Newborn Care & Physiology Quiz

Newborn Immediate Needs in Delivery Room

• Maintain warmth: Skin-to-skin contact with mother or radiant warmer.
• Dry thoroughly: Prevent heat loss; use dry blankets, cover head.
• Monitor temperature: Routine assessment.
• Routine care: Bathing possible while on mother's abdomen.
• Feed if stable: Breastfeeding initiated.
• Parent introduction: Crucial, lasting memories; proper wrapping, naming, bonding time.
• Explain defects gently: Focus on normal aspects.

Newborn Suctioning

• Vigorous newborns with good respirations and muscle tone: Routine suctioning not recommended.
• Depressed newborns (poor respirations, muscle tone, HR <100 bpm): Perform suctioning:
  • Use bulb syringe or suction catheter.
  • Suction mouth before nose to prevent vomiting.
  • Insert catheter into nostril, apply suction while withdrawing. Do not insert deeper than nasal opening.
  • Meconium present: Suction trachea with endotracheal tube under direct visualization before positive pressure ventilation.
• Suction quickly and gently: To avoid mucosal trauma and vagal stimulation.
• Limit suctioning duration: Minimize airway trauma and bradycardia.

Mother's Newborn Care Instructions

Cord Care

• Keep cord stump dry and exposed to air.
• Clean around base with soap and water if soiled.
• Avoid covering with dressings.

Circumcision Care

• Apply petroleum jelly to the area.
• Change dressing with each diaper change until healed.
• Watch for signs of infection.

Feeding

• Breastfeeding: Proper latch, feed on demand (8-12 times/24 hours), alternate breasts, burp after feedings.
• Bottle feeding: Hold infant semi-upright, use proper nipple size, burp frequently.

Burping

• Hold infant upright or across lap.
• Gently pat or rub back to release swallowed air.

Vital Signs

• Monitor temperature, respirations, color.
• Call provider for rectal temp over 100.4°F.

Clothing

• Light layers, avoid overheating.
• Use snug swaddle or sleep sack.

Diapering

• Check diapers frequently.
• Use super-absorbent diapers.
• Clean gently with warm water.

Safety

• Never leave infant unattended.
• Use car seat.
• Avoid smoke exposure.
• Keep vaccines updated.

Hypothermia Prevention and Treatment

Prevention

• Maintain warm delivery room.
• Skin-to-skin contact or pre-warmed radiant warmer immediately after birth.
• Dry thoroughly, cover head, use warmed blankets.
• Preterm infants: Use polyethylene wrap until stabilized.
• Monitor axillary temperature frequently.
• Use incubator or radiant warmer until infant self-regulates temperature.

Treatment

• Remove wet clothes, replace with dry, warmed blankets.
• Skin-to-skin contact, cover head.
• Use heating pads on heat-losing areas (head, neck).
• Give warm liquids if conscious.
• Avoid drafts or cold surfaces.
• Gradual rewarming to prevent complications.

Newborn Normal Characteristics and Deviations

Normal Characteristics

• Weight: 2500-4000 grams
• Length: 48-53 cm
• Head circumference: 32-37 cm
• Chest circumference: 30-38 cm
• Lanugo (fine hair) on back.
• Rounded head shape after molding resolves.
• Palpable anterior and posterior fontanels.
• Cyanosis of hands/feet resolves within 24 hours.
• Protuberant abdomen.

Deviations

• Low birth weight (<2500 grams).
• Microcephaly (small head) or macrocephaly (large head).
• Caput succedaneum (severe molding/scalp swelling).
• Congenital anomalies/birth defects.
• Respiratory distress/apnea.
• Hypoglycemia/jaundice.
• Lethargy/poor feeding.

Newborn Reflexes

• Rooting: Turns head towards cheek stroking to find nipple.
• Sucking: Sucking motions when something is in mouth.
• Moro (startle): Extension of arms/legs with crying face in response to sudden movement/noise.
• Tonic neck: Arm on side of head turn extends, opposite arm bends.
• Grasp: Tightly grasping object placed in palm.
• Plantar grasp: Toes flex and grasp when sole of foot is stroked.
• Babinski: Fanning of toes when sole is stroked.
• Most reflexes disappear by 4-6 months.

