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Ventilation a response to mechanical, chemical, thermal and sensory changes

Increased vascular flow at alveolar site

Surfactant peaks at 35 weeks

Characteristics

rate – 30-60, 60-70 first hour or two

periodic – 5-15 seconds not respiratory movement. Longer periods greater than 20 seconds called apnea. This needs to be assessed

Nasal breather – if mucous need to clear airway, can lead to respiratory distress

Acrocyanosis

Assess for – retractions, cyanosis, nasal flaring expiratory grunting, use of intercostal muscles

1.Increased aortic pressure

2.Increased systemic/decreased pulmonary pressure

3.Closure of foramen ovale – functionally 1-2 hours after birth

4.Closure of Ductus arteriosus – functionally within 15 hours after birth r/t prostaglandin E2

5.Measurement of HR

6.Neonatal RBCs have a life span of 80 to 100 days, 2/3 life span of adult RBC. In 1st days of life, hematocrit may rise to 1 to 1 g/dL above fetal levels as a result of placental transfusion, low oral fluid intake and diminished extracellular fluid volume. By 1 week postnatally, peripheral hemoglobin is comparable to fetal blood counts. The hgb level declines progressively over the first 2 to 3 months of live. This initial decline in hemoglobin creates a phenomenon know as physiologic anemia of infancy.

Physiologic Jaundice –

1. Increased amounts of bilirubin delivered to liver

2. Defective hepatic uptake of bilirubin from the plasma

3. Defective conjugation of the bilirubin

4. Defect in bilirubin excretion

Wt lost – 5-10% Shift ofintracellular water to extracellular space and insensible water loss

Stool – meconium within j8-24 hours then transitional, thenbreast or bottle

Urine – within 48 hours. Voids in utero

voids 2-6 times a day day 1 and 2. Then 5-25 times a day

volume of 24mL/kg per day

Immune system not fully activated until after birth – results in failure of newborn’s inflammatory response result in failure to recognize, localize and destroy invasive bacteria. S&S of infection are subtle. Fever not a reliable indicator of infection. Hypothermia ia a more reliable sign of infection.

Immunoglobulins- IgG crosses placenta and gives passive acquired immunity

IgM – produced by fetus – usually response to blood group antigens, gram-negative enteric organisms and some viruses in mom.Suggest exposure to TORCH infections

1st – awake, active, hungry, strong suck RR rapid HR rapid and irregular Bowel sounds absent Inactivity – HR RR decrease , sleep phase, no interest in sucking Bowel sound become audible 2nd – awake, alert. HR and RR increase, apneic periods.Change color rapidly Increase mucus responds to gagging, choking and regurgitating

Remind about APGAR

1Neuro – resting posture, square window, recoil, popliteal angle, scarf sign, heel-to-ear, ankle dorsiflexion

2Physical – skin, lanugo, sole creases, areola, ear form and cartilage distribution, genitalia

3Plan nursing interventions

Wt - 3405g or 7’8”

Length – 18-22”

Head – 32-37cm 12.5-14.5”

Chest – 30-35cm 12-14”

Temp. – 36.5-37 97.7-98.6 A hospital protocol for reporting and intervention

Skin – acrocyanosis, mottling, jaundice, erythema toxicum, milia, skin turgor, vernix caseosa, forceps marks, telangiectatic nevi, mongolian spots, port-wine stains, strawberry marks,

Head – fontanelle, cephalhematoma, caput succedaneum, molding

Eyes – strabismus color treatment

Mouth – thrush caused by candida albicans, epstein’s pearls

Ears – low set r/t chromosomal abnormalities hearing after first cry

Respirations – already covered RR, and signs of respiratory difficulty

Mention cry

CV – already talked about HR Apical pulse 120-160, below 100

Abdomen – rounded, BS within 1 hour, not scaphoid

Cord –

Genitals – Male – urinary meatus hypospadius (ventral surface)

criptorchidism

Phimosis

- female – labia/maturation

Anus – patency – meconium

Extremities – digits, creases

Hips – ortolani’s maneuver

Back – pilonidal dimple, tuft of hair – occult spina bifida

Reflexes – tonic neck, moro, grasping, rooting sucking/swallow, babinski