What are the changes needed for shunts to close properly? 3
Increase in blood oxygen levels
Shift in pressure in the heart and lungs
Closing of the umbilical vessels
When the baby's lungs inflate to cause pressure decrease in the pulmonary artery, it causes this shunt to close.
Ductus arteriosus
Pressure increase in the left side of the heart causes this shunt to close
Foramen ovale
What are the hazards of cold stress?
Increased oxygen need leads to respiratory distress, leading to metabolic acidosis
What happens during metabolism of brown fat
When brown fats are metabolized in the presence of insufficient O2 supply, increased acid production will result.
Acidosis can be life threatening, and can interfere with transport of bilirubin to the liver, increasing risk of jaundice
Fill in Normal Vital statistics:
1. Weight
2. Length
3. Head
4. Chest
1. Weight: 5.5 lbs to 8 lbs (1 lb = 454 grams)
2. Length: 19-21 inches (1 inch = 2.54 cm)
3. Head: 13-14 inches
4. Chest: 1 inch less than head
T or F: a newborn baby's heart rate could be irregular
True d/t immaturity
What is normal BP of newborn?
80/46 (not routinely measured; may be inaccurate)
T or F: Bilirubin will be low in the first week of being born
False: will be high in first week (12mg/dl) from destruction of unneeded RBCs
What is RDS in newborns? What causes it?
Neonatal respiratory distres syndrome, often seen in premature babies.
Causes: occurs in infants whose lungs have not yet fully developed.
Lack of substance in lungs called surfactant, which helps lungs fill with air and keep the air sacs from deflating.
What are some tx options for RDS?
cpap
warm, moist O2, blow-by
How much urine should you see the first 2 days? first week?
First two days: 30-60 ml/day
First Week: 300 ml/day by first week
T or F: Uric acid crystals in newborn urine is common
true
What is another name for the startle reflex?
Moro
What is normal physiologic range of jaundice?
What is a higher amount that would need phototherapy? How much that could cause Kernicterus (brain damage d/t Jaundice)?
Normal: >7mg/100mL
Phototherapy needed: 10-12mg/dl, sometimes 15-17
Kernicterus: 20mg/dl
What is vernix caseosa? (hint: appears as a white/ cheese-like substance)
Protective layer on the baby's skin. Developed on the baby's skin while in the womb.
Match term with definition:
1. an edema of the scalp at the neonate’s presenting part of the head. It often appears over the vertex of the newborn’s head as a result of pressure against the mother’s cervix during labor.
2. a collection of blood between the periosteum of a skull bone and the bone itself. It occurs in one or both sides of the head. It occasionally forms over the occipital bone.
a. Cephalehematoma
b. Caput Succedaneum
1. b
2. a
What is choanal atresia? (Hint: choana = back of the nasal passage)
a congenital disorder where the back of the nasal passage (choana) is blocked, usually by abnormal bony or sift tissue.
How can choanal atresia be temporarily treated?
Inserting an NPA. Surgery might be needed.
What keeps the foramen ovale open?
As long as the placenta is doing oxygenation of the fetus blood
Fill in what each value of apgar (0, 1, 2)
Color
HR
Reflex irritability
Muscle tone
REspiration
Color: blue, acryanotic, completely pink
HR: absent, <100, >100
Reflex: no response, grimace, active cry
Muscle tone: Limp, some flexion, active motion
Respiration: absent, hypoventilation / weak cry, good ventilation, crying
If APGAR score is less than ___, you want to recheck again at 10 minutes.
Less than 7.
Initially check at first minute, then 5, then 10 or 15 depending on low scores.
Preterm babies (24-36 weeks gestation) will lack this kind of fat, and what important factor for their lungs
Brown fat and surfactant
What is normal vital statistics for each:
Weight
Length
Head
Chest
Normal weight loss
Weight 5.5-8 lbs
Length: 19-21 inches
Head: 13-14 inches
Chest: 1 inch less than head
Normal weight loss 5-7%
- >10% is concerning
What is a normal Hct for newborns?
55-65%
The first stool of a newborn is called what?
Meconium
Fill in: Infants should void within the first __a__ hours.
__b__mL/day for the first two days
__c__mL/day by the first week
a. 24 hours
b. 30-60mL
c. 300mL
T or F: IgG comes from the mom, which is passed through breast milk
False: it passes through the placenta
T or F: IgA comes from the mom which is passed through breast milk
True
Which reflex is the startle reflex?
Moro
How do you perform the rooting reflex?
Stimulate the side of the baby's cheek or lip, this is for the baby to look for the nipple
What is dangerous bilirubin level (kernicterus) of jaundice? __mg/dl.
When do you start doing phototherapy?
20mg/dl
When levels get too high, bilirubin will get into the CNS, called kernicterus
Start doing phototherapy around 12-13mg/dl
Vernix is to protect against what?
Contact with amniotic fluid in the uterus
Premies are covered with it, and can be difficult to completely remove
A baby without enough vernix caseaso can have this happen to their skin
Desquamation: lines and peeling of the skin, which can cause rashes
What is difference between caput succedaneum vs. cephalohematoma?
A caput succedaneum is an edema of the scalp at the neonate’s presenting part of the head. It often appears over the vertex of the newborn’s head as a result of pressure against the mother’s cervix during labor. The edema in caput succedaneum crosses the suture lines. It may involve wide areas of the head or it may just be a size of a large egg.
Cephalhematoma is a collection of blood between the periosteum of a skull bone and the bone itself. It occurs in one or both sides of the head. It occasionally forms over the occipital bone. The swelling with cephalhematoma is not present at birth rather it develops within the first 24 to 48 hours after birth.
What is subconjunctival hemorrhage and when can it occur?
A subconjunctival hemorrhage is a medical condition that happens when the small blood vessels located just beneath the eye ruptures. Although it can happen at any age, it typically happens to newborn infants when trauma occurs during a stressful delivery.
What is the dubowitz exam?
An examination called the Dubowitz / Ballard Examination for Gestational Age is often used. A baby's gestational age often can be closely estimated using this examination. The Dubowitz /Ballard Examination evaluates a baby's appearance, skin texture, motor function, and reflexes.
What will you apply to the baby's penis after circumcision to prevent the diaper from sticking?
