Mom Baby

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gestational age when surfacetant production is dectable

Back 1

24-25 weeks

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gestational age when surfactant is suffiecient for baby to live

Back 2

34-36 weeks

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what can be given to mom in preterm labor to increase baby's surfactant production?

Back 3

steroids

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how do chemorecptors stimulate breathing

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repond to change in blood chemistry brought on by hypoxia---> stimulates respiratory center in the medulla

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mechanical factors that stimulate respirations

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fetal chest compressed by birth canal- small amount of fluidforced out of lungs into upper air passage and expelled during birth

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thermal factors

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sensors in baby skin respnd to sudden change in temp send impulse to stimulate repiratory center

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sensory receptors

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tactile stimuli stimulate skin sensors

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ductus venosus

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oxygenated blood enters fetal circulation through umbilical vein-->1/3 blood goes away from liver to inferior vena cava- 2/3 goes thru liver then to inferior vena cava-->as blood enters inferior vena cava joins blood from lower part of fetal body goes to heart in seperate streams-->very little mixing of blood

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foramen ovale

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blood from inferior vena cava--> R atrium-->flap of tissue directs highly O2 blood to foramen ovale(flap in septum allowsblood flow btwn R&L atria fo fetal hrt)

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blood flow thru foamen ovale

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thru foramen ovale from RA--> LA-->LV-->leaves thru ascending aorta------> heart, brain, head, upper body

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what allows blood flow thru foramen ovale

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blood flow from RV to lungs is restricted by narrow pulmonary artery and blood vessels--> ^ pressure on R side of the heart, low pressure on on L side allows blood flow thru foramen ovale

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blood from superior vena cava

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blood from superior vena cava & less oxygneated blood from from inferior vena cava flow into RA-->RV-->pulmonary artery-->most of blood goes thru ductus arteriosus and small @passes thru lings

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ductus arteriosus

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conucts pulmonary artery adn aorta

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characertistics that predispose infant to heat loss

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thin skin,blood vessels close to skin surface,little subq(white)fat,heat readily transferred from internal areas to cooler skin surfaces then to air, babies have 3xs more surface area to body mass--> rate of heat loss 4x greater

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methods of heat loss

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conduction, evaporation, convection, radiation

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nonshivering thermogenesis

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receptirs decect drop in skin temp-->norepi released--> iniates metaboislm of brown fat

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when baby becomes cold

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retless, crys,increase flexion and activity, vasocontstriction, metabolism rises, increased need for O2

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cold stress

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diminshed surfactant production-->which impedes lung expansion,glucose needs increase-->hypoglycemia, increased ascid production-->metabolic acidosis, vasocnstriction of pulmonary blood vessels-->more respiratory distress

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neural thermal environment

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environment when baby can maintain stable body temp w minimal O2 need and w out increase in metaboloic rate

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average blood volume for newborn

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85ml/kg
preterm infants have greater bv

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infant hematocrit

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48-69% first day
44-72% by 3rd day
level above 65% from a central site indicated polycythemia

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polycythemia

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increases risk of jaundice, damage to brain and organs an result as result of blood stasis, increase risk of respiratory distress and hypoglycemia

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WBCs in infant

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9000-30,000is normal
avearage 15,000
elevated WBCs doesn't indicate infection in newborn

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risk of clotting deficiency

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platelt count close to adult levels,
newborns low in vit K that activates clotting factors
vit K is given IM to newborns

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Newborn GI

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stomach capacity-->6ml/kg at birth
delayed gastric emptying
intestines are longer in proportion
bowl sounds are present w in 1 hr
digestive tract sterile at birth

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digestive enzymes

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pancreatic amylase deficient until 4-6mos
amylase frim salivary glands-- 3mos
pancreatic lipase..but is present in breast milk and fromula

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blood glucose level

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40-60 1st day
50-90 after

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indirect bilirubin

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unconjucated bilirubin- not water soluble...may be absorbed by skin and cause jaundice
if enough present brain can be strained

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conjugated bilirubin

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bilirubin has been changed by the liver to water soluble form
not toxic to body may be excreted

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risk factors for increased bilirubin

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excess production rbc life
albumin bindng sites
liver immaturity
intestional factors
delayed feeding
trauma
fatty acids
cultural/family background
maternal factors

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physiologic jaundice

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transient hyperbilirubenia, considered normal
not present 1st 24 hrs
appears 2nd or 3rd day after birth
jaundice visible when serum bilirubin reaches 5-7 mg/dl

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nonphysiologic jaundice

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bilirubin rises more rapidly& higher levels can leasd to problems n may need tx
causes:incompatabilities btwn mom n baby's blood, infection adn metabolic disorders
treated w phototherapy

