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1、Newborn,Terms,AcrocyanosisAppropriate for gestational age Caput succedaneumCephalhematomaCircumcisionCold stressConduction,Terms,ConvectionCryptorchidismDowns syndromeEpispadiasEpsteins pearlsErythema toxicum neonatorumEvaportation,Terms,ForemilkGynecomastiaHindmilkHallux varusHydroceleHyperbilirubi
2、nemiaHypospadiusKernicterus,Terms,LanugoLarge for gestational ageMeconiumMiliaMoldingMongolian spotsMyelomeningoceleNevus flammeus,Terms,RadiationTheromoregulationPsuedomenstration,Acrocyanosis,Although some newborn infants are uniformly pink in color,many have some degree of acrocyanosis.This means
3、 that the central portion(chest)is pink,but the extremities,particularly the hands and feet,are blue or purple.,Acrocyanosis is normal for a newborn during the first few hours,disappearing over the next day.It is due to relatively sluggish circulation of blood through the peripheral structures,relat
4、ed to immaturity or inexperience of the newborn blood flow regulatory systems.,Acrocyanosis,Appropriate for Gestational Age,Assigning size is a way to measure and monitor the growth of the infant throughout the pregnancy as well as at the time of birth.,The measurement is calculated based on the est
5、imated gestational age(how many weeks the mother was pregnant)in comparison to what is considered normal height,weight,head size,and developmental level for a child of the same gestational age and gender.,Appropriate for Gestational Age,Graphs are available showing the upper and lower normal limits
6、for different gestational ages from the mid-20s through 42 weeks of gestation.See pg 1561,Figure 54-20,An appropriate for gestational age full-term infant is heavier than 2500 grams(about 5.5 lbs.)and lighter than about 4000 grams(about 8.75 lbs.).,Caput Succedaneum,Caput succedaneum is swelling of
7、the scalp in a newborn.It is most often brought on by pressure from the uterus or vaginal wall during a head-first(vertex)delivery.,SymptomsSoft,puffy swelling of part of the scalp in a newborn infant Swelling may or may not have some degree of discoloration or bruising Swelling may extend over the
8、midline of the scalp Most often seen on the portion of the head which presented first May be associated with increased molding of the head,Caput Succedaneum,TreatmentNo treatment is necessary,and it usually heals spontaneously within a few days.CausesA caput succedaneum is more likely to form during
9、 a prolonged or difficult delivery.This is especially true after the membranes have ruptured,because the amniotic sac is no longer providing a protective cushion for the babys head.Vacuum extraction can also increase the chances of a caput succedaneum.,A caput succedaneum is sometimes identified by
10、prenatal ultrasound even before labor or delivery begins.It has been found as early as 31 weeks of pregnancy.More often than not,this is associated with either premature rupture of the membranes or too little amniotic fluid(oligohydramnios).All other things being equal,the longer the membranes are i
11、ntact,the less likely it is that a caput will form.Pg 1554,Cephalhematoma,swelling caused by subcutaneous bleeding and accumulation of blood.It may begin to form in the scalp of a fetus during labor and enlarge slowly in the first few days after birth.It is usually a result of trauma,often caused by
12、 forceps.,Large cephalhematomas may become infected,require surgical drainage,and take several months to resolve.Also called cephalhaematoma.,Caput Succedaneum vs Cephalhematoma,Important!Know how to recognize the difference between the two.,Circumcision,Breathing,Four FactorsPhysicalThermal,Chemica
13、lSensory,Immediate Needs,AirwayNewborns are usually nose breathers-if nose is stuffy-will open mouth to breatheSuctioning usually done by bulb syringe at birthAirway must be kept clear,Needs,BreathingPressure factors,chilling,noise light,environmental stimuli encourage initial newborn breathBreathin
14、g movements began in uterus at about 11 weeks,Breathing,At term 20 ml of fluid/kg in lungsAir is substituted for the fluid with the first breath Fluid moves into chest wall as trunk emerges at birthAs more air enters the lungs,more fluid moves interstitial,Breathing,Fluid is absorbed during the firs
15、t day after birthMay hear wet sounds in the lungAfter birth or soon after birthWet sounds are more prominent on c-section infants,Chemical factors,Arterial oxygen decreases-Carbon dioxide increases-Respiratory center is stimulated-Infant takes first breath Usually within 1 minute of birth,Thermal fa
16、ctors,Change in temperature from uterus to environment is 20 degrees Cool environment is a stimulus to breathe,Sensory factors,Auditory,visual,touch stimuli are increased when bornAll the stimuli are new and increase the stimuli to breathe,Circulation changes,Pulmonary blood vesselsBegin with the fi
17、rst breathLungs inflate and reduces pulmonary vasculature resistance Reduces pulmonary artery pressureDilation occurs and allows blood to flow for O2 in the lungs,Circulation,Pressure in the right atriumDecreases-allowing increased pulmonary return to the left side of the heartIncreased pressure in
