MB4 Newborn Goodman

birth to first 28 days of life

maternal

if mom is diabetic, STDs

important b/c one time will get good head to toe physical:  ID any probs

done before bath may miss something and find after bath

• 1. maternal Hx
• 2. phys exam
• 3. interaction & assessment of bonding
• 4. analysis of blood type, Hct, and HgB

studies show more likely to be abused if no bonding in hospital

Rh and ABO incompatibilities

if mom is anemic

iron supplements

take care of the baby well to be a good example

change often role model loving behavior

bathing baby teaching

allow for rest, sleep when the baby sleeps and get some help from family etc

PP depression and bad parenting

bonding

32-38cm

45-55cm

30-36cm

5.8lbs to 8lb& 13 oz (2500-4000 g)

120-160

30-60

97.7 - 99.1 axillary

• 1. head & chest circumference
• 2. length & weight
• 3. HR
• 4. RR
• 5. axillary temp

may not have patent butt - tissue trauma

measure around largest part


may not be a prob.  could be molding

sutures overlap and make head look thin and skinny - day 1 or 2 will get round again and will have a higher head circumference

anterior - 12 - 18 mo

post - 2 to 3 mo

head is made of 5 ind plates - sutures are where bones meet

sutures may overlap - will be normal in 2 days

1. could be ICP

2. could be subdural hematoma

• 1. preemies
• 2. babies with traumtic births

seperated sutures

• 1. fontanelles
• 2. sutures
• 3. molding
• 4. caput succedaeum
• 5. cephalhematoma
• 6. craniotabes

swelling that is a build up of fluid accumulation b/t bone and skin of the skull that occurs due to pressure against the pelvis of the mother

occurs over the head like a cap and crosses suture lines

bleeding b/t the bony plate & periosteum that does not cross suture lines

edema will go away in 1 to 2 days

can take weeks

softening of the bone that may be due to lack of Ca in mother's diet

must be very careful with baby's head until the bone hardens

scary for parents

soft and flat

1. increased ICP & ass. with hydrocephalus

• overriding
• meeting
• seperated

posterior head elongates to fit through mothers cervix and pelvic contours - cone head baby

in a few days

caput - appears at birth and resolves in a few days

cephalhematoma appears in 24 h and takes months to resolve

• 1. eyes,
• 2. ears
• 3. nose
• 4. mouth
• 5 neck/clavicles

conjunctival hemorrhage due to excessive pressure on eyes as coming through the birth canal

3 to 6 weeks

usually don't have them until 3 to 4 mo old b/c lacrimal duct not working yet

will have grey - brown eyes

will not get true eye color until 3 to 12 mo old

osteogenesis imperfecta

can occur normally esp if a lot of trauma

can be caused by ERY eye ung

can be congenital glaucoma

congenital cataracts

retinoblastoma

Asian or down syndrome

normal

normal in newborn

can be occluded lacrimal duct and will need Tx

not fully dev

look normal but really soft

should be even with outer canthus of eye

possibly down syndrome

look at mom and dad to see if genetic

usually in area in front of ear

can be clipped off or tied off

can indicate chromosomal abnormalities or kidney probs

in front of the ears

not a prob but parents will notice and ask about it

required for all newborns in every state

baby will usually cease crying to listen for sounds

nose - cannot breathe through their mouth

suction mouth then the nose

one side of nose has no opening

watch for congestion in open side

hold the side that is open closed and see if baby can breathe

• 1. open easily
• 2. sucking reflex
• 3. frenula membrane may be intact  (tongue tied) can correct itself
• 4. check palate

Teach parents that it should correct itself and if it doesn't will need to be clipped

Epstein pearls - inclusion cysts

candidiasis

wipe white spot with rag and if it doesn't come off it is yeast

• 1. gentian violet
• 2. griseofulvin

stains everything purple

baby born with teeth

usually not a prob unless they are loose - ped will pull them

check for loose teeth

• 1. short chubby neck with skin folds
• 2. check for fractured clavicle
• 3. check for Herb's palsy

