NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review 2025 update| comprehensive questions and
verified answers (complete solutions) A+ GRADE!!
Immediate extrauterine newborn transition - (ANSWERS)—immediate !@#$%%%%%
transition from
intrauterine to extrauterine life %%%%%%
Immediate extrauterine newborn transition depends on changes in four major areas: -
(ANSWERS)—respiration,
—circulation,
—thermoregulation, and
—glucose regulation
Biochemical Factors in initiation of respiration - (ANSWERS)—relative hypoxia at the end of
labor
Physical stimuli Factors in initiation of respiration - (ANSWERS)—cold, gravity, pain, light, noise
Physiologic Factor in initiation of respiration - (ANSWERS)Recoil from pressure on thorax while
passing through vagina
Sustained respiration depends on coordinated response of the
Following - (ANSWERS)a. Central nervous system (CNS) respiratory center
B. Aortic and carotid chemoreceptors
C. Thoracic mechanoreceptors
D. Diaphragm and respiratory muscles
Initial breathing serves the following purposes - (ANSWERS)a. Assist in conversion from fetal to
extrauterine circulation
B. Clear lungs of fluid
C. Establish lung volume and expand alveoli
Characteristics of normal newborn respiration - (ANSWERS)a. Respiratory rate 30 to 60 breaths
per minute
B. Irregular/fluctuating pattern
C. Diaphragmatic and abdominal breathing
D. Obligate nose breathing
E. Absence of nasal flaring, grunting, and retractions
Circulatory changes - (ANSWERS)Transition from fetal to adult circulation begins with clamping
of the umbilical cord and continues throughout the first weeks of life
Characteristics of fetal circulation - (ANSWERS)a. Low-pressure system, including placenta
(low-resistance circuit)
B. Minimal circulation to lungs; bypassed via foramen ovale and ductus arteriosus
,NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review 2025 update| comprehensive questions and
verified answers (complete solutions) A+ GRADE!!
C. Foramen ovale favors circulation of most oxygen-rich blood to the brain !@#$%%%%%
%%%%%%
Transition from fetal to neonatal circulation - (ANSWERS)a. Increased systemic resistance due
to loss of placental circuit
B. Increased pressure in left atrium causes functional closure of foramen ovale
C. Initial respiration opens pulmonary vasculature, favoring circulation to lungs
D. Increased oxygenation of circulating blood causes constriction and functional closure of
ductus arteriosus
E. Absence of placental circulation closes ductus venosus
Thermoregulation *Mechanisms of neonatal heat loss* - (ANSWERS)a. Convection
B. Conduction
C. Radiation
D. Evaporation
Thermoregulation *Neonate creates heat in three ways:* - (ANSWERS)a. Shivering (inefficient)
B. Muscle activity (limited benefit)
C. Thermogenesis by metabolism of brown adipose tissue (BAT)
High risks infants with ineffective Thermogenesis - (ANSWERS)(1) BAT stores are decreased in
*preterm and growth-restricted fetuses*
(2) *Hypoglycemia* decreases efficiency of BAT metabolism
Thermoregulation *Consequences of cold stress* - (ANSWERS)a. Increased oxygen
consumption, leading to relative hypoxia and acidosis
B. Metabolism of BAT and release of fatty acids decreases ph
C. Increased use of glucose, depletion of glycogen stores, and hypoglycemia
D. Worsening hypoglycemia and acidosis may result in respiratory distress
Thermoregulation *Management/Interventions to promote* - (ANSWERS)a. Skin-to-skin
contact on mother's chest or abdomen with blanket over both
B. Prewarm blankets and resuscitation area
C. Dry the newborn immediately and replace wet blankets
D. Regulate room temperature and minimize exposure to air convection
E. Postpone newborn bath at least two hours
F. Keep newborn warm and wrapped
Glucose regulation *Glycogen stores* - (ANSWERS)a. Predominantly in liver
B. Accumulated in third trimester
,NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review 2025 update| comprehensive questions and
verified answers (complete solutions) A+ GRADE!!
