Chapter 26: Care of the Newborn

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Welcome to the Deep Dive.

Today we're taking a focused look at the essential knowledge surrounding newborn care.

That's right.

And our guide is the Songers Comprehensive Review for the NCLE -XPN Examination Seventh Edition.

It's pretty comprehensive.

It really is.

So for you, our listener, keen on getting straight to what matters, well, our mission today is simple.

Extract the crucial info on newborn care.

Yep.

Everything from those first moments right after birth through understanding some common health issues.

Exactly.

And this source is really thorough, so rest assured we're hitting the key points.

We'll be covering, you know, initial assessments, the physical exam, body systems, safety,

parent teaching, and then some common newborn conditions.

It's a lot, but it's fundamental stuff.

Definitely.

Ever wondered, you know, what really happens in those critical first hours of a newborn's life and why every little detail seems so important?

Okay, let's get into it.

Starting right at the beginning,

the initial care.

This is all about, well, gathering info quickly and taking immediate action, right?

Exactly.

First thing's first.

We're looking at the initiation of respirations, making sure the baby actually starts breathing effectively on their own.

Okay.

And almost at the same time, we assess the APGAR score.

It's a really rapid evaluation done at one minute and five minutes after birth.

Right.

And sometimes 10 minutes if things are a bit shaky.

Yeah, exactly.

If the score is low, we'll check again in 10 minutes.

The APGAR score, everyone hears about it, but what's it actually telling us?

So the APGAR looks at five vital finds, heart rate, respiratory effort, muscle tone,

reflex, irritability, and color.

Okay.

Each gets a score, zero, one, or two.

Two is the best.

Add them up, and it gives a quick snapshot of how the baby's doing right after birth, how they're adapting.

Gotcha.

A quick overall check.

Beyond that number, what else are we immediately looking at?

Well, we note the cry.

Is it strong,

lusty, or maybe weak or high -pitched?

And we're watching very closely for any signs of respiratory distress.

Like what specifically?

Things like nasal flaring, nostrils widening, grunting, that little sound they make breathing out, retractions where you see the skin pulling in around the ribs,

and seesaw breathing.

Seesaw breathing.

That sounds like something you'd really want to spot.

Oh, absolutely.

It means the chest and abdomen are moving opposite ways when they breathe.

Chest goes in, belly goes out, and back.

It shows they're working really hard to breathe.

It's not normal.

Right.

Normal is synchronous.

Exactly.

We also check for sinusis, that bluish skin color.

And it's key to differentiate central sinusis, like on the core, which is worrying.

Suggests low oxygen.

Right.

Versus acrosinosis, which is just blue hands and feet.

That can actually be pretty normal for the first few hours, even off and on for a week or so.

Just circulation adjusting.

Good to know something alarming looking can be okay.

What about vital signs?

How soon do we get those?

Pretty quickly.

Normal resting heart rate is about 120 to 160.

Can dip to 8100 sleeping or go up to 180 crying.

Wow.

Quite a range.

Yeah.

We listen with the stethoscope, count for a full minute.

Respiration should be 30 to 60 breaths per minute.

Again, count for a full minute.

And we try to get these when the baby's calm.

Makes sense.

Get a baseline.

Yep.

Auxiliary temp under the arm should be about 96 .8 to 99 Fahrenheit.

That's 36 to 37 .2 Celsius.

BP isn't routine on healthy term newborns, but if you did it, maybe 80, 90 over 40, 50.

Okay.

And we're always watching for signs of hypothermia or hypothermia.

Temperature stability is just

critical.

And finally, a quick look for any obvious gross anomalies.

That's a lot right off the bat.

So what are the first actions we take after gathering all that data?

Okay.

Interventions focus on helping them adjust.

First, gently suction the mouth, then the nose with the syringe.

Mouth first.

Why?

So they don't aspirate if they gag when you do the nose,

then dry them thoroughly with warm blankets,

rub their back gently to stimulate that cry, helps open the lungs.

Newborns lose heat super fast, especially from their head.

So wrap them warm blankets, put on a little stockinette cap.

And that early skin -to -skin contact with mom is a big priority too, isn't it?

Definitely.

Huge for bonding and temperature regulation.

We encourage keeping baby with mom right away.

If breastfeeding, help get baby to the breast or just place baby on her abdomen.

Okay.

If they need extra help staying warm, maybe a radiant warmer,

position them on their side, small rolled blanket behind them, helps mucus strain, and of course, identification.

No way.

The bracelets.

Footprints of baby, maybe fingerprints of mom follow policy.

Matching ID bracelets securely on both before they're separated.

Let's circle back to Apgar for a sec.

You mentioned scoring, but what do the numbers mean for what we do?

Good point.

An Apgar of 8 to 10, baby's usually in good shape.