• 1. one arm will be just hanging and other moving around
• 2. may feel crepitus

paralysis of should and arm muscle due to permenant nerve injury during birth

meningitis

if you move/turn baby will let out horrific squeal b/c painful neck

can cause eye infection and blindness

lacrimal duct obstruction

blue sclera

white light test - pupil

congenital problem - chromosomal

white iris

neck injury during birth that causes shoulders to be offset (one lower)

2 years old

head is heaviest part and if get off balance will fall on their head/fall into things that they are looking into like buckets of water

may be slightly enlarged due to maternal hormones

may have leakage of milk called witches milk

should  be round and soft

may have no intestines

about an hour after birth

anytime after birth

do not use alcohol on umb and it can be submerged

when cord falls off need to cont to clean area for a few days

more mature they are = more rugae on testicles

testicles should be down

• 1. may be inguinal canal and not come down
• 2. may be born with no testicles

at risk for testicular cancer later in life

cryptorchidism - absence of testicles

epispadias

hypospadias

fluid accumulation in scrotal sack around testicles

if have large testicle shine light through it

hydrocele with transilluminate/light up

hernia will not transilluminate

2cm

cottage cheesy stuff around head of penis esp in males that are uncircumcised

no


put it back or can cause ischemia

prepuce

have a small penis inside vagina with meatus way inside the vagina

surgical removal of foreskin of the penis

on 8th day of life

• 1. if have epi or hypospadius
• 2. Hx of bleeding tendency in family

• 1. bleeding
• 2. infection
• 3. skin dehiscence
• 4. adhesions
• 5. urethral fistula
• 6. pain

quarter size

• 1. redness
• 2. discharge
• 3. odor
• 4. urethra fistula
• 5. pain

• 1. DPNB/ring block
• 2. topical anesthetic
• 3. sucrose pacifiers

inject local anesthetic around penile nerve

ring block

EMLA cream

takes 60-90 minutes to take effect

EBP shows that sucrose on passy helps with pain management as well as injections

• 1. mogen clamp
• 2. gomco/yellen clamp
• 3. plastibell clamp

plastic ring that fits over penis

suture tied around rim of the bell and a circle of prepuce is cut away so the foreskin can be easily retracted and glans exposed

rim remains in place for one week then falls off on its own

• 1. wash site daily, with each soiled diaper with warm water
• 2. apply vaseline if not plastibell
• 3. assess for urine output
• 4. cuddle, paci, console, observe for overstimulation
• 5. parent teaching
• 6. if see edema, drainage, redness, tenderness or inconsolable crying report to health care provider
• 7. apply diaper snug enough to prevent rubbing with movement but not tight encough to cause pain

always use vaseline on incision area with q diaper change

do not use vaseline - can cause ring to fall off and cause permenant damage

• 1. site may be red but should not have strong odor or discharge
• 2. site should not have active bleeding
• 3. a film of yellowish mucus is normal and should not be washed off

apply pressure and reassess - if still bleeding call physician

after ring comes off

baby should urinate within 6 to 8 h of circumcision

assess UO

don't over stimulate

teach s/s of infection and when to call the MD

normal to have a little spotting but not active bleeding

part of healing process and should not remove

if not off w/in 8 days

• 1. labia majora and minora cover clitoris?
• 2. hymenal skin tags
• 3. white mucoid discharge
• 4. pseudomenstruation
• 5. rectovaginal fistula

labia major and minora will cover clitoris

preterm will have small labia major and minora

skin tag that occurs around hymen of vag that is normal

normal - due to mom hormones

baby girl will have false period r/t mom's hormones

baby has actually cycled

rectovaginal fistula - opening b/t vagina and rectum

pull skin folds apart and may have dimple above butt

indication of spina bifida

tuft of black hair esp with spina bifida

sacral dimple not r/t spina bifida that doesn't go all the way to the spine

screens for hip dysplasia, clicks, and abnormal alignment

hips should be level and creases should be same on both sides

knees to chest then abduct legs with pressure on greater trochanter

checks for hip dysplasia

knee to chest with light pressure

if hip pops out = positive for dysplasia

1. should have meconium in 24 h

black, to dark brown and sticky

yellowish seedy stool with little odor

formula - offensive odor with green/brown color

• 1. less odor in breast fed
• 2. less poopy diapers in breast fed

will go from every day to 2 to 3 times per week

parents may think baby is constipated:  teach that baby may strain b/c doesn't know how to do it and is normal

