic jaundice-

appears after 24 hours of age and usually resolves without treatment. - If sets up within 24 hours. It is not normal.it is a pathologic jaundice After day 2 to 3- this is physiologic jaundice (normal) Baby liver is immature. cant keep up with RBC destruction and production. See elevation in bilirubin. Bc liver is immature. Cannot bind bilirubin Unconjugated bilirubin is the problem Early and frequent feeding. See yellowing of skin at 5-7. Total serum bilirubin peaks at 12-15. Do phototherapy- if above 15. stay under this continuously

what can gonorrhea cause in a newborn?

blindness

lung assessment

chest movement intercostal retraction xiphoid retraction nares dilatation expiratory grunt 0=no respiratory distress 1-3= indicated mild distress 4-6=moderate distress 7-10= severe distress

how shoukd breathe sounds be?

clear and equal bilaterally fine rales for the first few hours are common

methods to maintain newborn temperature

convection conduction radiation evaporation

milia

distended small white sebaceous glands. dont usually sweat for the first 24 hours. clogged sweat glands, common on bridge of nose, takes a couple weeks to resolve sweat glands are clogged. Or occluded. Cyst underneath the skin Right on bridge of the nose Look like pimples. Don't pop them Think it is an infection This is normal will go away on its own Takes a few weeks before it goes away .

immediate newborn care

dry infant off use bulb syringe to suction mouth and nose keep head lower than body to promote drainage assess for sign of respiratory distress

newborn jaundice

effectiveness of bilirubin excretion through the feces depends on the stooling pattern of the newborn and the substances in the intestine that break down conjugated bilirubin. - feeding is important in reducing serum bilirubin levels because it stimulates peristalsis and produces more rapid passage of meconium. - colostrum facilitates the passage of meconium.

infants skin

erythematous for a few hours after birth, then it fades to normal color often appears mottled, or blotchy. hands and feet appear slightly cyanotic, which is normal and appears intermittently over the first 7-10 days. esp. with exposure to cold. pplump appearance bc or subcutaneous fat. fine lanugo hair present

physiological adjustment tasks

est. and maintaining respirations adjusting to circulatory changes regulating temperature ingesting, retaining and digesting nutrients eliminating waste regulating weight

behavioral task

est. and regulating behavioral tempo independent of the mother self regulating arousal, self monitoring changes in state and patterning sleep processing storing and organizing multiple stimuli. est. a relationship with caregivers and environment

when to assess vital signs.

every 30 minutes for 2 hours every 1 hour for 5 hours

"Cradle Cap" aka Seborrheic Dermatitis-extremely

extremely common, think cause is from hormone levels, uses fine tooth come after bath when moist, or oil night before and comb in morning. Typically lasts a couple weeks, sometimes a couple months Very common Build up of the tissue Crustly scale like Wash scalp. Use fine tooth comb while scalp is soft and wet. Usually last a few weeks. use special shampoo If last for longer than a few weeks.

lanugo

fine hair typically on shoulders, face and back excess/whole body in premature births

when do the major adaptions associated with intrauterine to extrauterine life occur?

first 6 to 8 hours after birth mediated by the sympathetic nervous system and results in changes that involve, hr, respirations, temp, and GI function.

periods of reactivity

first period deep sleep period second period

early newborn period

firsts few days of life

convection

flow of heat from baby to cooler surrounding air- **Nursing interventions- keep baby away from windows or drafts, room temp 75 or above, hat on head, wrap open bassinets wrapped to protect them from the cold.

convection

flow of heat from the babies body to the cooler surrounding air. To reduce or eliminate heat loss, eliminate drafts from room, keep away from windows, keep in middle pf room, incourage parents to keep room around 75 degrees. Keep nursery at 75 degrees. Put hat or cap on babies head.

