N434: Newborn test
questions and answers
2025
How long does the transition to extra-uterine life take?
6-8 hours
First extra-uterine transition period include
cord clamp
- newborn detached form placenta (no more nutrients, O2)
Period of reactivity
1-2 hours
great time for breastfeeding
- newborn is alert, hungry
Second stage of extra-uterine transition
sleepy stage
Second period of reactivity
2 to 8 hours
Newborn awakens and shows an interest in stimuli -good for
breastfeeding; increase HR, muscle tone
Chemical respiratory changes in transition to extra-uterine life
cord clamped = no more exchange of O2/CO2
- baby become hypoxic (mild)
- increase CO = acidosis --> stimulate breathing in brain
Mechanical respiratory changes in transition to extra-uterine life
fluid is expelled from newborn lungs as they go through birth canal
increase surfactant
Thermal respiratory changes in transition to extra-uterine life
,go from wet/warm environment to dry
- stimulates respiratory system
Signs of respiratory distress in newborn
Need to be concerned about these:
- central cyanosis (lips, chest)
- apnea >20 sec
- tachypnea
- substernal retractions
- grunting
- seesaw breathing
- nasal flaring
- stridor
- gasping
Is it normal for infants to have acrocyanosis?
Yes, in the first 24 hours of life
- hands, feet
Is transient cyanosis normal for newborns?
When crying it is common
How long of apnea for newborn is concerning?
> 20 sec
Causes of respiratory distress syndrome in newborns
persistent pulmonary hypertension (PPHN)
- lungs and bv have low pressure
transient tachypnea (TTN)
- fluid retention in lungs
Meconium aspiration syndrome (MAS)
Which newborns are more likely to develop transient tachypnea?
C section baby
- no squeeze to remove fluids
Cardiovascular changes in the transition to extra-uterine life
first breath
- pulmonary vasculature dilates --> increase BF from lungs --> increase
pressure in L atrium --> close foramen ovale
clamp cord
- no BF through ductus venosus --> closure of ductus arteriosus --> shunts
blood from pulmonary artery to aorta
, What does the RN need to assess on a newborn regarding cardiovascular
status?
Auscultate apical pulse
- one full minute
- dysrhythmias/murmur common
Do we normally obtain BP on newborns?
NO
Normal newborn HR
110-160 bpm
Normal newborn RR
30-60
Are murmurs and dysrhythmias common in newborns?
YES
If a newborn HR is outside of the 110-160 range, what do we do?
Reassess in 30-60 min
Where is the apical pulse found on newborns?
fourth intercostal space
midclavicular line
WBC considerations for newborns
elevated initally after birth (9,000-30,000)
- not considered an indicator for infection
Clotting factor consideration for newborns
low clotting factors
- low vitamin K
Why do newborns have low vitamin K?
vitamin K is produced in bacteria of the gut and diet
- newborn gut is sterile
- takes weeks to produce
Does vitamin K cross the placenta?
NO
Why do we recommend the vitamin K shot at birth for newborns?
increase production of clotting factors in liver
prevent hemorrhagic complications
questions and answers
2025
How long does the transition to extra-uterine life take?
6-8 hours
First extra-uterine transition period include
cord clamp
- newborn detached form placenta (no more nutrients, O2)
Period of reactivity
1-2 hours
great time for breastfeeding
- newborn is alert, hungry
Second stage of extra-uterine transition
sleepy stage
Second period of reactivity
2 to 8 hours
Newborn awakens and shows an interest in stimuli -good for
breastfeeding; increase HR, muscle tone
Chemical respiratory changes in transition to extra-uterine life
cord clamped = no more exchange of O2/CO2
- baby become hypoxic (mild)
- increase CO = acidosis --> stimulate breathing in brain
Mechanical respiratory changes in transition to extra-uterine life
fluid is expelled from newborn lungs as they go through birth canal
increase surfactant
Thermal respiratory changes in transition to extra-uterine life
,go from wet/warm environment to dry
- stimulates respiratory system
Signs of respiratory distress in newborn
Need to be concerned about these:
- central cyanosis (lips, chest)
- apnea >20 sec
- tachypnea
- substernal retractions
- grunting
- seesaw breathing
- nasal flaring
- stridor
- gasping
Is it normal for infants to have acrocyanosis?
Yes, in the first 24 hours of life
- hands, feet
Is transient cyanosis normal for newborns?
When crying it is common
How long of apnea for newborn is concerning?
> 20 sec
Causes of respiratory distress syndrome in newborns
persistent pulmonary hypertension (PPHN)
- lungs and bv have low pressure
transient tachypnea (TTN)
- fluid retention in lungs
Meconium aspiration syndrome (MAS)
Which newborns are more likely to develop transient tachypnea?
C section baby
- no squeeze to remove fluids
Cardiovascular changes in the transition to extra-uterine life
first breath
- pulmonary vasculature dilates --> increase BF from lungs --> increase
pressure in L atrium --> close foramen ovale
clamp cord
- no BF through ductus venosus --> closure of ductus arteriosus --> shunts
blood from pulmonary artery to aorta
, What does the RN need to assess on a newborn regarding cardiovascular
status?
Auscultate apical pulse
- one full minute
- dysrhythmias/murmur common
Do we normally obtain BP on newborns?
NO
Normal newborn HR
110-160 bpm
Normal newborn RR
30-60
Are murmurs and dysrhythmias common in newborns?
YES
If a newborn HR is outside of the 110-160 range, what do we do?
Reassess in 30-60 min
Where is the apical pulse found on newborns?
fourth intercostal space
midclavicular line
WBC considerations for newborns
elevated initally after birth (9,000-30,000)
- not considered an indicator for infection
Clotting factor consideration for newborns
low clotting factors
- low vitamin K
Why do newborns have low vitamin K?
vitamin K is produced in bacteria of the gut and diet
- newborn gut is sterile
- takes weeks to produce
Does vitamin K cross the placenta?
NO
Why do we recommend the vitamin K shot at birth for newborns?
increase production of clotting factors in liver
prevent hemorrhagic complications