no

water ring around the stool in diaper

48 h

no opening in anus

• 1. dark meconium to brown-yellow
• 2. transitional stool - green and loose
• 3. yellow loosely formed

6 to 8

breast - 3 to 4 stools/day for first 2 weeks

bottle - 2 to 3 stools/day for first 2 weeks

12 - 24 h age

urea crystals have formed in urine and urinated out

not a prob

called "brick dust"

when pass meconium

single crease from one side of palm to the other

down syndrome

can be normal

• 1. simian crease
• 2. low-set ears

webbing of the toes or fingers

extra digits

hands usually stay clenched

no

can indicate chromosomal disorder

if have bones will have surgical intervention

if don't have bones will tie off and fall off

chromosomal disorder

have long nails - need to cover hands

do not trim the nails

educate mom not use fingernail clippers on the nails - can peel off or nail file instead

hands and feet

24 to 48 h or may indicate circulatory prob

resp obstruction or cardiac defect

circuforential cyanosis or center of body

anemia r/t Rh incompatibility, blood loss, baby being held up too high before cord cut

red - polycythemia, crying,

ruddy b/c no SQ tissue so see blood

unilateral redness

side lying on will be very red and other will be very pale

caused by immature circulatory system

• face level - ~5 to 7 mg/dL
• mid-abd level - ~15mg/dL
• down to toes ~20mg/dL

at 5 to 7

from head and moves down

kernicterus

bilirubin crosses BBB and stains brain yellow and causes permenant brain damage

• 1. physiologic
• 2. pathologic

after 24 h

will occur at birth and before 24 h

pathologic

has a physiologic explanation

EX:  when baby is born will have excess blood and when natural hemolyze these -> filter through liver-> stool

if liver not mature enough will build up bilirubin and have jaundice

feed them as much as possible to get them to poop more

feed at least q 2 h

put baby under bilirubin lights to break down RBC and excrete faster

will be green and frequent

at risk for skin b/d r/t frequent stools

when gets to level of 7 to 10

breastfed more than bottle fed babies r/t breakdown product of progesterone from mother

feed more often to increase poo

• 1. when levels reach about 10 will do phototherapy
• 2. fluids
• 3. feedings
• 4. promote stooling
• 5. exchange blood transfusion

• 1. first 24 h of life
• 2. usually Rh or ABO incompatibility

within 72 h  - will get progressively worse

usually need blood transfusion

pallor b/c extremely anemic b/c attacked inutero

hydrops fatalis

swelling/edema build up in baby that can be fatal

indirect coombs - indirectly see if mom has antibodies for Rh factor

direct coombs - check baby's blood cells for antibodies bound to baby's blood cells

usually mother is O type blood and baby is B

with subsequent pregnancies, amniocentesis, chorionic villi sampling, trauma

same interventions as jaundice

phototherapy and feed a lot

green stools

q 12 h or more often

2 to 10 mL of blood w/d from baby and replace with donar blood that is Oneg

can affect glucose levels

• check glucose levels
•  
• at least an hour after the transfusion

• 1. immatur liver - all newborns esp preemies
• 2. dalay in feedings
• 3. delay in stooling

