OB Ch. 18 The Newborn
Neonate temperature regulation
- have a higher ratio of body surface to body mass and blood vessels that are closer to the surface of the skin putting them at risk for HYPOTHERMIA - rarely shiver and do not have fully functional sweat glands which also contribute to thermoregulation problems - work to retain heat by maintaining a flexed position to reduce body surface and by increased body movement
Term neonates blood compostion
- higher hemoglobin concentration than adults or older infants (14 to 24 g/dL) - hematocrit between 51-56% hemoglobin and hematocrit levels drop quickly after birth, By 20 weeks, only 5% of hemoglobin is fetal and the remainder is mature - platelets like adults (150,000 to 300,000) - clotting factors are low during the first days of extrauterine life due to a low level of vitamin K
smell
- keen sense of smell and can recognize their mother's odor at 2 days of age - Infants who can smell breast milk after a painful procedure have a lower level of stress hormones and calm more readily
Neonatal infections
- may have a rise in neutrophils with infection, whereas others may not - WBC may go up for reason other than infection (exposure to oxytocin during labor, birth at high altitude, prolonged crying, etc)
Leukocytosis
increase in the number of white blood cells normal at birth, typical term neonate having a white blood cell count between 9,000 and 30,000/mm3. This count usually increases in the day after the birth before decreasing to 12,000/mm3 - WBC count is unreliable source of infection
drowsy
muscle movement; irregular breathing; eyes open and close; external stimuli typically results in change of state.
kangaroo care
the practice of the caregiver holding the infant with skin-to-skin contact
Bioavailability
the rate at and the extent to which a nutrient is absorbed and used - breast milk has LESS iron BUT more bioavailability meaning the form of iron it has is used more efficiently than the form in formula
Grunting
"uh" sound, occurs with a partially closed glottis. This partial occlusion increases the pressure within the lungs so more oxygen can diffuse into the bloodstream. Grunting may be auscultated with a stethoscope or, in more severe cases, heard without assistance
Neonate Stomach
- At birth stomach capacity of the neonate is approximately 5 to 10 mL, or 1 to 2 teaspoons, or 0.16 to 0.32 oz. - Volume increases to 60 mL within the first week.
Neonatal feeding
- On average, the infant receives a half ounce of colostrum per feeding in the first 24 hours - two thirds of an ounce per feeding on days 2 and 3 - an ounce per feeding after 3 days, roughly mirroring stomach capacity. It takes approximately 2 - 4 hours for the neonate's stomach to empty, and this is about as often as he or she should be fed, per infant demand.
Neonate Head
- accounts for approximately 1/4 of its length - face appears small in relation to the head - neck is proportionately smaller and weaker - can lift and turn heads for brief periods only when lying prone - Infants born vaginally have skulls subject to molding
identifying a subgaleal hemorrhage
- assess suture lines - Swelling that does not cross the suture line is unlikely to be a subgaleal hemorrhage - subgaleal hemorrhage is more boggy on palpation rather than firm - serial head measurements that increase are highly suspicious for subgaleal hemorrhage, and tachycardia and pallor also contribute to a suspicion of hemorrhage
neonatal heart rate assessment
- auscultation of the apical pulse (in the fourth intercostal space, left midclavicular line). for one full minute, preferably while the infant is asleep or quiet - normally rapid HR (120 to 160 bpm at rest) with brief extremes, such as with sleep when the apical rate may dip as low as 85 bpm or with crying or distress when it may reach as high as 180 bpm - Dysrhythmia is common in first hours of life and not generally considered concerning in the absence of other symptoms such as cyanosis or pallor. - Heart rates below 120 bpm or above 160 bpm should be reevaluated in 30 to 60 minutes or with changes in activity (e.g., the waking of a sleeping infant or breastfeeding of an infant who had been previously crying). - It is not unusual to auscultate heart murmurs in the neonate. Most of these murmurs are physiologic and resolve within 6 months
clamping the umbilical cord causes
- baby to initiate breathing on own - increase in systemic vascular resistance - eliminates the blood flow through the ductus venosus, which begins to atrophy
Tremors
- common in the hands and chin - occur at times of agitation and are usually accompanied by crying and end within a month. - tremors at rest or that last beyond a month are NOT normal and may be due to hypoglycemia (especially if they occur in the first 48 hours after birth), hypocalcemia, or an underlying neurologic condition
liver of the neonate
- disproportionately large in comparison with the liver of an adult - takes up 40% of the abdominal cavity - contains enough iron to contribute to the production of red blood cells for 4 to 6 months (stores are replenished with each feeding as both breast milk and formula contain iron, although the iron in breast milk has superior bioavailability)
first neonates breaths...