Glucose regulation *Risk factors for neonatal hypoglycemia* - (ANSWERS)a. Infants of diabetic
!@#$%%%%%
mothers %%%%%%
B. Small for gestational age (SGA) or large for gestational age (LGA)
C. Preterm or post-term
D. Intrapartum—perinatal acidemia, beta-agonist tocolysis, IV glucose administration
E. Maternal substance abuse
Glucose regulation *in the healthy neonate* - (ANSWERS)a. Normal physiologic decrease in
blood glucose appears to be essential to stimulate physiologic processes promoting glucose
production
(1) Lowest at 1-1.5 to 5 hours after birth
(2) Stabilizes at three to four hours after birth
(3) neonate hypoglycemia definition is controversial. Guidelines underscore the need to
measure glucose levels as soon as possible in symptomatic infants; if symptomatic and < 40
mg/dl, IV glucose is recommended for treatment.
(4) Infants without symptoms, ideally infants should feed
Within one hour of birth, and glucose should be screened 30 minutes after feeding; by 4-24
hours of age, blood glucose levels should remain ≥ 45 mg/dl
Glucose regulation *Indications for treatment with intravenous dextrose* - (ANSWERS)(1)
Symptomatic infants < 40mg/dl, or those with initial serum glucose less than 25 mg/dl even
without symptoms
(2) Asymptomatic infants with persistent serum glucose less than 45 mg/dl
Glucose regulation *Signs and symptoms of hypoglycemia* - (ANSWERS)a. Weak cry
B. Jitteriness
C. Cyanosis
D. Apnea
E. Lethargy
F. Poor feeding
Glucose regulation *hypoglycemia Management* - (ANSWERS)a. Encourage feeding as soon
as possible
B. Observe for signs/symptoms of hypoglycemia
C. Assess glucose levels if signs/symptoms or risk factors are
Present
Glucose regulation *Sources and mechanisms of glucose maintenance* - (ANSWERS)(1)
Intake of human milk or formula
(2) Glycogenolysis (use of glycogen stores)
(3) Gluconeogenesis (production of glucose from free fatty acids), glycerol, and amino acids
, NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review 2025 update| comprehensive questions and
verified answers (complete solutions) A+ GRADE!!
!@#$%%%%%
Glucose regulation *Mean glucose levels from 4 to 72 hours are* - (ANSWERS)60 to 70 mg/dl
%%%%%%
Hemoglobin F - (ANSWERS)(1) Predominates in fetal circulation
(2) High affinity for oxygen
(3) Gradually eliminated in first month of life
Physiologic Jaundice of the Newborn etiology - (ANSWERS)Short RBC life span leads to
increased bilirubin
Delayed cord clamping benefits - (ANSWERS)• Evidence of benefit particularly for preterm
infant
• increase in blood volume by 25-40%
• continued bolus of oxygenated blood during transition
• volume expansion that promotes pulmonary capillary perfusion
• more rapid acheivement of adequate oxygenation
Delayed cord clamping method - (ANSWERS)Neutral position on maternal abdomen is
preferable
Below introitus—theoretically may cause placental
Transfusion and polycythemia
Normal *Hemoglobin* Newborn values - (ANSWERS)(a) 13.7-20.0 g/dl
(b) Slight rise in first few days of life due to decreased
Plasma volume
(c) Mean value at 2 months of age 12.0 g/dl
Normal *Hematocrit* Newborn values - (ANSWERS)43-63%
Normal *RBC* count Newborn values - (ANSWERS)4.2-5.8 million/mm3
Normal *WBC* count Newborn values - (ANSWERS)10,000-30,000/mm3
Normal *Platelets* count Newborn values - (ANSWERS)—150,000-350,000/mm3
—Relatively low levels of vitamin K-dependent clotting factors
Obtaining Newborn blood samples - (ANSWERS)a. Venous stasis in extremities may lead to
false values from
Heel-stick samples
B. No longer recommended to use heel warmer before obtaining
Sample (evidence has not shown benefit)
Kelsey review 2025 update| comprehensive questions and
verified answers (complete solutions) A+ GRADE!!
