Newborn Physiology and Care Quiz

Normal Newborn

• Physiological adaptation of the newborn from intrauterine to extrauterine is a key topic.
• Assessment and immediate care of the normal newborn, including Apgar scoring, are crucial.
• Birth injuries are another significant aspect of newborn care.

Initiations of Respirations

• The first vital task for the newborn is initiating respiration.
• Fetal lung fluid is produced during fetal life, expanding the alveoli at a rate of 4-5 ml/kg/hr.
• As the fetus nears term, the fluid decreases preparing for air breathing.
• Absorption of the fluid is accelerated by fetal hormones (epinephrine and corticosteroids).
• Removal of the fluid reduces pulmonary resistance and enhances air breathing.
• Surfactant, a detergent-like lipoprotein, is detectable by 24-25 weeks of gestation.
• It lines the alveoli, reducing surface tension, keeping them partially open at birth.
• Without surfactant, alveoli collapse on exhalation.
• Sufficient surfactant is typically produced by weeks 34-36 of gestation, preventing respiratory distress syndrome.
• Secretion of surfactant increases during and after birth, aiding in the transition to neonatal life.
• Steroids administered to mothers in preterm labor can increase surfactant production and speed lung maturation.
• Chemical factors such as decreased PO2, PH, and increased PCO2 stimulate respiratory centers in the brain.
• Mechanical factors, like recoil of the chest after birth, draw air into the lungs and remove fluid in the airways.
• Thermal factors in the change of temperature from the uterus trigger respiratory responses in the newborn.
• Sensory factors like auditory, tactile, visual, and pain stimulate the respiratory center, initiating breathing.
• The first breaths result in 20-30 ml of residual air in the lungs, becoming functional residual capacity (FRC).
• By the first hour, 80-90% of FRC is established.
• The effort required for subsequent breaths is reduced compared to the initial ones due to the expansion of the alveoli.
• Fluid absorption from the lungs and removal of the fluid may take several hours or days.

Cardiovascular Adaptation

• During fetal life, three shunts (ductus venosus, foramen ovale, and ductus arteriosus) divert blood away from the lungs and liver.
• At birth, these shunts close, and the pulmonary and systemic circulations increase in response to increased blood oxygen levels.
• Shifts in pressure within the heart, pulmonary, and systemic circulations affect the transition.
• Clamping of the umbilical cord further initiates the change to neonatal circulation within minutes after birth.

Neurological Adaptation/Thermoregulation

• Maintaining body temperature is crucial for neonates.
• The temperature can drop significantly in the first minute if not kept warm.
• Neonates must generate their own heat to prevent cold stress, which can have fatal consequences .
• Methods of heat loss in the newborn include evaporation, conduction, convection, and radiation, thus keeping the new-born warm is crucial.

Hematological Adaptation

• The blood volume of a term newborn is 80-100 ml/kg.
• Hemoglobin (Hgb) is higher in infants (15-24 g/dL) than in adults.
• Packed cell volume (Hct) is 44%-70%.
• White blood cell count (WBC) averages 15,000/mm³ in a term infant.
• Low vitamin K in newborns can cause clotting issues; therefore, vitamin K is given to prevent bleeding.

Gastrointestinal Adaptation

• Newborn stomach capacity is 6 ml/kg at birth.
• Longer intestines in newborns enhance absorption but may also increase the risk of water loss with diarrhea.
• Bowel sounds are audible within 15 minutes of birth .
• Pancreatic enzymes, especially amylase, are often deficient for the first few months.
• Meconium, the first stool, is greenish-black and is typically passed within the first 12 hours, with 99% of newborns passing it by 24 hours.
• Breastfed infants often have seedy, mustard-colored stools 4 or more times daily, while formula-fed infants have pale yellow stools.

Hepatic system

• Blood glucose concentration is low immediately after birth, but it generally stabilizes by 2-3 hours.
• In term newborns, glucose levels should be 40-60 mg/dL in the first day.
• Premature or low-weight infants and those born to diabetic mothers may have reduced glycogen stores and excessive insulin production, increasing risk for hypoglycemia.
• The newborn liver may not be mature enough to prevent jaundice in the first week of life.
• Excessive bilirubin, which causes jaundice (yellowing of the skin), occurs in 60% of term and 80% preterm infants, and can stem from various factors.
• Causes for hyperbilirubinemia may include hemolysis of excessive erythrocytes (short RBC lifespan), lack of albumin binding sites, and liver immaturity.
• Breastfeeding is associated with increased risk for jaundice. Delayed or inadequate feedings affect bilirubin levels.

Urinary System

• Kidneys are fully developed by 34-36 weeks of gestation.
• About 50% of newborns void within the first 12 hours of birth and 99% void within 48 hours.
• Failure to void may result from hypovolemia or inadequate fluid intake.
• Infants typically void 6 times or more a day.
• Daily intake is 60-100 ml in the first two to three days of life, increasing to 150-175 ml after 5 days.