- expand lungs - dilate the pulmonary vasculature (reduces pulmonary vascular resistance) increases blow flow to left atrium - left atrium is now higher in pressure than the right atrium, causing the foramen ovale, a small hole in the wall between the two atria, to close
neonate respirations
- fast and shallow - 40 to 60 breaths per minute - Pauses in breathing that last up to 20 seconds are considered normal, but longer periods of apnea are concerning - chest and abdomen rise and fall synchronously during breathing - Patent nares must be maintained, as newborns are preferential nose breathers (use suction)
Second period of reactivity
- final phase of transition May occur between period of 2 to 8 hours after the first sleep following birth when the newborn may have an elevated pulse rate, increased respiratory rate, increased muscle tone and excessive mucus. - phase can last several minutes or several hours - neonates gag more easily and require suction of their mouths and nares as respiratory secretions break up - meconium often passed at this time
caput succedaneum
- generalized edema of the occiput common in infants born vaginally in the vertex position - collection of serous fluid (edema) between the periosteum and the scalp caused by the pressure of the fetal head against a partially dilated cervix - not painful and resolves spontaneously in the first week postpartum - Caput crosses the suture line, and the swelling is superficial. Caput is more common in infants who have been born with the assistance of a vacuum device
hyperthermic infant
- not fully developed sweat glands they do not sweat to a degree for cooling - hyperthermia for reasons other than sepsis appears flushed and assumes an extended posture to increase surface area and facilitate the radiation of heat away from the body. - hands and feet are warm to touch - an infant who is hyperthermic due to sepsis may instead appear pale with cool hands and feet. - hyperthermia may cause seizures, brain damage, and death.
neonate urinary system
- often born with a small amount of urine in their bladders, and they may urinate at the time of birth. - In the first 48 hours postpartum, newborns usually urinate 2 to 6 times daily - by the middle of the first week, urination increases 6 to 8 times daily - urine concentration has a lower specific gravity than adults for approximately the first 3 months of life. - urine is very pale straw color, which may be difficult to visualize, even against a white diaper and nearly odorless - Uric acid crystals that look like red brick dust are often found in diaper in first week and are not concerning. After the first week, however, may indicate dehydration - Report fewer than five wet diapers in 24 hours to the pediatric provider.
bathing of neonate
- perineal area should be wiped thoroughly with a clean, moist cloth with each cleaning and a protective barrier cream applied - daily bathing with soap is not necessary. - Bathing of face and hands with soap is not recommended, and any soap used on other body parts should be gentle with a neutral pH. - Newborns are typically bathed prior to discharge, although it is not a condition of discharge
Immunoglobulin (Ig) G
- provides protection against viruses and bacteria to which the host, in this case the mother, has been exposed - infant is born with IgG that passes the placenta into fetal bloodstream ** a form of passive immunity lasting ~ 3 months
Neonatal Glucose
- treatment required for level of less than 40 mg/dL or when symptomatic ** Treatment starts with breast or formula feeding and kangaroo care. ** Breastfed infants with resistant hypoglycemia may be fed formula, and infants with hypoglycemia resistant to formula may be treated with intravenous glucose or medications per orders
neonate body weight
- typically lose 5% to 10% of their birth weight within 3 to 5 days after birth because of diuresis, defecation, respiration, and limited fluid intake - weight is regained within 2 weeks after birth, more quickly in formula-fed infants than in breastfed infants
Breast milk jaundice
-appears in 2nd week of life (days 4-7, later onset form) - may last up to 4 months as it slowly diminishes -etiology of this form of jaundice is unclear, and it is rarely dangerous -levels drop rapidly when breastfeeding stops; give formula 1-2 d, and return to breastfeeding
postmaturity
Any infant born after 42 weeks' gestation.
