The Neonatal Period

Front 1

What is the neonatal period?

Back 1

Birth through the first 28 days of life.

Front 2

What nursing care helps protect and support the neonate as he adapts to extrauterine life?

Back 2

Maintaining body heat
Maintaining respiratory function
Decreasing risk for infection
Assisting parents in providing appropriate nutrition and hydration.
Assisting parents to care for their newborn.

Front 3

When does extrauterine life begin?

Back 3

When the umbilical cord is clamped and the neonate takes his first breath.

Front 4

What is the most critical and immediate physiological change that occurs in the neonate?

Back 4

Respirations

Front 5

Two factors that negatively affect the transition extrauterine respirations are:

Back 5

-Decreased surfactant levels related to immature lungs.
-Persistent hypoxemia and acidosis that leads to constriction of the pulmonary arteries.

Front 6

The three major circulatory structures that undergo changes in the neonate:

Back 6

Ductus venosus
Foramen Ovale
Ductus Arteriosus

Front 7

Ductus Venosus

Back 7

Connects to the umbilical vein to the inferior vena cava, closes by day 3 of life and becomes a ligament. Blood flow through the umbilical vein stops once the cord is clamped.

Front 8

Foramen Ovale

Back 8

An opening between the right atrium and the left atrium, closes when the left atrial pressure is higher then the right atrial pressure.

Front 9

Ductus Arteriousus

Back 9

Connects the pulmonary artery with the descending aorta, usually closes within 15 hrs. post birth.

Front 10

Thermoregulatory System

Back 10

The neonate's responses to extrauterine temperature changes during the first few weeks are delayed and place the neonate at risk for cold stress.

Front 11

How does the neonate respond to cold?

Back 11

Increase in metabolic rate
Increase of muscle activity
Peripheral vascular constriction
Metabolism of brown fat

Front 12

What is a neutral thermal environment (NTE)?

Back 12

An environment that maintains body temperature with minimal metabolic changes and or oxygen consumption.

Front 13

What is Brown Fat?

Back 13

Also referred to as brown adipose tissue or nonshivering thermogenesis, is a highly dense and vascular adipose tissue that is unique to neonates.

Front 14

When are Brown fat reserves rapidly depleted?

Back 14

During cold stress.

Front 15

Neonates are at higher risk for thermoregulatory problems related to?

Back 15

-Higher body surface-area-to-body-mass ratio
-Higher metabolic rate
-Limited and immature thermoregulatory abilities.

Front 16

Factors that negatively affect thermoregulation are?

Back 16

-Decreased subcutaneous fat
-Decreased brown fat in preterm neonates
-Large body surface
-Loss of body heat from convection, radiation, conduction, and evaporation.

Front 17

What is cold stress?

Back 17

A term that describes excessive heat loss that lead to hypothermia and results in the utilization of compensatory mechanisms to maintain the neonate's body temp.

Front 18

Risk Factors of Cold Stress?

Back 18

*Prematurity
*Small for gestational age
*Hypoglycemia
*Prolonged resuscitation efforts
*Sepsis
*Neurological, endocrine, or cardiorespiratory problems.

Front 19

Signs and Symptoms of Cold Stress?

Back 19

Axillary temp at or below 36.5
Cool skin
Lethargy
Pallor
Tachypnea
Grunting
Hypoglycemia
Hypotonia
Jitteriness
Weak Suck

Front 20

Hypoglycemia in the neonate.

Back 20

Blood glucose level under 40 mg/dL in the neonate is common during the transitional time, especially in neonates of diabetic mothers.

Front 21

Indirect bilirubin

Back 21

A fat-soluble substance is produced from the break down of red blood cells.

Front 22

Direct billirubin

Back 22

Indirect billirubin is converted to direct billirubin a water soluble substance by liver enzymes. It is in a form that can be excreted in the urine and the stool.

Front 23

Hyperbilirubinemia

Back 23

Is a condition in which there is a high level of unconjugated bilirubin in the neonates blood related to the immature liver function. High RBC count is common in neonates, and an increased hemolysis caused by the shorter life span of fetal RBC's.

