Factors affecting adaptation to extrauterine life:

Prenatal : Mother’s health – emotional problemsnutritional statuscomplications of PG ie: toxemia, placental

problems,diabetes, wt. gain, infection

Intrapartum: length of lavor - long ; precipitatelength of time membranes rupturedmedications given – type & when ie: Demerol found in

urine 2 wks latertype of delivery - forceps, vacuum extraction, C-Section

(transient tachypnea),

Immediate care: Airway assess respirations - head lower than body

If meconium stained What do you do?Circualtion ie fetal circulation vs neonatal circulationWarmth - from 98.6 to 72 degree, brown fat if full term

dry- skin to skin on mom, use warm blanket over bothInfection prevention – no protective skin flora, triple dye to cord

eyes - crede triple ung. , silver nitrate )gonococcal opthalmia neonatorium

Identification Measure & weigh

APGAR: 1 & 5 MINUTES

7 – 10 = normal newborn

4 – 6 moderately depressed may need ventilation support KEEP WARM

0 – 3 or 4 severely depress. endotracheal intubation, inflation of lungs with O2 use of cardiac stumulantes correction of metabolic acidlosis & hypoglycemia KEEP WARM

Chest circumference =Or 2 cm less than head

Interactionof stimuliin initiationof neonatalrespiration

Neonates areNOSE breathers

Shallow & respirations are irregular 30-60, apnea lessThan 15 seconds

Heart sounds: remember closures are functional NOTpermanent.

Blood pressure 78/42 often drops to 62/40 first hours of lifeVaries day to day first month, crying will increase BP

Blood volume 10% greater than adults, 20-30% increase in RBC, decrease of 20% plasma. Late cord clamping may Increase blood volume as much as 40-60%.80-110ml.

RBC’s = 5 to 5.8, decrease to 4.2-5.2 by end of first month

Hemoglobin at birth 80% = fetal hemoglobin BUT fetalhemoglobin has shorter life span, by 5 weeks only 5%.15-18g/100cc. What is norm adult? 12-16

WBC = 18,000 at birth, 23-24,000 first day, 11,500 afterffirst few days.

Platelets – essentially same as adult exception those that tookaspirin

Blood groups established early in fetal life, but become evenmore pronounce after birth

IMPERFORATED ANUS

Renal system: void 12-24 hours. Immature kidneys; therefore, decrease ability to excrete meds =buildup, toxicity.40% of body weight = ECF; therefore more susceptible to fluid & electrolyte imbalance. Void 6-10 / day. I & O = weigh diapers, 1gm = 1cc

GI: intestines sterile, VITAMIN K ?Stomach holds 15cc at birth, by second day up to 2-3 oz.

Right side placement for best digestion

Stools difference between breast and formula fed

Wt. Lose 5 – 10% of body loss

Hypoglycemia can compromise CNS, brain dependenton glucose, increase RDS. S&S: tremors, cyanosis, seizures, apnea, irregular resp.

hi-pitched weak cry, hypothermia, poor feedingBS falls rapidly – stabilizes at 6-12 hours after birth

Increase demand due to metabolic energy because:establish respirationsincrease muscular activitymaintenance thermoregulations

Increase incidence:preterm (decrease glycogen stores)IUGRcold stressedperinatal stress, asphyxia

` IDM – insulin dependent motherRH incompatibility

Physiologic hyperbilirubinemia or NORMAL jaundiceIn 50% term, 80-90% of preterm

Icterus Neonatorum = jaundice of the newbornIf noted before 24hours of age – breakdown started in utero

usually RH or ABO incompatibility or infection

See usually 48-72 hours after birth

Visible in nose at 3mg, face at 5mg, chest 7mg, abd 10my legs 12mg, palms at 20mg.

Hypoglycemia, hypothermia, apshaxia cause acidosis, whichincrease fatty acid, this decreases albumin binding of bilirubinsince fatty acids bind with albumin.

Cephalhemotma or bruising will increase jaundice WHY??Kernicterus = most serious complication

Psudomenstration = female

Swelling of breast = either sexSmegma = either sex, from sebaceous glands

white cheesy secretions

Acrocyanosis

Mongolian Spot

LANUGO

Molding

Bilateral Cephalhematoma

Desquamation

Nevus FlammeusPort Wine Stain - permanent not elevated; 3:1000 newbornsdoesn’t blanch with pressure

Stork bite or Nevus simplex or angel kissRed pigment, blanches with pressureFades in 1-3 years. Often at nape of neck, forehead occiput, eyelid or nose.

Strawberry hemangioma or Nevus vasculosus1 – 3 % born with another 10% develop within 1-4 wks.These may continue to grow but then disappear by school age. Usually do not take off surgically unless on eyelid or lips & interferes with everyday life

Milia

Erythema Toxicum or Newborn Rash

candidias

Candida albicans - thrush

Dermatitis

Neuromuscular:CNS is immature only some nerves are mylinated; therefore,

movement is uncoordinatedBrain is growing fast requires glucose and O2Newborn shows remarkable sensory development, ability for

self organization and social interactionTransient tremors& uncoordinated movement are normal

BUT if more severe check glucose level

REFLEXES check for absence, lag of response or most VIP SYMETRY

Absence, lag or asymmetrical response can be due to neuro (CNS) damage, injury, retardation or severe prematurity.

TONIC NECK

STEPPING OR DANCING REFLEX

GRASP

BABINISKI

MORO REFLEX - WITH SUDDEN MOVEMENT OR CHANGE OF EQUILIBRIUMSTARTLE - WITH SUDDEN LOUD SOUND

GRASP

Rooting