Bluish discoloration of the hands and feet caused by reduced peripheral circulation.
Area of edema over the presenting part of the fetus or newborn resulting from pressure against the cervix; often called simply caput.
Bleeding between the periosteum and skull from pressure during birth; does not cross suture lines.
Abnormality of the nasal septum that obstructs one or both nasal passages.
Ventral curvature of the penis.
Premature closure of the sutures of the infant's head.
Failure of one or both testes to descend into the scrotum.
Abnormal placement of the urinary meatus on the dorsal side of the penis.
Benign rash of unknown cause in newborns, with blotchy red areas that may have white or yellow papules or vesicles in the center.
Abnormal placement of the urinary meatus on the ventral side of the penis.
Fine, soft hair that covers the fetus.
White cysts, 1 to 2 mm in size, on the face.
Shaping of the fetal head during movement through the birth canal.
Bruiselike marks that occur mostly in newborns with dark skin tones.
Permanent purple birthmark; also called port-wine stain.
Flat, pink area on the nape of the neck, on the mid-forehead, or over the eyelids resulting from dilation of the capillaries; also called stork bites, salmon patches, or telangiectatic nevi.
Rough, red collection of capillaries with a raised surface that disappears with time; also called strawberry hemangioma.
Cessation of breathing lasting 5 to 10 seconds followed by 10 to 15 seconds of rapid respirations without changes in skin color or heart rate.
point of maximum impulse
Area of the chest in which the heart sounds are loudest when auscultated.
More than 10 digits on the hands or feet.
Vaginal bleeding in the newborn, resulting from withdrawal of placental hormones.
A turning inward ("crossing") or outward of the eyes caused by poor tone in the muscles that control eye movement.
Webbing between fingers or toes.
Respiratory rate greater than 60 breaths per minute in the newborn after the first hour of life.
Thick, white substance that protects the skin of the fetus.
What is the purpose of the early focused assessments of the infant after birth?
Focused assessments of the infant immediately after birth help detect serious abnormalities that need immediate attention. They focus on cardiorespiratory status, thermoregulation, and the presence of anomalies. A more complete assessment follows when the infant is stable.
What is included in assessment of the newborn's cardiovascular status?
The cardiovascular assessment includes evaluation of history, airway, color, heart sounds, and pulses. Blood pressure is assessed if indicated.
Why is taking a rectal temperature dangerous in an infant?
Taking a rectal temperature is dangerous because it risks perforation of the rectum, which turns sharply to the right after about 3 cm (1.2 inches).
What are the differences among molding, caput succedaneum, and cephalhematoma?
Molding of the head is a change in the shape because of normal temporary overriding of bones during birth. Caput succedaneum is localized swelling from pressure against the cervix, which can cross the suture lines. Cephalhematoma is bleeding between the periosteum and the bone that never crosses suture lines. Molding and caput disappear within a few days, but cephalhematoma may last for 6 to 8 weeks.
Why are measurements of the neonate important?
Measurements of the infant help determine if in utero growth was adequate for gestational age and if complications are present.
What are some signs of hypoglycemia?
Some signs of hypoglycemia are jitteriness, poor muscle tone, respiratory distress (tachypnea, dyspnea, apnea, and cyanosis), high-pitched cry, diaphoresis, low temperature, poor suck, lethargy, irritability, seizures, and coma.
Why is it important to use the correct site for heel punctures when obtaining blood samples?
Using an incorrect site for heel punctures risks injury to the bone, nerves, or blood vessels of the heel.
Why is assessment of newborn reflexes important?
Newborn reflexes provide information about the status of the neonate's central nervous system.
Why is it important for the nurse to observe the first feeding carefully?
The first feeding allows the nurse to evaluate the newborn's ability to suck, swallow, and breathe in coordination and assess for signs of a connection between the trachea and esophagus.
When do newborns pass the first stool? What can be done to stimulate stool passage?
Newborns usually pass the first stool within 12 to 48 hours of birth. Feeding and, if necessary, carefully taking a rectal temperature may stimulate stool passage.