Newborn Admission Assessments

• Vital signs (temp, heart rate, respiratory rate).
• Weight, length, head circumference.
• General appearance (skin color, hair, jaundice).
• Head/fontanels (shape, molding, caput succedaneum).
• Eyes (pupil size/reactivity, tearing/drainage).
• Ears (positioning, ear canal patency).
• Mouth (palate, suck/swallow reflexes).
• Chest (symmetry, respiratory effort).
• Heart sounds.
• Abdomen (bowel sounds, masses).
• Genitalia (anomalies in uncircumcised males).
• Extremities (posture, movement, grasp).
• Neurological (reflexes, tone, responsiveness).
• Skin (rashes, birthmarks, lesions).
• Elimination patterns.

Routine Post-Admission Assessments

• Vital signs every 4-8 hours.
• Daily weight.
• Skin color/jaundice assessment.
• Umbilical cord stump inspection.
• Feeding assessment (latch, swallowing).
• Urine/stool output and patterns.
• Neurological status (reflexes, tone, responsiveness).
• Circumcision site inspection if applicable.

Physiologic Jaundice

• Cause: Immature liver unable to metabolize/excrete bilirubin from red blood cell breakdown.
• Onset: 2nd or 3rd day after birth.
• Peak: Around 4th day.
• Resolution: Within 1-2 weeks.
• Bilirubin levels: Rise to 5-6 mg/dL, but usually don't require treatment.

Initiating Feedings

• Breastfeeding: Start within the first hour if stable.
• Positioning and latch techniques: Assist mother.
• Feeding frequency: Every 2-3 hours (breastfed or bottle-fed).
• Supplementation: Avoid water for breastfed, use formula if needed.
• Monitoring: Intake/output, weight gain, and feeding ability.

Infection Prevention

• Handwashing (most crucial): Thorough handwashing before handling infants and between infants.
• Separate supplies: Avoid cross-contamination.
• Prompt reporting: Report early infection signs.

Stool Patterns

• Meconium (birth): Thick, sticky, greenish-black, amniotic fluid, mucus, intestinal secretions.
• 12-24 hours: Usually passed.
• Days 2-3: Transitional stools (greenish-brown, loose).
• Days 3-5: Milk stools (breastfed: mustardy yellow, seedy, sweet odor; formula-fed: tan/yellow, firmer).
• Monitor frequently.

Voiding Patterns

• Day 1: 1-2 voids possible.
• Day 2: 1-2 voids.
• Day 3: 3-4 voids.
• Day 4: 4-6 wet diapers.
• Day 5: 6-8 wet diapers.
• Monitor urine output closely.

Medical Terminology Definitions

• Acrocyanosis: Bluish discoloration of extremities (normal in premature infants initially).
• Mongolian spot: Flat, blue-gray congenital birthmark (harmless, fades).
• Cephalohematoma: Blood collection between periosteum and skull bones (defined edges, non-crossing suture lines).
• Caput succedaneum: Scalp edema from birth pressure (crosses suture lines, entire presenting head).
• Thermoregulation: Newborn's limited temperature regulation (relies on non-shivering thermogenesis).
• Milia: Tiny white/yellowish bumps on face (harmless, usually resolve).
• Epstein's pearls: Small white cysts on hard palate or gums (harmless, disappear).
• Stork bites: Flat pink/reddish marks (harmless).

Postpartum Period

• Mother's recovery and knowledge: Assessment of physical recovery (vitals, fundal height, lochia, healing).
• Education and support: Self-care, perineal care, breast care, nutrition, exercise, family planning, signs of complications.
• Breastfeeding support: Education, positioning, monitoring for latch, milk supply.
• Mother-infant bonding: Assessment, guidance on newborn care, and recognizing postpartum depression.
• Discharge planning: Coordination, ensuring adequate support.
• Promoting healing: Rest, relaxation.

Additional Postpartum Client Education

• Self-care: Perineal, breast care, rest, nutrition, exercises for healing.
• Infant care: Bathing, cord care, safe sleep practices, soothing techniques, illness signs.
• Nutrition: Balanced diet with protein, iron, calcium, fluids for milk production/recovery.
• Infant feeding: Breastfeeding (latch, positioning, milk supply, pumping/storing), formula feeding (preparation, cues).
• Importance of breastfeeding.