• nevus simplex - stork bite
• nves flammeus - prot wine stain
• strawberry hemangioma
• mongolian spots
• mottling
• cafe/ au lait spots

babies are nose breathers only

neves flammeus

will lighten if above bridge of nose and darken if below

permenant

dark and big 

usually on head

filled with capillaries

will begin to shrink and will fade usually b/t 6 and 9

will get larger before they start shrinking

problem with parents if able to be seen

nevus simplex

forehead, on neck

usually on the booty, hip, may be on shoulder -  and look like bruises

usually in AA, asian, and hispanics

beginning to occur in caucasians due to interracial

discoloration

cold stress, hypovolemia, sepsis

LIGHT BROWN AND CREAMY COLORED MACULAR LESION

not a prob unless have 6 or more spots that are greater than 1cm each can suggest neurofibromatosis

across nose and chin

due to immature sebaceous glands

go away in 2 to 4 weeks

don't pick at it - can cause infection

cream cheese like covering on infant to protect skin/lubricant

rubs off with bathing

more in prematures

usually gone in 2 weeks

shoulders, back, and upper arms

flea bite rash

erythematous macular spots that will spread, become papules then become pustules

eosinophil reaction to the environment that is usually harmless

only use water on the baby - do not use soap etc at all & watch for s/s of staff infection (fever, not eating well)

term babies have blink and immature swallowing reflex but will still gag a lot

preterm babies do not have swallowing reflex

hold baby on stomach and rub babies back up  side of spine and baby will curve to the side where you touched

spit out their food

step in place reflex

lift one leg and act like take a step

palmar is grasp reflex

plantar reflex - toes hold finger

startle reflex

put baby down briskly and baby will flare arms out then will come back with arms and make a C with the hands

stroke foot and toes flare out

fencing reflex

turn baby's head to a different side and the arm and leg on side head is turned to will be stretched out and opposite side will be flexed

• 1. PKU
• 2. thyroid/T4
• 3. sickle cell

heel stick then let the blood transfer to a paper without touching the paper to the skin

must have ate enough protein to allow PKU to build up

must wait 24 hours before doing

do 2 to 3 days after discharge if not done

sent to state and get results at 6 weeks checkup

anything in mom's blood is on the baby

1. start from top and work way down - butt last

2. warm water

3. give in incubator or in warm water

4. Make sure soap up well and rinse off well to prevent drying of the skin wash and dry as go

5. front to back on female genitals and don't retract foreskin

monitor temp closely

in the labor room if possible

hole b/t trachea and esophagus where baby will blow milk bubbles out of mouth

15 to 30cc q 3 to 4 h

in carseat until they are 4'9"

rear-facing

preemies may not fit in carseat and can be injured/suffocate if not sitting properly in it

can use rolled up blanket, towel, or diape to support head

may get hot in the summer check metal peices

in rear seat facing backward until reaches 21 pounds or is able to sit alone without support

may need special carseat and need to be fitted in before leave hospital

check for hot spots and make sure it is buckled in

typically 16 to 24 hours for about 4 hours at a time

by 4 months most will

will not help sleep and will decrease good nutrition and can cause later food allergies

mother should sleep too

when awake and being observed

• 1. on back
• 2. firm matteress
• 3. no loose blankets or pillows & stuffed animals
• 4. no sleeping with baby
• 5. give pacifier when put down to sleep

• 1. failure to process bilirubin because of inadequate intake or elimination
• 2. traumatic birth injuries
• 3. breastfeeding jaundice

smoking in utero and after birth

• 1. sucking
• 2. swallowing
• 3. tracheoesophageal fistula

infants born prior to 38th week

large for gest age

appropriate for gest age

small for gest age

baby weighs less than 2500 g or 5lb 8oz or less at birth regardless of gest. age

IUGR AKA intrauterine growth retardation

baby has failed to grow normally in utereo

born after 42 weeks gest

• 1. poor nutrion
• 2. cardiac defect in mother
• 3. occurs more in adol
• 4. partial abruptio placentae
• 5. diabetics
• 6. preg induced HTN
• 7. cigs
• 8. congenital prob with baby
• 9. toxoplasmosis or rubella

fundal height during assessments prenatal can show LGA and SGA

• 1. wasted atrophied muscles
• 2. usually have underdev. liver
• 3. poor skin turgor
• 4. large head r/t to body
• 5. hair will be dull
• 6. abd may be sunken in
• 7. usually have high Hct
• 8. significant and longer lasting acrocyanosis
• 9. decreased glycogen stores
• 10.

