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Slide 2		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
Slide 3		Increased aortic pressure Increased systemic/decreased pulmonary pressure Closure of foramen ovale – functionally 1-2 hours after birth Closure of Ductus arteriosus – functionally within 15 hours after birth r/t prostaglandin E2 Measurement of HR Neonatal RBCs have a life span of 80 to 100 days, 2/3 life span of adult RBC. In 1^st 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.
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Slide 6		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
Slide 7		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
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Slide 9		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
Slide 10		1^st – 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 2^nd – awake, alert. HR and RR increase, apneic periods.Change color rapidly Increase mucus responds to gagging, choking and regurgitating
Slide 11		Remind about APGAR
Slide 12		Neuro – resting posture, square window, recoil, popliteal angle, scarf sign, heel-to-ear, ankle dorsiflexion Physical – skin, lanugo, sole creases, areola, ear form and cartilage distribution, genitalia Plan nursing interventions
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Slide 21		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
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Slide 28		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
Slide 29		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