The Normal Newborn: Assessment, Care, Feeding пЃєPresented by, пЃєJoy Haskin, RN, MS Joke for the dayвЂ¦. Should children witness childbirth? TERMS: пЃєNeonatal Period: пЃєBirth --> 28 days of life пЃєTerm Infant: пЃє38 - 42 weeks of gestation пЃєTransition Period: Phases of instability during the first 6-8 hours after birth Viability пЃєCapacity to live outside of the uterus about 22 to 24 weeks since the last menstrual period, or fetal weight greater than 500 g. пЃєIn the past was 28 weeks - with technology and advancements this is becoming shorter and shorterвЂ¦... Physiologic Changes of the NB to adjust to extrauterine life: What happens during birth to the neonate? Circulatory: пЃєTransitional Circulation = acrocyanosis пЃєPeripheral circulation = sluggish пЃєHigh: RBC 4.8-7.1; Hgb 14-24; Hct 44-64 пЃєWBC 18,000 @ birth; 23-24,000 @ 1 day пЃєCoagulation: Vit K dependent clotting factors are decreased. пЃєPlatelet counts ok (150,000-350,000) Respiratory пЃєBefore birth O2 needs met by placenta пЃєL/S ratio should be > 2:1 пЃєAfter delivery need mature lungs that are vascularized, have surfactant and sacules - usually adequate by 32-35 weeksпЃёat term the lungs hold approx. 20 ml of fluid/kg пЃєWhat initiates respiration? Periodic Breathing -vsApnea пЃєApnea: no breathing for periods of greater than 15 seconds should be evaluated. Periodic Breathing: Notify MD if resp < 30 or > 60 Gastrointestinal System пЃєImmature at birth, reaches maturity at 23 years of age пЃєplace food at back of tongue пЃєsucking becomes coordinated @32 wks пЃєlittle saliva until 3 months of age пЃєbowel sounds after 1 hour of birth Gastrointestinal (continued) пЃєNB have difficulty digesting complex starches and fat пЃєAbdomen becomes easily distended after eating пЃєInitial fecal material = meconium пЃєNo normal flora at birth in GI system to synthesize Vit. K Immune System пЃєLimited specific and Non-specific immunity at birth пЃєpassive immunity(from mom- IgG) for the first 3 months of life ~ this will be reduced if baby is born premature пЃєbreastfeeding = ^ passive immunity (IgA) Temperature Regulation пЃєNon-Shivering thermogenesis: пЃєbrown fat is the primary source of heat production. Brown fat is broken down into glycerol & fatty acids producing heat. пЃєBrown fat is found @ the nape of the neck, axillae, around the kidneys and in the mediastinum. пЃєSlightly warmer to touch than nml skin. Cold Stress пЃєAn increase in the metabolic rate associated with non-shivering thermogenesis --> increased O2 demands and caloric consumption пЃєItвЂ™s important to provide a neutral thermal environment to prevent metabolic acidosis and prevent depleted brown fat. Kidneys and Urination пЃє92% of all healthy infants void in the first 24 hrs of birth пЃєinitial urine:cloudy, scant amounts, uric acid crystals-> reddish stain on diaper пЃєKidneys not fully functional until child is 2 years of age. Hepatic Function пЃєLiver produces substances essential for clotting of blood. пЃєStores needed iron for the first few months. Preterm & small infants have lower iron stores than full term and heavier infants. (full term infants stores last 4-6 mo) пЃєNB at risk for Physiologic Jaundice after 24 hours of age, d/t increased breakdown of RBCвЂ™s and immature liver functioning. Increased Bilirubin Levels пЃє Jaundice in the 1st day is NOT normal пЃєBilirubin level greater than 12 at any time needs further attention пЃєMaternal causes of increased bilirubin levels in the NB: epidural use, oxytocin induced labor, infection, hepatitis пЃєEthnic Influences: Asian infants levels may be double other ethnic groups. Kernicterus пЃєComplication of neonatal hyperbilirubinemia --> encephalopathy пЃєbasal ganglia and other areas of the brain and spinal card are infiltrated w/ bilirubin (produced by the breakdown of hemoglobin -> levels of 20 - 25 or more). пЃєPoor prognosis if untreated. Neurologic пЃєAll neurons are present, but many are immature: пЃєuncoordinated movements пЃєpoor muscle control пЃєstartle easily пЃєtremors