Neonate Temperature
98-100 F - liquid to dry environment causes drop in temperature of baby due to by convection, conduction, evaporation, and radiation
New Ballard Score (NBS)
A postnatal gestational age assessment tool that is used within 12 hours of birth. - can be used from 20 weeks of gestation and later. •Posture: Observe the flexion of the infant's arms and legs when the infant is quiet and supine. •Square window: Apply gentle pressure using the index and third fingers to the back of the infant's hand while supporting the wrist. •Arm recoil: Flex and then extend the infant's arms and observe the rate and strength of recoil while the infant is in the supine position. •Popliteal angle: Flex the infant's thigh onto the abdomen. Extend the infant's knee and measure the popliteal angle (behind the knee). •Scarf sign: Move the infant's arm across the body. Observe the point to which the elbow moves readily in relation to the midline. •Heel to ear: With the infant supine, grasp the infant's foot and pull it toward the ear on the same side using minimal force. Observe the popliteal angle.
Nevi Simplex
AKA stork bites, angel kisses, salmon patches Flat, pink, blanchable area most commonly found on nape of the neck, on the mid-forehead, upper lip or over the eyelid resulting from the dilation of the capillaries. - facial lesions resolve in first few years - neck lesions may persist into adult hood - benign
Lymphocytes
B lymphocytes form in the bone marrow and release antibodies that fight bacterial infections; T lymphocytes form in the thymus and other lymphatic tissue and attack cancer cells, viruses, and foreign substances. a type of leukocyte responsible for antibody production. If lymphocytes are repeatedly exposed to a pathogen, they destroy the pathogen. Because newborns do not have prior exposure to pathogens, lymphocyte response is delayed.
breech birth
Baby is delivered feet or buttocks first
nonshivering thermogenesis
Because neonates cannot shiver, a limited amount of vascular brown adipose tissue present at birth can be metabolized for heat production. - mobilization of stores of brown fat that can double heat production - Brown fat reserves are most abundant in term infants, and stores of the fat are depleted within several weeks after birth, more quickly in the case of acute cold stress
signs of respiratory distress in newborn
Cyanosis Apnea Tachypnea Intercostal or substernal retractions Grunting Nasal Flaring Seesaw breathing Stridor Gasping
chemical cue to start breathing
O2 and CO2 - when cord is clamped and placenta can no longer provide exchange of O2 and CO2 to baby a mild state of hypoxia occurs - hypoxia initiates acidosis due to increase in CO2 which stimulates respiratory center of the medulla oblongata of the brain, which stimulates breathing - Repeated mild hypoxia throughout labor as the uterus contracts and temporarily restricts the exchange of CO2 and O2 may also contribute to this process
breastfeeding associated jaundice
Early onset begins at 2-5 days of age usually by first week. Caused by lack of effective breasfeeding. (NOT by breasfeeding in general or breast milk) - Colostrum works as a laxative, and less colostrum consumed means less peristalsis and fewer stools. Fewer stools means that unconjugated bilirubin is more likely to be reabsorbed by the intestinal mucosa and returned to the neonatal circulation
Erythromycin 0.5% ointment
Eye prophylaxis Must be given within 1 hour of birth Prevents opthamalia neonatrum which causes blindness
Nasal flaring
Flaring out of the nostrils, indicating that there is an airway obstruction. expands the airway and reduces airway resistance.
Cephalhematoma
deeper than the edema of caput succedaneum and occurs between the skull and the periosteum (layer of tissue that surrounds the bone) - firm on palpation - does not consist of interstitial fluid but rather blood - defined specific to a particular bone of the skull, does not cross suture lines - takes 2 to 8 weeks to resolve - resolution includes the hemolysis of accumulated red blood cells, hyperbilirubinemia is a potential complication
Evaporation
Heat loss due to evaporation of liquid from the body - Dry neonates thoroughly after the birth. Stabilize their temperature prior to the bath, and bathe them in a warm environment.
Convection
Heat transfer from the newborn to the surrounding air - Keep the ambient room temperature at least 72°F. Avoid having air currents from open windows and fans.