18、the left atrium promotes closure of the foramen ovale,Circulation,Ductus arteriosusBlood is shunted from the pulmonary artery to the descending aorta before birthCloses soon after birth and permanently closed within 3-4 months of life,Circulation,Foramen ovaleBefore birth the opening allows blood to
19、 flow directly to left atriumFunctionally closes at birth and permanently closes in a few months,Circulation,Ductus venosusConnection of umbilical vein and inferior vena is present before birthat birth the umbilical cord is cutWith blood loss from the umbilical vein,the connection closes and becomes
20、 ligamentum arteriosum,Warmth,Thermoregulation must begin at birth-balance of heat loss and heat productionWhen cold,the infant needs to raise the metabolism to increase the heatInfants do not shiver when coldInfant will break down brown fat on body to increase metabolism,Warmth,Brown at is on back
21、of neck,between scapula,around kidneys and around adrenalsBrown fat is deposited at 26-30 weeksIncreased metaboism requires more oxygenInfant may present with hypoxia,Heat retention,Infant normaly lays in fetal or flexed position to maintain heatVasoconstriction allows head retention,Heat loss,Newbo
22、rn heat moves from internal to periphery to external environmentExcess heat loss is cold stressInfant becomes cold and begins to break down brown fat To increase metabolismIncreased metabolism requires more oxygenhypoxia can develop,Heat loss,Prolonged cold stress reduces surfactant production which
23、 increases lung resistance and respiratory distressWhen glucose stores depleted;Hypoglycema develops from brown fat breakdown,fatty acids are released=metabolic acidosis,Heat loss,Excess fatty acid release causes less bilirubin to be transported to the liver and jaundice may develop,Heat loss method
24、s,Conduction:direct contact with a cool objectHands,stethoscopeConvection:movements of airAir conditioning,open doorEvaporation:water is changed into vapor Drying of wet infant,Heat loss methods,Radiationcooler objects near sides of crib walls of isoletteReduced by keeping cribs away from drafts,APG
25、AR,Newborn Test,The newborn is commonly assessed with the APGAR score,a quick test performed at 1 and 5 minutes after birth to determine the physical condition of the newborn.The five categories assessed are heart rate,respiratory effort,muscle tone,reflex irritability,and color.Each of these catego
26、ries is scored 0,1,or 2,depending on the observed condition of the newborn.,Resucitation,Usually suctioned with bulb syringe after birthMay need wall suction/suction trap for excess mucusMay need oxygenRN or Physican will apply O2,suction as needed,Thermal environment,Infant temperature should be 97
27、-99 fWarmth is importantInfant is placed under warmer after birth and in isolette in the nursery until infant can maintain own heat,Identification/bonding,Identification:identification bands on one leg,one hand,foot prints(bold numbers on the band)May breastfeed in delivery roomParents may hold infa
28、ntInfant is usually very awake during the first hour after birth,Prophylactic care,Vitamin k:given in delivery room in left vastus lateralis IMInfant does not make vitamin K until food is present in intestine Usually about 8 days of age vitamin K is produced,Prophylactic care,Erythromycin ointment:p
29、laced in both eyes in delivery room to prevent inflammation/eye problems from gonorrhea or chlamydia,Umbilical cord,Cord is checked for 3 vessels Cord is clamped until cord is dryCord is usually short and cleaned with alcoholCord clamp is removed when the cord is dry,Umbilical cord,Cord may be kept
30、long for Rh negative mother and Rh positive infant cord may be kept damp with normal saline dressingsSome hospitals clean the cord with triple dye-purple color,Physical characteristics,Weight:2500-4000g 5 lb 8 oz-8lb and 13 ozNeonates loose 10%of birth weight and will gain weight back by 10-14 days
31、of lifeAverage infant:7 lbs 8 ounces and 20 inches long,Height,45-55 cm or range 19-21 inches Head averages 13-14 inches and chest 12-13 inchesResp rate 30-60/minHeart rate 120-160/minAxillary temp 97.6-98.6 f(Hospitals 97-99f),Skin,Generally pinkAcrocyanosis of hands and feetLanugo on shoulders or
32、foreheadVernix caseosa-in creasesPhysiologic jaundice after 24 hoursPathologic jaundice before 24 hours,Head,Circumference 13-14 inchesMoldingAnterior fontanel-junction of saggital and coronal sutures Diamond shaped 5 cm in sizeCloses by 18 monthsPosterior fontanel-at junction of lambdoidal and sagg
33、ital sutures-closes by 2 monthsmay not be palpable,Eyes,Sclera:white and clear Pupils:react to lightDo not accommodateStrabismus(cross eyed):common for 3-4 months Dolls eyes:for 10 days commonColor:slate blue,grey,brownColor established in 3 months,Ears,Ears:symmetrical in shape and sizeTop of ear a
