NCM107j WEEKLY NOTES
Pediatrics
NURSING CARE OF NEWBORN
• Newborns undergo many profound physiologic changes at the moment of birth (and
probably, psychological changes as well).
• They have been released from a warm, snug, darkened, liquid-filled environment, which
has met all of their basic needs into a chilling, blaring, unbounded, gravity based outside
world.
• Within 24 hours, neurologic, renal, endocrine, gastrointestinal, and metabolic functions
must be operating competently for life to be sustained.
• The newborn’s adjustment to the external environment is affected by factors such as:
Genetic composition
Competency of intrauterine life
Care received by the mother during labor and birth period
Care received during newborn and neonatal period
Transition to extrauterine life
• Transition Period – happens between intrauterine and extrauterine existence. This is
the period where the infant undergoes phases of instability during the first 6 to 8 hours
after birth.
• Phases of Transition Period
1st Period of Reactivity – 30 minutes after birth
Sleep Phase – between 30 minutes and 2 hours after birth
2nd Period of Reactivity – between 2 hours and 8 hours after birth
• Neonatal Period – the time from birth through the first 28 days of life.
Profile of a Neonate
1. Weight and Length
The birth weight of newborns differs depending on:
o The racial,
o The nutritional,
o The intrauterine and,
o The genetic factors that were present during conception and pregnancy.
Average newborn birth length is 46 to 54 cm.
The average birth length of a mature female neonate is 53 cm (20.9 inches).
For mature males, the average birth length is 54 cm (21.3 inches).
2. Head Circumference
The head circumference is 34 to 35 cm (13.5 to 14 inches) in a mature newborn.
, 3. Chest Circumference
In a term newborn, it is about 2 cm (0.75 to 1 inches) less than head
circumference.
Average chest circumference – 32 – 33 cm.
VITAL SIGNS
4. Temperature
37.2°C (99°F) at the moment of birth.
o This is the temperature because they have been confined in an internal
body organ.
o Temperature falls almost immediately to below normal because of heat
loss and immature temperature-regulating mechanisms.
o The 21° to 22°C (68° to 72°F) temperature of delivery rooms can add to
this heat loss.
Brown fat – helps to conserve or produce body heat by increasing metabolism.
4 Mechanisms of Heat Loss
a) Convection
Is the flow of heat from the body surface to cooler surrounding air.
The effectiveness of convection depends on the velocity of the flow (a current of
air cools faster than non-moving air).
b) Radiation
Is the transfer of body heat to a cooler solid object not in contact with the baby.
c) Conduction
It is the transfer of body heat to cool or solid objects in contact with the baby.
d) Evaporation
Is the loss of heat through conversion of liquid to vapor.
Ways to conserve heat – how to prevent heat loss in newborn?
Drying and wrapping the newborn.
Placing newborn on the radiant heat source.
Kangaroo Mother Care (skin to skin contact)
5. Pulse
The heart rate of the fetus in utero average is 120 to 160 bpm immediately after
birth, as a newborn struggles to initiate respirations:
o Heart rate maybe as rapid as 180 bpm.
Within an hour after birth, as the newborn settles down to sleep:
o Heart rate stabilizes to an average of 120 to 140 bpm.
6. Respiration
The first few minutes of life maybe as high as 80 breaths per minute.
As respiratory activity is established and maintained, the rate settles to an average
of 30 to 60 breaths per minute when the child is at rest.
RR, depth and rhythm are likely to be irregular, and a short period of apnea
, 7. Blood Pressure
BP = approximately 80/46 mmHg at birth.
10th day = rises about 100/50 mmHg.
Blood pressure tends to increase with crying.
A doppler method may be used to take blood pressure.
Physiologic Function
1. Cardiovascular System
Changes are necessary at birth.
Blood that was formed oxygenated by the placenta now must be oxygenated by
the lungs.
CHANGES
o Cramping and severing the umbilical cord immediately closes the fetal
circulatory structures – the umbilical vein, arteries, and ductus venosus.
o Fibrosis occurs within 3 to 7 days; structures eventually convert into
ligaments.
Neonate forced to take Lungs inflate for the
Cord clamped in O2 through the lungs first time
Promoting closure of ductus Decreased pulmonary
arteriosus (fetal shunt) artery pressure
Peripheral Circulation
o Remains sluggish at least the first 24 hours.
o Common things to observe:
- Cyanosis in infants feet and hands = ACROCYANOSIS
- Feet to feel cold to the touch
Heart Rate
o At birth, the HR is 100 to 160 bpm.
o After the 1st cry, HR accelerates to 175 to 180 bpm.
o During sleep, HR is 85 to 90 bpm.
o Point of Maximal Impulse = “Precordial Activity”
- 4th intercostal space, left midclavicular line.
Blood Values
o Newborn’s blood volume = 80 to 110 mL per kilogram of weight, or
about 300 mL.
o Baby is born with a high erythrocyte count around 6 million/mm3.
o Hemoglobin = 17 – 18g/100mL of blood
o Hematocrit – 45% – 50%
o Capillary Heel Stick = falsely high Hct and Hgb
- This is because of sluggish peripheral circulation.