Vitamin K
Helps blood clot - usually obtained as a by-product of gut bacteria and through diet - gut of the neonate is sterile and does not yet have bacteria present to create vitamin K and vitamin K does not cross placenta and there is little in breast milk - injected in thigh after birth
Hepatitis B vaccine
Hep B is passed through blood and sexual contact. - Series of 3 vaccinations - first dose before discharge, the second dose at 2 months of age, and the final dose at 6 months of age. - neonates who were exposed to by an infected mother should be given a dose of hepatitis B immune globulin within 12 hours after the birth -IM through thigh
baby colic
Infants who cry for at least 3 hours a day, 3 days a week, for 3 weeks
Neonate Female genitalia
May be slightly swollen or appear bruised especially in breech birth Thin white or blood tinged mucus may be discharged from vagina or pseudomenstruation (caused by hormonal withdrawal from mother)
sleep-wake states
different states of consciousness, from deep sleep to high irritability, are described as the six sleep-wake states
First period of reactivity
Period beginning at birth in which newborns are active and alert. It ends when the infant first falls asleep. - typically 30 mins but may last up to 1-2 hrs - great time for early bonding and initiation of breastfeeding. RR: 40-60 HR: 120-160
skin to skin contact
Physical contact between the mother and baby which helps stabilize baby temp, blood glucose levels, establishes breast milk, bonding
Neonate vitals
RR: 40-60 HR: 120-160 Temp: 36.5-37 * right after birth may have tremors & cry easily * Bowel sounds are active and it is common for the first meconium to pass right after birth * take vital signs within the first 30 minutes after delivery, again at first hour, then hourly until the end of the fourth stage of labor (the first 4 hours after the birth)
Babinski reflex
Reflex in which a newborn fans out the toes when the sole of the foot is touched - lack of response warrants neuro assessment - goes away by 1 yr of age - in adults anticipate curling of toes, extension of toes in adult is concerning for neuro injury or disease
Intercostal or substernal retractions
Retractions are the pulling in of tissue with each breath and indicate reduced pressure inside the lungs, likely because of occlusion of the upper airways.
transitional stool
Thin, slimy, greenish-brown or greenish-yellow, passed 3rd-6th day - by end of 1st week stool of breastfed infants appears yellow and seedy and has a sour odor and a pasty consistency (4-8x daily) - by end of 1st week stool of formula-fed infants is browner, has an unpleasant rather than a sour odor, and is more formed (less frequent passings than breastfed babies)
Conduction
Transfer of heat by direct contact with a cooler object - Place infants on prewarmed surfaces or keep them skin to skin with the mother.
Radiation
Transfer of heat from or to the newborn from or to nearby surfaces - Keep the infant away from cool windows and exterior walls.
When does the foramen ovale close?
Within the first hour of birth when left atria is higher in pressure than right
constipation
difficulty in passing stools - rare in breastfed pts - Infants fed with formula that is not sufficiently diluted may cause constipation
vernix caseosa
a thick, white, creamy substance or "cheesy" white substance found coating the skin of newborn humans - formed in 3rd trimester -secreted by the fetal sebaceous gland -fused with the epithelium and forms a waterproof barrier in utero and a barrier against bacteria and dehydration after birth -At birth, the vernix is often limited to skin folds but may be distributed more diffusely and can be rubbed into the skin or washed off in the bath
rooting reflex
a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple - is weak or absent if baby is sated - disappears in 3-12 months
circumoral cyanosis
a bluish discoloration around the mouth - normal during transition period (6-8 h postpartum) - if persistent can indicate cardiac problem
Naegele's Rule
add 7 days to LMP, subtract 3 months, add 1 year
gestational age
age of an unborn baby, usually dated from the first day of an expectant mother's last menstrual cycle to birth - assessed early in the prenatal period and may be calculated using Naegele's rule, according to the first day of the last menstrual period, or determined via ultrasound, as indicated - should be done in cases of premature or postterm pregnancies, infants weighing under 2,500 g or over 4,000 g, infants admitted to the neonatal intensive care unit, and infants of mothers with diabetes