34、ligns with inner and outer canthi of eyesHearing test should be done for all infantsLoud noise will create the startle reflex,Ear Alignment,Top of ear aligns with inner and outer canthi of eyes,Neck/Chest,Neck is symmetrical without webbing neck short,thick,several folds,flexible Allows free movemen
35、t of the head from side to side,Chest:circumference 12-13 inches measured at the nipple line symmetrical,Abdomen,Symmetrical/roundMoves with breathingBowel sounds audibleUmbilical cord clamped-whitish blue color,3 vesselsCord dries and falls of about 2 weeks after birth,Meconium,Meconium passed with
36、in 24 hours,Genitalia,Mature for gestational ageCheck for descent of testiclesScrotum covered with rugaeVoiding should occur within 24 hoursRust stained urine(uric acid crystals)may occur Vernix in folds,Back,Spine should be straight and easily flexedNo limitation of movement or abnormality of spina
37、l columnNo bumps or tufts of hair seen,Extremities,Check:the number of toes and fingersAbsence of digitsExcess digitsSyndactly-webbing of fingersSymmetricalRange of motionCreases on anterior 2/3 of sole of foot,Variations of newborn,Vernix caseosayellowish white cream substance on bodyJaundice after
38、 24 hours-yellow color on chest,face,sclera,Acrocyanosisbluish color of hands/feetEcchymosisbruisingPetechiaesmall spots of bruising,Acrocyanosis,Blue discoloration of hands and feet after birth and for about 24 hours but can last as long as 7-10 days,Variations,Milia:Tiny white papules(plugged seba
39、ceous glands)located over nose,cheek,and chin.,Variations,Newborn rash/erythema toxicum neonatorum:hivelike rash that disappears without treatment,Variations,Talangietactic nevi/stork bites:Flat pink or red marks on eyelids,nose,neckDilated capillaries and will disappear at 1-2 years of age,Variatio
40、ns,Mongolian spots:pigmentation of lumbar dorsal/buttocks areaLook like black and blue spotsSeen in dark skinned personsWill dissapear in time,Variations,Nevus flammeus:Port wine colored reddish/purple discoloration on face or neckMay be lightened or treated by laser,Variations,Nevus vascularis/stra
41、wberry birthmark=enlarged superficial blood vessels often on head,face,neck,arms,may disappear by school age,Variations,Molding:will disappear in a day or two after delivery,Caput Succedaneum,Swelling of the soft tissue of the scalp caused by pressure of the fetal head on a cervix that is not fully
42、dilated.Swelling crosses suture line and decreases rapidly in a few days after birth.,Cephalhematoma,Subperiosteal extravasation of blood due rupture of vessels.Swelling increases in size on second and third day after delivery.Often associated with delivery by forceps.Swelling does not cross suture
43、line and may take several weeks after birth.Jaundice may occur as blood cells are broken down as the swelling resolves.,Face,Face movements symmetricalEpsteins pearls on hard palatePrecocious teeth-if loose removeNystagmus dissapears in 3-4 monthsUsually does not produce tearsCheck for candidia infe
44、ction,Eyes,Eyelids edematous to ointmentStrabismus common Can see 8-10 inches from faceEars pinna located with outer canthus of eyeLow set ears=may indicate chromosome disorder,Chest,Engorged breasts may be present due to estrogen nipples excrete whitish fluid-Witches milk-from day three to two week
45、s after birthWill stop without treatment,Abdomen,Check:umbilical cord,bowel sounds,bowel movementPatent anusElimination:psuedomentration to estrogen withdrawal during first week blood tinged mucus from vagina will stop without treatment,Stool,First stool is black-green and thick called meconiumTrans
46、itional stool is greenish brown to yellowish brown and thinnerMilk stool=about day 4 with yellow to golden stool breastfed infants have a looser stool than formula fed infants,Stool,Green watery stool is diarrhea and is serious in the newbornThis is not a normal stoolNotify physician immediatelyInfa
47、nt can dehydrate quicklyMonitor for:hydrocele,cryptochidism,phimosis(foreskin),epispadias(urethra displacement),hypospadius(urethra displacement),Cryptorchidism,In normal fetal development,during the last months of birth,the testicles develop in the abdomen and descend into the scrotum in the male f
48、etus.Sometimes at birth,one or both testicles may fail to descend into the scrotum.If the testicle has not descended within the first year of the babys life,surgery may be recommended to return the testicle to its proper position in the scrotum.,Hydrocele,A hydrocele is a collection of fluid inside
49、the area of the scrotum,surrounding the testicle.Hydroceles are common in newborn infants and normally resolve after a few months after birth.The main symptom is a painless,swollen testicle,on one or both sides,which feels like a water-filled balloon.Hydroceles are usually not dangerous,and they are
50、 usually only treated when they cause discomfort or embarrassment,or they get so large that they threaten the blood supply of the testicle.,Extremities,Spine straightExtremities symetrical and move freelyPolydactyly=extra digitsSyndactly=webbing of hands or feetHip dysplasia-one leg longerDowns synd