We just support their transition.

Score of 4 to 7, they need a bit of help, maybe some stimulation, rubbing, maybe a little oxygen.

And lower than that.

A score of 0 to 3 means immediate full resuscitation.

And we reassess the Apgar score to see how they're responding.

That five -minute score is really key.

It tells us how effective resuscitation efforts have been.

Okay.

That clarifies those first vital minutes.

Now, moving beyond immediate actions, what about the more detailed initial physical exam?

Right.

This is more comprehensive, usually done within the first few hours.

Same rule applies.

Keep the baby warm throughout.

Always warm.

Always.

And we tend to do the least disturbing things.

First observing, listening, then move to things requiring more touch.

If we find anything unusual, we intervene appropriately and document everything.

You mentioned the Ballard Scale before.

How does that fit in?

The Ballard Scale helps us estimate the baby's gestational age, how many weeks long they are.

It looks at physical signs, like skin texture, foot creases, and neurological signs, like posture and reflexes.

Gives a more precise picture than just the due date.

And that period right after birth, the first six to eight hours, the transition period, what's happening then?

It's a time of massive physiological adjustment, usually three phases.

First is the first period of reactivity, about 30 minutes to an hour.

Baby's alert, heart rate and breathing are up, maybe some tremors.

Good time for bonding, first feed.

Then the period of decreased responsiveness, maybe an hour or two.

They get quiet, vitals slow down, might sleep.

Finally, the second period of reactivity, two to eight hours after birth.

They wake up again, vitals might increase, often past their first stool, meconium.

Knowing these phases helps us know what's normal transition versus a potential problem.

That makes sense, like stages of waking up to the world.

In the detailed exam, you check vitals again, same normal ranges.

Yep, ranges are the same.

Heart rate 121 .60 resting, respirations 30 .60, axillary temp 96 .899.

But getting those rates when they're quiet initially is really important for a good baseline.

And then body measurements, what are we looking for typically?

Average full term is about 1822 inches long, weighs 5 .5 to 8 .75 pounds, head circumference around 13 .2 to 14 inches.

Okay.

And remember, the head looks big about a quarter of the total length.

That's cephalocautal development.

Now let's focus on the head itself.

Seems like a lot to check there, fontanelles, molding.

You got it.

Skull bones aren't fused, allows the head to mold during birth.

Sutures, the lines between bones are palpable, might even overlap slightly, that's molding, but they shouldn't be wide apart.

And the fontanelles, the soft spots.

Right, unossified areas where sutures meet.

Two main ones, the anterior fontanelle, top of the head diamond shaped, maybe three to four centimeters by two, three centimeters, soft and flat.

It takes 12, 18 months to close.

Okay.

And the other one?

Posterior fontanelle,

back of the head, smaller triangular, maybe half a centimeter to one centimeters.

Closes much faster, usually between birth and two or three months.

So feeling them is normal and important.

Absolutely.

Soft and flat is key.

Bulging could mean increased pressure, sunken might mean dehydration, and molding, that temporary reshaping from birth, usually results in about 72 hours.

What about those lumps or bumps sometimes seen after birth?

Caput sixidanium and cephalohematoma, they sound a bit worrying.

They can worry parents.

Caput sixidanium is edema, swelling in the scalp tissue.

Key thing.

It crosses suture lines, more generalized swelling, goes away in a few days.

Okay.

Caput crosses sutures, resolves fast.

Right.

Cephalohematoma is bleeding between a skull bone and its covering, the periosteum.

It does not cross suture lines, confined to one bone area, takes longer to resolve, maybe up to six weeks that the body reabsorbs it.

Got it.

And head lag, is that normal?

A bit of head lag when pulling to sit is normal initially.

But when prone on their tummy, they should be able to lift their head slightly and turn it side to side.

Significant lag later, or not lifting head when prone, could suggest a neuro issue.

Needs checking.

Okay.

Moving to the eyes.

What are the key observations?

Color varies.

Slate gray blue for lighter skin.

Maybe brownish gray for darker skin initially.

Should be symmetrical, clear.

People's equal, round, reactive to light and accommodation.

Blink reflex present.

And crossing eyes.

Common initially.

Eye muscles are still weak.

They should track briefly, focus momentarily.

Check for the red reflex, that orange glow with an ophthalmoscope should be there.

And puffy eyelids are common birth pressure, eye meds.

Right, the erythromycin weight, we'll get to that.

What about ears?

Symmetrical, firm, cartilage with recoil.

Important check.

Top of the ear should be at or above an imaginary line from the outer eye corner.

Low set ears can be linked to down syndrome, kidney issues, other things.

Significant finding.

And the nose.

Seems simple enough.

Mostly.

Flat, broad, centered.

