Factors affecting adaptation to extrauterine life:

1. Factors affecting adaptation to extrauterine life: Prenatal : Mother’s health – emotional problems nutritional status complications of PG ie: toxemia, placental problems,diabetes, wt. gain, infection Intrapartum: length of lavor - long ; precipitate length of time membranes ruptured medications given – type & when ie: Demerol found in urine 2 wks later type of delivery - forceps, vacuum extraction, C-Section (transient tachypnea), Immediate care: Airway assess respirations - head lower than body If meconium stained What do you do? Circualtion ie fetal circulation vs neonatal circulation Warmth - from 98.6 to 72 degree, brown fat if full term dry- skin to skin on mom, use warm blanket over both Infection prevention – no protective skin flora, triple dye to cord eyes - crede triple ung. , silver nitrate )gonococcal opthalmia neonatorium Identification Measure & weigh

2. APGAR: 1 & 5 MINUTES 7 – 10 = normal newborn 4 – 6 moderately depressed may need ventilation support KEEP WARM 0 – 3 or 4 severely depress. endotracheal intubation, inflation of lungs with O2 use of cardiac stumulantes correction of metabolic acidlosis & hypoglycemia KEEP WARM

4. Chest circumference = Or 2 cm less than head

8. Interaction of stimuli in initiation of neonatal respiration

9. Neonates are NOSE breathers Shallow & respirations are irregular 30-60, apnea less Than 15 seconds

13. Heart sounds: remember closures are functional NOT permanent. Blood pressure 78/42 often drops to 62/40 first hours of life Varies day to day first month, crying will increase BP Blood volume 10% greater than adults, 20-30% increase in RBC, decrease of 20% plasma. Late cord clamping may Increase blood volume as much as 40-60%. 80-110ml.

14. RBC’s = 5 to 5.8, decrease to 4.2-5.2 by end of first month Hemoglobin at birth 80% = fetal hemoglobin BUT fetal hemoglobin has shorter life span, by 5 weeks only 5%. 15-18g/100cc. What is norm adult? 12-16 WBC = 18,000 at birth, 23-24,000 first day, 11,500 afterf first few days. Platelets – essentially same as adult exception those that took aspirin Blood groups established early in fetal life, but become even more pronounce after birth

18. IMPERFORATED ANUS

20. Renal system: void 12-24 hours. Immature kidneys; therefore, decrease ability to excrete meds = buildup, toxicity. 40% of body weight = ECF; therefore more susceptible to fluid & electrolyte imbalance. Void 6-10 / day. I & O = weigh diapers, 1gm = 1cc GI: intestines sterile, VITAMIN K ? Stomach holds 15cc at birth, by second day up to 2-3 oz. Right side placement for best digestion Stools difference between breast and formula fed Wt. Lose 5 – 10% of body loss

21. Hypoglycemia can compromise CNS, brain dependent on glucose, increase RDS. S&S: tremors, cyanosis, seizures, apnea, irregular resp. hi-pitched weak cry, hypothermia, poor feeding BS falls rapidly – stabilizes at 6-12 hours after birth Increase demand due to metabolic energy because: establish respirations increase muscular activity maintenance thermoregulations Increase incidence: preterm (decrease glycogen stores) IUGR cold stressed perinatal stress, asphyxia ` IDM – insulin dependent mother RH incompatibility

22. Physiologic hyperbilirubinemia or NORMAL jaundice In 50% term, 80-90% of preterm Icterus Neonatorum = jaundice of the newborn If noted before 24hours of age – breakdown started in utero usually RH or ABO incompatibility or infection See usually 48-72 hours after birth Visible in nose at 3mg, face at 5mg, chest 7mg, abd 10my legs 12mg, palms at 20mg. Hypoglycemia, hypothermia, apshaxia cause acidosis, which increase fatty acid, this decreases albumin binding of bilirubin since fatty acids bind with albumin. Cephalhemotma or bruising will increase jaundice WHY?? Kernicterus = most serious complication

27. Psudomenstration = female Swelling of breast = either sex Smegma = either sex, from sebaceous glands white cheesy secretions

28. Acrocyanosis

29. Mongolian Spot

30. LANUGO

34. Molding

35. Bilateral Cephalhematoma

36. Desquamation

37. Nevus FlammeusPort Wine Stain - permanent not elevated; 3:1000 newbornsdoesn’t blanch with pressure

38. or Nevus simplex or angel kiss Red pigment, blanches with pressure Fades in 1-3 years. Often at nape of neck, forehead occiput, eyelid or nose. Stork bite

39. Strawberry hemangioma or Nevus vasculosus1 – 3 % born with another 10% develop within 1-4 wks.These may continue to grow but then disappear by school age. Usually do not take off surgically unless on eyelid or lips & interferes with everyday life

42. Milia

43. Erythema Toxicum or Newborn Rash

44. candidias

45. Candida albicans - thrush

46. Dermatitis

47. Neuromuscular: CNS is immature only some nerves are mylinated; therefore, movement is uncoordinated Brain is growing fast requires glucose and O2 Newborn shows remarkable sensory development, ability for self organization and social interaction Transient tremors& uncoordinated movement are normal BUT if more severe check glucose level REFLEXES check for absence, lag of response or most VIP SYMETRY Absence, lag or asymmetrical response can be due to neuro (CNS) damage, injury, retardation or severe prematurity.

49. TONIC NECK

50. STEPPING OR DANCING REFLEX GRASP