Normal Newborn Transition and Rashes
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Questions and Answers

Which feeding cue is considered the LAST hunger cue for a newborn?

  • Hand to mouth movements
  • Rooting
  • Crying (correct)
  • Suckling movements
  • What is colostrum and when is it produced?

  • A transitional milk produced between 3-4 days to 2 weeks
  • The first type of milk produced that is high in vitamins, occurring during the first 2-3 days (correct)
  • A type of mature milk that occurs after 2 weeks
  • The first milk produced that is yellow and thick, occurring after 2 weeks
  • What is a major hormonal factor involved in milk production during breastfeeding?

  • Prolactin (correct)
  • Estrogen
  • Testosterone
  • Insulin
  • Which of the following statements about mature milk is correct?

    <p>It contains 90% water and 10% carbohydrates, proteins, and fats. (C)</p> Signup and view all the answers

    Which of the following is a benefit of breastfeeding for infants?

    <p>It is easily digestible and tailored to infant needs. (D)</p> Signup and view all the answers

    What occurs if human milk is not removed effectively from the breast?

    <p>Negative feedback will reduce milk production. (A)</p> Signup and view all the answers

    What is one of the benefits of oxytocin release during breastfeeding?

    <p>It delays the return of menses and ovulation. (C)</p> Signup and view all the answers

    What is indicated by an APGAR score of 4?

    <p>Below normal (D)</p> Signup and view all the answers

    When should the vitamin K injection be administered to the newborn?

    <p>Within 1 hour of birth (B)</p> Signup and view all the answers

    What is the purpose of skin-to-skin contact immediately after birth?

    <p>To warm the baby and promote bonding (B)</p> Signup and view all the answers

    Which assessment should be performed every 30 minutes during the first hours after birth?

    <p>Monitor vital signs (B)</p> Signup and view all the answers

    What is the normal finding for acrocyanosis in newborns?

    <p>Blue/grayish hands and feet (C)</p> Signup and view all the answers

    What assessment should be made regarding gestational size/age?

    <p>Use the Ballard score (A)</p> Signup and view all the answers

    During which time frame is the newborn most alert for assessments?

    <p>1 - 4 hours after birth (B)</p> Signup and view all the answers

    What is a characteristic of physiologic jaundice in newborns?

    <p>Bilirubin levels peak at 5-6 mg/dL. (D)</p> Signup and view all the answers

    Which of the following is included in the complete assessments within the first 24 hours?

    <p>Nutritional status and feeding ability (D)</p> Signup and view all the answers

    What is the main purpose of the heel stick screening performed after 24 hours of age?

    <p>To perform metabolic screening (C)</p> Signup and view all the answers

    Which factor increases the risk of early onset breastfeeding jaundice?

    <p>Infant has poor suck reflex (B)</p> Signup and view all the answers

    What intervention is recommended for late onset breastfeeding jaundice?

    <p>Monitor bilirubin levels closely and ensure at least 8-12 feedings per day. (D)</p> Signup and view all the answers

    Which of the following is true regarding pathologic jaundice?

    <p>It usually appears within the first 24 hours of life. (C)</p> Signup and view all the answers

    What causes late onset breastfeeding jaundice in infants?

    <p>Milk substances increasing bilirubin absorption from the intestine. (C)</p> Signup and view all the answers

    What characterizes caput succedaneum?

    <p>Localized edema over the sagital suture (A)</p> Signup and view all the answers

    What is a key feature of cephalohematoma?

    <p>It is caused by pressure and presents with blood under the scalp (A)</p> Signup and view all the answers

    What should a nurse assess if a newborn does not void within 24 hours?

    <p>Adequacy of fluid intake (B)</p> Signup and view all the answers

    How many times per day should a breastfed baby typically void during the first two days?

    <p>2-6 times (C)</p> Signup and view all the answers

    What is the typical stool appearance for a breastfed infant?

    <p>Yellow, gold, soft or mushy, seedy (B)</p> Signup and view all the answers

    How often should jaundice be assessed in newborns?

    <p>Every 8-12 hours (A)</p> Signup and view all the answers

    What is one benefit of colostrum in newborn feeding?

    <p>It acts as a laxative to promote stooling (C)</p> Signup and view all the answers

    What is a common stool frequency for formula-fed infants?

    <p>Less than breastfed infants (A)</p> Signup and view all the answers

    What is a typical initial bladder volume for a newborn?