grasping reflex
an infant's clinging response to a touch on the palm of his or her hand - palmar: infant curls the fingers around an object placed in the hand (lasts 3-4 months) - plantar: infant curls the toes against an object placed at the base of the toes (lasts about 8 months)
Types of Fontanels
anterior, posterior, sphenoid, mastoid
petroleum jelly or zinc oxide
applied to perineum after diaper changes to protect skin integrity
Mongolian spots
area of bluish-black pigmentation that can appear like a bruise; more common in infants with darker skin and on the back and buttocks, but may also appear in infants with lighter skin and on other parts of the body - not associated with trauma - document carefully to avoid suspicion of physical abuse with future exams - may expand for first year before it begins to resolve
Nevus vasculosus (strawberry mark)
area of the skin that is raised and sharply demarcated. may be present at birth or appear in the first several weeks postpartum - may grow for up to 2 years then shrink and fade - typically resolve in first decade of life
Apgar score
assessed 1 minute and at 5 minutes after delivery and performs interventions as indicated - tool to inform care providers about infant status and the efficacy of interventions in the early postpartum period but does not predict long-term outcomes - scale between 0 & 10, scores between 7-10 are excellent whereas lower scores may indicate a need for warming, clearance of the airways, vigorous stimulation of the skin, and other interventions
fetus temperatue
in womb 0.5 C degree warmer than mom
neonatal stump
be left alone in the absence of signs of infection, such as redness or seepage. - diaper should be affixed so it is not snug at the top or overlying the stump
Subgaleal hemorrhage
bleeding into the subgaleal compartment - occurs under the galea aponeurosis, a tendinous sheath that forms the inner layer of the scalp - not associated with a single bone of the scalp, so the bleeding does cross the suture line. - Blood loss can be severe and may lead to shock and death - most common after a challenging operative vaginal birth.
Cyanosis
bluish discoloration of the skin Acrocyanosis, a blue color of the neonate's hands and feet, is normal in the first 24 h postpartum. Central cyanosis, which is indicated by bluing of the lips and chest, is abnormal. Transient cyanosis when crying is not uncommon immediately after birth.
Acrocyanosis
bluish tint to the hands and feet particularly when cold due to immature circulation - common finding first 7-10 d postpartum
active alert
body movements and possible fussiness; increased startle reflex and motor activity; eyes open; irregular respirations.
sleep states of newborn
deep and light sleep
thermal cue to start breathing
change in temperature from liquid to dry (drop in temp) stimulates the respiratory center of the medulla oblongata initiating breathing
seesaw breathing
chest and abdomen work in opposite directions - abdomen rises as the chest falls - abnormal and needs to be reported -suggests partial blockage of the airways.
Physiologic Jaundice of the Newborn
common to some degree in most term newborns and more common in premature babies - resolves without treatment - caused by a rise in unconjugated bilirubin due to high volume of RBCs at birth, the short life span of fetal RBCs, and a limited ability of the liver to conjugate sufficient bilirubin in the first days postpartum (normally bilirubin is conjuguated or joined with glucuronic acid of liver which can be excreted)
foramen ovale
connects the two atria in the fetal heart
ductus venosus
connects the umbilical vein to the inferior vena cava, bypassing the liver
hypothermic infant
cool to the touch and display acrocyanosis
Newborn Screening
done to detect disorders that may be debilitating or deadly before the infant is symptomatic - blood specimen is collected close to time of discharge and must be collected at 24 hours to 7 days after the birth (allows time for initiation of metabolic processes) - collected via heel stick and deposit it into the circles printed on special paper designated for this purpose
dressing tips for parents
dress the neonate in the same number of layers as the parents themselves intend to wear for the temperature, plus one. EX: if the father is planning to wear a t-shirt and a sweatshirt, he should dress his newborn in a onesie, t-shirt, and sweatshirt to promote a neutral thermal environment.