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kidney function

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nephrons formed 34-35wks gestation
GFR doubles during first weeks of life
full kidney function doesnt occur until 1-2 yrs
infants have decreased ability to remove waste from blood
infants usually void w in 12 hrs of birth n most have voided by 24 hrs

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fluid balance

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newborns have low tolerance for change in fluid volumes
fullterm infants need 40-60ml/kg in the first 2 days
by 7 days need 100-150 ml/kg

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s/s infection in newborn

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subtle changes in activity
change in color,tone, or feeding

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IgG

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only immunoglobolin that crosses the placenta
pasive temporary immunity
IgG production begins at 20 wks gestation
gradually dissapears over first 6-8 mos of life

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IgM

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protects against gram neg bacteria
production increases a few days after birth
reaches adult levels by 1 yr
if IgM is present in large amounts baby was probly exposed to infection inutero

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IgA

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production begins around 2 wks old
is found in colustrum and breast milk

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period of reactivity

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changes baby goes thru in early hours after birth

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first period of reactivity

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baby is awake, alert, interested in surrondings,
gazes at parents when held en face
move around, foot, appear hungry
respirationscan be up to 80
hr can be up to 180bpm
crackles, retractions,nasal flaring,increased mucus may be present
vitals gradually decrease
infant becomes sleepy after 20 mins-2 hrs

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period of sleep

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after first period of reactivity infant goes into deep sleep for several hours
pulse and respirations slow to normal
temp may be low

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second period of reactivity

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interested in feeding
may pass meconium
pulse and respirations may increase
some babies become cyanotic aqnd have apnea
mucus increases, some babies gag or spit up

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quiet sleep state

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*deep sleep no eye movement
*respirations quiet regular & slow
*startles occur in intervals, but body is mostly quiet
*lil to no response to noise or stimuli
*returns to sleep quickly

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active sleep state

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*lighter sleep
*babies move extremities,stretch,change expression,make sucking movements, fuss briefly
*respirations more rapid & irregular
*REM occurs
*more likely to startle from noise or stimuli
*may returnto sleep or staty awake

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drowsy state

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*transitional btwn sleep &wake
*eyes may be closed or open and unfocused
*startle &move slowly
*may go back to sleep or stay awake

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quiet alert

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*good time to increase bonding
*babies focus on things and ppl*seem alert and interested in surroundings
*respond to stimuli and ineteraction w others
*body movements are minimal

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active alert state

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*often fussy
*restless
*faster more irregular respirations
*more aware of discomfort
*seem less focused
*ofen preceeds crying

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crying state

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*may quickly follow active alert state
*cries r continues and lusty
*dooesn't respond positively to stimulation

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repsiratory assessment

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*assess immediatley after birth
*then 1 x q 30 mins until baby has been stable for 2 hours
*norma rate--30-60 breaths/min
*average rate in 40s
must be counted for 1 full min
*periodic breathing,pauses lasting 5-10secs w out other changes then rapid respirations for 10-15 secs may occur

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breath sounds

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*assess all lung fields
*some moisture may be present first few hours after birth

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signs of respiratory distress

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*tachypnea
*retraction
*flaring of nares
*cyanosis
*grunting
*seesaw respirations
*assymmetry

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grunting

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*noise made on expiration when pressure is increased in alveoli
*common sign of respiratory distress

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heart sounds

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*count apical pulse for a full minute
*rate 120-160 bpm w normal activity
*monitor q 30 mins for 1st 2 hrs
*if stable- hr checked q 8hrs
* apex of heart is at pmi-- 3rd or 4th intercostal space slighlty left of midclavicular line

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temp

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*assessed 1x q 30 mins for 1st 2 hrs then again in 4 hrs then q 8 hrs
*axillary temp

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head

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*head & neck make up 25% of body
*palapate to assess shape and identify abnormalities
*elevate head for accurate assessment
*anterior fontanel diamond shape 4-5 cm from bone to bone
*posterior fontanel triangle .5-1 cm

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caput succedaneum

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*appears ove vertex of head
*result of pressure against moms cervix-->localized edema
*soft & crosses suture lines
*resolves w in 12 hrs

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cephalhematoma

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*bleeding btwn periosteum and skull from pressure during birth
*develops w in 24-48 hrs
*one side of head-->doesn't cross suture lines
*may take 6-8 wks to resolve
*risk of jaundice

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hips

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*legs are extended to determineif they are equal in length

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weight loss

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*expected to lose 10% of birth weight during 1st few days

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transient strabismus

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*crossed eyes
*common for 1st 3-4mos