Untitled Quiz

Neonatal Assessment and Care (Part 1-3)

• This is a study guide for BSN-3 Childbearing Family Nursing
• The course covers neonatal assessment and care, specifically focusing on Part 1-3.
• Covers the first 6-8 hours after birth.
• Dr. Shirley Lo is the instructor for this course offered at the Hong Kong Polytechnic University.

Learning Outcomes

• Students will be able to describe physiological and behavioral adaptations during the transition from intrauterine to extrauterine life.
• Understand thermoregulation in newborns, including hypo- and hyperthermia.
• Students will be able to describe a systematic process, using a "head-to-toes" approach for evaluating newborns.
• Students will be able to identify normal and abnormal reflex responses in newborns.
• Describe nutritional needs for newborns, including the immunization program and neonatal screening in Hong Kong.
• Students will be able to analyze and explain cases, with management strategies for neonatal jaundice.
• Discuss care essentials for neonates at health risk (e.g., infections) and their associated managements.

Outline of NN Lectures

• Major neonatal adaptations: Physiological and behavioral development
• Nursing assessments and care: Immediately after delivery and then subsequent assessments.
• Neonatal needs: Nutritional needs, neonatal screening & neonatal jaundice.

Newborn Adaptation to Extra-uterine Life

• Neonatal period: from birth through the 28th day of life.
• Physiological adaptations: occur in the first 6-8 hours after birth
• Behavioral adaptations: Period of reactivity, state of organization & sleep patterns
• A. Physiological adaptations:
  • Establishing and maintaining respirations
  • Adjusting to circulatory changes
  • Regulating body temperature
  • Endocrine adaptations
  • Hepatic adaptations
  • Immunologic adaptation
  • Taking in, retaining, and digesting nutrients
  • Eliminating waste
  • Regulating body weight
  • Sensory / neurological system
• B. Behavioral development:
  • Period of reactivity
  • State of organization
  • Sleep-wake pattern

Physiological Adaptations (Details)

• To survive extra-uterine life, newborns must breathe on their own and initiate the first breath.
• Factors influencing the first breath:
  • Chemical factors (uterine contractions, cord clamping; decreased oxygen, increased CO2).
  • Mechanical factors (chest compression, fluid expulsion).
  • Thermal factors (significant drop in temperature)
  • Sensory factors (handling, suctioning, and other stimuli)

Lung Functions

• Surfactant production helps prevent alveolar collapse, especially important for premature infants born before 32 weeks.
• Lung compliance facilitates air entry or expansion.
• Airway resistance has to be overcome to open the lungs.

Successful Sustaining of Respiratory Adaptations

• Reabsorption of fluid from the lungs (with inspiration and expiration), enabling efficient air distribution.
• Increasing fluid flow from alveoli to capillaries and lymphatic circulation is crucial.
• Suctioning may be required.
• Catecholamines (hormones) promote fluid clearance from the lungs is important

Normal Newborn Respiration

• Respiratory rate (RR) is approximately 30-60 breaths per minute(bpm).
• Initially, respiration is shallow and irregular.
• Breathing is diaphragmatic with synchronized abdominal movements.
• Respiration is through the nose.

Abnormal Newborn Respiration

• RR < 30 or > 60 bpm at rest.
• Apnea (>20 seconds)
• Tachypnea (inadequate lung fluid clearance).
• Retractions (ribs).
• Cyanosis (blue skin/lips). - Nasal flaring.
• Expiratory grunting.
• Stridor or gasping (airway obstruction).
• Seek medical help for above indications.

Fetal Circulation

• Blood bypasses the lungs during fetal development.
• Umbilical vein: carries oxygenated blood.
• Foramen ovale: allows blood to shunt from right atrium to left atrium.
• Ductus arteriosus: connects pulmonary artery to descending aorta.
• Umbilical arteries: return deoxygenated blood to placenta.

Cardiovascular Adaptations

• A series of changes occur at birth, leading to the transition to neonatal circulation.
• The umbilical blood vessels close, helping to regulate blood flow to and from placenta.
• The Ductus arteriosus closes, leading to increased pulmonary vascular resistance.
• The Foramen ovale closes, leading to increased blood flow.
• Cardiac and blood pressure adjustments help sustain physiological functions.

Blood

• Blood volume at term.
• Hemoglobin and hematocrit levels.
• Red Blood Cell (RBC) levels. - White Blood Cell (WBC) levels.
• Platelets levels.
• Vitamin K levels.

