Newborn

1. Newborn

2. Terms • Acrocyanosis • Appropriate for gestational age • Caput succedaneum • Cephalhematoma • Circumcision • Cold stress • Conduction

3. Terms • Convection • Cryptorchidism • Down’s syndrome • Epispadias • Epstein’s pearls • Erythema toxicum neonatorum • Evaportation

4. Terms • Foremilk • Gynecomastia • Hindmilk • Hallux varus • Hydrocele • Hyperbilirubinemia • Hypospadius • Kernicterus

5. Terms • Lanugo • Large for gestational age • Meconium • Milia • Molding • Mongolian spots • Myelomeningocele • Nevus flammeus

6. Terms • Radiation • Theromoregulation • Psuedomenstration

7. Although some newborn infants are uniformly pink in color, many have some degree of "acrocyanosis." This means that the central portion (chest) is pink, but the extremities, particularly the hands and feet, are blue or purple. Acrocyanosis is normal for a newborn during the first few hours, disappearing over the next day. It is due to relatively sluggish circulation of blood through the peripheral structures, related to immaturity or inexperience of the newborn blood flow regulatory systems. Acrocyanosis

8. Acrocyanosis

9. Assigning size is a way to measure and monitor the growth of the infant throughout the pregnancy as well as at the time of birth. The measurement is calculated based on the estimated gestational age (how many weeks the mother was pregnant) in comparison to what is considered normal height, weight, head size, and developmental level for a child of the same gestational age and gender. Appropriate for Gestational Age

10. Graphs are available showing the upper and lower normal limits for different gestational ages from the mid-20s through 42 weeks of gestation. See pg 1561, Figure 54-20 An appropriate for gestational age full-term infant is heavier than 2500 grams (about 5.5 lbs.) and lighter than about 4000 grams (about 8.75 lbs.). Appropriate for Gestational Age

11. Caput succedaneum is swelling of the scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. Symptoms Soft, puffy swelling of part of the scalp in a newborn infant Swelling may or may not have some degree of discoloration or bruising Swelling may extend over the midline of the scalp Most often seen on the portion of the head which presented first May be associated with increased molding of the head Caput Succedaneum

12. TreatmentNo treatment is necessary, and it usually heals spontaneously within a few days. CausesA caput succedaneum is more likely to form during a prolonged or difficult delivery. This is especially true after the membranes have ruptured, because the amniotic sac is no longer providing a protective cushion for the baby's head. Vacuum extraction can also increase the chances of a caput succedaneum. A caput succedaneum is sometimes identified by prenatal ultrasound even before labor or delivery begins. It has been found as early as 31 weeks of pregnancy. More often than not, this is associated with either premature rupture of the membranes or too little amniotic fluid (oligohydramnios). All other things being equal, the longer the membranes are intact, the less likely it is that a caput will form. Pg 1554 Caput Succedaneum

13. swelling caused by subcutaneous bleeding and accumulation of blood. It may begin to form in the scalp of a fetus during labor and enlarge slowly in the first few days after birth. It is usually a result of trauma, often caused by forceps. Large cephalhematomas may become infected, require surgical drainage, and take several months to resolve. Also called cephalhaematoma. Cephalhematoma

14. Caput Succedaneum vs Cephalhematoma Important! Know how to recognize the difference between the two.

15. Circumcision

16. Chemical Sensory Breathing Four Factors • Physical • Thermal

17. Immediate Needs • Airway • Newborns are usually nose breathers-if nose is stuffy-will open mouth to breathe • Suctioning usually done by bulb syringe at birth • Airway must be kept clear

18. Needs • Breathing • Pressure factors, chilling, noise light, environmental stimuli encourage initial newborn breath • Breathing movements began in uterus at about 11 weeks

19. Breathing • At term 20 ml of fluid/kg in lungs • Air is substituted for the fluid with the first breath • Fluid moves into chest wall as trunk emerges at birth • As more air enters the lungs, more fluid moves interstitial

20. Breathing • Fluid is absorbed during the first day after birth • May hear wet sounds in the lung • After birth or soon after birth • Wet sounds are more prominent on c-section infants

21. Chemical factors • Arterial oxygen decreases-- • Carbon dioxide increases--- • Respiratory center is stimulated----- • Infant takes first breath • Usually within 1 minute of birth

22. Thermal factors • Change in temperature from uterus to environment is 20 degrees • Cool environment is a stimulus to breathe

23. Sensory factors • Auditory, visual, touch stimuli are increased when born • All the stimuli are new and increase the stimuli to breathe

24. Circulation changes Pulmonary blood vessels • Begin with the first breath • Lungs inflate and reduces pulmonary vasculature resistance • Reduces pulmonary artery pressure • Dilation occurs and allows blood to flow for O2 in the lungs