Breastfeeding Considerations

• Breast size: Not significant for breastfeeding ability.
• Supply and demand: Frequent nursing, complete breast emptying.
• Feeding on demand, avoiding restrictions.
• Cluster feedings, skin-to-skin contact, rooming-in.
• Proper latch, positioning, and milk transfer assessment.

Assessing Adequate Breast Milk Intake

• Frequent wet and dirty diapers (6+ wet, 3-4 stools daily from 6 days-6 weeks).
• Audible swallowing during feedings.
• Weight gain (4-7 oz per week).
• Contentment/sleep after feedings.
• Breast feels fuller before, softer after feeds.
• Seeing milk in baby's mouth.
• Weighting baby before and after feedings. (If intake is questionable).

Nursing Care for Postpartum Issues

• Hemorrhoids: Sitz baths, OTC creams, stool softeners, analgesics.
• Episiotomy: Perineal care (warm water, mild soap), ice packs, sitz baths, pain meds.
• Perineal pain: Sitz baths, ice packs, oral analgesics, perineal care, Kegel exercises, avoiding constipation.
• Sore/cracked nipples: Vary breastfeeding positions, apply purified lanolin, air-dry nipples, proper latch.
• Engorged breasts: Frequent nursing, massage before feeds, warm compresses, OTC analgesics, proper latch and emptying.

Treatment for Non-Breastfeeding Engorgement

• Supportive bra.
• Ice packs.
• Analgesics.
• Avoid breast stimulation.
• Warm water in showers/hand expression (small amounts for relief).

Factors Affecting After Pains

• Number of previous pregnancies.
• Breastfeeding (oxytocin release).
• Size of the infant.
• Uterine atony.
• Retained placental fragments.
• Dehydration.

Lochia and Fundal Height Progression

• Lochia:
  • Rubra (red/bloody): Days 1-3
  • Serosa (pinkish-brown): Days 4-10
  • Alba (white/yellowish): Days 11-28+.
• Fundal height: Descend 1 fingerbreadth daily.
• Umbilical initially, non-palpable by 2 weeks.

Deviations from Normal Progression

• Excessive bleeding/lochia: Uterine atony, retained products, trauma.
• Foul-smelling lochia: Endometritis/uterine infection.
• Absent lochia: Infection, Sheehan's syndrome.
• Fundus not descending: Uterine atony or obstruction.
• Subinvolution: Infection or retained products.

Interventions for Episiotomy/Lacerations

• Ice packs (first 24 hours).
• Sitz baths.
• Perineal hygiene.
• Topical anesthetics/ointments.
• Stool softeners.
• Analgesics (ibuprofen/acetaminophen).
• Kegel exercises.
• Monitor for infection.

Infection Prevention Techniques

• Hand hygiene.
• Personal protective equipment.
• Aseptic technique.
• Sterile equipment/supplies.
• Cleaning/disinfecting.
• Standard/transmission precautions.
• Safe handling/disposal of contaminated materials.
• Patient/staff education.
• Monitoring/reporting infections.
• Immunizations.

Recognizing Infection

• Fever/chills.
• Increased heart rate.
• Malaise/fatigue.
• Pain/tenderness.
• Redness/swelling/warmth.
• Purulent/foul-smelling drainage.
• Elevated white blood cell count.
• Positive culture results.

Uterine Atony Actions

• First action: Massage fundus firmly in a circular motion.
• Oxytocin or other uterotonics.
• Empty bladder.
• Remove clots/placental fragments.
• IV fluids.
• Vital signs monitoring.
• More aggressive interventions (if bleeding persists).

Maternal Touch in Bonding

• En face holding for mutual gazing.
• Fingertipping, gentle stroking.
• Enfolding/bringing close, stroking hair/cheek-to-cheek.

Bonding Significance

• Strong, healthy parent-child attachment.
• Security, trust, positive relationships.
• Optimal social, emotional, and cognitive development.
• Enhanced caregiving confidence, parent love.
• Overall well-being.

Typical Discharge Instructions

• Warning signs (heavy bleeding, severe pain, fever, foul discharge).
• Perineal care.
• Breastfeeding support.
• Contraceptive counseling.
• Postpartum exercise/activity.
• Nutritional needs.
• Emotional support.
• Infant care basics.
• Follow-up schedule.
• Contacting provider.

