Newborn and Fetal Vital Signs

• Normal newborn vital signs are important to know, considering both resting and active states.

Normal Temperature

• A newborn's temperature should be between 97.6-99.4°F.
• Take axillary temperature for 3-5 minutes minimum.

Normal Pulse

• A normal pulse rate is 120-160 beats/min.
• Begin Ambu bag ventilation for pulse rates less than 100.
• Start compressions for pulse rates less than 60.

Normal Respiration

• Respiration rate should be 30-60 breaths/min, counting for one full minute.
• Do not feed a newborn if the respiratory rate is over 60.

Fetal Vital Signs

• Fetal tachycardia is a baseline heart rate greater than 160 bpm for 10 minutes or more.
• Fetal bradycardia is a baseline heart rate less than 110 bpm for 10 minutes or more.

Interventions for Crying Baby

• Swaddle the baby.
• Soothe the baby by having the mother hold them.
• Allow the baby to suck on a gloved finger.
• Use a pacifier.

Gestational Age (GA) Review

• Pre-term infants are those born at or before 37 weeks.
• They may have wrinkled appearances.
• They typically have little brown fat.
• Abundant vernix is present.
• Infants may exhibit lots of lanugo.
• The soft pina shows minimal recoil.
• Their skin is thin and translucent.
• They are at an increased risk for hypothermia due to extended posture.
• Late preterm infants are those born between 34-36 6/7 weeks.
• Term infants are those born between >37 weeks - 41 6/7 weeks.
• Post-term infants are those born after > 42 weeks.
• Post-term infants may be large or small, depending on placental insufficiency.
• Their skin is often dry and cracked (parchment-like).
• They often have profuse scalp hair.
• Marked creases are present in the soles of their feet.
• Monitor for hypoglycemia.

Breastfeeding Nutrition

• Review the appropriate number of feedings per day.
• A newborn typically feeds 8-12 times per day.
• A newborn's stomach capacity at birth is about 0.5 oz to 1 oz (30mL).
• A neonate should urinate within 24 hours after delivery.
• Progesterone-only birth control pills decrease estrogen levels, increasing prolactin levels.
• Estrogen birth control pills can lead to decreased milk production.

Thrush (Oral Candidiasis)

• Oral candidiasis is a fungal infection of the oral mucosa.
• Thrush is common in newborns and infants.
• Fungal infection may be transmitted between the infant and the breastfeeding mother.
• Thrush appears as thick white patches on the tongue, mucosa, or palate, resembling curdled milk.
• Apply nystatin to the lesions with a cotton-tipped applicator in younger infants.
• If the mother is infected, she must receive antifungal treatment, as well.
• Breastfeeding can continue if the mother is appropriately treated.

Circumcision Information

• The American Academy of Pediatrics (AAP) does not recommend routine circumcision.
• Benefits of circumcision include reduced risk of UTI, HIV, or STIs.
• Apply Vaseline or bacitracin ointment to a newly circumcised baby's genitals.
• This prevents the dry edges of the incision from sticking to the diaper.

Thermo (Heat) Loss Mechanisms

• Radiant warmers and double-wall isolettes prevent heat loss from radiation.
• Radiation is heat loss from the warmer infant skin surface to objects or surfaces not in direct contact with the infant.
• Convection is heat loss from the warmer infant to cooler air currents.
• Conduction is heat loss to a cold surface or object contact with the infant.
• Evaporation involves heat loss when H2O evaporates from the infant's skin surface.

Cold Stress

• Cold stress refers to any environmental condition causing loss of body heat that can lead to respiratory distress, hypoglycemia, and ketoacidosis.
• Neonatal hypothermia may lead to depletion of glucose, leading to hypoglycemia.
• Brown fat is a specialized form of heat-producing tissue found only in fetuses and newborns.
• Premature and SGA infants have less brown fat.

