Vocab 5

meconium

first stool of the newborn: the greenish material that collects in the intestine of a fetus and forms the first stools of a newborn

erythema toxicum

(newborn rash) is a benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life. It consists of small papules or pustules on the skin resembling flea bites. It is often mistaken for staphylococcal pustules. The rash is common on the face, chest, and back

neonatal period

in humans, the neonatal (newborn) period extends through the first month after birth (28 days)

neurobehavioral response

Newborns demonstrate several predictable responses when interacting with their environment. How they react to the world around them is termed as neurobehavioral response. It comprises predictable periods that are probably triggered by external stimuli. Expected newborn behaviors include orientation, habituation, motor maturity, self-quieting ability, and social behaviors. Any deviation in behavioral responses requires further assessment, because it may indicate a complex neurobehavioral problem.

pseudomenstruation

A vaginal discharge composed of mucus mixed with blood may also be present during the first few weeks of life. This discharge, called pseudomenstruation, requires no treatment. Explain this phenomenon to the parents.

neutral thermal environment

An environment in which body temperature is maintained without an increase in metabolic rate or oxygen use is called a neutral thermal environment. Within a neutral thermal environment, the rates of oxygen consumption and metabolism are minimal, and internal body temperature is maintained because of thermal balance. A neutral thermal environment promotes growth and stability, conserves energy for basic bodily functions, and minimizes heat (energy) and water loss. Because newborns have difficulty maintaining their body heat through shivering or other mechanisms, they need a higher environmental temperature to maintain a neutral thermal environment. If the environmental temperature decreases, the newborn responds by consuming more oxygen. The respiratory rate increases (tachypnea) in response to the increased need for oxygen. As a result, the newborn's metabolic rate increases.

Mongolian spots

Blue-ish black macules appearing over the buttocks and/or thighs of darker skinned neonates benign blue or purple splotches that appear solitary on the lower back and buttocks of newborns, but may occur as multiple over the legs and shoulders. They tend to occur in African American, Asian, Hispanic, and Indian newborns but can occur in dark-skinned newborns of all races. The spots are caused by a concentration of pigmented cells and usually disappear spontaneously within the first 4 years of life. They should not be confused with bruises caused by trauma

vernix caseosa

is a thick white substance that protects the skin of the fetus. 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. It does not need to be removed because it will be absorbed into the skin.

harlequin sign

Harmless color change in a newborn in which the dependent side of the body is a deep color while the other side is pale. refers to the dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit. It gives a distinct midline demarcation, which is described as pale on the nondependent side and red on the opposite, dependent side. It results from immature auto-regulation of blood flow and is commonly seen in low-birth-weight newborns when there is a positional change. It is transient, lasting as long as 20 minutes, and no intervention is needed.

immunizations

Immunization is the key disease prevention activity during childhood health supervision visits. are a cornerstone of pediatric disease prevention. The nurse increases the effectiveness of immunization by understanding the principles of immunization and applying them to the child's individual circumstances. Adhering to good immunization management practices, as outlined by the ACIP and the AAP, enhances the benefits and reduces the risks of immunization

jaundice

In newborn infants, jaundice can be detected by blanching the skin with digital pressure on the bridge of the nose, sternum, or forehead, revealing the underlying color of the skin and subcutaneous tissue. If jaundice is present, the blanched area will appear yellow before the capillary refill. The assessment of jaundice must be performed in a well-lit room or, preferably, in daylight at a window. Jaundice is usually seen first in the face and progresses caudally to the trunk and extremities

infant abduction

Infant abduction continues to be a threat in hospitals and health care organizations across the country. The abduction by non-family members of newborns from health care facilities has clearly become a subject of concern for parents, maternal-child care nurses, health care security and risk management administrators, law enforcement officials, and the National Center for Missing & Exploited Children (NCMEC). Staff ID badges, training, video surveillance, access control, and tagging systems can help prevent a newborn from being abducted from the hospital. Proactive security measures must become everyone's responsibility to ensure the safety of all newborns and their families in all hospital settings. code pink

Apgar score

Is used worldwide to evaluate a newborn's physical condition at 1 minute and 5 minutes after birth. 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) o G = grimace (reflex irritability) o A = activity (muscle tone) o R = respiratory (respiratory effort) o Each parameter is assigned a score ranging from 0 to 2 points.

gestational age

the age of the fetus between conception and birth (the stage of maturity) Gestational age assessment is important because it allows the nurse to plot growth parameters and to anticipate problems related to prematurity, postmaturity, and growth abnormalities.

