NEWBORN by Prof. Unn Hidle Updated Spring 2010Suggested audio-visual:Suggested website:PowerPoint PresentationSlide 5Biological adjustment in the neonatal periodFetal breathingCardiopulmonary adaptationNewborn Pulmonary FunctionNewborn Cardiovascular AdaptationNewborn Cardiovascular Adaptation (continued……)Cardiac functionHeart MurmursIMMEDIATE CARE OF THE NEWBORNSlide 15Slide 16Bulb syringe Suction catheterSlide 18Slide 19Hollister clampAPGAR Scoring SystemAPGAR scoreAPGAR score (not in order of priority)Slide 24Newborn assessment summaryTemperature: ThermoregulationTHERMOREGULATIONVitamin K1 PhytonadioneVastus lateralisErythromycin Ophthalmic OintmentCircumcision careCIRCUMCISIONCircumcisionCultural / Religious PracticesFor Ethical Discussion……… Female CircumcisionSlide 36MALE CIRCUMCISIONPlastibell for circumcisionNEWBORN MEASUREMENTSWEIGHTSlide 41LENGTHSlide 43Slide 44Gastrointestinal functionSlide 46Stool variationsUrinary functionSlide 49Physiologic jaundice (also in lecture)Slide 51Slide 52Slide 53PKU (phenylketonuria) - will also be covered in lectureSlide 55PKU testingNutritional needs of the newbornSlide 58Breast feedingSlide 60BREAST or BOTTLE feeding?Slide 62Assisting with breast-feedingSlide 64Additional important factors in breast-feedingFormula feedingWhat is better,Slide 68GESTATIONA AGE ASSESSMENTSlide 70Estimation of gestational ageSafety and ComfortSleep-wake CycleSlide 74PHYSICAL EXAMSKINSlide 77BirthmarksTelangiactatic nevi (stork bite)Nevus flammeus (port-wine stain)Mongolian SpotHeadSlide 83CephalohematomaFaceSlide 86Slide 87Slide 88Slide 89Slide 90Slide 91NEWBORN REFLEXESSlide 93Slide 94Reflexes continuedSlide 96Slide 97Slide 98Slide 99Slide 100Slide 101Slide 102Slide 103THE END!NEWBORN by Prof. Unn Hidle Updated Spring 2010Suggested audio-visual:Nursing Care of the Newborn: The first 12 hours of life (Video)Newborn Bath (Prof. Dillon) – An old, but good video (we haven’t changed much in terms of giving a newborn bath!Suggested website:Breastfeeding issues:http://www.lalecheleague.orgBiological adjustment in the neonatal periodNeonatal transition – first few hours of life when the newborn stabilizes respiratory and circulatory functionsFetal breathing can be perceived as a continuation of an intrauterine process as the lungs convert from a fluid-filled to a gas-filled organFetal breathingTwo radical changes takes place for the lungs to function. Pulmonary ventilation must be established through lung expansion following birth (strong cry) An increase in the pulmonary circulation must occurCardiopulmonary adaptationThe onset of respiration stimulates changes in the cardiovascular system that are necessary for successful transition to extrauterine lifeFor adequate oxygenation to occur, the heart must deliver sufficient blood to functional, open alveoliNewborn Pulmonary FunctionThe normal newborn respiratory rate is 30-60 breaths/min. Periodic breathing occurs when the breathing pattern is paused by 5-15 seconds – very common in newborns Neonates = Obligatory nose breathersNewborn Cardiovascular AdaptationDuring fetal life, blood with a higher O2 content is diverted to the heart and brainChanges that occurs during birth includes expansion of the lungs (first breath) which decreases the pulmonary vascular resistance and increases pulmonary blood flow.Newborn Cardiovascular Adaptation (continued……)Pressure in the L-atrium increases as blood returns to the pulmonary veinsPressure in the right atrium drops, and systematic vascular resistance increases as umbilical venous blood flow is halted when the cord is clampedCardiac functionHeart rate: Accelerates immediately to 175-180 BPM. Levels off in the full-term newborn to 120-160BP: Highest immediately after birth (this is the “normal BP”) and then descends to its lowest level about 3 hours of age. By days 4-6, the BP levels off at the original high (“normal”) level after birthHeart Murmurs90% of all murmurs in newborns are transient and not associated with anomalies. Murmurs associated with VSD and PDA are usually not picked up until first well-baby visit due to early dischargeIMMEDIATE CARE OF THE NEWBORNPlace in Trendelenburg position for pulmonary & NP (naso-pharyngeal) drainageSuction with bulb syringe prn (may need deep suctioning)Maintain infant warm (skin-to-skin contact, blankets or warmer)Bulb syringe Suction catheterUmbilical cord: Before placing the cord clamp, examine for presence of two arteries (smaller vessels) and one vein (larger vessel)The Hollister clamp is removed in the newborn nursery approximately 24 hours after the cord has dried.Hollister clampAPGAR Scoring System Used to evaluate the physiological condition of the newborn at birthRatings take place 1 and 5 minutes after birth and an Apgar score or total score ranging from 0-10 is givenThe scoring categories include (from most important to least important) – REFER TO TEXTBOOK FOR SCORES: heart raterespiratory effortmuscle tonereflex irritabilityskin colorA score of 8-10 indicates a newborn in good condition who requires only NP suctioning and possibly “blow-by” O2A score <8 may need resuscitative measuresAPGAR scoreAPGAR score (not in order of priority)Attachment In the first few hours post-delivery is extremely important as the newborn has gone through dramatic events. Remember, the infant is most alert in the first 30 minutes post-delivery. (“Kangeroo” care)Newborn identification: The nurse places two bracelets on the newborn – one on the wrist and one on the ankle. The mother gets either 1 or 2 ID bands depending on the institution. Now, also electronic alarm bracelets.Nurseries are ALWAYS locked unitsNewborn assessment summaryRespirations: For signs of respiratory distress such as retractions, rhonchi or crackles which may indicate aspiration of oral secretions. Suctioning may be needed. Normal RR: 30-60, irregular without retractions or gruntingApical pulse: 120-160 AR, irregularTemperature: >36.5C (97.8F)Skin color: Body pink with bluish extremities (acrocyanosis)Umbilical cord: 2 arteries and 1 veinGestational age: 38-40 weeks in order to remain with parents for extended time (variable)Temperature: ThermoregulationNormal skin temperature is 36-36.5C (96.8-97.7F).If no heat conservation measures are started, the normal term newborn’s core body temperature falls 0.1degree C (0.2F) per minute and skin