wake states
drowsy, quiet alert, active alert, crying
circumcision
elective procedure performed primarily on neonates that involves removal of the foreskin of the penis - performed between 1 and 8 days after the birth - Major contraindications include penile anomalies, bleeding abnormalities, or medical instability of the neonate. - at least 12 hours old and have voided at least once to provides reassurance that no penile abnormality is present - avoid eating 1 hr prior to avoid vomiting / aspiration - confirmation of vit k procedure to avoid excess bleeding - topical local anesthesia or anesthesia injected into the base of the penis - gauze applied to penis with petroleum jelly, should be changed with each changing for 3-5 days ** blood in diaper larger than a quarter & no voiding for 12 hrs should be reported to provider
Clamping of the umbilical cord after delivery
ends fetal circulation and marks infant's first breath.
suture lines
fibrous connective tissue joints that hold the bony plates of the cranium together
Leukocytes (WBC)
fight bacteria and other foreign substances and increase in number when infection invades the body. - immature in neonates, leaving them more vulnerable to infection
Lanugo
fine, downy hair that covers the body and face of the fetus from week 16 of gestation on - most abundant in week 20 then begins to shed into amniotic fluid - The fetus, swallowing the amniotic fluid, also swallows the lanugo, which makes up a large part of the meconium - helps anchor the vernix and has mostly been replaced by a different fine hair, 'vellus' hair, by term. -Some term infants may still have some lanugo, which is often noted over the shoulders, forehead, and temples but is shed within first few weeks after birth. - - Lanugo is seen more often and in greater abundance in preterm infants
neonatal period
first 28 days of life outside womb - clamping of umbilical cord and first breath of neonate begin the transition to extrauterine life - transition period typically lasts 6 to 8 hours after the birth
IgM
first antibody type produced in response to an infection and also the first produced by the fetus. -helps destroy foreign substances in the body.
meconium
first stool of the newborn - appears thick, green, and tarry - usually occurs within first 24 hrs of birth but may also be passed in utero (esp if born postterm or who experienced distress in utero)
gavage feeding
for an infant is used when an infant is too weak for sucking, unable to coordinate swallowing, and lacks a gag reflex. ●● Gavage feeding is implemented to conserve energy when an infant is attempting to breast feed or bottle feed, but becomes fatigued, weak, or cyanotic.
Neonate Male genitalia
foreskin completely covers the glans of the penis and is not retractable - if urethra occurs in ventral aspect of the penis or scrotum, it is known as hypospadias - if urethra is on the dorsum of the penis, it is known as epispadias. (rare) A form of epithelial cyst is found rarely on the tip of the prepuce and is a benign finding. (Epstein's pearls) may also be found on the gums and palate of the mouth.(typically disappear within a few weeks) scrotum is more dark than the rest skin. - By the time of birth, most male term infants have testes that have descended into the scrotum. A neonate who is delivered breech will have an edematous and possibly bruised scrotum.
IgA
found in tears, blood, and saliva and on mucus membranes in places such as the nose, vagina, and gi tract - Neonates are not born with it but can acquire IgA to protect the gi tract from bacterial and viral pathogens via breast milk.
Vitamin K *shot for babies
given to babies after birth to help with the clotting factor. *this shot will allow liver will create the clotting factors necessary to prevent a pathologic bleed that may be life-threatening - 5/8 in 25-gauge needle in the vastus lateralis muscle of the anterior thigh - 0.5 and 1 mg dose
crying
intense crying, difficult to calm, ample body movement. Breathing irregular. - How babies communicate - indicate hunger, physical discomfort, illness, or boredom - generally increases until ~ 6 weeks then gradually decreases
extrusion reflex
involuntary response in which a young infant thrusts its tongue forward when a solid or semisolid object is placed in its mouth - sticks tongue out if tip is touched or pushed - educate parent as they may misinterpret for food rejection - lasts for 4-5 months
Fontanels (soft spots)
large membrane-covered spaces between developing skull bones; unossified - aid with passage through the birth canal - allow for more rapid brain growth than would the closed skull
ductus venosus becomes
ligamentum venosum of liver
fluid in neonates lung
lungs of the neonate have fluid in them, despite the fluid having decreased as the pregnancy neared term and during labor (because some is expelled from the lungs as the fetus squeezes through the birth canal) and after delivery and despite an increase in catecholamines, which promote clearance of fluid from the lungs. The lymphatic system also absorbs some of the fluid.