Newborns are obligatory nose breathers initially, so nares need to be patent, open.

No flaring, that's a sign of respiratory distress.

Occasional sneezing is normal, clears the passages.

Okay, now the mouth.

Lots of reflexes to check here, I bet.

You bet.

Gums pink, moist.

Palates intact, hard and soft.

Might see obscene pearls, tiny white cysts on the hard palate, harmless.

Uvula midline.

Tonmus freely, symmetrically.

Short frenulum.

Sucking, crying should be symmetrical.

Need to be able to swallow.

Rooting and gag reflex is present.

Rooting reflex.

Touch cheek or mouth corner, they turn an open mouth, seeking nipple.

Gag reflex protects airway.

Also watch for thrush candida.

White patches you can't wipe off, might be sore.

Moving down to the neck, always looks so short.

It is.

Head midline, trachea midline.

Check range of motion, flexion extension.

Look for torticollis head tilted to one side from tight neck muscles.

And the chest, what's characteristic there?

More circular shape, AP and lateral diameters, but equal.

30 -33 cm.

Breathing is diaphragmatic chest and belly rise and fall together.

No seesaw.

Hear bronchial sounds.

Nipples prominent.

Maybe edematous.

Which is milk that little bit of discharge is common for maternal hormones.

Breast tissue present.

Gently palpate clavicles for fractures.

The skin, so many special terms for newborn skin.

There really are.

Color varies.

Pinkish red to pinkish brown yellow.

Vernix caseosa, that cheesy coating, protects skin and utero.

More on primis.

Lugo von Sein, downy hair, especially on the back.

Millia, tiny white bumps on the face.

Sebaceous glands.

Dry, peeling skin if post -term.

Plethoric dark red, sometimes in primis.

We covered cyanosis and acrosynosis.

What else?

Echemosis.

Bruising.

Patechiae.

Piney red spots.

From birth pressure.

Skin turgor for hydration, pinched gently.

See how fast it bounces back.

Foresips marks, if used.

Harlequin sign, one side pink, other pale, temporary, but could signal cardiac sepsis issues sometimes.

And birth marks, sore, bites, Mongolian spots, etc.

Document everything.

Quite the visual tour.

Down to the abdomen, the umbilical cord is key.

Huge focus.

Should have three vessels, two arteries, one vein.

AVA,

two vessels, notified provider.

Could be linked to IUGR, genetic issues.

Thin cord might mean poor fetal growth.

Check it's intact, clamp secure.

Usually 24 plus hours.

Check for bleeding, drainage.

Cord cleaning varies by policy preference.

Watch for infection signs.

Moisture, oozing, discharge, redness around base.

Maconium is dating, possible.

And the abdomen itself.

Gently feel for umbilical hernia.

Any unusual depression, suggesting diaphragmatic hernia.

Dissension, which could mean blockage, mass, sepsis.

Bowel sound should be present within about an hour.

And we need to check the anus, too.

Yep.

Ensure opening is present.

And watch for a passage of maconium within 24 hours.

That tarry, greenish -black first stool.

Then genitals.

With differences for males and females?

For females.

Labia might look swollen.

Clitoris, slightly enlarged for maternal hormones.

Smegma, whitish mucus, is normal.

Pseudomistration, bit of blood -tins mucus also from hormone withdrawal.

Maybe a hymenal tag.

Need to void within 24 hours.

And males.

Prepeus, foreskin, covers glands.

Scrotum might be edematous.

Metis, urethral opening, should be at the tip.

Testes descended, though, might retract with cold.

Check for hernia, hydrosil.

Also need to void within 24 hours.

Spine and extremity is next.

Key points.

Spine, straight.

Newborn posture is flexed.

Should momentarily lift head when prone, chin to chest.

Movement somewhat coordinated, maybe sporadic.

Note hypotonicity.

Floppy or hypotonicity.

Stiff, could be CNS issues.

Check spend for hair tufts, dimple signs of possible opening.

Arms and legs.

Flexed, full symmetrical range of motion.

Fists, often clenched.

Ten fingers, ten toes, separate.

Legs look bowed.

Gluteal folds even.

Creases on soles give clues about gestation.

Check for fractures, clavicle especially.

Hip dislocation.

Assess for developmental dysplasia of hip, looking for clicks with gentle rotation.

Ortolani's, Barlow's maneuvers.

Palpable pulses, radial, brachial, femoral.

And tremors.

Slight tremors can be common, but could also mean hypoglycemia or drug withdrawal.

Always consider those possibilities.

Wow, that's an incredibly thorough exam.

Amazing how much you learn.

Okay, let's dig into specific body systems now.

Data collection interventions.

Cardiovascular first.

Right.

Keep baby warm.

Always apical heart rate for a full minute.

Listen for murmurs.

