ch. 15 from notes

• newborn
• -birth through first 28 days
• -needs to adjust from intrauterine to extrauterine life

• -approx 30 ml amniotic fluid in lungs
• -surfactant in alveoli
• -initiation of respitations (pg. 282)
• -effect on pulmonary circulation and gas exchange

• -physiological changes
• -initiation of changes
• -decrease pulmonary resistance-increase pulmonary blood flow-increase systemic vascular resistance
• -ductus venosus, foramen ovale, ductus arteriosus

• -physiological changes
• -neutral thermal environment
• -brown fat
• -factors that negatively affect thermoregulation
• -decreased subcutaneous fat
• -decreased brown fat in preterm infants
• -large body surface
• -LOSS OF HEAT (cover head)
• -convection-air, o2
• -radiation-heat from baby to cooler objects
• -conduction-direct skin contact
• -evaporation-through fluid on skin

-cold stress occurs when: decreased environmental temp-decreased body temp-increased heart and resp. rate-increased o2 consumption, depletion of glucose and decrease surfactant-respiratory distress

signs and symptoms: cool skin, low temp, lethargy, tachypnea, hypoglycemia, etc

• -physiological changes
• -hypogylcemia - blood sugar less than 40

• -conjugation of bilirubin
• -conversion of yellow lipid soluble pigment into water soluble pigment (pee out)
• -conjugated (direct)

• -unconjugated (indirect) is the breakdown product derived from hemoglobin released primarily from destroyed RBC's
• -not in extractable form (cannot excrete)
• -potential toxin to CNS because of immature CNS and Liver

• -physiological changes
• -characteristics of stools
• -meconium- 1st stool within 1st 24 hrs (forms within the 4th gestational week-tarr like)
• -transitional-similar to meconium (watery 3-4 days)
• -breastfeed-yellowish, semi formed
• -formula feed-yellow, more formed
• -diarrhea-liquid

• -physiological changes
• -active humoral immunity-immunizations
• -passive immunity-not permanent, from moms immunoglobins
• -immunoglobins-delayed response
• -lymphocytes

• -3rd and 4th intercostal space
• can feel babys heart beat

neonates in the NICU

physical and neuromuscular maturity

small gestational age

average gestational age

large gestational age

• -initial period of reactivity (alot of mucous, cry alot)
• -period of relative inactivity (minutes after birth-sleep state-not reactive to external stimuli)
• -second period of reactivity (2-8 hrs-awake and alert-quiet, alerty, rapid, resp. with stimuli)

• -universal precautions
• -maintain body heat
• -dry immediately
• -support respirations
• -apgar score
• -vital signs
• -identify bands
• -neonatal assessment
• -gestational age assessment
• -administer erythromycin opthalmic
• -administer vit. k
• -bath with neutral ph soap
• -promote parent infant attachement
• -glucose level

• -vitals
• -temp
• -promote parent infant attachment
• -promote sibling attachment
• -prevent infant abduction
• -instruct parents to place neonate on back
• -assist with feedings
• -provide info on newborn care
• -provide information on normal newborn characteristics

• -newborn screening
• -state and national requirements
• -obtaining blood sample
• -newborn hearing screening

immunizations, hep b, vit k, intramuscular injections

• 1) plastibell
• 2) mogen
• 3) gomco