glucose below 40

symmetric - will grow abnormally in proportion

asymmetric - grow abnormally out of proportion

usually weight will be low and others OK

• 1. gest. diabetes
• 2. may have GH prob
• 3. obese mom with too much calories
• 4. transposition of the great vessels

higher fundal height than expected

CPD - cephalopelvic disproportion

more shoulder distocia, clavicle fractures, herb's palsy

• 1. usually have immature reflexes
• 2. low Ballard scores for maturity
• 3. bruising and injury
• 4. may have more caput succedeum and cephalohematomas
• 5. hyperbilirubinemia
• 6. hypoglycemia when from gest diabetes mother

transposition of the great vessels

baby has lots of insulin on board

will go straight to ICU b/c blood sugar WILL bottom out within 24 h b/c cut off from mom's high blood sugar

• 1. ruddy
• 2. small
• 3. not much SQ
• 4. no/less creases on feet
• 5. no rugae on boys
• 6. can see clitoris on girls
• 7. head is large
• 8. acrocyanosis
• 9. covered with lanugo and vernix
• 10. fontanels are small
• 11. ear cartiledge immature
• 12. poor/no muscle tone - laying flat
• 13. no sucking reflex and feeding probs

unknown mostly

premature

• 1. low socioeconomic status
• 2. lack of prenatal care
• 3. closely spaced pregnancies
• 4. UTI
• 5. preterm rupture of membranes

smoking

not much SQ or brown fat

no shivering mech (not in newborns either)

exposed more because don't flex

don't move a lot

should return to normal

if stay down can mean not mature or preterm

will be afraid to touch them b/c they look so fragile

limp and extended

have trouble learning to feed, breathe, and swallow at same time and don't want to eat

• 1. airway
• 2. resuscitation
• 3. lung expansion
• 4. positioning
• 5. drug therapy

first hours of life most critical to decrease risk or neuro defects like cerebal palsy

most are born acidotic and if they can't breathe -> more acidotic and will turn off production of surfactant

suction mouth then nose

dry the baby well

• 1. conduction - transferred to cold surface
• 2. convection - air movement/circulating
• 3. radiation - heat transfers from baby to nearby source of heat (window/heater)
• 4. evaporation - lose body heat thru moisture

evaporation b/c wet

heart failure

60 or less

it starts moving to increase temp and will burn brown fat if it has it

moving will increase need for energy and can cause hypoglycemia -> shock and loss of conciusness -> death

can cause blood flow to go back to intrauterine blood flow and stop surfactant  and decrease blood sugar

once expanded surfactant keeps them expanded

if need to give O2 give by mask 100% warmed and humidified

listen to both lungs - does baby have 2 lungs

if mother had narcotics with L&D need narcan avail. in case of resp depression

do not give baby narcan for resp depression - can cause withdrawals

EPI

sodium bicarbonate

suction well then admin thru endotracheal tube into baby's airway and dropped down

cannot suction again for an hour after surfactant is placed in airway - make sure suction well before

• 1. fussy and moving
• 2. acrocyanosis
• 3. jittery

BG and temp

transfer from newborn nursery to NICU

bare skin to bare skin on chest of parent

dehydrated

no BP no peepee

hypervolemia from too much IV fluids can cause brown hemorrhaging and can cause ductus arteriosus to reopen

• 1. pallor
• 2. tachypnea
• 3. tachycardia

bulging fontanel

give in as little fluids as possible to prevent hypervolemia

must monitor to prevent hypovolemia

1. will get NG b/c can't suck, swallow, and breathe and most have no suck reflex

2. best to give breast milk for immunity needed

3. give pacifiers to learn to suck

usually in 24 h

if void or defacate during

may or may not have bowel movement within 48 h

• 1. Encourage visiting and handling baby
• 2. take pics and send them with parents
• 3. encourage bonding
• 4. watch siblings for RSV
• 5. if infant dies take the equipment off the baby before letting them see it

