1. The Normal Newborn: Adaptation and Assessment
Chapter 21
The Normal Newborn:
Adaptation and Assessment
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2. Development of the Lungs
Surfactant lines the alveoli and reduces surface tension to keep the alveoli open.
Fetal lung fluid moves into the interstitial spaces before, during, and after birth.
Lung fluid is absorbed by the lymphatic and vascular systems.
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3. Initiation of Respirations
A number of factors combine to stimulate the respiratory center in the brain and initiate respirations at birth.
Chemical
Mechanical
Thermal
Sensory
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5. Cardiovascular Adaptation
Transition from fetal to neonatal circulation
Increases in blood oxygen level
Shifts in pressure in the heart and lung
Closing of the umbilical vessels
Closing of the ductus arteriosus, foramen ovale, and the ductus venosis at birth
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6. Thermoregulation Newborn characteristics leading to heat loss
Skin with little subcutaneous (white) fat
Blood vessels close to the surface
Large skin surface
Methods of heat loss
Evaporation
Conduction
Convection
Radiation
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8. Thermogenesis Methods of heat production
Increase activity
Flexion
Metabolism
Vasoconstriction
Nonshivering thermogenesis (brown fat)
These factors increase oxygen and glucose consumption and may cause respiratory distress, hypoglycemia, and jaundice.
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10. Effects of Cold Stress Increased oxygen need
Decreased surfactant production
Respiratory distress
Hypoglycemia
Metabolic acidosis
Jaundice
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12. Question
A newborn is placed under a radiant heat warmer. The nurse knows that thermoregulation presents a problem for newborns because __________.
their renal function is not fully developed, and heat is lost in the urine
their small body surface area favors more rapid heat loss than does an adult's body surface area
they have a relatively thin layer of subcutaneous fat that provides poor insulation
their normal flexed posture favors heat loss through perspiration
Answer: C
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13. Hematologic Adaptation
Erythrocytes, hemoglobin, and hematocrit
Higher for newborns than for adults because less oxygen was available in fetal life than after birth
Leukocytes
Elevated white blood count
Clotting
Newborns are given helpful levels of vitamin K, which is necessary to activate clotting factors.
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14. Gastrointestinal System
Stomach
Intestines
Enzymes
Stools
Progress from thick, greenish black meconium to loose, greenish brown transitional stools to milk stools
Stools of breastfed infants are frequent, seedy, and mustard-colored.
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15. Blood Glucose Maintenance
The neonate uses glucose rapidly and is at risk for hypoglycemia.
Infants at risk for hypoglycemia include:
Preterm and late preterm
Small for gestational age
Large for gestational age
Born to diabetic mothers
Exposed to stressors
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16. Hyperbilirubinemia Physiologic jaundice Pathologic jaundice
Occurs after the first 24 hours of life as a result of hemolysis of red blood cells and immaturity of the liver
Pathologic jaundice
Begins in the first 24 hours and may require treatment with phototherapy
Breast milk jaundice
Often caused by a lack of sufficient intake
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18. Factors that Increase Hyperbilirubinemia
Hemolysis of excessive erythrocytes
Short red blood cell life
Lack of albumin-binding sites
Liver immaturity
Preterm and late preterm infants
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19. Factors that Increase Hyperbilirubinemia (cont.)
Lack of intestinal flora
Delayed feeding
Trauma resulting in bruising or cephalhematoma
Fatty acids from cold stress or asphyxia
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20. Urinary System Kidney function Fluid balance
The ability of the newborn kidneys to filter, reabsorb and maintain fluid and electrolyte balance is less than that of the adult kidney.
Fluid balance
The newborn body is composed of a greater percentage of water.
The first void should occur within 24 hours.
Absence of stool or urine for 48 hours may signify an abnormality.
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21. Immune System
Neonates are less effective at fighting off infection than the older child or adult.
IgG crosses the placenta in utero and provides a newborn with passive immunity.
IgM and IgG are produced to protect against infection.
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22. Psychosocial Adaptation
First period of reactivity
Wide awake, alert, and seems interested in their surroundings
Temperature may be decreased and heart rate may be elevated
Period of sleep or decreased activity
Falls into a deep sleep
Second period of reactivity
Become interested in feeding
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23. Behavioral States Deeper quiet sleep Light or active sleep Drowsy
Quiet alert
Active alert
Crying
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24. Assessment Assess immediately after birth to detect abnormalities.
Cardiorespiratory status
History, airway, color, heart sounds, pulses, and blood pressure
Cyanosis, acrocyanosis
Thermoregulation
Axillary temperatures are preferred over rectal temperatures.
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27. Normal Vital Signs in the Newborn
Temperature
Axillary
° C
° F
Rectal
° C
° F
Skin
° C
° F
Apical pulse: beats per minute (bpm)
(100 sleeping, 180 crying)
Respirations: breaths per minute
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28. Assessing for Anomalies
Head
Molding
Fontanels
Caput
Cephalhematoma
Facial symmetry
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32. Assessing for Anomalies (cont.)
Neck
Clavicles
Cord
Extremities
Hands and feet
Hips
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35. Measurements An important way to learn about growth prior to birth
Weight
Length
Head and chest circumference
Eyes and ears
Reflexes
Abnormal measurements alert the nurse that complications may occur.
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39. NOTE: Some infants may be asymptomatic.
Signs of Hypoglycemia
Jitteriness, tremors
Poor muscle tone
Sweating
Tachypnea
Grunting
Cyanosis
Apnea
Diaphoresis
Low temperature
Poor suck
High-pitched cry
Lethargy
Irritability
Seizures, coma
NOTE: Some infants may be asymptomatic.
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40. Gastrointestinal System
Initial feeding provides information about the ability to coordinate:
Sucking
Swallowing
Breathing
Tolerance to feedings
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41. Genitalia
Female
Labia majora should be large and completely covered the clitoris and labia minora.
Genitalia may be darker than the surrounding skin.
A small amount of vaginal discharge is normal.
Male
At term the scrotum should be pendulous.
Genitalia may be dark brown.
Palpation of the scrotum determines if the testes have descended.
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43. Integumentary System
Marks on the skin should be documented, including location, size, and a general description.
Vernix
Lanugo
Milia
Erythema toxicum
Birthmarks
Marks from delivery
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50. Gestational Age Assessment
Neuromuscular characteristics
Posture
Square window
Arm recoil
Popliteal angle
Scar sign
Heel to ear
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58. Gestational Age Assessment (cont.)
Physical characteristics
Skin
Lanugo
Plantar surface
Breasts
Eyes and ears
Genitals
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