McKinney: Maternal-Child Nursing, 4th Edition

Chapter 21: The Normal Newborn: Adaptation and Assessment

Key Points - Print

 Chemical, mechanical, thermal, and sensory factors stimulate the respiratory

center in the brain and initiate respirations at birth.
 Surfactant reduces surface tension in the alveoli and prevents them from
collapsing as the infant exhales. Surfactant secretion increases during labor and
immediately after birth to enhance the transition from fetal to neonatal life.
 At birth, the ductus arteriosus, foramen ovale, and ductus venosus close, and the
pulmonary vessels dilate in response to increases in blood oxygen, shifts in pressure in
the heart and the pulmonary and systemic circulations, and clamping of the umbilical
cord.
 Infants are predisposed to heat loss because they have thin skin, little
subcutaneous fat, blood vessels close to the surface, and a large skin surface area. They
lose heat by evaporation, conduction, convection, and radiation.
 In newborns, the main method of heat production is nonshivering thermogenesis,
the metabolism of brown fat, which is located primarily around the back of the neck; in
the axillae; between the scapulae; along the abdominal aorta; and around the kidneys,
adrenals, and sternum.
 Laboratory values for erythrocytes, hemoglobin, and hematocrit are higher for
newborns than for adults because the partial pressure of oxygen of fetal blood is much
lower than the normal adult level.
 After birth, the initial stools are thick, greenish black meconium. Loose, greenish
brown transitional stools follow meconium, and milk stools follow transitional stools.
 Breastfed infants have seedy stools that are the color and consistency of mustard
and have a sweet-sour smell. Formula-fed infants have firmer stools that are pale yellow
to light brown.
 The neonate uses glucose rapidly for breathing, heat production, movement, and
activation of neonatal functions.
 Physiologic jaundice results from transient hyperbilirubinemia, appears after the
1st 24 hours of life, and is normal. Nonphysiologic jaundice results from abnormalities
causing excessive destruction of red blood cells or problems with bilirubin conjugation.
This type of jaundice begins during the first 24 hours and is abnormal.
 The newborn’s kidneys are immature. The glomerular filter and the renal tubules
reabsorb much less than adult kidneys.
 When IgG crosses the placenta, newborns receive passive temporary immunity to
bacteria, bacterial toxins, and viruses to which the mother has immunity. This passive
immunity gradually disappears over the first 6 to 8 months of life.
 During the first period of reactivity after birth, infants are wide awake, alert, and
interested in their surroundings. They move their arms and legs, root, and appear hungry.

Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.
Key Points - Print 21-2

During the second period of reactivity, infants are interested in feeding and may pass
meconium.
 Newborns progress through six behavioral states: deep or quiet sleep, light or
active sleep, drowsy state, quiet alert state, active alert state, and crying state.
 Immediately after birth, the nurse performs a quick assessment to determine
whether the neonate requires resuscitation or other immediate intervention. If no such
problems are detected, a more comprehensive examination is performed.
 Assessment of cardiorespiratory status includes airway, color, heart sounds,
brachial and femoral pulses, blood pressure, and capillary refill.
 Obtaining an axillary temperature is safer than obtaining a rectal temperature
because it avoids the risk of irritating or injuring the rectum.
 Molding, changes in the shape of the head, allows the head to pass through the
birth canal more easily. Molding usually resolves within a week of birth.
 The delivery may result in caput succedaneum, localized edema on the head from
pressure against the cervix, or cephalhematoma, a hematoma caused by bleeding
between the periosteum and the skull from pressure during birth.
 Measurements provide important information about the infant’s growth in utero.
 An absence of reflexes in a neonate may indicate a serious neurologic problem.
 Signs of hypoglycemia include jitteriness, tremors, poor muscle tone, diaphoresis,
poor suck, tachypnea, tachycardia, dyspnea, grunting, cyanosis, apnea, low temperature,
high-pitched cry, lethargy, irritability, seizures, and coma. Some hypoglycemic infants
may be asymptomatic.
 The initial feeding provides an opportunity to assess the infant’s ability to suck,
swallow, and breathe in a coordinated manner.
 The nurse assesses the type, color, and consistency of the newborn’s stools.
Newborns often pass the first meconium stool within 12 hours of birth and almost all
within 48 hours.
 The newborn may void only once or twice during the first 2 days. If the newborn
does not void in the expected time, fluid intake should be increased, and the physician or
nurse practitioner should be alerted.
 The nurse should document the size, location, color, elevation, and texture of all
birthmarks. Marks should be explained to parents.
 The gestational-age assessment provides an estimate of the number of weeks from
conception to birth. Preterm neonates, postterm neonates, and neonates whose size is
inappropriate for gestational age have an increased risk of complications.
 During the first and second periods of reactivity, newborns may have elevated
pulse and respiratory rates, low temperatures, and excessive respiratory secretions.
During the sleep period between the periods of reactivity, newborns cannot be awakened
easily and are not interested in feeding.

Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.