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Maternal Physiologic Changes After Birth, Exams of Nursing

A.T. Still University of Health Sciences (ATSU)Nursing

A comprehensive review of the physiological changes that occur in a mother's body after giving birth. It covers topics such as uterine involution, endocrine system changes, urinary system changes, cardiovascular system changes, and postpartum complications. The document also discusses factors affecting response to parenthood, parent-infant communication, and becoming a father. It is a useful study guide for nursing students preparing for exams on maternal health.

Typology: Exams

2022/2023

Available from 06/09/2023

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NURS 3526 EXAM REVIEW STUDY GUIDE-MATERNAL
PHYSIOLOGIC CHANGES 2023 A+
Uterus: involution – return of uterus to a nonpreg state.
•1 cm above or at umbilicus at 12h
•Descends 1-2 cm q24h
•No longer palpable by 2wks
•Nonpreg state by 6wks
Uterus subinvolution – the uterus does not return to its normal size; most common causes are retained
placental fragments and infection
Uterus contraction – hemostasis by compression of intra-myometrial blood vessels. Mediated by
oxytocin
•Uterine atony – fail to contract after the delivery; most common cause of excessive
bleeding (hemorrhage)
•After-pains – worse for multigravida, large baby and multiple
births. Uterus – Lochia: post-birth uterine discharge.
•Rubra: blood, decidua, trophoblastic debris; 3-4 days
•Serosa: old blood, serum, leukocytes, debris; 4-10 days
•Alba: leukocytes, decidua, epithelial cells, mucus, serum, bacteria: 2-6 wks
Uterus – cervix: soft after birth; bruised
•12-18h regains short, firm form
•Os 1cm by 1wk; External os never regains pre-preg form
Vagina & Perineum: walls thin and dry – thicken with ovarian func return
•Rugae absent; reappear in 3wks
•Perineum – edematous & erythematous. Lacerations/episiotomy (4-6 wks to heal
fully). Hemorrhoids (decrease by 6wks)
•Pelvic muscles: torn/stretched during delivery. Poor tone – 6m to regains; Kegels to help
oLift pelvic floor and contract muscles. They have been proven effective in
reducing urinary incontinence
oSqueeze muscles use to hold urine hold 10 secs, let go, 10 repetitions
Endocrine system – placental hormones: dramatic decrease in placental derived hormones – estrogen
and progesterone levels lowest at 1wk
•Decreases in hCS, estrogens, cortisol, insulinase reverse effects of pregnancy
•Diabetic mothers will likely req much less insulin for several days
Endocrine sys – pituitary & ovarian: cont increase in prolactin
•70% of non-breastfeeding mothers menstruate by 12th week
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PHYSIOLOGIC CHANGES 2023 A+

Uterus: involution – return of uterus to a nonpreg state.

  • 1 cm above or at umbilicus at 12h
  • Descends 1-2 cm q24h
  • No longer palpable by 2wks
  • Nonpreg state by 6wks Uterus subinvolution – the uterus does not return to its normal size; most common causes are retained placental fragments and infection Uterus contraction – hemostasis by compression of intra-myometrial blood vessels. Mediated by oxytocin - Uterine atony – fail to contract after the delivery; most common cause of excessive bleeding (hemorrhage)
  • After-pains – worse for multigravida, large baby and multiple births. Uterus – Lochia : post-birth uterine discharge.
  • Rubra : blood, decidua, trophoblastic debris; 3-4 days - Serosa: old blood, serum, leukocytes, debris; 4-10 days
  • Alba : leukocytes, decidua, epithelial cells, mucus, serum, bacteria: 2-6 wks Uterus – cervix: soft after birth; bruised
  • 12-18h regains short, firm form
  • Os 1cm by 1wk; External os never regains pre-preg form Vagina & Perineum: walls thin and dry – thicken with ovarian func return
  • Rugae absent; reappear in 3wks - Perineum – edematous & erythematous. Lacerations/episiotomy (4-6 wks to heal fully). Hemorrhoids (decrease by 6wks) - Pelvic muscles: torn/stretched during delivery. Poor tone – 6m to regains; Kegels to help o Lift pelvic floor and contract muscles. They have been proven effective in reducing urinary incontinence o Squeeze muscles use to hold urine hold 10 secs, let go, 10 repetitions Endocrine system – placental hormones: dramatic decrease in placental derived hormones – estrogen and progesterone levels lowest at 1wk **- Decreases in hCS, estrogens, cortisol, insulinase reverse effects of pregnancy
  • Diabetic mothers will likely req much less insulin for several days** Endocrine sys – pituitary & ovarian: cont increase in prolactin
  • 70% of non-breastfeeding mothers menstruate by 12 th^ week