• 1. look at condition of baby and mother during check ups
• 2. make sure the parents understand dev needs of baby
• 3. carseat fits
• 4. bonding

• 1. risk for infection
• 2. risk for altered nutrition
• 3. hypothermia
• 4. risk for altered bonding r/t equipment and absent from parent for long period

• 1. no adhesive tapes - will rip skin
• 2. disinfectants b/c not much tissue b/t skin and cells - use chlorhexidine
• 3. warm water - no soap

skin is so thin will leak through

betadine can cause thyroid issues

huge risk for infection

will not get high temp - will get low temp

preterm rupture of membrane

they have it

pain threshhold may be permenantly altered r/t so many needle sticks in preemies - will be more sensitive to pain

kangaroo care, swaddling, holding close, sucrose passy before sticks

tylenol

close softly

keep lights low and quiet

alarms turned down

need inutero env

1. dry skin and leathery appearance (alligator skin)

1. risk for meconium aspiration- will stool inutero

2. decreased placental function - decreased nutrition - will start loosing weight

3. injury risk if they are still big when delivered

4. hypoglycemia

5. hyperbilirubinemia

hypoglycemia

will have polycythemia r/t hypoxia r/t decreased placental functioning and RBC will be destroyed after birth to decrease blood volume

resp distress syndrome -lack of surfactant

hyaline membrane disease

baby born with a lot of fluid in lungs and come thru birth canal the fluid is sqeezed out -> blood that has been bypassing lung will now go to the blood -> RDS baby has no surfactant -> alveoli sticks together -> blood starts to shunt again like fetal circulation -> big prob

• 1. nasal flaring
• 2. sternal/subcostal retractions
• 3. tachypnea
• 4. cyanotic
• 5. grunting min to h after develops

• 1. treat with surfactant
• 2. may do O2 admin usually by CPAP
• 3. ventilation
• 4. supportive care

retinopathy - blindness that can be caused by too much O2

preemies

• 1. keep warm
• 2. monitor fluid & glucose
• 3. feed them

CPD - cephalopelvic disproportion

jaundice

• may have RR of 80 to 120X per minute
• along with s/s of resp distress but mostly high rr is imporatnt

s/s of resp are milder than RDS

retained fluid in the lungs during birth

C-section babies that didn't get squeezed

can occur hours after delivery

will peak in 36 h and gone in 72 h

RDS occurs imm.

1. gavage feeding until better

meconium aspiration syndrome - breathe meconium into the airway

suck tarry meconium into airway -> causes alveoli and airway to stick together

• 1. intrapartum can do amnioinfusion
• 2. at delivery when head first comes out use delee suction device to get as much meconium off perineum as possible
• 3. do not stim baby to cry b/c will suck it down farther - suction first and look down with endotrach light then look at RR ect

• clear the airway of meconium and clean up first
• then CPR

same as transient tachypnea -> stop producing surfactant -> can lead to cardiac arrest

mom's with negetive and O

babies with positive and B

pathologic

• 1. phototherapy
• 2. exchange transfusions
• 3. feed them
• 4. change diaper
• 5. serum bilirubin
• 6. skin tone

1. feed ASAP

genitals and eyes

feed q 2 h and check levels q 12 h

• 1. hypoglycemia r/t baby high insulin r/t mother hyperglycemia
• 2. all organs will be larger except the brain
• 3. baby will be huge if mom diet sucks - will have to take them out early b/c so big

40 to 60

will get too big

feed the baby then check again based on hospital policy

jittery

check BG

• 1. jittery
• 2. disturbed sleep pattern
• 3. want dark and left alone
• 4. frequent sneezing
• 5. convulsion
• 6. most like to be swaddled but not usually held
• 7. most like sucking a pacifier

if a mom is on drugs do not breastfeed

watch for need to call social services - baby may not go home with mom