Glucose Levels

• Normal glucose levels are 40-45, anything less than 40 is hypoglycemia and should be concerning.
• Signs and symptoms of hypoglycemia include jitteriness, tremors, grunting, irritability, lethargy, hypotonia, weak cry, and instability.
• If glucose is under 40, attempt breastfeeding for a max of 15 minutes on each breast/or formula.
• Ensure that the baby is taking the milk.
• Repeat glucose screening 20-30 minutes after feeding.
• Notify the provider if two or more values are between 30-40.

Respiratory Information

• Normal respiratory rate for a newborn is 30-60 breaths/min.
• Bradypnea is less than 30 breaths/min (in less than one month).
• Tachypnea is greater than 60 breaths/min.
• Respiratory distress syndrome (RDS) is a breathing disorder resulting from lung immaturity and lack of alveolar surfactant.
• RDS occurs in 50% of preterm newborns born at 26 to 28 weeks.

Respiratory Distress Syndrome (RDS) Symptoms

• Expiratory grunting
• Shallow breathing
• Nasal flaring
• Chest wall retractions
• Seesaw respirations
• Generalized cyanosis
• Tachycardia (150-180 bpm)
• Fine inspiratory crackles
• Tachypnea (>60)

Respiratory Distress Syndrome (RDS) Symptoms

• Begins soon after birth
• Increased difficulty at 3 to 6 hours
• Tachypnea
• Grunting
• Retractions
• Hypoxia
• Flaring
• Increased O2 requirements
• Decreased urinary output
• CXR: white out... more serious

Surfactant

• Lecithin and Sphingomyelin are compounds that lower the surface tension between two liquids and a solid.
• Surfactant provides the lung stability needed for gas exchange.
• Surfactant is a surface tension-reducing lipoprotein found in the newborn's lungs that prevents alveolar collapse and loss of lung volume.

Decreased or Absent Surfactant Causes

• Prolonged rupture of membranes, gestational or chronic maternal hypertension, and maternal narcotic addiction
• Use of prenatal corticosteroids reduce the newborn's risk for RDS due to physiologic stress on the fetus.

Transient Tachypnea of the Neonate (TTN)

• TTN is caused by a "wet lung."
• Higher incidence with C/S
• Show Mild to moderate hyper expansion of the lungs
• Low O2, causes the infant to breathe faster to compensate

TTN Signs and Symptoms

• Respiratory distress
• Tachypnea, Rapid RR (> 60 bpm)
• Mild Retractions (pulling in at the ribs with breathing)
• Grunting sounds when breathing
• Nasal flaring
• Cyanosis on Room Air

Meconium Aspiration Syndrome (MAS)

• MAS is caused by ingested meconium.
• Mechanical obstruction of the airways
• Can potentially cause chemical pneumonitis
• Vasoconstriction of the pulmonary vessels can be triggered
• Can cause Inactivation of natural surfactant
• Do not stimulate at birth, suction first.
• Deep suction can be considered per Respiratory Therapist

Pneumonia related to GBS

• GBS is the most common cause of sepsis and meningitis in newborns and frequent cause of newborn pneumonia.
• If the mother has GBS, then watch for neonatal respiratory distress.

Jaundice Classifications

• Cessation of breathing greater than 20 seconds
• Pathological jaundice is noted within 24 hours.
• Physiologic jaundice is noted after the first 24 hours.

Photo-Therapy

• Involves exposing the skin to ultraviolent light, which converts unconjugated bilirubin into conjugated bilirubin that can be excreted through feces and urine.
• Protect genitalia by using a diaper, place eye patches, turn every 2-3 hours, and check the baby's temperature every 2-4 hours.
• Possible side effects Skin breakdown, hyperthermia, tachycardia, dehydration, transient rash and loose stool.

Bilirubin

• Direct bilirubin is water-soluble
• Indirect bilirubin is fat soluble
• Jaundice is noticeable at 6 mg/dL.
• Jaundice appears from head to chest.
• Kernicterus is a neurological syndrome due to deposits of unconjugated bilirubin in the brain cells.
• If bilirubin is greater than 6, jaundice is noticeable.