PHYSIOLOGIC CHANGES 2023 A+

- Return of ovulation depends on breastfeeding patterns for breast-feeders o Persistence of prolactin suppresses ovulation o Contraception Urinary sys – fluid loss **- diuresis (increase peeing) within 12h of birth greater than 3L per day in first 2-3 days

  • profuse diaphoresis (sweating) at night – up to 6.6lb wt loss in early days** urinary sys – urethra and bladder
  • decreased urge to void = bladder distention = excessive bleeding o encourage frequent voiding - stress incontinence – Kegels GI sys: increase appetite. Bowel evacuation delayed for 2-3 days
  • decrease muscle tone, anesthesia, pre-labor diarrhea, NPO, dehydration, psychological factors, encourage regular bowel habits/appropriate diet Breasts:
  • breastfeeding: 24h – no change in breast tissue. Colostrum expressed; 72-96h – breast enlargement (warm, tender, lumpy – increased blood and lymphatics). True milk production
  • non-breastfeeding: same as breast feeding mother. Engorgement resolves spontaneously and discomfort decreases within 24-36 h cardiovascular sys - blood vol
  • CO increased 60-80% from pre-labor; drop within 1h. pregnancy-induced hypervolemia (up 40- 45%)
  • Avg blood loss: 300-500ml (Vagina); 500-1000ml (C-section); additional loss via diuresis Cardio – vs:
  • Temp up to 100.4 in first 24h due to dehydration; return to normal afterwards
  • Pulse remain elevated for 1 st^ hr ; gradual decrease over 48h
  • Resp – no changes - BP transient – increase by 5% for few days, return to normal over wks or months, orthostatic hypo possible Cardio – blood components: - Hematocrit and hemoglobin decrease – rise in HCT and Hgb by 7 th^ day; WBC count increase; coagulation factors increase Integumentary sys: **- Melasma usually disappears
  • Hyperpigmentation may persists – areola. Linea nigra.
  • Striae gravidarum (stretch marks) fades**

PHYSIOLOGIC CHANGES 2023 A+

Breast care – breastfeeding: support lactation

  • Assist, edu, lactation consult
  • Treat engorgement: express manually, hot packs, and supportive bra Breast care – non breastfeeding: suppress lactation
  • Firm support, cabbage leaves, ice packs, analgesics Health promotion:
  • Rubella vaccines o Titer < 1: o Informed consent o Avoid pregnancy for next 3mon. breastfeeding is ok
  • Rhogam – given within 72h I/M Discharge planning: begins on admission. Newborns’ and mothers’ health protection act of 1996 allow mother and newborn to remain in the hospital for a minimum of 48h (vagina)/96h (c-section) Discharge teaching:
  • Self-care and watch for signs of complications
  • Sexual activity and contraception – nothing in vagina till checkup
  • Med
  • Follow-up: 2-6wks with OB

Chapter 20: Transition to Parenthood

Parental role: becoming mother

  • Rubin’s stages: taking-in (2-3 days; talkative, animatedly describing birth experience), taking hold (3rd^ day), letting go (5th^ wk) Postpartum blues: a let down feeling, restlessness, fatigue, depression, insomnia, headache, anxiety, sadness and anger. 75-80% experiences it. Blues are normal, get plenty of rest, use relaxation tech. assess severity of “blues” Parenting: period of change and instability for all. Ongoing process – cognitive, affective, motor skill Parental attachment:
  • Attachment/bonding process: Parent loves/ accepts child, child loves/accepts parent
  • Assessment: Skillful observation, interviewing
  • Interventions: Promote attachment, protect fam integrity, edu, risk identification Parent-infant contact:
  • Early contact: skin to skin immediately, breastfeed 1 st^ hr

PHYSIOLOGIC CHANGES 2023 A+

  • Extended contact: family-centered care, rooming-in, couplet care, family participation – father, grandparents, siblings Parent-infant communication: The senses – touch, eye contact (en face), voice, odor Parental tasks and responsibilities:
  • Reconcile fantasy with reality – sex, appearance, crying
  • Nurture/care for infant – feed, clothe, respond to cues
  • Socialize infant – est place Becoming father: adjustment (responsibility uncertainty less attention), engrossment (absorption, preoccupation, interest) Siblings: new position within hierarchy, behavioral changes, involve inc are, acquaintance behaviors Factors affecting response to parenthood: age, same-sex couples, social support, culture, socioeco, personal aspirations.

