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NEWBORN, Neonatal transition
first 6 hours of life
-when the cardiac…
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Neonatal transition
- first 6 hours of life
-when the cardiac and respiratory system undergo the most changes
Respiration
- must immediately happen after birth
- pulmonary ventilation to establish lung expansion
- marked increase in pulmonary circulation
- first gasp initiates opening of alveoli
- passive liquid absorption happens with the fluid in the lungs; it may take several hours but the fluid will move into the interstitial tissue
- opposing factors: contracting force between alveoli, viscosity of lung fluid, and lung compliance
- respirations are diaphragmatic, shallow, and irregular in depth and rhythm
- obligatory nose breathers
- RR: 60-70 bpm
Cardiovascular
- first breath increases pulmonary blood flow
- pressure in left atrium increases and pressure in the right atrium drops
- increased aortic pressure and decreased venous pressure
- closure of the foramen ovale
- closure of the ductus arteriosus
- closure of the ductus venosus
- BPM 110-160
Hematopoietic
- hematocrit 1-2 g/dL
- neonatal RBCs have a lifespan of 60-70 days
- RBC count is 5.1-5.3 million
- BV is 85 mL/kg
Temp Regulation
- homeothermic
- thermoregulation is closely related to the rate of metabolism and oxygen consumption
- requires higher environmental temp to maintain a thermoneutral environment
Hepatic Adaptations
- liver is relatively large
- plays major role in iron storage, carbohydrate metabolism, conjugation of bilirubin, and coagulation, production of bile, regulation of plasma proteins and glucose
Gastrointestinal adaptations
- sufficient intestinal and pancreatic enzymes to digest most simple carbs, proteins, and fast
- lactose is the primary carb and is easily digested and well absorbed
- absorbed fats and proteins of breast milk better than other milks
- air immediately afters the stomach
- adequate digestion and absorption are essential nor newborn growth/development
- three stool kinds: meconium (1-2 days), transitional stools (3-4 days), fecal stools (day 5)
Urinary tract adaptations
- less able than adults to concentrate urine
- void immediately after birth
- bladder volume is 6-44 mL of urine
- appears cloudy, high in specific gravity
Immunologic adaptations
- not fully activated until sometime after birth
- s/sx of infection are subtle and nonspecific
- three major immunoglobulins (IgG, IgA, and IgM)
Reflex tests for newborns
- tests for neurologic integrity
Thermoregulation, respiratory, and cardiac function are the primary concern
Apgar Assessment
-used to evaluate physical condition of newborn at birth
- Heart rate, respiratory effort, muscle tone, reflex irritability, skin color
- 7-10 is good condition, less than 7 at 5 minutes should be watched closely
Clamping the cord
- placing a cord clamp on the newborn umbilical cord
- examine the cut end of the cord for 2 arteries and 1 vein
- number of vessels is recorded
- do NOT clamp abdominal skin
Newborn identification and security
- 4 ID bands are printed with matching numbers and places one on a wrist and one on an ankle
- the mother and partner also get a band
- band allows access to baby
- in some facilities an alarm is within the ankle band alerts if it is being tampered with or if the baby is removed from area
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Encouragement
- encouraging parents to identify unique behaviors in their newborns and learn their nurturing activities
- encouraging attachment of parents
Initial physical assessment
- abbreviated by systematic physical assessment in birthing area to look for any abnormalities
- size of newborn, contour, size of head, posture, movements
- RR, apical pulse, temperature, skin color, umbilical cord, gestational age, sole creases
Gestational Age
- used to make any connections with age related problems
- done within 4 hours
- external physical characteristics
- neurologic/neuromuscular development
Subsequent physical assessments
- more thorough, systematic assessment
- head to toe manner
- general appearance, weight and measurement, temperature,skin characteristics, birthmarks, head, face, nose, eyes, mouth, ears, neck, chest, cry, respirations, heart, abdomen, umbilical cord, genitals, anus, extremities, back, neurologi status, newborn behavior,
Religious Considerations
- may impact some of the process of the birth, post birth, and discharge
- work with family and pregnancy team to accommodate families wishes
Initial Care of Newborn
- maintaining clear airway
-keeping a close eye on the vital signs
- promoting thermoregulation
- preventing eye infection
- early assessment of neonatal distress
- initiation of first feeding
Prevention of complications
- are at higher risk for numerous complications
- keep a close sign on patient and mother
Patient education
- educating mother and partner on many aspect of baby
- answering questions they may have that will better care of baby
Hospital policy
- policies surrounding newborn identification and discharge
Circumcision
- a common procedure done post birth to male children
Breastfeeding
- a common and encouraged practice for feeding the child
- takes education and practice
Blood screening
- a few drops of blood from the heel can be used to test for certain disorders
- cystic fibrosis,galactosemia, congenital adrenal hyperplasia, congenital hypothyroidism, maple syrup urine disease, PKU, sickle cell trait, etc.
Other screenings
- new technology has created a screening done in newborn period
- can test for 31 health conditions
Standard tests
- CBG: look for early signs of diabetes
- CBC: signs of infection and to see if hematocrit is healthy
- urinalysis: look for maple syrup urine condition or other complications
Postpartum
- checking on the mothers well being
- ensuring the baby is going home to a safe space/family