Immediate extrauterine newborn transition - (ANSWERS)—immediate !@#$%%%%%
transition from
intrauterine to extrauterine life %%%%%%
Immediate extrauterine newborn transition depends on changes in four major areas: -
(ANSWERS)—respiration,
—circulation,
—thermoregulation, and
—glucose regulation
Biochemical Factors in initiation of respiration - (ANSWERS)—relative hypoxia at the end of
labor
Physical stimuli Factors in initiation of respiration - (ANSWERS)—cold, gravity, pain, light, noise
Physiologic Factor in initiation of respiration - (ANSWERS)Recoil from pressure on thorax while
passing through vagina
Sustained respiration depends on coordinated response of the
Following - (ANSWERS)a. Central nervous system (CNS) respiratory center
B. Aortic and carotid chemoreceptors
C. Thoracic mechanoreceptors
D. Diaphragm and respiratory muscles
Initial breathing serves the following purposes - (ANSWERS)a. Assist in conversion from fetal to
extrauterine circulation
B. Clear lungs of fluid
C. Establish lung volume and expand alveoli
Characteristics of normal newborn respiration - (ANSWERS)a. Respiratory rate 30 to 60 breaths
per minute
B. Irregular/fluctuating pattern
C. Diaphragmatic and abdominal breathing
D. Obligate nose breathing
E. Absence of nasal flaring, grunting, and retractions
Circulatory changes - (ANSWERS)Transition from fetal to adult circulation begins with clamping
of the umbilical cord and continues throughout the first weeks of life
Characteristics of fetal circulation - (ANSWERS)a. Low-pressure system, including placenta
(low-resistance circuit)
B. Minimal circulation to lungs; bypassed via foramen ovale and ductus arteriosus
,NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review 2025 update| comprehensive questions and
verified answers (complete solutions) A+ GRADE!!
C. Foramen ovale favors circulation of most oxygen-rich blood to the brain !@#$%%%%%
%%%%%%
Transition from fetal to neonatal circulation - (ANSWERS)a. Increased systemic resistance due
to loss of placental circuit
B. Increased pressure in left atrium causes functional closure of foramen ovale
C. Initial respiration opens pulmonary vasculature, favoring circulation to lungs
D. Increased oxygenation of circulating blood causes constriction and functional closure of
ductus arteriosus
E. Absence of placental circulation closes ductus venosus
Thermoregulation *Mechanisms of neonatal heat loss* - (ANSWERS)a. Convection
B. Conduction
C. Radiation
D. Evaporation
Thermoregulation *Neonate creates heat in three ways:* - (ANSWERS)a. Shivering (inefficient)
B. Muscle activity (limited benefit)
C. Thermogenesis by metabolism of brown adipose tissue (BAT)
High risks infants with ineffective Thermogenesis - (ANSWERS)(1) BAT stores are decreased in
*preterm and growth-restricted fetuses*
(2) *Hypoglycemia* decreases efficiency of BAT metabolism
Thermoregulation *Consequences of cold stress* - (ANSWERS)a. Increased oxygen
consumption, leading to relative hypoxia and acidosis
B. Metabolism of BAT and release of fatty acids decreases ph
C. Increased use of glucose, depletion of glycogen stores, and hypoglycemia
D. Worsening hypoglycemia and acidosis may result in respiratory distress
Thermoregulation *Management/Interventions to promote* - (ANSWERS)a. Skin-to-skin
contact on mother's chest or abdomen with blanket over both
B. Prewarm blankets and resuscitation area
C. Dry the newborn immediately and replace wet blankets
D. Regulate room temperature and minimize exposure to air convection
E. Postpone newborn bath at least two hours
F. Keep newborn warm and wrapped
Glucose regulation *Glycogen stores* - (ANSWERS)a. Predominantly in liver
B. Accumulated in third trimester
,NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review 2025 update| comprehensive questions and
verified answers (complete solutions) A+ GRADE!!