Cord Management

• Immediate cord clamping (delaying the clamping) has benefits (increased blood volume, decreased risk of anemia) in some instances
• Delayed cord clamping (immediate clamping) is not recommended unless the neonate is asphyxiated and requires immediate resuscitation (moderate quality evidence).

Neonatal Thermoregulation

• Normal axilla temperature: 36.4-37.2°C.
• Neonatal hypothermia: axilla temperature < 36.5°C.
• Body temperature is controlled by the hypothalamus, and brown adipose tissue plays a major role in regulating temperature.

Heat Production (Thermogenesis)

• Increase in muscle activity.
• Increase in cellular metabolic activity (brain, heart, and liver).
• Peripheral vasoconstriction.
• Nonshivering thermogenesis.

Heat Loss From a Newborn

• Convection: air currents
• Radiation: cooler surfaces.
• Conduction: direct skin contact - Evaporation: moisture conversion to vapor.

Neonatal Hypothermia

• The 10-step recommendations to regulate the temperature of neonates, include preparing a 'warm chain' at the delivery suite.

Other observations

• Airway
• Chest wall movement
• Abdomen
• Skin
• Genitalia
• General

Head-to-toe assessments

• General appearance: head, neck, chest, hips, muscles, extremities, hands
• Assessment of the general appearance and physical characteristics.

Newborn Measurements

• Weight: 2.5-4 kg (37-41 weeks).
• Physiological weight loss: 5-10% in first 3-4 days
• Head circumference: 32-37 cm.
• Chest circumference
• Length

Physical Assessment of the Newborn.

• Head symmetry: large, 1/4 of body size.
• Head circumference.
• Soft Spots (anterior & posterior fontanels).
• Face: symmetry, hair, Milia, facial nerve palsy.
• Eyes: symmetry, eyelids, eyeballs.
• Ear: symmetry, position & shape.
• Neck: short, creased and soft.
• Chest - cylindrical & symmetric.
• Abdomen - cylindrical & protruding.
• Extremities: movement, symmetry

Physiological Neonatal Jaundice, Breast Milk Jaundice

• Onset, bilirubin levels.
• Causes.
• Treatment.
• Management of babies with Physiological Jaundice

Pathological Neonatal Jaundice

• Suspects.
• Additional criteria.

Prevention of NNJ

• Neonatal screening is essential.
• Efficient care of the newborn.
• Early detection.

Management of Neonatal Jaundice

• Phototherapy.
• Exchange blood transfusion

Phototherapy

• Maximize baby's skin exposure to the light.
• Cover only the eyes.
• Vital signs & SB monitoring.
• Extra fluid.

Preparing for Discharge

• Health education.
• Client-centered approach.
• Providing information and arranging follow-up with resources.
• Including immunization, follow-up checks, and family planning considerations

Neonatal Nutrition

• Needs
• Breastfeeding
• Formula feeding
• Important considerations
• How to determine if newborn is getting enough nutrition.

Elimination

• Pass urine/meconium within 12 hours.
• Monitor stool & urine
• Abnormal appearance of stools/urine

Hygiene

• Care for eyes. - keeping of cord clean & dry.

Neonatal Immunizations

• Vaccination schedule (Hong Kong)

Assessment of Maturity

• Estimation of gestational age, neurological maturity, musculoskeletal, external physical characteristics, and assessment tools

Assessment of Neuromuscular Maturity.

• Determining neurologic function
  • Common newborn reflexes: reflex testing
  • Estimations of gestational age: posture, square window (wrist), arm recoil, popliteal angle and scarf sign.

Transitional Period

• Stages of reactivity
• Period of inactivity to sleep phase.
• Second period of reactivity.

Normal Newborn: Needs and Care

• Aims of nursing care: maintain neutral thermal environment, identify physical problems and abnormal functions, promote hydration and nutrition, protect from injuries and infections, enhance parent knowledge.

Observation

• Observing general appearance, vital signs (temperature, respiration, pulse, blood pressure), eyes, nose, mouth, cord conditions, nutrition, elimination (urine, stool), sleep-wake cycle.

Additional Important Notes

• The content of this document is a summary of the provided materials. Further research and study for each concept listed are recommended.
• The information may include information from multiple sources and are specific to neonatal assessments in Hong Kong.