Objectives Identify key physical differences between the preterm infant and full term infant Identify normal vital signs for a newborn What are key signs of resp distress?

Newborn facts Neonatal period- 1st 28 days of life 1st 24 hours after birth is the most hazardous time 2/3’s of infant deaths that occur during the 1st year of life happen during this time and ½ of those occurs in the 1st 24 hours

Physiologic Adjustment Periods of reactivity 1st 6 hours of life, all newborns go thru periods of irregularity prior to their body systems stabilizing 1st period of reactivity (1st ½ hour) Quiet resting period (sleeps for 1 ½ hours)

Physiologic Adjustment Second period of reactivity (b/t 2 & 6 hours) This typical reactivity pattern demonstrates that the newborn is adjusting well to extrauterine life

Dubowitz Maturity Scale Gestational Assessment Observation of sole creases Breast nodule diameter Scalp hair Ear lobe Testes and scrotum Skin

Gestational Age Ballard’s assessment of gestational age Score is determined and “matches” weeks gestation

Nursing Care Vital Statistics Weight Length Head circumference Abd circumference Temp, Pulse, Respirations BP only if cardiac defect suspected

Weight Establish a baseline Is infant small or large for gestational age? IUGR? Preterm? Post dates? Average weight at term for infant = 7.5 lbs Newborns of non-white women in USA weight 0.5 lbs less Loses 5-10% of birth weight (6-10 oz) during first few days of life

Length Average 53 cm (20.9 in) female to 54 cm (21.3 in) male 46 cm to 57.3 cm (18-24 in) All data points need to be plotted on graph

Head and Chest Circumference The chest circumference of a newborn should be about two cm’s less than head circumference Average 34-35 cm. Any >37 or < 33 needs to be investigated

Vital Signs Temperature – range 36.5 to 37 axillary Heat loss in newborns occurs by Convection Conduction Radiation Evaporation

Temperature If chilling is prevented the neonates’ temperature will stabilize within 4 hours after delivery and be 98.6 F or 37 C Infection may not cause an increase in temperature and subnormal temperatures need to be investigated

Etiology/Precipitating Factors for Temperature Changes Hypothermia Prematurity Asphyxia Sepsis Neurologic conditions Inadequate drying and warming Exposure to cold environmental conditions

Etiology/Precipitating Factors for Temperature Changes Hyperthermia Excessive environmental temperature Dehydration Infection Phototherapy CNS damage from trauma or drugs

Pulse Range 120-160 bpm May be as low as 100 bpm while sleeping to 180 bpm when crying Color pink with acrocyanosis May be irregular with crying

Signs of Distress Heart murmurs - all murmurs should be followed up and referred for medical evaluation Faint sound Central cyanosis

Respirations Range 30 – 60 breaths per minute Nose breathers Moist breath sounds may be present shortly after birth Bronchial breath sounds bilateral

Respiratory Distress Asymmetrical chest movements Apnea >15 seconds Diminished breath sounds Grunting, Nasal flaring, Retractions Persistent irregular breathing Persistent fine crackles Tachypnea- >60 Excessive mucus Stridor

Blood Pressure Not done routinely Average newborn 65/40 in both upper and lower extremities Varies with change in activity level Must use appropriate size cuff for accurate reading

Eyes and Ears Acuity takes 6 months but able to track mom’s face, no peripheral vision, loves complex patterns Ears-hearing acute

PREVENTING “SHAKEN Preventing “Shaken Baby Syndrome” P=Peak of crying U=Unexpected R=Resists soothing P=Pain like face L=long lasting E=Evening Step back, take 5.

What’s New? (AAP 2012) Post Transcutaneous Bilirubin meter done at 24 hours (a touch on the forehead) Pulse Ox test done at 24 hours ( on hand right wrist and leg) CCHD screening No rectal temps after birth No use of bulb syringes in cribs (VVMC)

In delivery room Delay blow by O2 Observe infant closely by using O2 sat monitoring New standard of practice in all hospitals