Glucose regulation *Risk factors for neonatal hypoglycemia* - (ANSWERS)a. Infants of diabetic
!@#$%%%%%
mothers %%%%%%
B. Small for gestational age (SGA) or large for gestational age (LGA)
C. Preterm or post-term
D. Intrapartum—perinatal acidemia, beta-agonist tocolysis, IV glucose administration
E. Maternal substance abuse
Glucose regulation *in the healthy neonate* - (ANSWERS)a. Normal physiologic decrease in
blood glucose appears to be essential to stimulate physiologic processes promoting glucose
production
(1) Lowest at 1-1.5 to 5 hours after birth
(2) Stabilizes at three to four hours after birth
(3) neonate hypoglycemia definition is controversial. Guidelines underscore the need to
measure glucose levels as soon as possible in symptomatic infants; if symptomatic and < 40
mg/dl, IV glucose is recommended for treatment.
(4) Infants without symptoms, ideally infants should feed
Within one hour of birth, and glucose should be screened 30 minutes after feeding; by 4-24
hours of age, blood glucose levels should remain ≥ 45 mg/dl
Glucose regulation *Indications for treatment with intravenous dextrose* - (ANSWERS)(1)
Symptomatic infants < 40mg/dl, or those with initial serum glucose less than 25 mg/dl even
without symptoms
(2) Asymptomatic infants with persistent serum glucose less than 45 mg/dl
Glucose regulation *Signs and symptoms of hypoglycemia* - (ANSWERS)a. Weak cry
B. Jitteriness
C. Cyanosis
D. Apnea
E. Lethargy
F. Poor feeding
Glucose regulation *hypoglycemia Management* - (ANSWERS)a. Encourage feeding as soon
as possible
B. Observe for signs/symptoms of hypoglycemia
C. Assess glucose levels if signs/symptoms or risk factors are
Present
Glucose regulation *Sources and mechanisms of glucose maintenance* - (ANSWERS)(1)
Intake of human milk or formula
(2) Glycogenolysis (use of glycogen stores)
(3) Gluconeogenesis (production of glucose from free fatty acids), glycerol, and amino acids
, NM717 Module 5 Newborn Midwifery Care of the Newborn
Kelsey review 2025 update| comprehensive questions and
verified answers (complete solutions) A+ GRADE!!
!@#$%%%%%
Glucose regulation *Mean glucose levels from 4 to 72 hours are* - (ANSWERS)60 to 70 mg/dl
%%%%%%
Hemoglobin F - (ANSWERS)(1) Predominates in fetal circulation
(2) High affinity for oxygen
(3) Gradually eliminated in first month of life
Physiologic Jaundice of the Newborn etiology - (ANSWERS)Short RBC life span leads to
increased bilirubin
Delayed cord clamping benefits - (ANSWERS)• Evidence of benefit particularly for preterm
infant
• increase in blood volume by 25-40%
• continued bolus of oxygenated blood during transition
• volume expansion that promotes pulmonary capillary perfusion
• more rapid acheivement of adequate oxygenation
Delayed cord clamping method - (ANSWERS)Neutral position on maternal abdomen is
preferable
Below introitus—theoretically may cause placental
Transfusion and polycythemia
Normal *Hemoglobin* Newborn values - (ANSWERS)(a) 13.7-20.0 g/dl
(b) Slight rise in first few days of life due to decreased
Plasma volume
(c) Mean value at 2 months of age 12.0 g/dl
Normal *Hematocrit* Newborn values - (ANSWERS)43-63%
Normal *RBC* count Newborn values - (ANSWERS)4.2-5.8 million/mm3
Normal *WBC* count Newborn values - (ANSWERS)10,000-30,000/mm3
Normal *Platelets* count Newborn values - (ANSWERS)—150,000-350,000/mm3
—Relatively low levels of vitamin K-dependent clotting factors
Obtaining Newborn blood samples - (ANSWERS)a. Venous stasis in extremities may lead to
false values from
Heel-stick samples
B. No longer recommended to use heel warmer before obtaining
Sample (evidence has not shown benefit)
