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newborn lecture

BC3- maternity newborn lecture

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
Created by: goryan