    <p>6-44 mL (A)</p> Signup and view all the answers

    When should the first feed of a newborn ideally occur?

    <p>1-2 hours post-birth (D)</p> Signup and view all the answers

    What role does fetal lung fluid play in the initiation of respiration?

    <p>It expands the alveoli. (B)</p> Signup and view all the answers

    What is a key factor that helps force out remaining fetal lung fluid during the baby's first breath?

    <p>Fetal chest compression during vaginal birth. (A)</p> Signup and view all the answers

    How does the placenta function in fetal circulation?

    <p>It bypasses the liver. (C)</p> Signup and view all the answers

    Which of the following factors is NOT associated with the baby's first breath?

    <p>Low blood pressure. (D)</p> Signup and view all the answers

    What is significant about the 'golden hour' after birth?

    <p>It allows for immediate skin-to-skin contact. (B)</p> Signup and view all the answers

    During which period does relative inactivity occur post-birth?

    <p>2-3 hours. (A)</p> Signup and view all the answers

    What is NOT a characteristic of small for gestational age (SGA) infants?

    <p>They typically exceed the 90th percentile. (A)</p> Signup and view all the answers

    What function does the patent foramen ovale serve in fetal circulation?

    <p>Connects both atria. (D)</p> Signup and view all the answers

    Which factor influences the closure of bypasses in fetal circulation post-birth?

    <p>Decreased resistance and pressure in the lungs. (D)</p> Signup and view all the answers

    Which structure bypasses the lungs in fetal circulation?

    <p>Ductus arteriosus. (B)</p> Signup and view all the answers

    Flashcards

    Feeding Cues in Newborns

    Signs a newborn is hungry, including eye movements, sucking, hand-to-mouth motions, body movements, sounds, rooting, and lastly, crying.

    Colostrum

    The yellowish, thick milk produced in the first 2-3 days after birth, high in protein, fat-soluble vitamins, minerals, and immunoglobulins.

    Transitional Milk

    Milk produced from days 3-4 to 2 weeks after birth, higher in fat, lactose, and water-soluble vitamins.

    Mature Milk

    Milk produced after 2 weeks, consisting of 90% water, 10% carbs, protein, and fat. It has different parts: foremilk and hindmilk.

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    Foremilk and Hindmilk

    Foremilk-Higher in water, vitamins, protein; Hindmilk-Higher in fat.

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    Breast Milk Production

    Milk produced in the alveoli of the breasts, mainly during infant sucking. Supply is influenced by hormone levels and milk removal.

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    Breastfeeding Benefits for Infant

    Reduces allergies/infections, tailored to needs, easily digestible, promotes healthy portion control, and doesn't depend on clean water.

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    APGAR Score

    A scoring system used to assess a newborn's health immediately after birth.

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    APGAR Score Ranges

    Scores categorized as critical (0-3), below normal (4-6), or normal (7-10).

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    Newborn Metabolic Screening

    Heel stick test performed to detect potential genetic or metabolic disorders.

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    Vitamin K Injection

    Given within the first hour of birth to help with blood clotting.

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    Initial Newborn Assessment

    Evaluates newborn's health in the period immediately following birth.

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    Newborn Feeding Assessment

    Evaluates the newborn's ability to suck and swallow for feeding.

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    Ballard Score

    Assessment to determine gestational age of a newborn.

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    Post-Natal Assessment

    Assess newborn's adaptation to extrauterine life within the first 4 hours of birth

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    Acrocyanosis

    Bluish/grayish hands and feet of a newborn, it's a normal condition.

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    Fetal Lung Fluid Absorption

    About 65% of fetal lung fluid is absorbed before birth, leaving approximately 80-100 cc remaining.

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    Surfactant Detection

    Surfactant, crucial for lung function, is detectable in fetal lungs by 24-25 weeks of gestation.

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    First Breath Mechanism

    The baby's first breath is driven by mechanical, chemical, and thermal factors. These factors enable the expulsion of fetal lung fluid.

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    High Pulmonary Resistance

    High pressures in the fetal lungs keep fetal circulatory bypasses open.

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    Patent Foramen Ovale Function

    The patent foramen ovale connects the two atria, facilitating brain perfusion in the fetus.

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    Ductus Arteriosus Purpose

    Ductus arteriosus bypasses the fetal lungs by allowing blood flow to the lower limbs.

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    Ductus Venosus Function

    The ductus venosus bypasses the liver, directing blood flow elsewhere.