- Warming the extremity before the drawing of blood improves the
accuracy of this value by increasing circulation movement.
o Indirect bilirubin level at birth = 1 – 4 mg/100 mL
- Any increase over this amount reflects the release of bilirubin as
excessive RBC begin their break down.
o Equally high WBC count at birth
3
, - Value as high as 40,000 cells/mm3 may be seen if the birth was
stressful caused by trauma of birth; nonpathogenic.
2. Respiratory System
The first breath of a newborn is initiated by a combination of:
o Cold receptors,
o A lowered PO2 (Falls from 80 mmHg to as low as 15 mmHg) before 1st
breath, and;
o An increased PCO2 (rises as high as 70 mmHg).
Fluid in the lungs called surfactant eases the surface tension on alveolar walls
and makes the first breathing easier:
o This allows the alveoli to inflate more easily than if the lungs walls were
dry.
o About 1/3 of this fluid is forced out of the lungs by pressure of vaginal
birth.
o Additional fluid is quickly absorbed by lung blood vessels and lymphatics
after the first breath.
3. Gastrointestinal System
Although the GIT is usually sterile at birth, bacteria maybe cultured from the
intestinal tract in most babies within 5 hours after birth, from all babies at 24
hours of life.
o Most enter through the mouth from airborne sources.
Accumulation of bacteria in the GIT:
o Necessary for digestion and;
o For the synthesis of vitamin K, milk, the infant’s main diet for the first
year, is low in vitamin K. This intestinal synthesis is necessary for blood
coagulation.
STOOLS
o The first stool of the newborn is usually passed within 24 hours after
birth.
- Consist of meconium
- A sticky, tar like, blackish-green, odorless material from the
mucus, vernix, lanugo, hormones and carbohydrate that are
accumulated during the intrauterine life.
o 2nd and 3rd day of life:
- Stool changes in color and consistency, becoming green and loose.
- Transitional stool
- May resemble diarrhea to the untrained eye.
o By the 4th day:
- Breast fed babies past three or four light yellow stools a day.
- Sweet smelling – breast milk is high in lactic acid which reduces
the amount of putrefactive organism in the stool.
o Formula-fed – 2 or 3 bright yellow stools/day:
- more noticeable odor.
o Under phototherapy treatment for jaundice:
- Bright green stool
- Increased excretion of bilirubin
o Clay colored stool:
- Obstruction of bile ducts
- Bile pigments don’t enter the intestinal tracts
o Mucus with stool, or watery and loose:
- Milk allergy, lactose intolerance
o Tarry stool after 2 more days:
- Newborn swallowed maternal blood.
Pediatrics
NURSING CARE OF NEWBORN
• Newborns undergo many profound physiologic changes at the moment of birth (and
probably, psychological changes as well).
• They have been released from a warm, snug, darkened, liquid-filled environment, which
has met all of their basic needs into a chilling, blaring, unbounded, gravity based outside
world.
• Within 24 hours, neurologic, renal, endocrine, gastrointestinal, and metabolic functions
must be operating competently for life to be sustained.
• The newborn’s adjustment to the external environment is affected by factors such as:
Genetic composition
Competency of intrauterine life
Care received by the mother during labor and birth period
Care received during newborn and neonatal period
Transition to extrauterine life
• Transition Period – happens between intrauterine and extrauterine existence. This is
the period where the infant undergoes phases of instability during the first 6 to 8 hours
after birth.
• Phases of Transition Period
1st Period of Reactivity – 30 minutes after birth
Sleep Phase – between 30 minutes and 2 hours after birth
2nd Period of Reactivity – between 2 hours and 8 hours after birth
• Neonatal Period – the time from birth through the first 28 days of life.
Profile of a Neonate
1. Weight and Length
The birth weight of newborns differs depending on:
o The racial,
o The nutritional,
o The intrauterine and,
o The genetic factors that were present during conception and pregnancy.
Average newborn birth length is 46 to 54 cm.
The average birth length of a mature female neonate is 53 cm (20.9 inches).
For mature males, the average birth length is 54 cm (21.3 inches).
2. Head Circumference
The head circumference is 34 to 35 cm (13.5 to 14 inches) in a mature newborn.
, 3. Chest Circumference
In a term newborn, it is about 2 cm (0.75 to 1 inches) less than head
circumference.
Average chest circumference – 32 – 33 cm.
VITAL SIGNS
4. Temperature
37.2°C (99°F) at the moment of birth.
o This is the temperature because they have been confined in an internal
body organ.
o Temperature falls almost immediately to below normal because of heat
loss and immature temperature-regulating mechanisms.
o The 21° to 22°C (68° to 72°F) temperature of delivery rooms can add to
this heat loss.
Brown fat – helps to conserve or produce body heat by increasing metabolism.
4 Mechanisms of Heat Loss
a) Convection
Is the flow of heat from the body surface to cooler surrounding air.
The effectiveness of convection depends on the velocity of the flow (a current of
air cools faster than non-moving air).
b) Radiation
Is the transfer of body heat to a cooler solid object not in contact with the baby.
c) Conduction
It is the transfer of body heat to cool or solid objects in contact with the baby.
d) Evaporation
Is the loss of heat through conversion of liquid to vapor.