Provider listens to it.

If murmur, often check pulse oximetry.

Feel peripheral pulses.

Check cap refill, press skin.

See how fast color returns.

Watch for distress signs, especially during feeding color changes.

Increased breathing effort.

Respiratory system ongoing care beyond the initial suctioning.

Continue suctioning as needed.

Bulb syringe for upper airway.

Maybe French catheter for deeper.

Keep watching for distress signs.

Flaring.

Worsening retractions.

Grunting.

Cyanosis.

Bradycardia apnea longer than 15 seconds.

Give oxygen if prescribed.

Moving to the hepatic system?

The liver?

Lots going on there.

Absolutely.

Watch for jaundice.

Physiological jaundice appears after 24 hours term or 48 hours preterm.

Peaks around day five.

Pathological jaundice is before that concerning.

Report it.

Early frequent feeding helps clear bilirubin.

Keep baby warm.

Cold stress leads to acidosis.

Hinders bilirubin processing.

Liver does more than bilirubin, right?

Oh yeah.

Stores iron for five, six months.

Stores glycogen for blood sugar regulation.

And it's involved in clotting.

Newborns lack vitamin K initially because gut bacteria aren't established yet to make it.

Risk for bleeding.

So that's why we give the vitamin K shot.

Exactly.

Phytonidione IM injection.

Usually vastus lateralis muscle.

Handle baby gently.

Watch for bruising.

Monitor stools.

Check hemoglobin, blood glucose too.

Renal system, the kidneys.

Still immature.

Very.

Can't concentrate urine well?

Normal to lose 5 -10 % weight initially.

Water loss, low intake.

Should retain by 10 -14 days.

Daily weights.

Monitor intake output.

Often weigh diapers.

One gram difference equals one LML urine.

Know the dry diaper weight first.

Watch for dehydration signs.

Dry mouth.

Sunken eyes, fontanel, poor skin, turgor.

And the immune system.

Relying on mom, initially.

Pretty much.

Get IgG via placenta.

IgA via colostrum.

High IgM might mean a utero infection.

So infection prevention is key.

Aseptic technique, standard precautions, meticulous hand washing.

Healthy staff only.

Monitor temp.

Check skin openings.

Give eye prophylaxis within one hour.

Prevent subthalmia and neonaturum.

And cord care is part of this too.

Yes.

Keep clean and dry.

Clamp off after 24 hours of dry occluded no bleeding.

Reinforce parent instructions.

Full diaper below cord.

Monitor for odor, redness, discharge.

Sponge baths until cord falls off.

Usually two weeks.

What about circumcision care?

Apply petroleum jelly gauze unless PlastiBell used.

Remove gauze after first void if applied.

Observe for edema, infection, bleeding.

Teach parents.

Clean gently with warm water each diaper change.

Why does shallowish film as normal healing?

Don't scrub.

Monitor for urinary retention.

So much for parents to learn.

Metabolic and GI systems.

How do they function?

Digest simple carbs.

Okay.

Limited fat digestion.

Lack lipase.

Proteins partially breaking down potential allergens.

Small summit capacity.

Initially grows fast.

Rapid peristalsis.

Empties every 2 .53 hours.

Leading schedule.

Breast feed ASAP usually.

Bottle fed start maybe 30 mV max per orders.

Watch feeding reflexes.

Rooting, sucking, swallowing.

Assist with feeds.

Breast Q238ers.

Formula Q248ers per orders.

Burp during after.

Monitor regurgitation vomiting.

Side positioning after feeds isn't recommended for sleep.

Now SIDs risk.

Back is best for sleep.

Stool progression.

Observe meconium.

Green, black, tarry within 24 -hers.

Then transitional.

Greenish -brown, looser.

Then breast fed.

CD yellow or formula fed.

Pale yellow to light brown.

Assist with newborn screening tests like PKU for discharge after baby's head protein, milk formula for at least 24 -hers.

Neurological system considerations.

Head proportionally large.

Cephalocautal.

Myelinization incomplete, hence primitive reflexes.

Fontanel is open for brain growth.

Assess head size abnormal.

Bulging, depressed anterior fontanel.

Measure graph head circumference compared to chest length.

Assess movements, symmetry, posture,

abnormal.

Jitteriness.

Mark tremors, sequest, test reflexes.

Assess lesergy.

No cry pitch.

High pitch could be bad.

Thermoregulation, keeping warm.

Huge deal, right?

Absolutely critical.

High risk for cold stress.

Leads to increased O2 consumption, vasoconstriction, anaerobic glycolysis, metabolic acidosis.

They don't shiver, have brown fat for heat, but prevention is key.

How do we prevent heat loss?

Prevent evaporation.

Keep dry rep.

Radiation.

During convection, shield from drafts.

Conduction.