infant breast tissue
may be swollen as a response to high estrogen environment of uterus - due to withdrawal of this estrogen at birth, some infants may produce some nipple discharge (witch's milk) - No intervention is required, and both the breast enlargement and nipple discharge resolve spontaneously.
cues to start breathing
mechanical, chemical, and thermal - fetus begins "practice breathing" in 1st trimester although lungs not completely functional until until end of term pregnancy
Brazelton Neonatal Behavioral Scale
method of explaining, describing, and categorizing infant behavior as the infant progresses through the four different levels of developmental challenges •Habituation (sleep protection): the ability to adjust to audio and light stimulation in relation to sleep •Motor: the maturity of muscle tone and control •Self-regulation: the ability to self-console and to be consoled when crying •Stress response: the newborn's threshold of stimulation in response to stress •Social interactive capacity: alertness and responsiveness to human and other stimuli
nevus flammeus (port wine stain)
nonblanchable discoloration of the skin mostly found on the neck and face that is typically pink at birth but darkens and becomes textured with time - often removed with surgery or laser treatment
Fetal blood pressure
not routinely checked unless there is a known or suspected problem - may be ordered for prematurity, tachycardia, a symptomatic murmur, pallor, or cyanosis indicating poor perfusion. - If a cardiac defect is suspected, blood pressure is measured in both the upper and lower extremities - cuff is wrapped around the upper arm or leg and should cover two thirds of that appendage during baby rest to avoid false high readings - At birth, the normal neonatal blood pressure is 50 to 70/30 to 45 mm Hg, rising to 90/50 mm Hg at approximately 10 days of life
bilirubin
orange-yellow pigment in bile; formed by the breakdown of hemoglobin when red blood cells are destroyed, released by liver in bile
Placenta
organ that nourishes the fetus - functioned as the lungs, nutrition source, and temporary endocrine gland of pregnancy
gasping
out of breath a sign of upper airway obstruction.
mottling
pattern of pale and dark splotchiness that occurs with cold - keep infant swaddled or under a warmer when in cold environment to prevent
Desquamation
peeling skin primarily of palms, ankles, and soles within a few days after birth - may be sign of postmaturity - advice caregivers to avoid removing skin
deep sleep
possible startle reflex but no other movement; regular breathing; no eye movement or change in state due to external stimuli.
hearing
prefer higher-pitched noises and often find rhythmic noises soothing, likely as a result of habituation to the maternal heartbeat in utero - automated auditory brainstem responses and otoacoustic emissions are routine assessments to detect hearing loss (nonpainful and performed when baby is asleep or quiet alert)
taste
prefer sweet tastes, and, as with the smell of breast milk, sweet tastes appear to reduce pain from procedures
molding
process by which the shape of the head changes temporarily because of mobility of the skull sutures and overlapping of the bones of the skull during passage through the vagina. The shape of the head is restored within a few days
Gluceoneogenesis
production of new glucose from noncarbohydrate sources which happens primarily in the liver - in utero, maternal glucose passes the placenta into the fetus's circulation, but insulin does not - after birth, infant continues to produce insulin from the pancreas as prior to birth, but does not have mothers incoming glucose causing drop in blood glucose level which bottoms out between 30 and 90 minutes after birth before beginning to rise again because of gluconeogenesis in the liver.
Tachypnea
rapid breathing Neonates typically take 30-60 breaths per minute. Sustained tachypnea is abnormal and may indicate respiratory distress syndrome or fluid in the lungs. It may also indicate infection or cardiac or metabolic illness.
Iron supplements
recommended that all infants receive an iron supplement beginning at the age of 4 months until the regular feeding of iron-containing solids begins despite formula & breastfeeding
erythema toxicum
red rash with white papules and red macules that may occur over any part of body but most common on trunk - appears between 24 h and 2 wk postpartum - benign - may last up to 3 weeks - does not appear uncomfortable for infant - no treatment indicated
quiet alert
regular respirations; eyes open, may focus on stimuli; optimal time to attempt breastfeeding.
vision
see best when the object they are viewing is about 17 to 20 cm away from the eyes, the approximate distance between the face of the infant and the face of the caregiver when cuddling or nursing. - prefer faces and high contrast patterns to other images
touch
sense of touch is well developed. Human touch is a critical component of normal infant and child development. Like sweet tastes and the smell of breast milk, gentle human touch can mitigate the pain experience of the neonate
Milia
small raised white spots on nose, chin, and forehead (sebaceous glands) - typically resolve in 2-4 wk without treatment
light sleep
some body movement; irregular breathing; rapid eye movement; possible change in state due to external stimuli.