Ways to conserve heat – how to prevent heat loss in newborn?
Drying and wrapping the newborn.
Placing newborn on the radiant heat source.
Kangaroo Mother Care (skin to skin contact)
5. Pulse
The heart rate of the fetus in utero average is 120 to 160 bpm immediately after
birth, as a newborn struggles to initiate respirations:
o Heart rate maybe as rapid as 180 bpm.
Within an hour after birth, as the newborn settles down to sleep:
o Heart rate stabilizes to an average of 120 to 140 bpm.
6. Respiration
The first few minutes of life maybe as high as 80 breaths per minute.
As respiratory activity is established and maintained, the rate settles to an average
of 30 to 60 breaths per minute when the child is at rest.
RR, depth and rhythm are likely to be irregular, and a short period of apnea
, 7. Blood Pressure
BP = approximately 80/46 mmHg at birth.
10th day = rises about 100/50 mmHg.
Blood pressure tends to increase with crying.
A doppler method may be used to take blood pressure.
Physiologic Function
1. Cardiovascular System
Changes are necessary at birth.
Blood that was formed oxygenated by the placenta now must be oxygenated by
the lungs.
CHANGES
o Cramping and severing the umbilical cord immediately closes the fetal
circulatory structures – the umbilical vein, arteries, and ductus venosus.
o Fibrosis occurs within 3 to 7 days; structures eventually convert into
ligaments.
Neonate forced to take Lungs inflate for the
Cord clamped in O2 through the lungs first time
Promoting closure of ductus Decreased pulmonary
arteriosus (fetal shunt) artery pressure
Peripheral Circulation
o Remains sluggish at least the first 24 hours.
o Common things to observe:
- Cyanosis in infants feet and hands = ACROCYANOSIS
- Feet to feel cold to the touch
Heart Rate
o At birth, the HR is 100 to 160 bpm.
o After the 1st cry, HR accelerates to 175 to 180 bpm.
o During sleep, HR is 85 to 90 bpm.
o Point of Maximal Impulse = “Precordial Activity”
- 4th intercostal space, left midclavicular line.
Blood Values
o Newborn’s blood volume = 80 to 110 mL per kilogram of weight, or
about 300 mL.
o Baby is born with a high erythrocyte count around 6 million/mm3.
o Hemoglobin = 17 – 18g/100mL of blood
o Hematocrit – 45% – 50%
o Capillary Heel Stick = falsely high Hct and Hgb
- This is because of sluggish peripheral circulation.
- Warming the extremity before the drawing of blood improves the
accuracy of this value by increasing circulation movement.
o Indirect bilirubin level at birth = 1 – 4 mg/100 mL
- Any increase over this amount reflects the release of bilirubin as
excessive RBC begin their break down.
o Equally high WBC count at birth
3
, - Value as high as 40,000 cells/mm3 may be seen if the birth was
stressful caused by trauma of birth; nonpathogenic.
2. Respiratory System
The first breath of a newborn is initiated by a combination of:
o Cold receptors,
o A lowered PO2 (Falls from 80 mmHg to as low as 15 mmHg) before 1st
breath, and;
o An increased PCO2 (rises as high as 70 mmHg).
Fluid in the lungs called surfactant eases the surface tension on alveolar walls
and makes the first breathing easier:
o This allows the alveoli to inflate more easily than if the lungs walls were
dry.
o About 1/3 of this fluid is forced out of the lungs by pressure of vaginal
birth.
o Additional fluid is quickly absorbed by lung blood vessels and lymphatics
after the first breath.
3. Gastrointestinal System
Although the GIT is usually sterile at birth, bacteria maybe cultured from the
intestinal tract in most babies within 5 hours after birth, from all babies at 24
hours of life.
o Most enter through the mouth from airborne sources.
Accumulation of bacteria in the GIT:
o Necessary for digestion and;
o For the synthesis of vitamin K, milk, the infant’s main diet for the first
year, is low in vitamin K. This intestinal synthesis is necessary for blood
coagulation.
STOOLS
o The first stool of the newborn is usually passed within 24 hours after
birth.
- Consist of meconium
- A sticky, tar like, blackish-green, odorless material from the
mucus, vernix, lanugo, hormones and carbohydrate that are
accumulated during the intrauterine life.
o 2nd and 3rd day of life:
- Stool changes in color and consistency, becoming green and loose.
- Transitional stool
- May resemble diarrhea to the untrained eye.
o By the 4th day:
- Breast fed babies past three or four light yellow stools a day.
- Sweet smelling – breast milk is high in lactic acid which reduces
the amount of putrefactive organism in the stool.
o Formula-fed – 2 or 3 bright yellow stools/day:
- more noticeable odor.
o Under phototherapy treatment for jaundice:
- Bright green stool
- Increased excretion of bilirubin
o Clay colored stool:
- Obstruction of bile ducts
- Bile pigments don’t enter the intestinal tracts
o Mucus with stool, or watery and loose:
- Milk allergy, lactose intolerance
o Tarry stool after 2 more days:
- Newborn swallowed maternal blood.