Place a warm pad at surfaces.

Keep room warm.

Monitor axillary temp frequently initially.

Then popolicy.

Educate parents on seriousness of cold stress.

Let's quickly run through those reflexes again.

Good recap.

Okay.

Sucking rooting.

Touch lip, flip, jig, turn, suck.

Disappears.

Three -formose swallowing.

Follows sucking.

Tonic neck fencing.

Turn head.

Arm, leg on that side.

Extend.

Opposite flex.

Gone by three -formose.

Pulmar grasp.

Finger and palm.

Grasp tight.

Gone three -formose.

Plantar grasp.

Press ball of foot.

Toes curl.

Gone eight -mose.

Or April reflex.

Startle feeling of falling.

Arms, legs extend out, then pull in.

Gone by six -mose.

Startle reflex.

Loud noise.

Arms abducted duct.

Fits clench.

Gone four -mose.

Pull to sit.

Head lags and little briefly.

Then lifts.

Depends on toe maturity.

Bobinski plantar.

Stroke sole.

Heel to toe.

Toes fan out.

Big toe up.

Normal toe winner.

Stepping walking.

Slober head.

Hold upright feet to touch surface.

Make steps.

Gone three -formose.

Crawling on belly.

Makes crawling movements.

Great refresh.

Now, shifting to newborn safety.

Critical protocols.

ID is paramount.

Matching bracelets on mom baby immediately after birth, before separation.

Name, sex, date time, ID numbers.

Maybe photos footprints.

Some places use RFID tags for abduction alerts.

Regular abduction drills for staff are essential.

And specific ways to prevent abduction.

Teach parents.

Always check ID of anyone taking baby.

Staff must wear SODO ID badge.

Question anyone suspicious near exits.

Never leave baby unattended.

Keep bassinet away from door.

Home safety awareness too.

Hospitals use CCTV.

Security bands monitoring.

Transport baby in bassinet.

Never carried in arms.

Moving to parent teaching.

So much to cover.

Let's start with formula feeding.

Teach proper sterilization if needed.

UG well water.

Absolutely NO microwave heating risk of hot spots.

Reassure that formula is complete nutrition for first four, six months.

Show how to burp effectively.

And for breastfeeding moms.

Assess latch and suck.

Provide guidance, support.

Teach pumping storage if needed.

Reassure breast milk is complete nutrition for first four, six months.

Provide resources, support groups, lactation consultants.

Crucial for ongoing success.

Bathing can seem intimidating.

Guidance.

Warm room.

Before feeding often best.

Gather supplies first.

Mild unscented soap.

Not usually needed on face.

Cleanest to dirtiest.

Eyes.

Inner to outer corner.

Pay attention to folds.

Neck, underarms, groin, genitals.

Dry well.

Make it enjoyable.

Clothing advice.

Assess what they have.

Cover head and cold weather prevents heat loss.

Layering is good for cooler weather.

General rule.

Baby needs one more layer than adult feels comfortable in.

We covered cord and circumcision care.

What about uncircumcised care?

Explain foreskin naturally attached.

Separates over time.

Usually by three years, maybe later.

Never force retraction causes injury.

Natural process.

Once it retracts naturally, gentle daily washing with soap water is enough.

And emphasize importance of touch, cuddling, talking.

Okay, now let's discuss specific types of newborns and common conditions.

Preterm first.

Characteristics and care.

Born before 37 weeks.

Main issue.

Immature systems.

Assessment.

Irregular respiration and sapthia.

Low temp.

Poor suck swallow.

Diminished bowel sounds.

Variable urine output.

Physically.

Thin lens.

Minimal sole creases.

Extended posture.

Lanugo.

Thin skin visible vessels.

Little fat.

Jaundice.

Maybe undescended tests.

Boys.

Nerolabia.

Girls.

Interventions for preterm.

Monitor vitals.

Q2 to 4 -agers.

Maintain airway cardiopulmonary function.

Oxygen humidity as prescribed.

Monitor INO electrolytes.

Daily weight.

Warming device.

Prevent infection exposure rigorously.

And postterm newborns.

Born after 42 weeks.

Risks.

Hypoglycemia.

Assessment.

Parchment -like skin.

Dry crack.

No lanugo.

Long fingernails.

Profuse scalp hair.

Long thin body wasting a fat muscle.

Possible meconium staining.

Interventions.

Normal newborn care.

Plus monitor closely for hypoglycemia.

Maintain temp.

Watch for meconium aspiration.

Then small for gestational age, SGA.

And large for gestational age, LGA.

SGA's below 10th percentile weight.

Fetal distress signs.

Temp instability.

Physical abnormalities.

Hypoglycemia risk.

Polycythemia signs.

Ruddy cyanosis.

Jaundice.