APGAR Scoring

• Appearance: color
• Pulse: heart rate
• Grimace: reflex irritability
• Activity: muscle tone
• Respiration: breathing

Erythromycin Ointment

• Erythromycin ointment application: apply light off, on the conjunctival sac.
• Yes, this is mandatory in all 50 states to prevent ophthalmia neonatorum.
• This medication is categorized as a macrolide.

Vitamin K

• Vitamin K is given to prevent bleeding because newborns do not produce it until after they feed.
• It helps newborns produce clotting facts.
• Newborns lack vitamin K due to a sterile gut.
• Another name for vitamin K injection is phytonadione.
• The injection prevents brain bleed.
• Vitamin K is given IM on the vastus lateralis 1-2 hours after birth.

Neonatal Terms

• Molding: elongated shaping of the fetal head to accommodate passage through the birth canal. Normal and resolves within a week.
• Acrocyanosis: Persistent cyanosis of fingers, hands, toes, and feet with mottled blue or red discoloration and coldness. Intermittent
• Mongolian Spots: are benign blue or purple splotches on the lower back and buttocks of newborns.
• Erythema toxicum: benign rash occurring in 70% of newborns.

Cephalhematoma

• Localized subperiosteal collection of blood of the skull which is always confined by one cranial bone that does not cross suture lines caused by the pressure on the head that disrupts vessels during birth.

HSV in Relation to Fetal Delivery

• HSV infections during pregnancy can result in severe systemic symptoms in the mother and significant morbidity and mortality in the newborn.
• May cause spontaneous abortion, birth anomalies, IUGR, or preterm labor
• The greatest risk of transmission occurs when the mother develops a primary infection near term.
• In the absence of active lesions, a vaginal birth is acceptable, but if the woman has active herpetic lesions within 6 weeks of term, a cesarean birth is preferred.
• Delivery should be C section.

Phenylketonuria (PKU)

• Newborns must ingest enough breast milk or formula for accurate PKU screening.
• The test should not be performed before 24 hours of age
• Screening test for genetic and inborn errors of metabolism, requiring a few drops of blood from the newborn's heel
• PKU leads to irritability, vomiting of protein feedings, musty odor to skin, mental/motor retardation, seizures, microcephaly, and poor growth/development, mental/motor retardation
• Education includes lifetime diet of foods low in phenylalanine (low protein) and monitoring blood levels.

Immunity in Newborns

• Immunoglobulin G (IgG) crosses the placenta to the fetus while in utero.
• Newborns who are breastfed receive antibodies from the breast milk, which includes IgE, IgA, IgM, and IgG.
• IgG passes in the last trimester so pre-termers are at risk for increase bacterial infection.
• IgA is the second most abundant immunoglobulin predominantly found in the gastrointestinal and respiratory tracts, tears, saliva, colostrum, and breast milk.

VEAL CHOP

-V (Variable Decelerations) → Cord Compression -E (Early Decelerations) → Head Compression -A (Accelerations) → Oxygenation -L (Late Decelerations) →Placental Uterine Insufficiency

• Late Deceleration: The fetal heart rate drops in the middle of the contraction, and continues after the contraction has ended related to uterine placental insufficiency
• Variables: quick drop in heart rate and quick return to fetal heart tone baseline; occurs at any point related to cord compression

Neonatal Abstinence Syndrome (NAS)

• The harmful effect of heroin and other narcotics on newborns during withdrawal.
• Morphine therapy may be implemented if the score is greater than or equal to 8
• Withdrawal signs

1. Neuro Excessive or high pitched crying, Excessive irritability, Jitteriness, seizures
2. GI Vomiting, Diarrhea, Poor nippling
3. Other Sweating

• Babies are monitored with NAS every 4 hours if score is greater than 8 then increase to 2 hours intervals
• Morphine is used score greater than or equal to 8 consecutively, Minimum dose of morphine and continue scoring every 4 hours, then gradually wean them off morphine can take 2-4 weeks.