25. Circulation • Pressure in the right atrium • Decreases-- allowing increased pulmonary return to the left side of the heart • Increased pressure in the left atrium promotes closure of the foramen ovale

26. Circulation Ductus arteriosus • Blood is shunted from the pulmonary artery to the descending aorta before birth • Closes soon after birth and permanently closed within 3-4 months of life

27. Circulation Foramen ovale • Before birth the opening allows blood to flow directly to left atrium • Functionally closes at birth and permanently closes in a few months

28. Circulation Ductus venosus • Connection of umbilical vein and inferior vena is present before birth at birth the umbilical cord is cut… • With blood loss from the umbilical vein, the connection closes and becomes ligamentum arteriosum

29. Warmth • Thermoregulation must begin at birth-balance of heat loss and heat production • When cold, the infant needs to raise the metabolism to increase the heat • Infants do not shiver when cold • Infant will break down brown fat on body to increase metabolism

30. Warmth • Brown at is on back of neck, between scapula, around kidneys and around adrenals • Brown fat is deposited at 26-30 weeks • Increased metaboism requires more oxygen • Infant may present with hypoxia

31. Heat retention • Infant normaly lays in fetal or flexed position to maintain heat • Vasoconstriction allows head retention

32. Heat loss • Newborn heat moves from internal to periphery to external environment • Excess heat loss is cold stress • Infant becomes cold and begins to break down brown fat … • To increase metabolism • Increased metabolism requires more oxygen…hypoxia can develop

33. Heat loss • Prolonged cold stress reduces surfactant production which increases lung resistance and respiratory distress • When glucose stores depleted; Hypoglycema develops… from brown fat breakdown, fatty acids are released=metabolic acidosis

34. Heat loss • Excess fatty acid release causes less bilirubin to be transported to the liver and jaundice may develop

35. Heat loss methods • Conduction: direct contact with a cool object • Hands, stethoscope • Convection: movements of air • Air conditioning, open door • Evaporation: water is changed into vapor • Drying of wet infant

36. Heat loss methods • Radiation • cooler objects near sides of crib walls of isolette • Reduced by keeping cribs away from drafts

37. APGAR

38. The newborn is commonly assessed with the APGAR score, a quick test performed at 1 and 5 minutes after birth to determine the physical condition of the newborn. The five categories assessed are heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each of these categories is scored 0, 1, or 2, depending on the observed condition of the newborn. Newborn Test

39. Resucitation • Usually suctioned with bulb syringe after birth • May need wall suction/ suction trap for excess mucus • May need oxygen • RN or Physican will apply O2, suction as needed

40. Thermal environment • Infant temperature should be 97-99 f • Warmth is important • Infant is placed under warmer after birth and in isolette in the nursery until infant can maintain own heat

41. Identification/ bonding • Identification: identification bands on one leg, one hand, foot prints (bold numbers on the band) • May breastfeed in delivery room • Parents may hold infant • Infant is usually very awake during the first hour after birth

42. Prophylactic care • Vitamin k: given in delivery room in left vastus lateralis IM • Infant does not make vitamin K until food is present in intestine • Usually about 8 days of age vitamin K is produced

43. Prophylactic care • Erythromycin ointment: placed in both eyes in delivery room to prevent inflammation/ eye problems from gonorrhea or chlamydia

44. Umbilical cord • Cord is checked for 3 vessels • Cord is clamped until cord is dry • Cord is usually short and cleaned with alcohol • Cord clamp is removed when the cord is dry

45. Umbilical cord • Cord may be kept long for Rh negative mother and Rh positive infant cord may be kept damp with normal saline dressings • Some hospitals clean the cord with triple dye-purple color

46. Physical characteristics • Weight: 2500-4000g 5 lb 8 oz-8lb and 13 oz • Neonates loose 10% of birth weight and will gain weight back by 10-14 days of life • Average infant : 7 lbs 8 ounces and 20 inches long

47. Height • 45-55 cm or range 19-21 inches • Head averages 13-14 inches and chest 12-13 inches • Resp rate 30-60/min • Heart rate 120-160/min • Axillary temp 97.6--98.6 f • (Hospitals 97-99f)

48. Skin • Generally pink • Acrocyanosis of hands and feet • Lanugo on shoulders or forehead • Vernix caseosa-in creases • Physiologic jaundice after 24 hours • Pathologic jaundice before 24 hours

49. Head • Circumference 13-14 inches • Molding • Anterior fontanel-junction of saggital and coronal sutures • Diamond shaped 5 cm in size • Closes by 18 months • Posterior fontanel-at junction of lambdoidal and saggital sutures-closes by 2 months—may not be palpable

50. Eyes • Sclera: white and clear • Pupils: react to light • Do not accommodate • Strabismus (cross eyed): common for 3-4 months • Dolls eyes: for 10 days common • Color: slate blue, grey, brown • Color established in 3 months