OB Exam 4

first few hours of life, in which the newborn stabilizes respiratory and circulatory functions

composed of surface-active phospholipids (lecithin and sphingomyelin) which are critical for alveolar stability

the contracting force between the alveoli

the ease with which the lung is able to fill with air

a breathing pattern characterized by pauses lasting 5-15 seconds

as a result of placental transfusion, low po intake, and dimished extracellular fluid volume

initial decline in hemoglobin

80-100 days, approximately 2/3 the life span of an adults

specific environmental temp range, where the rates of O2 consumption and internal body temp are maintained because of thermal balance

loss of heat from the warm body surface to the cooler air currents

losses occur when heat transfers from the heated body surface to the cooler surfaces and objects not in direct contact with the body

the loss of heat incurred when water is converted to vapor

the loss of heat into a cooler surface by direct skin contact

important mechanism of heat production unique to newborns, skin receptors percieve a drop in temp and thus stimulate the SNS

dark colored fat, enriched blood supply, dense cellular content, and abundant nerve endings

the sum of direct (conjugated) and indirect (unconjugated) bilirubin

less than 3 mg/dl

caused by accelerated destruction of fetal rbc's, impaired conjugation of bilirubin and increased bilirubin reabsorption from the intestinal tract

4-6 mg/dl

3-5 and 5-7

appears in the first days of life, appears to be associated with poor feeding practices

formed in utero from amniotic fluid and its constuents, intestinal secretions, and shed mucosal cells, thick, tarry black or dark green

the pregnant woman forms antibodies in response to illness or immunizations

when IgG antibodies are transerred to the fetus in utero

closed eyes with no movement, regular even breathing, jerky motions or startles at regular intervals

active rapid eye movement, irregular resp, minimal activity, irregular sucking

the newborns ability to process and respond to complex stimulation ie bright light

newborns ability to be alert,, to follow and fixate on appealing and attractive complex visual stimuli

1. external physical characteristics 2. neurologic or neromuscular development

a set of procedures developed to determine gestational age through neuromuscular and physical assessment of a newborn infant

fine hair covering the baby, greatest amounts between 28-30 weeks

bluish discoloration of the hands and feet

lacy pattern of dilated blood vessels under the skin

  (clown) color change is occasionally notes: a deep red color develops over one side of the newborns body and the other side remains pale

 yellowish discoloration of skin and mucous membrane

 an eruption of lesions in the area surrounding a hair follicle that are firm, vary in size from 1-3 mm and consists of a white or pale yellow pustule with an erythematous base

 exposed sebaceous glands, appear as raised white spots on the face especially across the nose; no tx necessary.

assess over the abdomen, forearm or thigh

 whitish, cheeselike substance, covers the fetus while in utero and lubricates the skin of the newborn

 pale pink or red spots frequently found on the eyelids, nose, lower occipital bone, and nape of the neck. usually fade by 2nd bday.

macular areas of bluish black or gray-blue pigmentation on the dorsal area of the buttocks. common in dark skin races. gradually fade. should be documented on newborns chart-as they can be confused as bruises

capillary angioma directly below the epidermis. red-to-purple area of dense capillaries. does not grow in size, fade nor does it blanch.* if convulsions and other neurological problems accompany the mark it suggest Sturge-Weber Syndrom with invlovement of the 5th cranial nerve

 capillary hemangioma. raised, clearly defines, dark red, rough surface, commonly found on head; grows rapidly starting 2nd - 3rd week of life reaches full size 1-3 months. they can later shrink and are best cosmetically when allowed to resolve spontaneously

asymmetry caused by over-riding of the cranial bones during labor and birth

 premature closure of the cranial sutures

asymmetry caused by pressure on the fetal head during gestation

 a collection of blood resulting from ruptured blood vessels between the surface of a cranial bone and the periosteal membrane

 localized and easily identifiable soft are of the scalp, usually from long difficult labor and use of vac. causes increase of tissue fluids, swelling and occasionally some bleeding

may be caused by the instillation of silver nitrate drops into the newborns eyes

 appear in about 10% of newborns and are commonly found on the sclera, remain for a few weeks, no long-term effect

small glistening white specks on hard palate and gum margins (keratin-containing cysts) that feel hard to the touch, are often present. usually disappear and are of no significance.

