Newborn Physiology Quiz

Chapter 11: The Term Newborn

• The term newborn refers to a baby born at full term
• Objectives for lesson 12.1 include describing newborn assessment, normal reflexes, pain management, physical assessment, and maintaining newborn body temperature

Apgar Score

• Standardized method for evaluating a newborn's condition immediately after delivery
• Assesses heart rate, respiratory effort, muscle tone, reflexes, and color
• Scores are obtained 1 and 5 minutes after birth

Transition Period

• First 6 to 8 hours after birth
• Transition from intrauterine to extrauterine life
• Nurses balance observation/assessment of newborn with needs of the birthing person and family
• First period of reactivity (30-60 minutes): best time for breastfeeding and bonding
• Period of decreased responsiveness (1-3 hours): infant sleeps, less active
• Second period of reactivity (3-8 hours): infant is alert and responsive

Initial Assessment

• Skin-to-skin contact
• Obtaining vital signs
• Gestational age assessment
• Observing for injuries or anomalies
• Weighing and measuring length and head circumference
• Assessing for passage of urine and meconium

Supporting Thermoregulation

• Non-shivering thermogenesis: metabolism to produce heat, beginning at 6 months
• Brown fat appears at 26-28 weeks gestation
• Hypothermia can lead to cold stress and hypoglycemia
• Heat loss through: evaporation (wet skin), conduction (exposure to cold surfaces), convection (exposure to cold air), radiation (loss of heat to cold surfaces)
• Maintaining a stable heat-regulating system is important

Maintaining body Temperature

• Keep head covered
• Keep infant covered at all times
• Prevent drafts to avoid heat loss from convection
• Do not place infant on cold surfaces

General Nursing Care

• Ophthalmic prophylaxis

Vitamin K Prophylaxis

• Essential for blood clotting

Initial Assessment - Gestational Age Assessment

• Skin
• Vernix
• Hair
• Ears
• Breast tissue
• Genitalia
• Sole creases
• Heart rate
• Apical
• Temperature
• Blood pressure
• Measurements (Weight, Length, Head circumference)
• Vital Signs (Respiratory rate)

Obtaining Temperature, Pulse Rate, and Respirations

• Temperature: axillary, skin-to-skin if abnormal
• Pulse and respiratory rates: count for 1 full minute
• Student must report abnormal temperatures, pulse rates, or respirations
• Temperature elevations >37.5°C or <36.5°C
• Pulse rates >160 or <110 beats/min
• Respirations >60 or <30 breaths/min
• Respiratory sounds (noisy, flaring, retraction)

Ongoing Assessment and Care

• Nurse identifies expected findings and variations/deviations from normal
• Report deviations to the healthcare providers

Length and Weight

• Average length: 45 to 55 cm (19 to 21.5 inches)
• Average weight: 2500 to 4000 g (6 to 9 pounds)
• Infants lose 7 to 10% of birth weight in the first 3 to 4 days

Nervous System

• Active movements of arms and legs, but no control
• Head lag for 3-4 months
• Can cry, swallow, and lift head slightly when lying on abdomen
• Reflexes: Suck, grasp (palmer and planter), Moro/startle, rooting, tonic neck, galant, walking

Newborn Reflexes - Video

• Link to YouTube video

Head

• Molding from birth: Swelling of soft tissues of the scalp (caput succedaneum)
• Cephalohematoma: Collection of blood beneath the periosteum of the cranial bone
• Fontanelles (soft spots): Protect the head during birth and allow for brain growth

Eyes & Ears

• Eyes: Best visual acuity 17-20 cm, prefer human faces, follow moving objects. Conjunctival hemorrhage, strabismus.
• Ears: Present at birth, react to sudden sounds, respond to voices, hearing screenings before discharge

Sensory Overload

• Sensory overload occurs from too much detrimental stimulation
• Keep environment quiet and calm, avoid bright lights and alarms

Sleep

• 15 to 20 hours per day
• Various sleep-wake states (deep sleep, light sleep, drowsy, quiet alert, active alert, crying)

Respiratory System

• First breath expands collapsed lungs
• Full expansion may take several days
• Respiratory distress signs: tachypnea/bradypnea, color change (cyanosis), sternal retractions, nasal flaring, grunting

Circulatory System

• Approximately 300 mL of circulating blood volume
• Newborn circulation differs from fetal circulation
• Dependent on ducts closing at certain points (foramen ovale, ductus arteriosus)