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    Golden Hour Significance

    The baby's first hour after birth is critical for initial assessment and skin-to-skin contact.

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    Period of Relative Inactivity

    A period of decreased activity and vital signs (heart rate and respiratory rate) follows the golden hour.

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    Small for Gestational Age (SGA)

    Describes a baby whose size falls below the 90th percentile for its gestational age.

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    Physiologic Jaundice

    A normal process that occurs in most newborns within 3-5 days of birth, caused by the breakdown of fetal red blood cells. Bilirubin levels peak and then decrease, typically resolving by days 5-7.

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    Early Onset Breastfeeding Jaundice

    This type of jaundice develops in breastfed babies within a week of birth, often due to insufficient milk intake. Sleepy infants, poor suckling, or infrequent nursing can contribute to this.

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    Late Onset Breastfeeding Jaundice

    This type of jaundice persists even if the baby gets enough milk, suggesting a possible issue with breast milk itself. A substance in breast milk may increase bilirubin absorption or interfere with its processing.

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    Pathologic Jaundice

    This type of jaundice appears within the first 24 hours of birth and is not related to breastfeeding. It's caused by underlying problems like infections, blood incompatibility, or metabolic disorders.

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    What causes Pathologic Jaundice?

    Pathologic Jaundice can occur due to various causes, including infections, blood incompatibilities, metabolic disorders, and conditions like cephalohematoma or bruising, which lead to excessive red blood cell breakdown or difficulty in processing bilirubin.

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    Caput Succedaneum

    A localized swelling on the scalp of a newborn, caused by pressure during birth, which crosses the suture lines. It usually disappears within a few days.

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    Cephalohematoma

    A collection of blood under the scalp of a newborn, caused by birth trauma. It does not cross the suture lines and usually reabsorbs slowly. It can increase the risk of jaundice.

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    Newborn Voiding - First 24 Hours

    Most newborns will urinate within 24 hours of birth. If a newborn does not void within this timeframe, further assessment is needed.

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    Newborn Voiding - Frequency

    The frequency of urination in a newborn varies with age: Day 1-2: 2-6 times; Day 3-4: 6-8 times; Day 5+: 6-8 times

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    Breastfed Stools

    Stools from a breastfed baby are typically yellow or gold, soft or mushy, and may have a sweet-sour odor.

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    Formula Fed Stools

    Stools from a formula-fed baby are usually paler in color, more formed, and have a typical odor. Frequency varies but generally less than breastfed babies.

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    Jaundice Assessment

    Jaundice should be assessed every 8-12 hours. Predischarge bilirubin screening includes a serum test or transcutaneous measurement. Readings over 12 or 15 mg/dL warrant a serum level.

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    Jaundice Prevention - Feeding

    Adequate feeding is essential for jaundice prevention. The first feed should start within 1-2 hours postpartum, and infants should be fed 8-12 times a day. Colostrum helps promote stooling, which removes bilirubin.

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    Meconium

    The first stool passed by a newborn, usually dark green and sticky, with a lot of bilirubin.

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    Universal Predischarge Bilirubin Screening

    A mandatory screening for jaundice in newborns before discharge. It involves a blood test (serum) or a transcutaneous scan.

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    Study Notes

    Normal Newborn Transition

    • Pulse: 120-160 bpm (may be as low as 100 bpm during sleep, up to 180 bpm when crying). Apical pulse counted for a full minute due to fluctuations.
    • Respirations: 30-60 breaths per minute, predominantly diaphragmatic but synchronous with abdominal movements. Brief periods of apnea (less than 15 seconds) are normal.
    • Temperature: Axillary 36.4°C - 37.2°C (97.5°F - 99°F), skin temperature 36°C-36.5°C (96.8°F to 97.7°F).
    • Blood pressure: 90-60/50-40 mmHg at birth, 100/50 mmHg at day 10.
    • Blood glucose: Greater than or equal to 40 mg/dL.
    • Hematocrit: Less than 65%-70% in a central venous sample.

    Normal Newborn Rashes

    • Congenital dermal Melanocystosis: Bluish-black pigmentation, commonly found on the back or buttocks of newborns. Typically fades over a year, more common in darker skin tones.
    • Nevus Simplex: Also known as salmon patches, these are telangiectatic nevi, which are superficial capillary defects. Often found on the face, neck, and eyelids. They typically fade within the first 1-2 years of life, but occasionally persist into adulthood.
    • Erythema Toxicum Neonatorum: Transient rash, appearing in the first 24-72 hours, and lasting up to three weeks. Can appear anywhere on the body. It's an inflammatory response, and no treatment is needed.
    • Hemangioma: Dilated newly formed capillaries, these are superficial, raised lesions that are bright red in color. Often seen on the scalp, face, back, or anterior chest.
    • Milia: Small, white sebaceous glands, appearing as small white bumps. They are a normal finding.