periodic breathing

Respirations should not be labored, and the chest movements should be symmetric. In some cases, periodic breathing may occur, which is the cessation of breathing that lasts 5 to 10 seconds without changes in color or heart rate. Periodic breathing may be observed in newborns within the first few days of life and requires close monitoring.

nevus vasculosus

Rough, red collection of capillaries with a raised surface that disappears with time; also called strawberry hemangioma. also called a port-wine stain, commonly appears on the newborn's face or other body areas. It is a capillary angioma located directly below the dermis. It is flat with sharp demarcations and is purple-red. This skin lesion is made up of mature capillaries that are congested and dilated. It ranges in size from a few millimeters to large, occasionally involving as much as half the body surface. Although it does not grow in area or size, it is permanent and will not fade. Although they may occur anywhere on the body, the majority are located in the head and neck areas. Port-wine stains may be associated with structural malformations, bony or muscular overgrowth, and certain cancers

molding

Shaping of the fetal head during movement through the birth canal. is the elongated shaping of the fetal head to accommodate passage through the birth canal. It occurs with a vaginal birth from a vertex position in which elongation of the fetal head occurs with prominence of the occiput and overriding sagittal suture line. It typically resolves within a week after birth without intervention.

acrocyanosis

Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.

nevus flammeus

also called a port-wine stain, commonly appears on the newborn's face or other body areas. It is a capillary angioma located directly below the dermis. It is flat with sharp demarcations and is purple-red. This skin lesion is made up of mature capillaries that are congested and dilated. It ranges in size from a few millimeters to large, occasionally involving as much as half the body surface. Although it does not grow in area or size, it is permanent and will not fade. Although they may occur anywhere on the body, the majority are located in the head and neck areas. Port-wine stains may be associated with structural malformations, bony or muscular overgrowth, and certain cancers

milia

are multiple pearly-white or pale yellow unopened sebaceous glands frequently found on a newborn's nose. They may also appear on the chin and forehead. They form from oil glands and disappear on their own within 2 to 4 weeks.

cold stress

is excessive heat loss that requires a newborn to use compensatory mechanisms (such as nonshivering thermogenesis and tachypnea) to maintain core body temperature in the newborn can lead to the following problems if not reversed: depleted brown fat stores, increased oxygen needs, respiratory distress, increased glucose consumption leading to hypoglycemia, metabolic acidosis, jaundice, hypoxia, and decreased surfactant production

Epstein pearls

multiple pearly-white or pale yellow unopened sebaceous glands in a newborn's mouth and gums

reflex

o Assess the newborn's reflexes to evaluate neurologic function and development. Reflexes commonly assessed in the newborn include sucking, Moro, stepping, tonic neck, rooting, Babinski, palmar grasp, and plantar grasp reflexes. Spinal reflexes tested include truncal incurvation (Galant reflex) and anocutaneous reflex (anal wink). o The sucking reflex is elicited by gently stimulating the newborn's lips by touching them. The newborn will typically open the mouth and begin a sucking motion. Placing a gloved finger in the newborn's mouth will also elicit a sucking motion. o The Moro reflex, also called the embrace reflex, occurs when the neonate is startled. To elicit this reflex, 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 newborn initially appears startled and then relaxes to a normal resting position o Assess the stepping reflex by holding the newborn upright and inclined forward with the soles of the feet touching a flat surface. The baby should make a stepping motion or walking, alternating flexion and extension with the soles of the feet o The tonic neck reflex resembles the stance of a fencer and is often called the fencing reflex. Test this reflex by having the 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 Elicit the rooting reflex by stroking the newborn's cheek. The newborn should turn toward the side that was stroked and should begin to make sucking movements o The Babinski reflex should be present at birth and disappears at approximately 1 year of age. It is elicited by stroking the lateral sole of the newborn's foot from the heel toward and across the ball of the foot. The toes should fan out. A diminished response indicates a neurologic problem and needs follow-up. o The newborn exhibits two grasp reflexes: palmar grasp and plantar grasp. Elicit the palmar grasp reflex by 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. Newborns have strong grasps and can almost be lifted from a flat surface if both hands are used. The grasp should be equal bilaterally. The plantar grasp is like the palmar grasp. Place a finger just below the newborn's toes. The toes typically curl over the finger. o Blinking, sneezing, gagging, and coughing are all protective reflexes and are elicited when an object or light is brought close to the eye (blinking), something irritating is swallowed or a bulb syringe is used for suctioning (gagging and coughing), or an irritant is brought close to the nose (sneezing). o The truncal incurvation reflex (Galant reflex) is present at birth and disappears in a few days to 4 weeks. With the newborn in a prone position or held in ventral suspension, apply firm pressure and run a finger down either side of the spine. This stroking will cause the pelvis to flex toward the stimulated side. This indicates T2-S1 innervation. Lack of response indicates a neurologic or spinal cord problem. o The anocutaneous reflex (anal wink) is elicited by stimulating the perianal skin close to the anus. The external sphincter will constrict (wink) immediately with stimulation. This indicates S4-S5 innervations