Immediate Assessment of the Normal Newborn: Apgar Score

• Apgar score is a standardized method to assess the newborn's clinical status at 1 and 5 minutes after birth.
• It evaluates heart rate, respiratory effort, muscle tone, reflex response, and color.
• Apgar scores help predict potential need for resuscitation or additional support. Different scores require differing levels of care. One to three requires resuscitation, four to six require stimulation and additional intervention (breathing support), and seven to ten requires no additional action.

Birth Injuries

• Common birth injuries, such as caput succedaneum, cephalhematoma, shoulder dystocia, and brachial plexus or clavicle fractures.

Nursing Care and Teaching

• Maintaining a patent airway, initiating breathing and resuscitation, and recognizing and managing early asphyxia are essential nursing interventions.
• The back-to-sleep position for newborns is crucial for avoiding sudden infant death syndrome (SIDS).
• Proper newborn care includes managing excessive blankets (to prevent overheating), protecting the head from coverings, and ensuring a safe environment (no smoking around the baby).
• Vitamin K is given within the first hour of birth to prevent bleeding disorders, as newborns can't synthesize it without bacteria in the gut.
• Eye ointment can be given to newborns to prevent certain eye infections, and protocols and details can be found after consulting specific labour-related information.
• Care of the umbilical cord, including ligation and keeping the stump clean and dry, minimizes infection risks during the postpartum period.

Rooming-In

• Rooming-in is a nursing practice where newborns stay with their mothers.
• Advantages include facilitating bonding, promoting exclusive breastfeeding, early exposure to maternal flora, reduction of nosocomial infections, and provision of continuous maternal monitoring.

Feeding

• Breastfeeding is the best feeding method for newborns.
• Advantages include a nutritionally balanced diet, reduced risk of infections in unhygienic conditions, protection against diarrhea and other infections, and promotes mother-child bonding and child spacing.

Measurements- Weight and Length

• Measurements for weight and length are important indicators of a newborn's health and well-being.
• Weight classifications include large for gestational age(LGA),average for gestational age (AGA), and small for gestational age (SGA).
• These measurements are indicators of possible risk factors.
• Appropriate growth for term newborns.

Assessment of Body Systems

• Comprehensive newborn examinations include assessment of neurologic reflexes (rooting, sucking, grasp reflexes, etc.), a full examination of cardiovascular status, assessing for any abnormalities, and thermoregulation.

Focused Assessment on Cardiorespiratory Status

• Respiratory rate (RR) should be between 30 and 60 breaths per minute.
• Assess RR every 30 minutes initially, every 2 hours later, noting symmetry and equal breath sounds.
• Breathing should be unlabored and symmetrical.
• Common newborn breathing sounds include crackles for the first 1-2 hours, which is not unusual.
• Assess for pallor (anemia, slight hypoxia) and ruddy color (polycythemia - increased red blood cells).
• Identify apnea (pauses in breathing lasting 20 seconds or more, accompanied by cyanosis) or respiratory distress - tachypnea, retractions, flaring of the nares (nostrils), and cyanosis.

Focused Early Assessment—Thermoregulation

• Assess temperature using an axillary method.
• Normal temperature range for newborns is 36.5–37.5 с.

General Assessment: Head to Toe

• Examination from head to toe, noting symmetry for each component and any abnormalities.
• Hair characteristics and fontanels (soft spots on the skull) are assessed as part of a complete head examination.
• The face should be symmetrical, and abnormalities can include injuries, facial palsy, asymmetrical eyes, low-set ears, cleft lip or palate, precocious teeth, or tongue tie.
• Inspect the neck for any masses or restricted range of motion. The clavicle should be assessed for fractures, particularly if there's a history of shoulder dystocia.
• Examining the chest notes both the nipple and breast symmetry, breath sounds (for any crackles or abnormal wheezing), and presence of tachycardia or bradycardia.

Umbilical Cord

• Assess the umbilical cord for three vessels (two arteries and one vein).
• Two-vessel cords might indicate developmental problems and must be evaluated further.
• Assess cord for coloration due to any traces of meconium.
• Abnormal coloration may mean that the baby has been exposed to meconium, which can contribute to potential health issues.

Extremities

• Observe for full, symmetrical, random movement during examination.
• Assess for any flexion and resistance in extending extremities of the arms and legs.
• Evaluate any fractures, redness, lumps, or swelling in the extremities.
• Assess for extra digits (polydactyly) or webbing between digits (syndactyly).
• Examine the arms and legs for symmetry in size and shape.
• Assess for any deformities or abnormalities in size or shape.

Hips

• Evaluate for developmental dysplasia of the hips.
• Assess for symmetric leg lengths.
• Perform Barlow and Ortolani tests to rule out hip instability.

Vertebral Column

• Assess for symmetry, masses, or deformities of the vertebral column;
• Spina bifida, a condition where the vertebral column doesn't fully close, is a potential abnormality.

Test your knowledge on the essential physiological tasks and adaptations of newborns immediately after birth. This quiz covers topics such as surfactant functions, bilirubin levels, and factors influencing newborn respiratory health. Perfect for students of pediatric nursing or healthcare.