Chapter 21: postpartum complications

After birth hemorrhage (PPH): loss of more than 500ml (vaginal) or 1000ml (c-section); leading cause of maternal death worldwide

  • Early – occurs within 24h. the greatest danger is the first 24 h
  • Late – afte 24h and before 6wk
  • Risk factors: uterine atony, retained placenta, lacerations of genital tract (fundus is firm. Slow trickle or oozing or frank hemorrhage), hematomas, inversion of the uterus (emergency), sub involution (cause of late PPH – 2 nd^ day to 28 days – common causes are pelvic infection, or retained placental fragments) Uterine atony: leading cause of PPH in the first 24h. asso with high parity, overstretched uterus, polyhydramnios, fetal macro, multiple gestation, med.
  • Assess fundus (if boggy, massage). If fundus is firm, suspect laceration
  • Assess bleeding, perineum, vs, bladder, lab studies
  • Med management: IV infusion of oxytocin, methylergonovine (methergine) – check BP prior to admin, prostaglandin (hemabate) – contraindicated for htn. Hemorrhagic (hypovolemic) shock: care management
  • Admin oxygen, start IV and admin meds, vs, insert foley catheter (urine must be 30cc/hr), prepare for operative intervention (vessel ligation, hysterectomy) After birth infections:
  • Puerperal infection: bacteria infect the uterus and surrounding areas after a woman gives birth. Presence of fever of 38 C (100.4) on 2 consecutive days of the first 10 PP days after the 1 st^ 24hr. Strict aseptic tech, including hand washing is important to prevent this. o Endometritis: s/s: fever, tachycardia, chills, anorexia, nausea, fatigue, foul smelling profuse lochia, uterine tenderness, etc

PHYSIOLOGIC CHANGES 2023 A+

▪ Change in env temp stimulates receptors in the skin that stimulates the resp center in the medulla o Sensory factors: handling of the infant by physician and midwives ▪ Suctioning the mouth and nose ▪ Drying the baby by nurses ▪ Pain asso with birth can be a factor

  • A result of comb of factors: o Int: message is transmitted to resp center in the medulla, diaphragm is stimulated to contract, infant draws first breath o Ext: cold air and touch stimulate skin sensors, impulses f/ skin sensors and responses to sound and light affect resp center/ chest compression and release during birth cause air to be draw into lung, infant draws first breath. Signs of resp distress: nasal flaring, intercostal or subcostal retraction, grunting. Normal finding in the first 24h of life: Acrocyanosis – bluish discoloration of hands and feet Physiologic adj: cardiovascular sys
  • Functional closure of the foramen ovale due to increase pressure in lef t atrium
  • Closure of ductus arteriosus asso with increased oxygenation, high systemic vascular resistance and circulating prostaglandin E levels. o Ductus arteriosus becomes ligamentum arteriosum. Closes within the first hrs after birth. Permanent closure occurs within 3-4 wks
  • Ductus arteriosus can open in response to low o2 level and in prematurity
  • Patent ductus arteriosus detected as heart murmur
  • Closure of umbilical arteries, umbilical vein, and ductus venosus asso with clamping and severing of the umbilical cord
  • HR from 120-160 bpm
  • Apical PR auscultated for a full min
  • Heart sounds – S1 typically louder and duller than S2, S3 and S4 not auscultated in nb.
  • BP vary with gestational age and wt o For term nb, avg systolic 60-80 mmHg o Avg diastolic 40-50 mmHg
  • Signs of risk of cardiovascular problems: persistent tachycardia, persistent bradycardia, skin color: pallor, cyanosis Physiologic adj: thermogenic sys
  • Maintenance of bal b/w heat loss and heat production is important
  • Hypothermia common and dangerous for nb babies
  • Nb loose heat by 4 modes o Convection: flow of heat from the body surface to cooler ambient air ▪ Protect infant by wrapping them in bassinet/put a cap on o Radiation: loss of heat from the body surface to a cooler solid surface not in direct contact but in relative proximity ▪ Place cribs and examining tables away f/ outside windows. Avoid air drafts.