 white patches in infants mouth, usually from infected mother during birth, treated with nystatin

first week of life infant has vaginal discharge composed of thick whitish mucous, which can be tinged with blood. caused by withdrawal of maternal hormones

 white cheeselike substance, often present between the labia -do not remove

occurswhen the urinary meatus is located on the ventral surface of the penis

 where the meatus is on the dorsal surface of the glans

condition in which the opening of the foreskin is small and the foreskin can not be pulled back

 failure of the testes to descend

a collection of fluid surrounding the testes in the scrotum

presenseof extra digits on either the hands or the feet

 fusion or webbing of fingers or toes

 damage to the upper arm (5th and 6th cranial nerves)

 when the newborn is supine and the head is turned to one side, in response, the extremities on the same side straighten, whereas on the opposite side they flex

when the newborn is startled by a loud noise or lifted slightly above the crib and then suddenly lowered. in response, the newborn straitens areas and hands outward while knees are flexed

 seen when newborn is prone, stroking the spine causes the pelvis to turn to the stimulated side.

a surgical procedure in which the prepuce, an epithelial layer covering the penis is separated from the glans penis and excised

released from the anterior pituitary in response to breast stimulation from suckling or the use of a breast pump-doubles each time an infant suckles, stimulating milk secreting cells

the milk that flows from the breast at the start of feeding or pumping -watery milk high in protein and low in fat

acts on myoepithelial cells surrounding the alveoli in the breast tissue to contract, ejecting milk called the 'milk-ejection reflex'

rich in fat (can exceed 10%) and therefore high in calories

initial milk that begins to be secreted during midpregnancy and is immediately available to the baby at birth. thick, creamy yellowish fluid with concentrated amounts of protein, fat-soluble vitamins and minerals and has lower amounts of fats and lactose compared to mature milk

qualities intermediate to colostrum and mature milk, still slight yellow.

white or slightly blue-tinged in color. present by 2 weeks postpartum and continues thereafter. 13% solids (carbs, protein and fats) and 87% water

modified cradle, cradle, football or clutch and side-lying

the infant's chance of death within the newborn period (1st 28 days of life)

infants that are less that the 10th percentile for birth weight

pregnancy circumstances of advanced gestation and limited fetal growth

long term maternal conditions (chronic hyptertension, substance abuse, etc.)

associated with acute compromise of uteroplacental blood flow

any newborn born after 42 completed weeks of gestation

infant who is born after 42 completed weeks of gestation and also demonstrates characteristics of postmaturity sydrome (hypoglycemia, meconium aspiration, polycythemia

any infant born at 36 6/7 or less weeks gestation

cessation of breathing for 20 seconds +, or for less than 20 seconds when associated with cyanosis, pallor, and bradycardia.  common problem in preterm infants between day 2 and 7.

the ductus arteriousus fails to close because of decreased pulmonary arteriole musculature and hypoxemia

results from inadequate surfactant production

very common bleed in preterm infants of less than 34 weeks gestation and weighing less than 1500g

during labor pH 7.25 + is considered normal (nonacidemia) a pH of 7.20 - is considered an ominous sign of intrauterine asphyxia (acidemia) and a pH of less than 7 is considered pathogenic acidemia

aka hyaline membrane disease is the result of a primary absence, deficiency or alteration in  the production of pulmonary surfactant

excessive heat loss resulting in the use of compensatory mechanisms (such as increased respirations and nonshivering thermogenesis/use of brown fat stores) to maintain core body temperature

plasma glucose concentration of less than 40 mg/dl at any time in any newborn

normal process that occurs suring the transition from intrauterine to extrauterine life and appears after 24 hours of life

occurs when an Rh-negative mother is pregnant with an Rh-positive fetus and the maternal antibodies cross the placenta, thus destroying fetal rbc's

most severe form of erythroblastosis fetalis, occurs when maternal antibodies attach to the Rh site on the fetal rbc's making them susceptable to destruction; severe anemia and multiorgan system failure result

a result of the normal gradual drop in hemoglobin for the first 6-12 weeks of life; at about 72 days of life the infants bone marrow begins producing rbc and anemia disappears

condition in which blood volume and hematocrit values are increased, more common in IUGR, fullterm or late preterm infants, transfusion from delayed cord clamping, cord stripping, twin-twin transfusions, mothers who smoke and intrauterine hypoxia

newborns up to 1 month are susceptible to this infection. caused by organisms that would not cause significant disease in older children