Acrocyanosis

• Normal for the first few weeks

Musculoskeletal System

• Flexible skeleton
• Random, uncoordinated movements
• Head and neck muscles develop first

Genitourinary System

• Kidneys not fully developed at birth, glomeruli are small
• Renal blood flow is about a third of adult's
• Reduced ability to handle water load and limited reabsorbing capacity.
• Important for nurse to note first void; newborn has about 6-8 wet diapers per day

Male Genitalia

• Testes descend into scrotum before birth (cryptorchidism)
• Urethral opening on tip of penis.
• Hypospadias (not at tip) and epispadias (at top)
• Smegma

Circumcision

• Surgical removal of foreskin
• Benefits: Decreased risk of penile cancer, fewer UTIs, fewer STIs
• Risks: Pain, infection, hemorrhage
• Nursing role: ensure consent and NPO, pain management

Female Genitalia

• May be slightly swollen
• Thin, white or blood-tinged mucus discharge (pseudomenstruation)
• Cleanse from urethra to anus to prevent fecal matter from entering urinary tract and UTIs

Lesson 12.2 Objectives

• Define skin manifestations: lanugo, vernix caseosa, congenital dermal melanocytosis, milia, acrocyanosis, and desquamation.
• State the cause and appearance of physiological jaundice in the newborn.
• State methods for preventing newborn infections.
• State ways to prevent sudden infant death syndrome (SIDS).
• Review appropriate discharge teaching for newborn care

Integumentary System

• Assess skin turgor
• Normal skin findings may include lanugo, vernix, milia, Epstein pearls, telangiectatic nevi, and congenital dermal melanocytosis.

Jaundice

• Yellow tinge of skin (hyperbilirubinemia), rapid destruction of excess red blood cells
• Normal response
• Kernicterus: extremely high bilirubin levels, seen between 2nd-3rd day, lasts 1 week
• Screening: Healthy newborns > 35 weeks gestation should have hour-specific serum bilirubin levels before discharge

Gastrointestinal System

• Meconium (first stool): Mixture of amniotic fluid and intestinal secretions, passed 8-24 hours after birth
• Stool color and consistency change over time, dependent on feeding

Digestion

• Breastfeeding should start within the first hour.
• Stomach capacity is 30ml and peristalsis is rapid
• Regurgitation is common
• Saliva is not produced fully until 2-3 months

Hypoglycemia

• Blood glucose below 2.6mmol/L after 12 hours of age, indicates hypoglycemia
• May be 2.0 mmol/L immediately after birth
• Place skin-to-skin and encourage breastfeeding immediately after birth

Risk for Newborn Hypoglycemia

• Preterm/post-term infant
• LGA/SGA infant
• Diabetic birthing person
• Newborn stressed due to hypoxia
• Close observation, monitoring blood glucose after feeding and 2 hours later
• Early, frequent feedings are important

Signs and Symptoms of Hypoglycemia in the Newborn

• Jitteriness; Poor muscle tone
• Sweating
• Respiratory difficulty; Low temperature
• Poor suck; High-pitched cry
• Lethargy; Seizure

Preventing Infections

• Newborn's immune system is immature
• Routine precautions, hand hygiene, cleaning/replacing equipment, proper disposal of soiled diapers and linens

Newborn Screening

• Up to 40 conditions screened (depending on province)
• Treatment can prevent significant health problems (PKU, hypothyroidism, galactosemia, sickle cell, thalassemai, etc.)
• Screening done between 24-48 hours after birth

Providing for Security

• Identifying the newborn; wristbands
• Recognition of employees
• Other security measures

Promoting Bonding and Attachment

• Bonding: strong emotional tie between parent and newborn forms soon after birth
• Attachment: affectionate tie occurs over time with increased interaction
• Nursing assessments should observe for these to occur

Nursing Interventions to Aid in Bonding and Attachment

• Teach learning infant communication cues (hunger, diapers)
• Model positive behavior to parents
• Call infant by name
• Encourage skin-to-skin contact
• Talk in gentle high-pitched tones
• Point out unique characteristics

Health Teaching

• Newborn bath, diaper care, umbilical cord care
• Prevention of SIDS
• Clothing
• Siblings
• Car seat safety

Prevention of SIDS

• Sleep in supine position
• Avoid exposure to tobacco smoke
• Sleep in a safe crib, cradle or bassinet
• Avoid pillows, stuffed animals, bumper pads and blankets
• Avoid overheating
• Sleep in same room with parents for 6 months
• Breastfeeding
• Use of pacifiers

Newborn Assessment

• YouTube link to a newborn assessment video