PHYSIOLOGIC CHANGES 2023 A+

o Evaporation: heat loss occurs when a liquid is converted to a vapor ▪ Dry infant quickly after birth/remove wet linens o Conduction: loss of heat from the body surface to cooler surfaces in direct contact. ▪ Place infant in a prewarmed warmer/place protective cover on scales used for weighing infants

  • Goal is to maintain a neutral thermal env.
  • Thermogenic sys – thermogenesis: term nb conserves heat by assuming a position of flexion and by constricting peripheral blood vessels o Heat is generated through nonshivering thermogenesis accom by metabolism of brown fat o Effect of cold stress: decreases o2 uptake in the lungs and causes metabolic acidosis Physiologic adj: other sys
  • Hematopoietic sys – blood groups: group determined genetically and est early in infant life. Cord samples used to id the infant’s blood group and Rh status
  • Renal sys: an infant should void within 24h of life o Signs of renal sys problems: hypospadias, exstrophy of the bladder, enlarged or cystic kidneys id as masses during abd palpation
  • GI sys: capacity of nb stomach varies from < 30 mL on day 1 to more than 90 mL on day 3 o Stools: meconium – first meconium sterile, subsequent ones contain bacteria. Passed within first 12-24 hrs and by 48 hrs. o Signs of problems: ▪ Failure to pass meconium – bowel obstruction related to cystic fibrosis, Hirschsprung’s disease or imperforate anus ▪ Fullness of abd above the umbilicus – hepatomegaly, duodenal atresia, or distention ▪ A scaphoid (sunken) abd – diaphragmatic hernia ▪ Fullness below the umbilicus – distended bladder ▪ Diarrhea ▪ Gagging and projectile vomiting – esophageal and tracheoesophageal anomalies
  • Hepatic sys: o Jaundice – caused by elevated serum levels of unconjugated (indirect) bilirubin ▪ Appears after 24h of age and usually resolves without tx ▪ Patho (nonphysiologic) – appears within 24h of birth o Breastfeeding-asso jaundice: lack of effective breastfeeding, early-onset jaundice begins at 2-5 days of age o Breast milk jaundice – occurs 5 to 10 days of age. seems to relate to factors in the breast milk that either inhibit the conjugation or decrease the excretion of bilirubin o Coagulation: coagulation factors, which are synthesized in the liver are activated by vitamin K. ▪ The lack of intestinal bacteria needed to synthesize vitamin K results in transient blood coagulation deficiency b/w the second and fifth days of life ▪ Vitamin K admin shortly after birth helps prevent clotting problems

PHYSIOLOGIC CHANGES 2023 A+

▪ NB reflexes – sucking, rooting, palmer (grasp), stepping/walking, moro reflex (abduction and adduction of the arms), Babinski (extensor plantar response) Behavioral characteristics: NB behavioral assessment scale (NBAS)

  • Sleep-wake states: variations in the state of consciousness of infants. Six states of deep sleep to extreme irritability o Deep, light, drowsy, quite alert, active alert, crying
  • Sensory behaviors: o Vision: pupils react to light and blink reflex easily stimulated. Term NB can see obj as far as 50cm (2.5ft) o Hearing: similar to that of an adult as soon as amniotic fluid drains from the ears ▪ Responds to Moro reflex at 90 decibels of sounds ▪ Routine hearing screening recommended before discharge o Smell: attracted by sweet smells but turns away from strong odors. Can recognize mother’s smell, differentiate smell of mother’s breastmilk f/other lactating mothers o Taste: no response to tasteless solution, eager sucking with sweet solution o Touch: responsive to touch on all parts of the body
  • Response to env stimuli: temperament – 3 types o The easy child, slow-to warm up child, difficult child.