post term

greater than 40 weeks

how to assess the newborn

head to toe fashion

first period of reactivity

heart rate increases to 160-180 First 30 min after birth, irregular respirations with rate between 60-80 breaths per minute. fine crackles may be present audible grunting, nasal flaring, and retractions of the chest present, but should cease within the first hour of birht NB is alert and active, vigorous suck reflex=good latch, eyes open, spontaneous startle bowel sounds audible

stepping reflex

hold newborn above a surface. Try to walk. 3 - 4 months

Moro (startle)

if there is a loud sound, or moved in bed. When startled, baby symmetrically extends and abducts all extremities Forefingers form a C shape Lasts until 3- 4 months

normal skin conditions

milia vernix lanugo Erythema toxicum Telangiectatic nevi Mongolian spots- Strawberry hemangioma-bright "Cradle Cap" aka Seborrheic Dermatitis-extremely

Mongolian spots

more common in dark skinned infants, macule, fade over time, document! Could be mistaken for bruise bluish black/grey discoloration. Right around the sacral area or the back region. More common in dark skin infants. Flat. Macular rash. Looks like a deep bruise. Fade overtime. By the time the child is in school Must document these well. Where they are located. The size. Etc. more commonly seen on the back and buttocks. fade gradually over months to years. should be documented carefully in medical record. these are normal skin pigmentation

signs of respiratory distress

nasal flaring intercostal or sub-costal retractions grunting with respirations respiratory rate less than 30 or greater than 60 needs to be evaluated -tachypnea can result from inadequate clearing of lung fluid. - changes in the color of skin - central cyanosis if abnormal and signifies hypoxemia. - acrocyanosis is normal in the first 24 hours.

thermogenesis

neonate attempts to generate heat by increasing muscle activity. - cry and appear restless if cold -skin cool to touch - acrocyanosis -increase in cellular metabolic activity (primarily brain, heart and liver), increases oxygen and glucose consumption. - assume flexion position to guard against heat loss - do not have the shivering mechanism like adults do.

Strawberry hemangioma

nevus vascularis common type of hemangioma dilated newly formed capillaries occupying the entire dermal and subdermal layers with associated connective tissue hypertrophy. typically raised sharply demarcated, bright or dark red rough surfaced swelling, usually on the head. most are present at birth bright red, can have pale patch around, after birth or appear several months after birth, normally on face or neck, no tx needed hemangiomas- raised. Red. Circular, bright red. Can have pale patch of skin around them. Present at birth or after several months old. Doesn't have to be immediately. On the face or the neck typically. No treatment needed. Can see dermatologist later to have removed

how to newborns produce heat?

nonshivering thermogenesis metabolism brown fat. -heat produced by intense lipid metabolic activity in brown fat can warm the newborn by increasing heat production as much as 100%. -brown fats storage is rapidly depleted with cold stress.

what infants are at greater risk for hyperbilirubinemia?

prematurity is the most significant late preterm infants. breast feeding infants

newborn reflexes

rooting moro (startle) tonic neck babinski palmar grasp plantar stepping

signs of hunger

rooting, sucking on hands, become restless, irritable, agitated, crying,

plantar reflex

take foot and put finger laterally right at base at toes. Grasp onto finger. Toes curl 8 months

where can you usually see jaundice appear first?

the head, especially in the scelera, and mucous membranes. then progresses to the thorax, abdomen, and extremities. most likely to appear when bilirubin levels exceed 5-6mg/dl.

prevent cold stress

thermoregulation

neonatal period

time from birth through day 28 of life.

conduction

transfer of heat from the body to a cooler surface that is in direct contact with the infant. **Ways to prevent: place infant on pre-warmed surfaces. Bed to be warm before lay baby down, measuring babies weight put warm blanket on the scale. Warm stethoscope before putting on babies skin.

pathologic jaundice

unconjugated bilirubin can accumulate to hazardous levels and lead to pathologic condition - unconjugated hyperbilirubinemia that is either pathologic in origin or severe enough to warrant further evaluation and treatment - appears within 24 hours after birth - if total serum bilirubin levels increase by more than 6mg/dl in 24 hours, and if the serum bilirubin level exceeds 15mg/dl at any time - if untreated, can lead to neurotoxicity can result as bilirubin is transferred into the brain cells.

what happens when neonates temp drop?

vasoconstriction occurs as a mechanism to conserve heat.

what does jaundice appear?

when levels of unconjugated bilirubin exceed the ability of the liver to conjugate it, plasma levels of bilirubin increase, and jaundice appears.