caput succedaneum

o Describes localized edema on the scalp that occurs from the pressure of the birth process. It is commonly observed after prolonged labor. o (soft tissue swelling) is caused by edema of the head against the dilating cervix during the birth process

circumcision

o It is performed for medical, religious, cultural, and social reasons. Circumcision is the surgical removal of all or part of the foreskin (prepuce) of the penis. This has been traditionally done for hygiene and medical reasons and is the oldest known religious rite. o There are three commonly used methods of circumcision: the Gomco clamp, the Hollister Plastibell device, and the Mogen clamp.

ophthalmia neonatorum

o Ophthalmia neonatorum is a severe form of conjunctivitis caused by chlamydia and/or gonococcal infections that is potentially a blinding condition in newborns. o All newborns in the United States, whether delivered vaginally or by cesarean birth, must receive an installation of a prophylactic agent in their eyes within an hour or two of birth. This is mandated in all 50 states to prevent ophthalmia neonatorum, which can cause neonatal blindness (Centers for Disease Control and Prevention. Ophthalmia neonatorum is a hyper acute purulent conjunctivitis occurring during the first 10 days of life. It is usually contracted during birth when the baby comes in contact with vaginal discharge of the mother infected with gonorrhea and chlamydia. Most often both eyelids become swollen and red with purulent discharge.

phototherapy

o Phototherapy reduces bilirubin levels in the blood by breaking down unconjugated bilirubin into colorless compounds. These compounds can then be excreted in the bile. Phototherapy aims to curtail the increase in bilirubin blood levels; thereby preventing kernicterus, a condition in which unconjugated bilirubin enters the brain. If not treated, kernicterus can lead to brain damage and death. o During the past several decades, phototherapy has generally been administered with either banks of fluorescent lights or spotlights. Factors that determine the dosage of phototherapy include spectrum of light emitted, irradiance of light source, design of light unit, surface area of newborn exposed to the light, and distance of the newborn from the light source. For phototherapy to be effective, the rays must penetrate as much of the skin as possible. Thus, the newborn must be naked and turned frequently to ensure maximum exposure of the skin. Several side effects of standard phototherapy have been identified: frequent loose stools, increased insensible water loss, transient rash, and potential retinal damage if the newborn's eyes are not covered sufficiently.

surfactant

o The preterm infant lacks surfactant, which lowers surface tension in the alveoli and stabilizes them to prevent their collapse. Even if preterm newborns can initiate respirations, they have a limited ability to retain air due to insufficient surfactant. Therefore, preterm newborns develop atelectasis quickly without alveoli stabilization. The inability to initiate and establish respirations leads to hypoxemia and ultimately hypoxia (decreased oxygen), acidosis (decreased pH), and hypercarbia (increased carbon dioxide). This change in the newborn's biochemical environment may inhibit the transition to extrauterine circulation, thus allowing fetal circulation patterns to persist

cephalhematoma

o localized subperiosteal collection of blood of the skull which is always confined by one cranial bone. This condition is due to pressure on the head and disruption of the vessels during birth. It occurs after prolonged labor and use of obstetric interventions such as low forceps or vacuum extraction. The clinical features include a well-demarcated, often fluctuant swelling with no overlying skin discoloration. usually appears on the second or third day after birth and disappears within weeks or months. Large cephalohematomas can lead to increased bilirubin levels and subsequent jaundice

stork bites

or salmon patches are superficial vascular areas found on the nape of the neck, on the eyelids, and between the eyes and upper lip. The name comes from the marks on the back of the neck where, as myth goes, a stork may have picked up the baby. They are caused by a concentration of immature blood vessels and are most visible when the newborn is crying. They are considered a normal variant, and most fade and disappear completely within the first year.

thermoregulation

the process by which animals maintain an internal temperature within a tolerable range