in extremities Weight Loss пЃєIt is normal for the newborn infant to loose 5-10% of weight in the first 4 to 5 days of life. Infants at Risk пЃєвЂњRED FLAGSвЂќ after birth include: пЃєgagging --> turning blue (esp. after fdg) пЃєgeneralized cyanosis пЃєweak cry пЃєgrunting or respiratory distress пЃєdecreased or absent movements пЃєexcessive twitching or trembling пЃєOTHERS>>>>> Nursing Diagnosis: пЃєIneffective Airway Clearance R/T excessive oropharyngeal mucus пЃєIneffective Thermoregulation R/T newborn transition to extrauterine life пЃєHigh Risk for infection R/T maturational factors, immature immune system пЃєPC: Hypoxemia PC: Hyperbilirubinemia пЃє(W) Beginning Integration of NB into Family Unit Nursing Care to Meet NB Needs пЃєPrevent infection: пЃєhandwashing, stay away from large groups or ill individuals, prophlactic agents (EES, cord care, bathing) пЃєVernix пЃєBreastfeeding Warmth пЃєBath after temperature is stable пЃєwarmer/isolette/bundle пЃєhat пЃєkeep out of drafts пЃєskin to skin Position of sleep/prevent SIDS пЃєBack to sleep пЃєfeet to foot of bed пЃєno stuffed animals or excessive blankets in bed пЃєdonвЂ™t cover head in stroller пЃєdonвЂ™t keep house too warm пЃєNo smoking around infant Cleanliness пЃєNo tub baths until cord off and healed пЃєclean around organs of elimination and mouth after soiling to prevent skin break down пЃєdaily head to toe bath not necessary пЃєOK to clean and touch the вЂњsoft spotвЂќ пЃєfold diapers away from umbilicus пЃєNEVER leave child alone in tub!! Research and Cord Care пЃє1,811 NBвЂ™s- 2 groups - one receiving cord care with alcohol and one group not: пЃє* equal # infections in infants who received and did not receive cord care пЃє*cord separation ~ alcohol use: 9.8 days вЂ“no alcohol used: 8.16 days Carseats пЃєвЂњAS a condition for licensure, public and private hospitals, birth centers, and clinics must have a written policy on the dissemination of child passenger restraint system information to parents or the person to whom the child is releasedвЂќ (SB503 REQ) Genital Care пЃєMale Infant: if penis is uncircumcised DO NOT RETRACT THE FORESKIN--вЂњleave it aloneвЂќ пЃєFemale Infant: wipe front to back. If вЂњsmegmaвЂќ has accumulated in the labial folds it can be carefully removed Infant Feeding пЃєWhy may a mother decide to Breast Feed? пЃєDiscussion Formula feeding пЃєWhy may a mother decide to formula feed her infant? пЃєDiscussion Frequency of Feedings пЃєBreastfeeding: successful latch-on and feeding should occur every 1.5 to 3 hours daily. пЃєFormula Feeding: 3-4 oz every 3-4 hours for full-term babies. пЃєBaby should have 6-10 wet diapers/day пЃєcalculate amnt of formula mult. babyвЂ™s wt in lbs by 2 then 3, this is oz per day. пЃє (EX: 8lb. Baby~ 8 X2 = 16; 8 x3 = 24 therefore 16-24oz of formula per day is needed for adequate nutrition) Nursing Diagnosis пЃєEffective Breastfeeding пЃєRisk for Altered Nutrition (more or less than body requirements) R/T (insufficient caloric intake or excessive caloric intake) Circumcision пЃєElective Procedure пЃєNot pd for by medi-cal пЃєDecision made based on tradition, religion, culture, or personal factors пЃєVALUE пЃєOPPOSITION Procedure пЃєUsually delayed 12 to 24 hours until NB is stabilized пЃєDo not feed 1 hr prior to procedure пЃєConsent required from one parent пЃєMethods: Gomco or Plastibell пЃєRestraint required пЃєAnesthetic is physician dependent After Care пЃєComfort measures пЃєkeep wound clean and dry (warm water) пЃєck urination w/in 12 hrs after procedure пЃєmonitor for bleeding пЃєs/s of infection will not occur immediately after procedure Periods of Reactivity пЃєREVIEW пЃє1st period of reactivity:after birth of baby, bursts of rapid movements. Quiet times during this period are ideal for breastfdg & interacting пЃєDeep Sleep - lasts 60-100 minutes пЃє2nd period of reactivity: occurs 4-8 hrs after birth lasts 10 min to several hours. Periods of tachycardia & tachypnea. Increased muscle tone, skin color, mucus production, pass meconium The endвЂ¦.