Infection risk.

Meconium aspiration risk.

Interventions.

Maintain airway cardiopulmonary.

Temp.

Observe for distress.

Sepsis.

Monitor prevent hypoglycemia.

Early feeds.

Monitor aspiration.

NLGA.

Above 90th percentile.

Assessment.

Risk for respiratory distress.

Birth trim injury.

Hypoglycemia.

Interventions.

Monitor vitals respiratory distress.

Monitor hypoglycemia.

Early feeds.

Monitor prevent sepsis.

Provide stimulation.

Okay, specific health conditions.

Respiratory distress syndrome, RDS.

Big one for premiums.

Yes.

Lung immaturity.

Lack of surfactant.

Leads to hypoxia.

Acidosis.

Assessment.

Tachypnea.

Nasal flaring.

Grunting retractions.

Seesaw breathing.

Decreased breath sounds.

Apnea.

Polycynosis.

Hypothermia.

Porthone.

Interventions.

Monitor color at effort.

Maintain airway cardiopulmonary support.

Monitor ABGSO2 sat.

Use lowest effective O2.

Eye exam before discharge if pre -meon O2.

ROP risk.

Suction Q2H hers or pre -end.

Position side back.

Neck slightly extended.

Respiratory therapy.

Percussion vibration.

Provide nutrition.

Support bonding.

Prepare parents for possible long -term O2.

Encourage pumping parent participation.

Prepare to assist with surfactant administration.

Meconium aspiration syndrome.

Usually term post -term.

Fetal stress meconium release.

Aspirin utero or first breath.

Assessment.

Respiratory distress at birth.

Tachypnea.

Sinosis.

Retractions.

Flaring.

Grunching.

Crackles.

Runky.

Yellow green staining of nail skin cord.

Interventions.

Have resuscitation gear skilled staff ready.

Assess effort tone HR.

If, okay, just bulb suction catheter.

If decreased effort tone or HR 100 ET suction.

Severe cases might need ECMO.

Bronchopulmonary dysplasia.

BPD.

Chronic lung condition.

From respiratory failure O2 dependence 28 days.

Abnormal x -ray.

Overinflation into lactasis.

Assessment.

Tachypnea.

Tachycardia.

Retractions.

Flaring.

Labored breathing.

Crackles.

Decreased air movement.

Maybe wheezing.

Interventions.

Monitor airway cardiopulmonary.

O2 therapy.

Maybe fluid restriction.

Meds.

Surfactant.

Bronchodilators.

Diuretics.

Corticosteroids.

Transient tachypnea of the newborn.

TTN.

Sounds less severe.

Usually is.

Incomplete absorption of fetal lung fluid.

Usually full term.

Results in 24 -48 hours.

Assessment.

Tachypnea.

Grunting.

Retractions.

Flaring.

Fluid breath sounds.

Cyanosis.

Interventions.

Supportive care.

Maybe oxygen.

Intraventricular hemorrhage.

IVH.

Bleeding in the brain.

Yes, in the ventricles.

Risk factors.

Prematurity.

RDS.

Trauma.

Asphyxia.

Assessment.

Diminished absent moro.

Lethargy.

Apnea.

Poor feeding.

High -pitched cry.

Seizures.

Interventions.

Supportive treatment mainly.

Retinopathy of prematurity.

ROP.

Eye issue and preemies.

Vascular disorder in retina.

Fibrous tissue replaces vessels.

Cause.

Prematurity.

Supplemental O2 30 days.

Leukocoria.

White reflex.

Vitreous hemorrhage.

Myopia.

Strabismus.

Cataracts.

Check that red reflex.

Interventions.

Laser photocoagulation surgery often.

Necrotizing enterocolitis.

NEC.

Serious gut problem.

Vary.

Acute GI inflammation.

Usually for 10 days after birth.

Mostly preterm.

Assessment.

Increased abdominal girth.

Decreased absent bowel sounds.

Distention.

Vomiting bile stained.

Tenderness.

Occult blood in stool.

Prevention.

Maybe withhold feeds 24 -48 hours after asphyxia.

Breast milk preferred later.

Probiotics.

Corticosteroids to mom before birth.

Interventions.

Hold oral feeds.

NG tube for decompression.

Four antibiotics.

Fluids.

Manage electrolytes.

Acid base.

Surgery if needed.

Hyper bilirubinemia jaundice.

Very common, but when is it a worry?

Concern oint bilirubin.

12mg DL term.

Risk of conicteris.

Brain damage.

Assessment.

Jaundice.

Skins clara.

Head to toe.

High bilirubin.

Enlarged liver.

Portone.

Lethargy.

Poresuck.

Interventions.

Monitor jaundice.

Natural light.

Hydration.

Early frequent feeds.

Report jaundice in first 24 -eaches.