Front 24

Neonates are at risk for infections related to.

Back 24

Immature defense mechanisms
Lack of experience with and exposure to organisms, which leads to delayed response to antigens.
Breakdown of skin and mucus membranes that provide a portal of entry.

Front 25

Neonates posture:

Back 25

Extremities are flexed.

Front 26

Deviations from normal posture

Back 26

Extension of extremities often related to prematurity; effects of medications given to mother during labor such as magnesium sulfate and analgesics/ anesthesia; birth injuries; hypothermia; or hypoglycemia.

Front 27

Head circumference.

Back 27

33-35.5cm

Front 28

Microcephaly:

Back 28

Head circumference is below the 10th percentile of normal newborns gestational age. This is often r/t congenital malformation, maternal drug or alcohol ingestion, or maternal infection during pregnancy.

Front 29

Macrocephaly:

Back 29

Head circumference is >90th percentile. This can be r/t hydrocephalus.

Front 30

Neonate normal weight

Back 30

2500g-4000g

Front 31

Large for gestational age

Back 31

Weights above the 90th percentile are common in neonates of diabetic mothers.

Front 32

Small for gestational age

Back 32

Weight below the 10th percentile is due to prematurity, intrauterine growth restriction, malnutrition during the pregnancy.

Front 33

Neonate Eyes

Back 33

Eyes are equal and symmetrical in size and placement.
The neonate is able to follow objects within 12 inches of the visual field. Pupils are equally reactive to light. No tear production

Front 34

Abnormal neonate eyes:

Back 34

Absent red light reflex inicates cataracts.
Unequal pupil reactions indicate neurological trauma.

Front 35

Abnormal chest findings of the neonate:

Back 35

Funnel chest: congenital abnormality.
Pigeon chest can obstruct resps.
Chest retractions are a sign of resp. distress.
Decreased or absent breath sounds are often r/t meconium aspiration or pneumothrax.

Front 36

Cardiac in the neonate:

Back 36

Normal rhythm with variation r/t resp changes.
Murmurs in 30% neonates which disappear within 2 days of birth.
The femoral pulse may be difficult to palpate.

Front 37

Normal neonate abdomen:

Back 37

Soft, round protuberant, and symmetrical.
Bowel sounds are present, but may be hypoactive for the first few days. Passage of meconium stool within the first 48 hours post birth.

Front 38

Deviations from normal neonate abdomen:

Back 38

Asymmetrical abdomen indicates a possible abdominal mass.
Hernias or diastatsis recti are more common in african american neonates. One umbilical artery and vein is often associated with heart or kidney malformation.

Front 39

Female genitalia preterm infant

Back 39

Prominent clitoris and small labia minora are often present.

Front 40

Neurological findings of a term neonate:

Back 40

Flexed position
Rapid recoil of extremities to the flexed position
Positive newborn reflexes.

Front 41

Neurological Deviations in neonate
Hypotonia:

Back 41

Hypotonia: Floppy, limp extremities indicate possible nerve injury r/t birth, depression of cns r/t maternal medication received during labor or to fetal hypoxia, during labor, prematurity , or spinal cord injury.

Front 42

Hypertonia:

Back 42

Tightly flexed arms and stiffly extended legs with quivering indicate possible drug withdraw

Front 43

Tremors in the neonate

Back 43

Possibly due to hypoglycemia, drug withdrawal, cold stress.

Front 44

Paralysis in the neonate:

Back 44

Indicates possible birth trauma or spinal injury.

Front 45

Acrocyanosis

Back 45

Hand and or feet are blue r/t response to cold environment, or immature peripheral circulation.

Front 46

Circumoral Cyanosis

Back 46

A benign localized transient cyanosis around the mouth. Observed during the transitional period; if it persist is may be related to cardiac anomaly.

Front 47

Mottling

Back 47

A benign transient pattern of pink and white blotches on the skin; response to a cold environment.

