The Newborn Assessment Assessments of neonates include 1 Initial assessment immediately after birth including vitals Apgar score quick review of systems 2 Gestational age assessment within 2 hours 3 Comprehensive physical exam by MD within 24 hours after birth Transition from Intrauterine to Extrauterine Life Newborns undergo a transition period between intrauterine extrauterine life after delivery The respiratory circulatory systems must rapidly adjust from being dependent to independent Newborns must also establish maintain thermal stability Their respiration norm is 30 60 periods of apnea 5 10 seconds are normal have to listen or count for a full minute because they re irregular try to count when they re calm Respiratory The most critical immediate adjustment birth is the establishment of independent respirations There are mechanical chemical environmental stimulants to respiratory effort Three things that affect breathing 1 Mechanical With vaginal deliveries the chest is squeezed as the baby is delivered pushing fluid out of the lungs stimulating the baby to breathe in Oxygen C Section babies don t get this stimulus they may retain fluid in their alveoli requiring deep suctioning C section fluid stays in they ll have to cough it out or suction their mouth and nose mouth before the nose gets some of the fluid it out clamp the cord and cut the cord and then ductus arteriosus and foramen ovale shut and they circulate blood on their own 2 Chemical PO2 and increased CO2 levels will stimulate breathing All this stuff is happening very quickly 3 Environmental respirations Delivery room lights noises and touch will also stimulate crying With the cutting of the umbilical cord a brief period of asphyxia decreased Initial Steps to Establish Airway 1 Position the head to open clear the airway Suction the mouth 1 st then the nose b c they may aspirate mouth contents 2 Dry the skin stimulate the baby to breathe and reposition the head to open the airway 3 Provide warmth Norms Once the infant begins breathing spontaneously respirations are shallow irregular with a rate of 30 60 breaths per min They may also have brief periods of apnea which shouldn t last more than 20 seconds this is called periodic breathing periodic apnea 1 Signs Symptoms of Respiratory Distress 1 Nasal flaring 2 Audible grunting 3 Retractions 4 Respirations greater than 60 or less than 30 bpm 5 Labored breathing Circulation With delivery with the clamping of umbilical cord we see conversion from fetal circulation to neonatal circulation Acrocyanosis blue hands feet is a normal finding in the first 24 hrs of life Umbilical cord has to arteries and one vein normal in a umbilical cord look for it to make sure the fetus has normal circulation fetal circulation at the vein is big and fat big blue vein once it s cut it ll be a big hole and blood will be coming out Fetal Circulation All this is happening while the umbilical gets clamped and cut 1 Umbilical cord vein carries oxygen from maternal placenta to the fetus 2 Blood flows into the ductus venosus allowing most blood to bypass the liver and connecting to the inferior vena cava 3 Blood flows into the right atrium 4 Blood flows into the foraman ovale which allows the fetal blood to bypass the fetal lungs by shunting it into the left atrium 5 The ductus arteriosus allows fetal blood to bypass the lungs by shunting it form the pulmonary artery into the aorta 6 The two umbilical arteries carry away wastes After delivery the umbilical cord is clamped the newborn begins to breath spontaneously and the three shunts functionally close Normal heart rate after delivery 110 160 bpm Temperature 97 5 99 With incomplete closing of foramen ovale ductus arteriosus murmurs will be auscultated These usually close on their own within a few months don t require intervention Acrocyanosis is normal the 1st 24 hours Thermoregulation Neonates are at increased risk for heat loss due to their large body surface r t body mass and decreased body fat They also do not have the shivering mechanism present at birth Normal temp is 97 5 F to 99 F Decreased body temp will increase oxygen demand and increase utilization of blood glucose This can lead to metabolic acidosis Neonates do have brown fat stores which assist in thermoregulation however preterm babies have little to none present at delivery Crying gets rid of extra fluid in lungs we want the baby to cry brown fat helps keep the temperature a full term baby is 38 weeks 42 weeks 38 weeks and up they have brown fat the preterm babies not as much pre term 22 weeks 36 7 weeks they have amniotic fluid and maybe poop if baby is pink and crying we can put baby around moms tummy to promote bonding and dry the baby off it stimulates the baby to cry and get fluid out of lungs they have big heads and a lot of surface so you put a hat on their head to keep the 2 temperature in skin to skin contact putting baby naked on moms naked chest best way to promote warmth and bonding Heat Loss burrito wrap There are four mechanisms of heat loss convection radiation evaporation and conduction This is the flow of heat from the body surface to cooler ambient air This is the loss of heat from the body surface to a cooler solid surface not 1 Convection 2 Radiation This is the loss of heat that occurs when a liquid is converted to a vapor This is the loss of heat from the body surface to cooler surfaces in direct indirect Contact but in close proximity 3 Evaporation 4 Conduction contact Interventions to Prevent Heat Loss 1 Dry fluids off after delivery with warmed blankets 2 Place warm hat on top of head 3 Wrap tightly in warm blankets 4 Establish skin to skin contact with Mom cover both with blankets 5 Keep bassinets away from drafty windows doors 6 Keep under radiant warmer while doing procedures assessments radiant warmer nice cooker temperature regulator pad attached to them to keep their temperature a certain level increases temperature in newborn area want them to be 98 6 rectal to come out from radiant warmer axillary temp 97 6 if below 97 5 check the other arm bc it could be your technique if axillary temp are both under 97 5 check the rectal temperature you could stimulate the rectal area and they would poop Uncover one body part at a time Apgar Scoring System This is tool which provides a standard mechanism to record fetal adaptation to extrauterine life This is done at 1 minute after delivery 5 minutes after delivery Five categories are assessed and each category