Murmurs
sounds created by abnormal, turbulent flow of blood in the heart - neonate murmurs associated with feeding difficulties, cyanosis, pallor, and neonatal apnea for more than 15 to 20 seconds may indicate a cardiac defect !
mechanical cue to start breathing
squeeze through the birth canal expels fluid from neonates lungs - this also causes a rebound of thoracic expansion as the chest leaves the birth canal. (rebound of the chest to its previous dimensions pulls in air, much like a set of bellows)
Catecholamines (epinephrine and norepinephrine)
stimulates by sympathetic NS; increases heart rate, blood pressure, blood glucose levels and dilates lung passageways - promote clearance of fluid from the lungs
stridor
strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx abnormal, high-pitched breath sound, is a sign of upper airway obstruction.
apnea
temporary cessation of breathing Cessation of breathing for 20 s or more is concerning. Shorter periods of apnea in the absence of other signs of distress are considered normal. Apnea over 20 s may indicate sepsis, hypothermia, hypoglycemia, or another problem.
passive immunity
the short-term immunity that results from the introduction of antibodies from another person - protection offered is temporary
Harlequin sign
transient condition in which one side of body is blanched and the other erythematous - associated with low birth weight - benign - often occurs on day 3 or 4 postpartum and resolves by week 3
tonic neck (fencing) reflex
turning the infant's head quickly to one side causes the infant to extend the arm and leg on that side and to flex the arm and leg on the other side - lasts 3-4 months; if longer is concerning for cerebral palsy
infant glucose levels
typically stabilize between 50 and 60 mg/dL after initial drop, and measure between 60 and 80 mg/dL within the first week postpartum. ** Infants born to DM mothers are at risk for hypoglycemia because of continued overproduction of insulin from the neonate's pancreas after birth.
second phase of neonate transition
when baby falls asleep for 1st time - RR and HR slow to within normal parameters - breathing should be unlabored, with no grunting, retractions, or crackles
swallowing reflex
when fed, the neonate successfully coordinates sucking, swallowing, and breathing - may be uncoordinated in prematurity
stepping reflex
when held upright by the torso, such that the feet touch the surface, the infant stimulates the walking movement - term infants walk on the soles; preterm infants walk on the toes - disappears within a month postpartum
crawling reflex
when placed in the prone position the infant moves the arm and legs in a crawling motion - this reflex resolves within about 6 weeks
Moro reflex (startle reflex)
when startled by a loud noise or a small, controlled drop of the head and neck (supported), the infant abducts and extends the arms with the hands forming the shape of a C - legs may also relax, after initial startle limbs adduct and relax - complete response until 8 weeks and partial response for 6 months - response beyond 6 mos is suspicious for neurodevelopmental problem - asymmetric response is concerning for injury to upper extremity - preterm infant may have incomplete response bc of muscle weakness - exaggerated response with CNS excitability as wth neonatal abstinence syndrome
APGAR Mnemonic
•Activity and muscle tone •Pulse •Grimace with stimulation (such as suctioning the nares) •Appearance (skin color) •Respirations
Risk Factors for Hypoglycemia
•Maternal diabetes •Maternal obesity •Gestational age < 37 wk •Gestational age > 42 wk •Newborn is large for gestational age •Intrauterine growth restriction •Admission to the neonatal intensive care unit •Perinatal stress
Response to Stimuli
•Temperament: an infant's habitual response to stimuli; often described in terms such as "calm" or "active" •Crying: the amount of crying and stimuli that trigger crying •Consolability: the ease with which the crying infant may be self-soothed or soothed by a caregiver •Irritability: the threshold at which the infant begins to cry •Cuddliness: the degree to which an infant relaxes into an embrace
Neonatal hypothermia
↑risk of hypoglycemia; Tx place under a warmer - 1.5°C warmer than the neonate's temperature