Front 48

Harlequin Sign

Back 48

One side of body is pin and the other side is white. Related to vasomotor instability

Front 49

Mongolian Spots

Back 49

Flat bluish discolored area on the lower back and or buttock seen more often in blacks, asian, latinos. Need to document size and location. Resolves on own by school age.

Front 50

Erythema Toxicum

Back 50

A rash with red macules and papules that appear in different areas of the body, usually the trunk area. Can appear within 24 hours of birth and up to 2 weeks. Benign, disappears without treatment.

Front 51

Epstein Pearls

Back 51

White, pearl like epithelial cysts on gum margins and palate. Benign and usually disappear in a few weeks.

Front 52

Natal Teeth

Back 52

Immature caps of enamel and dentin poorly developed roots Usually only one or two present. Usually benign but can be associated with congenital defects. Often loose and need to be removed.

Front 53

Gestational age assessment is commonly completed on:

Back 53

Neonates who, based on the maternal menstrual history, are preterm, born before 37 weeks; or postterm, born after 42 weeks. Neonates of diabetic mothers.

Front 54

Dubowitz neurological exam

Back 54

Is a standardized tool that assesses 33 responses in four areas: Habituation(the response to repetitive light and sound stimuli)
Movement and muscle tone
Reflexes
Neurobehavioral items

Front 55

Ballard Maturational Score

Back 55

Is calculated by assessing the physical and neuromuscular maturity of the neonate.

Front 56

Initial period of reactivity:

Back 56

Occurs in the 1st 15 to 30 minutes post birth. The neonate is alert and active. The neonate vigorously responds to external simuli. Resps. are irregular and rapid. Brief periods of apnea may occur. The heart beat can be as high as 180 bpm. Brief periods of cyanosis can occur. The amount of oral mucus increases.

Front 57

Period of Relative Inactivity:

Back 57

Begins approx. 30 minutes after birth and lasts 2 hours . Sleep state. The neonate is unresponsive to external stimuli.

Front 58

Nursing Care of the Neonate

Back 58

Note time of delivery
Dry the neonate
Place neonate under preheated radiate warmer or skin to skin.
lace stocking cap on.
Support respirations by sucking out nose and mouth.
Obtain apgar score.
Assess vitals.
Inspect clamped cord. for number of vessels and bleeding.
Complete and place identifying bands, Complete gestational age assessment. Administer eye ointment, Bathe the neonate (post birth 2 hours when temp is stable) Promote parent infant attachment.

Front 59

Phenylketonuria (PKU)

Back 59

Is an inborn erro of metabolism. Neonates with PKU are unable to metabolize phenylalanine, which is an amino acid commonly found in many foods such as breast milk and formula. This leads to buildup of phenypyruvic, and phenylacetic acids, which are abnormal metabolites of phenylalanine. The buildup of abnormal metabolites can cause permanent brain damage and death, which can be prevented by early detection and dietary management.

Front 60

Advantages of Breastfeeding

Back 60

Decreased risk of infant diarrhea
decreased risk of resp infections.
Decreased risk of ear infections.
Decreased risk of childhood obesity.
Decreased cost.

Front 61

Contraindictions of breastfeeding:

Back 61

Women who are using illicit drugs.
Women who with active and untreated tuberculosis.
Women receiving radio isotopes.
Woman receiving antimetablites or chemo.
Woman with herpes on her breast or HIV positive.

Front 62

Prolactin

Back 62

Primary hormone responsible for lactation.

Front 63

Breastfeeding success is dependent on:

Back 63

Mothers desire, proper positioning, latching on, suckling and transferring milk.

Front 64

Newborns indicate hunger by:

Back 64

An awake alert state, making mouth and tongue movements, making hand to mouth movements, rooting.

Front 65

Signs of successful breastfeeding:

Back 65

The woman feels a tugging sensation when the newborn begins to suckle. Latch on pain should last no longer than 10 seconds. Pain beyond this is sign of poor latch on. The newborn's tongue is between the lower gum and breast. Swallowing can be heard.

Front 66

Signs that the newborn's hunger has been satisfied:

Back 66

Spontaneously releases suction from breast. Does not respond with a rooting reflex when stimulated. Is relaxed and calm.