Or abnormal signs.

Prepare for phototherapy.

Phototherapy care.

Expose skin.

Cover genitals.

Monitor eye shields.

Check eyes cue shift.

Allow eye contact.

Visual lamp output.

Monitor temp.

Increase fluids.

Expect green stools.

Monitor skin color with lights off.

Cue 4 -8 -8ers.

Watch for bronze baby syndrome.

Reposition cue 2 -8ers.

Provide stimulation.

Teach parents for home therapy.

Monitor rebound after.

Turn lights off for bilirubin draw.

Remember, jaundice in first 24 hours is pathological.

Erythroblastosis.

Fatalis.

Blood incompatibility.

Yes.

RBC destruction from RH or ABO incompatibility.

Leads to hemolytic anemia.

High bilirubinemia.

Maternal antibodies cross placenta.

Attack of babies RBCs.

Rare in first pregnancy usually.

ABO usually less severe.

Assessment.

Anemia.

Jaundice.

Rapid at 24 -eagers.

Aedema.

Interventions.

Roe D.

Immune.

Globulin.

Roe GM to RH native mom.

Within 72 hours of RH post -birth if unsensitized.

Assist with exchange transfusion after birth or intruderine transfusion.

Replace baby's blood with RH NIC.

Parent support.

Sepsis generalized infection.

Key signs.

Bacteria and blood.

AREG Group B strep.

Assessment.

Power.

Tachypneicocardia.

Poor feeding.

Abdominal distension.

Temperature instability.

High or low.

Interventions.

Assess apnea or aspirations.

Stimulate if needed.

Oxygen if prescribed.

Monitor vital stem.

Maintain warmth.

Isolation proverani.

Monitor INO daily weight.

Monitor diarrhea.

Check feeding suck.

Maybe poor.

Monitor jaundice.

Observe irritability lethargy.

Assist with antibiotics.

Monitor toxicity.

Immature liver kidneys.

TRCH syndrome we touched on this.

Group of congenital infections.

Right.

Toxposmosis.

Other syphilis, hep B, varicella, rubella, cytomegalovirus, herpes.

All can cross placenta.

And congenital syphilis specifically.

Treponema pallidum crosses placenta.

18 weeks.

Risks.

Preterm.

Stillbirth.

Low weight.

Irreversible effects.

CNS damage.

Hearing loss.

Assessment.

Hepatisplenomegaly.

Joint swelling.

Palmar rash lesions.

Anemia.

Jaundice.

Snuffles.

Acytes.

Pneumonitis.

CSF changes.

Interventions.

Monitor signs.

Prepare for serol detest.

Assist antibiotics.

Standard secretion precautions.

Gloves till 24 -eaters antibiotics.

Parent support follow -up.

Neonatal abstinence syndrome.

NAS.

Withdrawal in newborns.

Tough situation.

It is.

Passive addiction via placenta.

Findings withdrawal times vary by drug.

Assessment.

Irritability.

Tremors.

Hyperactivity.

Hypertonicity.

Respiratory distress.

Vomiting.

High -pitched cries.

Sneezing.

Fever.

Diarrhea.

Excessive sweating.

Poor feeding.

Extreme fist sucking seizures.

Interventions.

Monitor respiratory cardiac status frequently.

Monitor temp vitals.

Hold firmly close.

Seizure precautions.

Small frequent feeds.

Allow extra time.

Monitor INO.

Assist for hydration if needed.

Protect skin from rubbing.

Swaddle.

Quiet room.

Reduce stimuli.

Allow mother to express feelings.

Refer mother for treatment.

Fetal alcohol spectrum disorders.

FASDs.

Lifelong impact.

Caused by maternal alcohol use.

Cognitive physical delays.

FAS most severe.

Assessment.

Facial changes.

Short palpable fissures.

Smooth philtrum.

Short upturned nose.

Flat mid -face.

Thin upper lip.

Low nasal bridge.

Abnormal pulmonary creases.

Respiratory distress.

Apnea sinosis.

Congenital heart disorders.

Irritability.

Hypersensitivity.

Tremors.

Poor feeding.

Seizures.

Interventions.

Monitor respiratory distress.

Side position for drainage.

Vesuscitation.

Gear ready.

Monitor hypoglycemia.

Assess suck swallow.

Small feeds.

Burp well.

Suction per garron.

Monitor I know weighthead circumference.

Decrease stimuli.

Refer to early intervention.

Newborn of a mother with HIV.

Specific considerations.

Monitor mom closely in pregnancy.

Baby may test positive initially due to maternal antibodies.

Up to 18 months doesn't mean infected.

Antivirals.

Reduced exposure.

Early ID cut transmission.

All get antibodies.

Not all infected.

Maybe asymptomatic for years.

