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Terms in this set (31)
Which newborn procedures and screenings fall under the scope of a CPM?
Vitamin K injection, CCHD, metabolic screen, hearing screen, physical exam
What are the five circulatory adaptations of the fetus and what was their purpose in- utero?
1.) Ductus arteriosus: Blood vessel (shunt) connecting the fetal pulmonary artery to the descending aorta
Creates a pathway for most of the fetal blood supply to bypass the fetal lungs in circulation
2.) foreman ovale: Fetal cardiac shunt that allows blood to enter the left atrium from the right atrium
This bypass diverts a portion of fetal blood volume away from the lungs, (which are supplied by the right ventricle in mature circulation), and toward greater circulation
3.) Ductus venosus: Blood vessel (shunt) connecting the umbilical vein to the inferior vena cava
Creates a pathway for variable amounts of oxygenated blood from the placenta to bypass the liver
4.) Umbilical vein: brings oxygenated blood from placenta to fetus
5.)Umbilical arteries: brings deoxygenated blood from fetus to placenta
What triggers a newborn to take their first breath?
exposure to "cold" air and the "Vaginal Squeeze" during pushing expels fluid from lungs, trachea, & oropharynx which compresses the thorax à subsequent recoil = passive inspiration
How does the timing cord of clamping impact the newborn's blood?
"Early clamping can result in 30% difference in blood volume & RBC mass" -Blackburn
What is the purpose of surfactant?
keep alveoli from collapsing
What happens to lung fluid during the transition?
80% of fluid in baby's lungs absorbed in 1-2 hours after birth
Remaining 20% in the next 12- 24 hours
What is the normal newborn respiration rate?
30-60 breaths per minuteIn first 2 hours, may be up to 80 breaths per minute
What tasks must the brain takeover when the baby is born?
-Temperature RegulationBreathing & Respiratory
-CoordinationCardiac Activity (oxygenation & metabolic waste management)
-Nutrient Intake (hunger and thirst)
-"Making decisions" to maintain homeostasis
Which senses are well developed at birth?
vision, smell, hearing
True or False: Neurologic well being of the baby can be assessed by eliciting reflexes?
When do newborns typically pass their first meconium?
Timeline for Term Infants
By 12 hours (69%)
By 24 hours (94%)
By 48 Hours (99.8%)
What does vitamin K have to do with the gastrointestinal system?
Vitamin K is synthesized in the human gut.
Colonization of neonatal gut flora is thus linked to eventual production of vitamin K
What physical factors contribute to newborn reflux?
Introduction of + air to GI system w/ swallowing
Competition of air & milk for limited stomach space
Anatomical angle of the esophagus & the stomach is less acute in newborns than in older children and adults
More prone to "backflow" into esophagus
Supine positioning of newborns
What is typically the cause of neonatal weight loss in the days following birth?
milk hasn't fully come in. Newborn is taking in less calories than burning.
When is it typical for newborns to first void?
Initial void usually occurs in the 1st 24 hours (+95%)
When does urine output correlate with input?
In the first 2 days, they typically urinate 2-6 times per hour, eventually developing a pattern of voiding 1 or more times with each feeding
Tip for parents of newborns - likely change diaper following each feeding
How can midwives support a newborn's immature immune system?
Vernix- not washing it off
Surfactant- not suctions the nose and mouth unless indicated
Breastmilk- breast/chest feeding support
How does the newborn skin differ from skin in an older infant?
Smooth, semi-transparent, rosy
Fairer skin pigmentation at birth d/t limited melanin production (skin pigmentation will darken in time)
Darker pigmentation may be noted at tips of ears, scrotum, linea alba and areola d/t placental hormones
Vernix - moisture & heat retention postnatally
What are the ways by which a newborn loses heat?
being wet, a cold environment/inappropriately dressed, heat loss through the head and chest
What is the purpose of brown fat in the newborn?
What is the best way to support newborn temperature stability in the postpartum?
Skin to skin
What things should you think through when preparing to "midwife on baby"?
• Am I gloved?• Do I have a stethoscope on my body or next to me? (Is it turned the
• Do I have NNR equipment set up and near me?
• Is the room warm and free of fans/drafts?
• Do I have warmed blankets near me?
• What position is birthing parent in and what will we need to do to reposition/do skin to skin immediately after birth?
• Tub considerations: What is the temperature? What is the water level? If parent needs to get out quickly, is there a place to go?
What factors are you using to evaluate baby at the time of birth?
Gross Physical Assessment
How do you know if you should begin neonatal resuscitation?
"TERM? TONE? BREATHING"?
Initiate resuscitation by 30sec as necessary
What does APGAR stand for? Describe each with points.
0: pale, blue all over 1: acrocyanosis 2: pink all over
0: absent 1: <100 bpm. 2: >100 bpm
0: no responce to stimulation 1: grimmace no cry 2: grimace w/active cry
0: non, flaccid 1: some flexion of arms and legs 2: arms and legs flexed
0: absent 1: weak, irregular cry. 2: strong, vigorous cry
When do you give APGAR scores?
Evaluated at 1 min and 5 min after birth
Repeat q 5 until stable and score of 7+
Describe the periods of reactivity in the immediate postpartum
First Period of Reactivity • birth to 30-70min
• Period of Decreased Reactivity • 30min - 2hrs
• Second Period of Reactivity • 2-8hrs
What is the AAP and ACOG recommendation for frequency with which newborns should be evaluated in the immediate postpartum?
• Assess HR, Resps & Temp q20 min in first hour if all is well, more frequently prn
After first hour, q30 checks
How should you measure baby's temperature? What is normal newborn temperature?
axillary. 97.7 - 99.5 F
WHAT RESPONSIBILITIES ARE INCLUDED IN "BEING ON BABY" AT A BIRTH?
Dry & Stimulate Baby
Immediate Assessment of Newborn HR & Respirations
Immediate Evaluation of Newborn Condition
Communicate HR and Respiration Info; Call for Initiation of PPV PRN
Position Baby for PPV PRN
Monitor Effectiveness of Resuscitation Efforts PRN
Assess & Initiate Suction, PRNManage Clamping & Cutting the Cord
Manage/Monitor Newborn Temperature (dry blankets)
Maintain Clear Airway (wipe away secretions, reposition prn)
Continually Monitor Newborn Condition
Collect Newborn Vitals at Regular Intervals
Gross Examination of Baby Assess TransitionNewborn Exam & Meds Chart Findings Throughout
What observations about respirations would be concerning?
gurgling, nose flaring,
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