When should the first voiding occur? How often do infants void?
Infants should void within 12 to 24 hours. Infants void at least one to two times during the first 2 days and at least 6 times a day by the fourth day.
What is the nurse's responsibility regarding marks on the newborn's skin?
The nurse documents location, size, color, elevation, and texture of marks on the skin; explains marks to parents; and offers emotional support as needed.
Why is the gestational age assessment important?
The gestational age assessment provides an estimate of the infant's age since conception and alerts the nurse to possible complications related to age and development.
How do the periods of reactivity affect nursing care?
The periods of reactivity are important because the infant may need nursing intervention for low temperature, elevated pulse and respiratory rates, and excessive respiratory secretions. During the sleep period, the infant will have relaxed muscle tone and no interest in feeding.
Nurses assess newborns immediately after birth to detect serious abnormalities. If no problems are detected with a quick assessment, a more comprehensive examination is performed.
Assessment of cardiorespiratory status includes history, airway, color, heart sounds, pulses, and blood pressure.
Because they are safer, axillary temperatures are preferred to rectal temperatures.
Molding of the head is normal during birth and may cause the head to appear misshapen. Caput succedaneum (localized swelling from pressure against the cervix) or a cephalhematoma (bleeding between the periosteum and the bone) may be present.
Measurements are an important way to learn about growth before birth. Abnormal measurements alert the nurse that complications may occur.
Reflexes are an indication of the health of the central nervous system. Asymmetry or retention of reflexes beyond the time when they should disappear is abnormal.
Early signs of hypoglycemia include jitteriness, poor muscle tone, respiratory distress, sweating, low temperature, and poor suck.
In performing heel sticks to obtain blood samples, the nurse must choose the site carefully to avoid damage to the bone, nerves, or blood vessels of the heel.
The initial feeding provides information about the neonate's ability to coordinate sucking, swallowing, and breathing and tolerance to feeding.
Newborns pass the first stool within 12 to 48 hours of birth. Absence of stool for 48 hours may indicate an obstruction.
The newborn's first void occurs within 12 to 24 hours. Infants may void only one to two times during the first 2 days and at least six times daily by the fourth day.
Marks on the skin should be documented, including location, size, color, elevation, and texture. Because marks can be upsetting, they should be explained to the parents.
The gestational age assessment provides an estimate of the infant's age from conception. It alerts the nurse to possible complications related to age and size.
During the first and second periods of reactivity, the infant may have a low temperature, elevated pulse and respiratory rates, and excessive respiratory secretions. Between these periods, the infant is in a deep sleep with relaxed muscle tone and no interest in feeding.
Normal Vital Signs in the Newborn
Temperature: 36.5° to 37.3° C (97.7° to 99.1° F) axillary, 36.5° to 37.7° C (97.7° to 99.8° F) rectal
• Apical pulse: 120 to 160 bpm (100 bpm sleeping, 180 bpm crying)
• Respirations: 30 to 60 breaths/min
Jitteriness or Tremors
• Stop when the extremities are held firmly in a flexed position.
• Are commonly caused by low glucose or calcium levels.
• Continue even if extremities are held.
• May include abnormal mouth or eye movements.
• Indicate central nervous system or metabolic abnormality.
Risk Factors for Neonatal Hypoglycemia
• Late preterm infant
• Intrauterine growth restriction
• Large or small for gestational age
• Problems at birth
• Cold stress
• Maternal diabetes
• Maternal intake of terbutaline
Signs of Neonatal Hypoglycemia
• Jitteriness, tremors
• Poor muscle tone
• Diaphoresis (sweating)
• Poor suck
• Low temperature
• High-pitched cry
• Seizures, coma
• No signs (some infants may be asymptomatic)
Common Risk Factors for Hyperbilirubinemia
• Delayed or poor intake
• Cold stress
• Rh or ABO incompatibility
• Sibling with jaundice
• Male gender
• Asian, Native American, Eskimo heritage
• Maternal diabetes or preeclampsia