What is Apgar scoring?
Scoring test performed at 1 minute then at 5 minutes. If the score is less than 8, then it is probable that some measure need to be taken
Each of the following gets a score of 0 – 2, giving a total score of 0 – 10:
Heart Rate, Respiratory effort, Muscle tone, Reflex irritability, Color
Describe the newborn sleep cycles.
Defined according to duration, length of cycle dependent on age of the newborn.
First period of reactivity – baby is alert, initiate breast feeding
Period of inactivity / sleep phase – Baby sleeps for a few hours
Second period of reactivity – Baby is bathed within 3rd and 4th hour, sometimes under a heat lamp. The baby may be submerged into water.
The baby sleeps 16 to 20 hours per day for the 1st 2 weeks.
Describe the newborn sleep states.
Sleep states: Deep / Quiet sleep – regular breathing, no movement except sudden body jerks, Active REM – irregular breathing, body twitching, may cry out but not awake, Quiet alert – Infant awake and involved with the surroundings, Awake / crying states
Discuss newborns and temperature.
Temperature regulation – babies lose heat very rapidly. When a baby is cold, there is: An increase of O2 consumption, An increase of utilization of glucose (hypoglycemia) & brown fat, An increase need for calories, An increased risk for metabolic acidosis, A decrease in surfactant production.
They lose heat by: Convection – Body heat lost to cool air flow, Conduction –Body heat lost to blankets, etc., Radiation – Body heat lost to cool temps., Evaporation – Body heat lost due to moisture from skin and lungs., Management – babies are stimulated to breath by drying action post birth.
Discuss the normal newborn vital signs.
Vital signs: Temperature – per axila 36.5 – 37.0 C / 97.9 – 98.0 F ** first temperature is done rectally to check for unperferated anus. Then it is performed at the axillary. If the baby’s temp in < than 97.8, double wrap the baby and check again. Babies cannot shiver to warm their own body.
Pulse / Heart Rate – Apical: 120-140 bpm. Varies with sleep / crying
Respirations – 30 – 60 breaths / minute
Blood Pressure – In arm / thigh. May be higher in thigh. 65-41 mm/hg. It is important for the closing of the vessels.
Discuss the normal newborn weight.
Average weight: 3400 grams or 7 lbs 8 oz. There is usually a 5 to 10 % weight loss in the first few days. It is regained within 10-14 days.
Discuss the normal newborn length.
Average length: 45.2 cm to 55 cm or 17.8 inches to 27.7 inches
Discuss the normal newborn head.
33 –35 cm / about 2 – 3 cm larger than chest. Measure right above the brow. Look at fontanels – anterior and posterior – Bulging? Sunken?
Caput succedaneum – Spongy, collection of fluid (like coneheads). It does cross the suture line, will settle down in 24 hours. – Due to edema. Cephalohematoma – Does not cross the suture line – Due to birth trauma. **Extreme size differences in head may indicate microcephaly, hydrocephaly or ICP.
Discuss the normal newborn eyes, nose, mouth & throat.
Check alignment, symmetry – helix of the ear should be above the eyeline. Check for cleft palate. Check for Birthmarks, Milia – White pinhead size keratin-filled cysts. Will go away on its own. Check for newborn rash.
What are the different types of newborn birthmarks?
Birthmark = hemangioma. Strawberry hemangioma - bright red and sticks out of the skin, so it does look a little bit like a strawberry. Some strawberry hemangiomas go away on their own by the time a kid is about 5 years old. Almost all strawberry hemangiomas go away by themselves by the time a kid is about 9 years old.
Cavernous hemangioma - is beneath the outer layer of skin. This type of birthmark is deep beneath the outer layer of skin. This kind of birthmark is puffier than a strawberry hemangioma. It's bluish-red. Cavernous hemangiomas usually don't go away by themselves.
Port-Wine Stains: This isn't puffy or raised, it's level with the outer layer of skin. A port-wine stain is an area of skin that is either maroon or dark red. Kids who have port-wine stains usually have them on the face and neck.
Moles - any brown, blue, or black spots on your skin since birth. Moles are tiny collections of pigment cells -cells that contain color. Like other birthmarks, moles don't hurt and usually aren't a sign of illness in kids.
Discuss the normal newborn neck and body.
Vernix – waxy substance that protects the baby in utero. More than usual = that the baby is immature. Check for skin folds, if not, baby has a web neck. Lanugo – downy, fine hair that is lost as the baby matures.
Discuss the normal newborn chest.
Circumference 32-33 cm. Evident xiphoid. Chest measured a the nipple line. Breast enlargement – enlarged do to hormones. Witch’s milk. Do not squeeze out this milk. Check for extra nipples. Sternal retractions. Listen for lung sounds. Lung maturation: Lung functions after 26th week gestation. Lung surfactant okay at 35 weeks gestation. Check clavical for breaks – can occur during delivery. Respiratory effort: Within the 1st minute of birth: Loud & lusty cry, No dyspnea, No retractions, Respiratory rate < 60 / min, Diaphragmatic & abdominal muscles used, Nose breather.
Mouth = circumoral cyanosis
Discuss the normal newborn abdomen.
Umbilical cord – 2 arteries and 1 vein – Obtain cord blood sample in delivery room.
When cord cut, check to see the three vessles. Brachial and femoral pulses – measured at the umbilicus.
Discuss the normal newborn back and shoulders.
Spine intact. Check for lanugo. Check for mongolian spots – greenish color, lower portion of the body. Run finger down the spine to assess for abnormalities. Check shoulder for break / dystocia – can occur during delivery.
Discuss the normal newborn gastrointestinal and genitourinary.
Listen for bowel sounds. Patent anus. Passes meconium within 24 hours. Urinate within 24 hours. Stools will transition from meconium to:
Seedy – breast fed. Pasty – formula fed.
Discuss the normal newborn genitalia.
Male: Testes palpable in scrotum. Scrotum pendulous, rugae. Check for no hypo or epispadia. Check for testicle descended. Female: Check that labia & clitoris is edematous.
Pseudomentruation. Hymenal tag. If baby is premature, you may see labia minora, labia majora and clitoris all at once.
Discuss the normal newborn extremities.
Check for syndactly / polydactly – check both upper and lower. Check for webbed extremities. Check ortolani’s maneuver – for hip dislocation.
What are the newborn reflexes?
Blink, Rooting – Aid to breastfeeding - Rub jaw, baby will turn and open mouth. Sucking – should be strong, Palmar and plantar grasp – place finger on palm, baby will grasp. Stepping – simulate walking. Tonic Neck / Fencer – Moro – Startle reflex – baby will move hands close together, Babinski – not present as normal in adults. Will fan toes when stroking bottom of foot. Trunk incurvation – Rub the side of the trunk and the baby will turn to that side.
What is the newborn nutrition?
Breast Milk: Colostrum – in the first 3-4 days after birth. Rich in protein, low in sugar and fat, also has minerals, vitamins and maternal antibodies. Transitional milk – Seen day 2 – 4. Mature milk – by day 10
Fore milk, Hind milk – higher in fat – allows for rapid growth of the newborn.
Metabolic Screning Test (or PKU) – blood from baby done prior to 72 hours.
Discuss the newborn stools.
Meconium – Sticky, tarry, blackish green appearance. Passed within the first 24 hours. Transitional – 2nd or 3rd day of life color and consistency changes to greenish brown loose stools
Breast fed stools – More liquid, seedy, yellow color – breast milk easier to digest.
Bottle fed stools – Formed, pasty, brownish-yellow.
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