    Infant Feeding

    • Feeding Cues:

      • Rapid eye movement under eyelids
      • Sucking movements
      • Hand-to-mouth movements
      • Body movements
      • Small sounds
      • Rooting reflex
      • Crying (the last hunger cue)
    • Types of Milk:

      • Colostrum: First 2-3 days, yellow, thick, high in protein, fat-soluble vitamins, minerals, and immunoglobulins.
      • Transitional Milk: 3-4 days to 2 weeks, higher concentration of fat, lactose, and water-soluble vitamins.
      • Mature Milk: After 2 weeks, 10% carbs, protein, and fat, 90% water. Foremilk and hind milk differ in fat content.

    Breastfeeding

    • Colostrum development: Begins as early as 12-16 weeks.
    • Milk produced: In alveoli of breasts. Most milk production happens during infant sucking.
    • Hormones involved: Prolactin and oxytocin.
    • Supply and demand: If milk isn't removed, negative feedback will happen.

    Breastfeeding Benefits

    • Reduces allergies, infections, and lowers risks of various diseases.
    • Tailored to meet specific needs.
    • Easily digestible, reduces constipation.
    • Promotes healthy portion control.
    • Not reliant on clean water.
    • Oxytocin release enhances uterine involution, reduces blood loss, and delays the return of menses.

    Discharge Teaching (Breastfeeding)

    • Wear nonbinding bra: To prevent clogged ducts.
    • Breastfeed on demand: 8-12 times daily.
    • Allow feeding until breast softens: Offer both breasts per session.
    • Use warm/cold compresses: pre/post feeding for comfort.
    • Ensure complete breast emptying.
    • Nipple care
    • Hydration

    Discharge Teaching (Non-breastfeeding)

    • Lactation suppression: Supportive bra continuously for 72 hours, avoid breast simulation and warm water.
    • Engorgement relief: Cold compresses, fresh cabbage leaves, analgesics/anti-inflammatories.

    Normal Newborn Transition (Vitals)

    • Heart rate: 120-160 bpm (apical), checked for 1 minute.
    • Respiration rate: 30-60 breaths per minute.
    • Temperature (Axillary): 36.4-37.2°C (97.5-99°F).
    • Blood pressure: (Brachial or Apical) 90-60/50-40 mmHg.

    Other Topics

    • APGAR score: Assess newborn at 1 and 5 minutes after birth (color, heart rate, reflex irritability, muscle tone, respiratory effort). Scores of 0-3 are critical, 4-6 below normal, 7-10 normal if scores less than 7 repeat checking every 5 min for up to 20min
    • Wet diapers and poopy diapers
    • Gestational age/size: Ballard or other scales assess physical maturity.
    • High-risk problem assessment: Vitals (every 30-60 min), identify infant, assess name band, length, wt, and head circumference.
    • Heat loss: Conduction, convection, radiation, evaporation
    • Newborn reflexes: Blinking, Babinski, grasping, Moro (startle), rooting, stepping, sucking, swimming, tonic neck.
    • Elimination/Voiding: Urine should be produced within 24 hours of birth (approx 93%).
    • Jaundice: Assess every 8-12 hours (visual or universal predischarge screening). Physiologic jaundice, early-onset breastfeeding jaundice, pathologic jaundice and treatment options.
    • Immunizations: Scheduled immunizations for infants (e.g., HepB, RV, DTaP, etc.)
    • Development milestones for 0-12 months.
    • Immunoglobulins (IgG): Crosses the placenta; provides passive immunity.
    • Active Immunity: Development through exposure to pathogens.
    • Hypothermia: Reliable indicator of infection instead of fever as it would be for adults. Additional signs include altered activity, tone, color and feeding.
    • Types of Play: Unoccupied, solitary, onlooker, parallel, associative, cooperative

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    Description

    This quiz covers essential concepts regarding the normal physiological parameters of newborns and common rashes they may present with. From heart rate to skin pigmentation, test your knowledge on the vital signs and dermatological conditions of newborns.

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