Transmission.

Placenta.

Labor booth.

Breast milk.

Contraindicated if mom HIV plus in many places.

Assessment and interventions for HIV exposed newborn.

May show no signs at birth.

Later.

Immunodeficiency signs.

Hepatospilinomegaly.

Lymphadenopathy.

Impaired growth development.

Interventions.

Clean skin carefully before invasive procedures.

Delay circumcision till status known.

Room with mother.

Treat all exposed to prevent pneumocystis pneumonia.

Enter atrial viral meds.

First six weeks plus.

Monitor for immunodeficiency signs.

Frequent follow -up visits.

HIV culture recommended.

1 to 4 months.

Delay live vaccines.

MMR.

Until status confirmed.

If infected, no live vaccines.

Regular immunizations needed.

But live ones delayed if at risk.

Newborns of diabetic mothers.

Unique risks.

Yes.

Mom has type 1, 2, or gestational.

Baby risks.

Hypoglycemia.

Hyperbilirubinemia.

RDS.

Hypocalcemia.

Birth trauma.

Often LGA.

Anomalies.

Assessment.

Excessive size weight.

LGA.

Edema puffiness.

Face cheeks.

Hypoglycemia signs.

Twitching.

Poor feeding.

Lethargy.

Apnea.

Seizure cyanosis.

Hyperbilirubinemia.

RDS signs.

Interventions.

Monitor for respiratory distress.

Trauma.

Anomalies.

Monitor belly -rubbing glucose weight.

Feed soon after birth.

Glucose water.

Breast milk formula.

Prepare for IV glucose for hypoglycemia.

Monitor edema.

Monitor distress.

Tremor.

Seizure.

Hypoglycemia itself.

How do we define and manage it?

Low blood glucose.

Generally, 40mgol for 72 hrs.

45mgdl after three days.

Check local policy.

Assessment.

Increased RR.

Twitching tremors.

Unstable temp.

Lethargy.

Apnea.

Seizure.

Cynosis.

Interventions.

Prevent with early feeds.

Oral formula or IV glucose as prescribed.

Monitor blood glucose.

Monitor for feeding problems.

Apnea.

Shrill cry.

Lethargy.

Poor tone.

Hypothyroidism.

Low thyroid hormone.

Yes.

Assessment.

Protruding thick tongue.

Dull look.

Swollen face.

Decreased tone.

Interventions.

Thyroid hormone replacement therapy.

Okay, finally, emergency situations.

Choking relief and CPR for infants.

Choking.

Assess mild versus severe obstruction.

Mild.

Good ear exchange.

Cough.

Don't interfere.

Monitor.

Call EMS if persist.

Severe.

Poor no exchange.

Weak no cough.

High pitch no noise.

Cynosis can't cry.

Act fast.

Sit kneel.

Infant face down on forearm.

Head lower.

Support head jaw.

Five back slaps.

Heel of hand between shoulder blades.

Turn face up on other forearm.

Support head neck.

Five chest thrusts.

Two fingers.

Center chest.

Below nipple line.

Repeat five slaps, five thrusts until object out or unresponsive.

Call for help EMS.

Start CPR.

Check for object when opening airway and no blind sweeps.

Infant CPR differences.

Infants say one year.

Pulse check.

Brachial artery.

Inner upper arm compressions.

Two fingers.

One rescuer.

Two thumb encircling.

Two rescuers.

Depth.

13 chest depth.

1 .5 inches.

Four centimeters.

Ratio.

Two rescuers.

15 .2.

EMS activation.

Unwitnessed alone.

CPR two.

Mints.

Then call AED.

EMS activation.

Witness sudden.

Call it AED before CPR.

Absolute critical skills.

And the chapter includes practice questions too, right?

Yes.

Covering things like erythromycin ointment, vitamin K, care for HIV -exposed newborns, priority actions for post -term babies with low Avcars, umbilical cord infection signs, bathing teaching, preventing heat loss, phototherapy care, post -circumcision instructions, recognizing RDS and FAS,

identifying teaching needs for HIV plus moms,

info for moms with herpes, and cord care teaching.

The answers and rationales are in the book.

Great way to test understanding.

Definitely.

Well, that really wraps up our deep dive into newborn care essentials, drawing from that Saunders chapter.

We hope you, our listener, feel more informed and prepared about this critical stage.

Yeah, we covered a lot from those first crucial moments to potential health challenges.

It's a huge topic.

It really is.

You know, considering everything, what single element do you think is maybe the most critical for a healthy newborn transition?

Something to ponder.

Good question.

So many things are interconnected.

True.

And if you want to explore specific areas, further preterm care, specific conditions, maybe we can tackle those in future deep dives.

But for today, you can be confident we've covered the key concepts from this comprehensive chapter.