Vernix (the white stuff covering the skin) is less abundant the longer GA
Acrocyanosis – blue periphery and is normal
1st period of reactivity is before the baby falls back asleep. Lasts about an hour.
- do a lot of mother to baby contact and feeding at this time.
The next period is the period of inactivity when the baby cannot really be woken up
L.A.T.C.H. score 0-10 10 being best.
Latch, Audible swallowing, Type of nipple, Hold
Normals: 110-160bpm, 30-60RR, 98-99F
Reasons that babies are bad at controlling temp:
- Large body SA to Mass, thin epidermis, posture flexed, and need a higher ambient temp to keep their body temp up.
- Can’t shiver
- give the baby a layer more than you are wearing
- once depleted it does not come back
- 2-7% of body weight
- on chest and back
Blood glucose at 1 hour is ordinary
- <40ish mg/dl is too low.
- needs some sort of calories if this is the case.
- syringe, cup feeding, gavage feed – g tube feeding directly into the stomach.
- lavage is the cleaning out of the stomach
- this will happen if the baby swallows bloody amniotic fluid.
before placing ID bads what should you do
- double check identities
- explain that there may be an alarm system associated with baby’s band to make sure that no one takes it.
- dont take it off if the baby is still at the hospital
milia – don’t pick them
- keratin cysts
- they go away
- reddened area, may go away
- white round dots in the back of the throat
- normal and goes away
- painfull for breast feeding and could be a choking hazard
sucking blister in utero
polydactyly – extra finger
- check the rest of the baby closely
- body hair, that is fuzzy and falls off
Hair tuft at low back or sacral dimple point towards spina bifida
- rooting sucking
- Palmar grasp
- tonic neck
- Plantar grasp
- Protective reflex – link to stanford website
Signs or effective breastfeeding
- good latch
- stool color change
- stooling after feeds
- eventual weight gain, after an initial weight loss of no more than 10% of initial body weight.
- normal baby rash and goes away
- PKU test
- car seat test
- Hearing test
- Hearing test can be failed due to fluid in the ear canal, need to see a pediatrician to fix this
- total bilirubin (sometimes)
circumcision is an elective procedure
- plasta bell, the plastic part is left on until it falls off naturally.
- clamp types need petroleum jelly to prevent adherence to the diaper.
danger or warning signs for parents
- lay baby on back to prevent SIDS
- does not cross suture line
- can cross suture lines
Pseudo menstruation, from hormonal withdrawal
brick dust, uric acid excretion in boys and should only happen once.
syndactyly, webbed toes
slate grey spots – ok and go away
Nevus Flammeus – do not generally go away
Physiologic jaundice – happens after 24 hours and is OK
Pathologic Jaundice – happens before 24 hours and is bad
- can be caused by ABO incompatibility
Hypoglycemia – <40 mg/dl
- risk factors:
- Neonate of DM mother
We treat HTN with Aldomet 250mg if the mother has bad HTN, not proteinuria if HTN before
- HTN can cause Nephrotoxic issues
Preeclampsia – HTN after 20 week GA w/ proteinuria
- Volume overload and leaky vessels
- HELLP – hemolysis, elevated liver enzymes, and low platelets
- cause is mostly know, but thought to be from the placenta developing incorrectly, increased inflammatory response, with endothelial response and leaky.
- only cure is delivering baby.
- risk factor: 1st time, HTN or vascular Dx, big baby from DM
- risks: DIC, abruptio
- Mag sulfate is for the neural maturity of the baby
- 4-6 gm loading dose
- Lab: 4-7 mEq/mL
- monitor mag and RR
- Pulmonary edema, resp depression and arrest,
- Calcium gluconate IV is the antidote for MAG toxicity
- should be on this for 24 hours postpartum, and still at risk for at least 6 weeks