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M6 13-005

Exam 10: Variations in the Normal Term Newborn

Hyperbilirubinemia An abnormally high concentration of bilirubin in the blood.
two types of jaundice (1)Physiologic Jaundice (also called nonpathological or developmental jaundice). (2)Pathologic Jaundice.
Physiological Jaundice not present during the first 24 hours of life in term infants but appears on the second or third day after birth and is considered a normal phenomenon occurring in 60% of term infants. D/T immature function of the liver. Jaundice visible at 5-7 mg/dl
Pathologic Jaundice Jaundice that appears during the first 24 hours after birth is generally from a pathologic process. Commonly a result of: Abnormalities destroying erythrocytes. Incompatibilities between mom and baby blood type (c) Infection. (d) Metabolic diso
Jaundice Associated with Breastfeeding 1. The most common cause of jaundice in breastfed infants is inadequate intake due to poor suckling or a sleepy baby who feeds infrequently.
Kernicterus A grave form of jaundice of the newborn characterized by very high levels of unconjugated bilirubin in the blood and by yellow staining and degenerative lesions in the cerebral gray matter. Also called nuclear jaundice.
Kernicterus: Infants who survive may suffer from 1)Cerebral palsy. 2)Mental retardation. 3)Hearing loss. 4)More subtle long-term neurologic and developmental problems.
Factors that Increase Hyperbilirubinemia Hemolysis of excessive erythrocytes. (2) Short red blood cell life. (3) Liver immaturity. (4) Lack of intestinal flora. (5) Delayed feeding. (6) Trauma resulting in bruising or cephalohematoma. (7) Cold stress or asphyxia.
Hyperbilirubinemia: Therapeutic Management Phototherapy is most common treatment and involves placing the infant under special fluorescent lights. Bilirubin in the skin absorbs the light and changes fat soluble bilirubin into water-soluble photoisomers which can be excreted in the bile and urine
Hyperbilirubinemia: Nursing Interventions Maintain Neutral Environment. Provide Optimal Nutrition. Protect the eyes. Enhance Response to therapy. Detect Complications.
Hyperbilirubinemia: Patient teaching Anxiety their infant in an incubator with the eyes covered. Causes of jaundice & purpose of phototherapy. F/U visits. Encourage infant care participation. Discharge instructions on S/S of jaundice.
Skin Manifestations (Types) Acrocyanosis Harlequin Color Change Cutis Marmorata Milia. Erythema Toxium. Mongolian Spots. Nevus Simplex. Nevus Flammeus. Nevus Vasculosus. Cafe'-au-lait spots. Bruises. Petechiae.
Acrocyanosis a bluish discoloration of the hands and feet caused by reduced peripheral circulation indicating that the infant is not getting enough oxygen.
Harlequin Color Change 1. Clear color division over the body from the head to the abdomen with one half deep pink or red and the other half pale or of normal color. 2.Cause is vasomotor instability and is usually benign
Cutis Marmorata (Mottling): lacy red or blue pattern from dilated blood vessels under the skin
Milia (1)Pearly white pinpoint papules on face and nose of newborn. . (2)Disappear within a few weeks. (3)Educate parents not to attempt to "squeeze out" the white material because infection can occur.
Erythema Toxicum benign rash of unknown cause in newborns, blotchy red areas that may have white or yellow papules or vesicles in the center
Mongolian Spots bluish black marks that resemble bruises
Nevus Simplex aka “salmon patch”, "stork bite", or telangiectatic nevus. Flat, pink, or reddish discoloration from dilated capillaries that occur over the eyelids, just above the bridge of the nose, or at the nape of the neck.
Nevus Flammeus known as port wine stain. Permanent, flat, dark, reddish-purple mark
Nevus Vasculosus known as strawberry hemangioma. A dark red and raised with a rough surface, giving a strawberry-like appearance. Usually located on the head.
Café-au-lait spots permanent light brown areas that may occur anywhere on the body. Six or more spots or spots larger than 0.5 cm are associated with neurofibromatosis, a genetic condition of neural tissue.
Bruises may occur on any part of the body where pressure occurred during delivery. Especially true when second-stage labor was difficult.
Petechiae pinpoint bruises that resemble a rash and may appear over areas such as the back, face, and groin. (1) Result from increased intravascular pressure during the birth process, such as occurs with a nuchal cord during delivery.
Circumcision the most common surgical procedure performed on males. removal of the prepuce (foreskin), a fold of skin that covers the glans penis.
Reasons for choosing circumcision May reduce urinary tract infections which occur in approx 1% of uncircumcised infants. (c) However, other factors, such as poor hygiene and risk-taking behavior, are also important causes of these conditions
Reasons for rejecting circumcision Pain and risk of surgery. Considered cosmetic surgery and unnecessary.
Circumcision: Pain Relief Local anesthesia is recommended by the AAP and ACOG. Acetaminophen may be given before the procedure and during the first day post-op. Non-pharmacologic methods, recordings of intrauterine sounds, talking softly to the infant and dimming the lights.
Methods of Circumcision Gomco clamp. Plastibell
Gomco clamp Metal clamp is used to assist in removal of the foreskin.
Plastibell (a) Physician places a plastic ring over the glans, draws the foreskin over it, and ties a suture around the foreskin and Plastibell.
Created by: jtzuetrong