A Typical Newborn

1
A Typical Newborn

• Flexed
• Puffy
• Molded
• Nose breathers
• Irregular HR and RR
• Acrocyanosis
• Periods of reactivity

2
Apgar score What does it tells us?

• HR, Resp. effort, tone, reflexes, color
• 1 min 5 min
• 0-10
• Good 7-10

3
They do all kinds of weird things

• Cross their eyes
• Holes in their heads
• Have dry skin (after the vernix absorbs)
• They sneeze
• Like being wrapped up tightly
• Dont get spoiled

4
Know your Patients history!

• Prenatal IDM?, GBS?, mothers bld type,
  significant labs or tests, gen. history
• Intrapartum length of labor, PROM, medications
  received, anoxia, assisted birth, FSE,

5
Determining Gestational Age

• Neuromuscular
• Physical
• skin
• lanugo
• plantar surface
• breast
• eye/Ear
• Genitals
• Score i.e. 3036 wks

6
Gestational Age and Weight

• AGA
• LGA
• SGA
• LBW (
• VLBW (
• IUGR (

7
Erythromycin, Hep B and Vitamin K!
8
Newborn Screening

• Hypothyroidism (most common)
• PKU
• Galactocemia
• Sickle cell
• CF
• Congenital adrenal hyperplasia (CAH)

9
Algo hearing test

• 50 congenital 50 environment
• OAE otoacoustic emissions testing
• ABR auditory brainstem response
• They have to be calm and quiet!!!

10
On a scale of 1-10 rate your pain!

• Obvious
• Subtle
• Grimace, eye squeeze, brow contraction,
  nasolabial furrows
• Flexed and rigid
• Really quiet or restless
• Pain scales for Infants CRIES or NIPS

11
Newborn stools
12
Newborn Jaundice

• Physiologic (baby on left)
• Pathophysiologic (baby on right)
• Breast milk

13
Physiologic Jaundice

• RBCs
• breakdown (60-90 days)
• Liver immature
• Direct bili binds with globulin is excreted
  Good!
• Indirect Unbound so absorbs into skin Bad!!

• Day 3-7
• Appears healthy eating, eliminating
• Jd to nipple line

14
Pathophysiologic Jaundice

• Premature
• Sepsis
• Cold stress
• ABO incompatibility
• Excessive RBCs or release (i.e. hematoma)
• Problem with liver
• NA or Asian

• Occurs within 24 hrs
• 15 mg/dl (10 in premies), 5 mg/dl/day or
  0.5 in 4 hrs
• Visible jd 10 days
• Lethargic, irritable, poor feeding

15
Breast Milk Jaundice???

• Early
• Day 2-4
• Rx take off Br for 24-48 hrs??

• Late
• Peaks at 2 weeks
• Can last up to 12 weeks
• BrM interferes with conjugation or excretion of
  bili
• Less stools
• Acts normal Thriving

16
Hyperbilirubinemia Treatment

• Transcutaneous Biliometry for screening only
• Bili lights unconjugated into conjugated
• Needs fluids, protein
• Eye shields remove when out of crib feeding
• Goal avoid kernicterus!

17
Hypothermia Prevention

• 36.5-37.2
• Remember 4 ways to lose heat
• Large surface area for weight
• More reptilian and mammalian?
• Can use brown fat

18
Hypothermia

• Signs Cyanosis, Temp RR
• Control heat loss, Monitor VS, dont be pushed
  into bathing a cold baby

19
Cold Stress
20
Hypoglycemia BS

Risks LGA, IDM, preterm, cold stress, asphyxia

Signs poor feeding, jittery, hypothermia,
lethargic, flaccid, shrill cry,
diaphoreticseizures, coma

What to do??? Know risk factors!, monitor signs,
keep warm, monitor glucose, feed

21
Circumcision

• Informed consent from parents
• Pain medication for patient Before and after)
• Post op care
• Check for bleeding, voiding

22
Reasons for circumcision

• Religious
• Cultural
• HIV Prevention?
• Cleanliness?

23
Newborn Reflexes