Postpartum Blues

• Mild, temporary mood disorder (50-75% new mothers).
• Onset: 3rd day after delivery.
• Duration: Up to 10 days.
• Symptoms: Insomnia, irritability, fatigue, tearfulness, mood swings, anxiety.
• Usually self-limiting.
• Empathy, support, encouragement.

Preterm Infant Care

• Thermoregulation (minimize heat loss).
• Respiratory support (oxygen, CPAP, ventilation).
• Nutritional management (parenteral nutrition, feeding tubes).
• Infection control (hand hygiene, sterile procedures, visitor screening).
• Developmental care (minimize overstimulation).
• Family support/education.
• Frequent monitoring and adjustments.
• High-risk complications (respiratory distress, feeding issues, jaundice, infections).
• Crucial for preterm infants' survival and development, a calm, controlled environment is necessary.

Preterm vs Term Infant Characteristics

• Term: 37-42 weeks gestation.
• Preterm: <37 weeks.
• Preterm characteristics: Frail, less muscle tone, flexed extremities, thin/translucent skin, visible blood vessels; lack of subcutaneous fat, abundant vernix and lanugo; less mature features (plantar creases, ear cartilage).
• Specialized care for preterm infants (NICU) needed, due to physiologic immaturity.

Surfactant

• Surfactant: Lipoprotein produced by lungs that lines alveoli.
• Function: Reduces surface tension, keeping alveoli open during exhalation.
• Deficiency (e.g. Respiratory Distress Syndrome or RDS): Alveoli collapse, decreased gas exchange, atelectasis, hypoxemia, increased work of breathing.
• High chest wall compliance causes severe retractions in the infant.
• Severe hypoxia can result in pulmonary hypertension and a return to fetal circulation patterns.
• Primay cause of RDS in preterm neonates.

Signs of Respiratory Distress

• Tachypnea.
• Nasal flaring.
• Grunting.
• Retractions.
• Accessory muscle use.
• Cyanosis.
• Diminished breath sounds.
• Stridor (high-pitched inspiratory sound).
• Wheezing.
• Apnea.

Increased Risk For Thermoregulation Problems in Preterm Infants

• Immature temperature regulation mechanisms.
• Thin skin, poor insulation
• High surface area to body mass ratio.
• Lack of brown fat (for non-shivering thermogenesis).
• Treatment involves incubators, radiant warmers.

Preventing Infection in Premature Infants

• Strict infection control in NICU (hand hygiene, sterile procedures, visitor screening, isolating infants, protocols for central line/ventilator care.)
• Minimize exposure to pathogens.
• Immature immune systems of Preemies require reduced exposure to pathogens and infections.

Major Differences in Body Systems of a Preterm vs Term Newborn

• Respiratory:* Lack of surfactant leads to respiratory distress syndrome (RDS). Issues with respiratory drive and muscle tone increase risk of apnea.
• Cardiovascular:* Persistent fetal circulatory patterns (patent ductus arteriosus). Immature myocardium.
• Neurological:* Increased risk of intraventricular hemorrhage (IVH). Immature coordination of suck, swallow, breathe.
• Renal:* Decreased nephrons, reduced concentrating ability increasing fluid/electrolyte imbalance risk.
• Gastrointestinal:* Delayed gut motility and digestive enzyme production impact feeding tolerance.
• Immune:* Immature humoral and cellular immunity increases infection susceptibility.
• Thermoregulatory:* Poor insulation, high surface area/mass ratio, and lack of brown fat impair temperature regulation.

Erythromycin Ophthalmic Ointment

• Prophylaxis against ophthalmia neonatorum (neonatal eye infection).
• Administered to newborns within the first hour after birth.
• Prevents transmission from a mother with gonorrhea.
• Temporary vision blurring; important preventive treatment.

Vitamin K

• Essential for clotting factor formation.
• Routinely administered to newborns shortly after birth to prevent Vitamin K deficiency bleeding (VKDB).
• Newborns have low vitamin K levels.
• Risk of deficiency due to inadequate intake, malabsorption or lack of intestinal flora to synthesize.
• Prophylactic dose activates clotting factors.
• Reduces risk of life-threatening bleeding.

Test your knowledge on the physiological challenges and care requirements for newborns. This quiz covers important topics such as intraventricular hemorrhage risk, vitamin K administration, and breastfeeding techniques. Perfect for healthcare professionals and students studying neonatal care.