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newborn lecture
BC3- maternity newborn lecture
Question | Answer |
---|---|
respiratory | lungs continually develop throughout fetal life |
Surfactant in fetus | by week 35, enough surfactant is in alveoli of lungs to prevent collapse. |
surfactant | compromised of surface active pphospholipids, lecithin, the most important for stability |
lung maturation | 35-36 weeks generally |
lecithin/sphingomyelin ratio | 2:1 lungs are developed enough to function properly at birth know through amniocentesis |
diabetes mother lecithin/ sphingomyelin ratio | d/t complications of diabetes, a 3:1 ratio is necessary to evidence lung maturity for babies of diabetic mom |
fetal breathing in utero | occur in utero as early as 11 weeks gestation, good development of chest wall muscles lead to good external adaption |
initiation of breathing | the first breath |
chemical events of first breath newborn | PCO2 goes up, PH, PPO2 goes down, stimulates respiratory center of medulla |
Thermal Stimuli/ related to first breath | decreases in temp. around fetus 98.6 down to 70 deg. (cold stress) |
physical stimuli of first breath | thouroughly drying infant stimulates respirations and prevents excessive heat loss |
mechanical events of first breath | exchange of fluid in lung to gasses, air replaces fluid |
secretion of lung fluids in utero | drop 48 hours before birth |
Lung fluids at delivery | 1/3 of fluid is squeezed out durring delivery |
successive breaths after birth | each successive breath leads to more lung expansion |
pulmonary vascular resistance at birth | decreases, pulmonary blood flow increases and more fluid is absorbed in blood stream |
s/s of respiratory distress | retraction, nasal flaring, grunting, high resp rate >60 |
transiant ticipnea | in c sections, respiratory distress |
PDA | patent ductus arteriousis, hear a murmur |
functional closure of foramen ovale | from changing arterial pressures (total closure takes from several weeks to 1 year) opening between atria of the heart |
closure/ constriction of ductus arteriosus | as a result of increased PO2 after air enters the lungs (functional closure within 15 hours) ductus eventually occludes and becomes a ligament. |
ductus arteriosus | channel between main pulmonary artery and aorta of the fetus |
closure of ductus venosis | immediate closure of umbilical vein and arteries, from clamping and cutting of cord |
peripheral circulation of newborn | sluggish, causing acrocyanosis |
acrocyanosis | blue extremities of newborn |
newborn BP | 78/42 |
heartrate of newborn | 120-160 |
HGB newborn | 14.5- 22.5 |
hct of newborn | 44- 72 |
RBC's newborn | 5- 7.5 |
WBC's of newborn | 18,000 |
blood sugar of newborn | 40 - 60 < 40 is concern |
take infant blood sugar if ... | large baby, small baby, low temp, moms diabetic, gittery baby, symptomatic |
urine in utero | forms in kidneys by 4th month gestation and is excreted to amniotic fluid |
mature kidney function of newborn | not established until 2nd year of life: has narrow margin of safety in chemical balance |
newborn voids?.... | 12- 24 hours after birth |
Brick Dust | pinkish stains on diaper formed by newborns kidney, is normal |
baby weight | record in lbs. and grams |
newborn length | crown to rump, rump to heal |
newborn GI system | newborn is capable of swallowing, digesting, metabolizing, absorbing proteins, simple carbs, and limited ability to digest fats. NO cow milk until after 1 year |
Mucous membrane of newborn mouth | moist and pink, no saliva for .... |
Epsteins pearls in mouth | common, white cysts on gums and palate |
stomach capacity of newborn | 30- 90 mls, emptying time is variable 1-24 hours regurgitation is normal: burp baby |
Bowel sounds newborn | heard within one hour of birth |
bacteria not in bowel at birth | but... soon enter. Normal intestinal flora synthesize vit.K, folic acid, and biotin |
Meconium at birth | sticky, sterile, substance usually passed within 24 hours of life. |
breast fed babies stools | soft golden yellow, non irritating to babies skin |
bilirubin | yellow pigment derived from hgb. resulting from breakdown of RBC's and myoglobin in muscle cells. |
unconjugated bilirubin or indirect bilirubin | unsoluble in water and causes jaundice in skin, sclera, and oral mucous membranes |
circulating indirect bilirubin | newborns can have a high amount d/t normal newborn jaundice, physiological jaundice, occurs in 50% newborns, 80% of preemies |
physilolgical jaundice is defined as | jaundice occuring after 24 hours and can be caused by: delayed clamping of cord, delayed emptying of intestine, maternal prebirth ingestion of certian drugs (sulfa, aspirin) and cold stress |
normal pattern of bilirubin following birth | 2 mg at birth. Increases to 6 mg by 72 hours, receeds to 5 mg by day 5 and should never exceed 12 mg |
pathological jaundice | appears before 24 hours, exceeds 12 mg at any time |
kernicterus | levels of bilirubin over 20 mg. the distruction of braincells resulting in mental retardation or cerebral palsy |
phototherapy | treatment for 12-15 mg level of bilirubin |
bilirubin level 20 mg. treatment | an exchange transfusion |
rhogam | drug used to give rh negative moms to prevent severe hemolytic disease |
Breast milk jaundice | occurs after first week of life , related to enzyme present in the milk of some women, which inhibits the conjugation of bilirubin |
newborn integumentary appearence | plump, pink , blotchy |
acrocyanosis | normal, bluish color of extremities |
lanugo | fine hair covering shoulders and back, keeps them warm |
caput succadaneum | edematous area of scalp, crosses suture lines , disappears in 3-4 days, from vacuum extraction |
cephalohematoma | collection of blood between a skull bone and its periostem. appears from about 3 hours after birth to 3 days old. does not cross suture lines, dissolves in 3-6 weeks |
mongolian spots | fade gradually over months / years go away between 4-7 years |
stork bites | pink, easy to blanch, appear on eyelids, nose ,lower occiput bone, upper lip, neck, usually disappear in 1-2 years |
erythema toxicum | normal newborn rash, pink area with white pustual center for 2 months, goes away on its own, dont treat. |
reproductive organs | swelling normal, and darkened scrotum area |
sensory and development | capable of social interacction |
brain size newborn | 1/4 size of adult |
coordination of newborn | uncoordinated, labile in temp and startles easily |
reflexes | moro (startle), stepping, rooting, sucking, grasp, babinski pos. up to 6 mos |
temperature regulation | only bathe when temp is up |
thermoregulation in newborn | closely related to metabolic rate and oxygen consumption |
newborns require a higher enviornmental temp.... | to maintain internal body temp |
newborn at risk for heat transfer because.... | limited supply of body fat and large surface area in relation to body weight. |
brown fat | most important source of heat in a cold stressed newborn |
conduction | surface heat loss |
convection | drafts, vents, air conditioner, dont bathe near vent |
evaporation | loss of heat through excess moisture, dry thorough |
radiation | heat transfers from heated body to cool surface |