Chapter 23: nursing care of the newborn and family

First 2 hours:

  • Est resp
  • Skin-to-skin on the mother
  • Prevent heat loss by evaporation o Dry infant to stimulate resp effort and removes moisture o Wet linens are removed o Put cap on NB’s head o Cover mom and nb with warm blanket
  • Apgar score given at 1 and 5 minutes of birth – HR, resp, tone, reflex, skin color
  • Gestational age assessment completed within the first hr of birth
  • Physical assessment: o Initial examination while nb is lying on the mom’s right after birth or while nb is lying on the warmer bed o More detailed exam follow within 12-18hrs after birth o Obtain wt, length, head size, chest size (2-3 cm < head circumference)
  • Gestational age and birth wt assessment: o Classification of nb by gestational age and birth wt ▪ Appropriate for gestational age (AGA) – b/w 10 th^ and 90 th% ▪ Large (LGA) – >90th%

PHYSIOLOGIC CHANGES 2023 A+

▪ Small (SGA) - <10th%

PHYSIOLOGIC CHANGES 2023 A+

o Early and freq breastfeeding and skin-to-skin care with the mother for as long as possible after birth promote thermoregulation and stabilization of glucose levels

  • Hypocalcemia – serum calcium level < 7 mg/dl

PHYSIOLOGIC CHANGES 2023 A+

o Late onset presents with jitteriness, seizures, or apnea. Laboratory and dx tests: standard labs, bilirubin screening, universal NB screening, nb hearing (ABR), congenital heart disease screening (CCHD) Prevent infant abduction: check the identity of any person remove the baby from their room. Personnel are req to wear pic id badges. Staff wearing matching scrubs or special badges. Use closed-circuit tv and monitoring sys. Never leave the NB in the birthing facility room without direct supervision. Id band verification b/w transfers. Preventing NB falls: therapeutic and surgical procedures

  • IM: immune, hep B (recombivax HB), hep B (HBIG) – within 12h of birth if the mother is positive for HepB
  • Circumcision: procedure – use of Yellen (Gomco) or Mogen clamp; PlastiBell device o Assess bleeding q 15-30 min for the first hr and then q hr for the next 4-6 hr o Monitor urinary output, noting the time and amt of the first voiding after o Apply gentle pressure with a folded sterile gauze pad if bleeding occurs. o Provide edu – wash hand, check for bleeding, observe for urination, keep area clean, check for infection, provide comfort. Assessment of neonatal pain: **- Neonatal infant pain scale (NIPS)
  • Premature infant pain profile (PIPP)
  • Neonatal pain agitation and sedation scale (NPASS)
  • CRIES – for use in the neonatal intensive care unit (NICU)**

Chapter 24 Newborn nutrition and feeding

Breastfeeding benefits for mother – decrease PPH and more rapid uterine involution Breastfeeding contraindicated in:

  • Infant siwth galactosemia
  • Maternal human T-cell lymphotropic virus types I or II
  • Brucellosis
  • TB and not under tx
  • Active herpes lesions on breasts
  • Varicella that occurs 5 days before or 2 days after birth
  • H 1 N 1 infection
  • HIV Nutrient needs:
  • Fluids: breast milk contains 87% water, feeding additional water unnecessary to breast or bottle- fed infants
  • Energy: human milk provides an avg of 67 kcal/100 mL or 20 kcal/oz

PHYSIOLOGIC CHANGES 2023 A+

**- Sucking motions

  • Rooting reflex
  • Mouthing Breastfeeding positions: football/clutch, modified cradle, cradling, side-lying** Latch-on:

edge of the areola few drops of colostrum or milk and spread it over the nipple in one hand with the thumb on top and four fingers underneath at the back

  • tickling the baby’s lips to open the mouth
  • painful breastfeeding – inadequate latching on
  • insert a finger b/w the breast and the baby’s mouth to break suction and prevent trauma to the nipple milk ejection or let-down: perceived as a tingling sensation in the nipples and breasts
  • triggers uterine cramping and increased lochia during and after feedings
  • opposite breast may leak
  • audible swallowing with sucking signs of effective breastfeeding:
  • latch without difficulty; bursts of 15-20 sucks/swallows at a time; audible swallowing; easily releases breast; content infant after and has at least 3 bowel movements and 6-8 wet diapers q24h after day 4
  • assess hydration status for adequacy of feeding special considerations:
  • sleep baby – unwrap, change diaper, sit upright, massage stroke, talk
  • fussy – calm before
  • slow wt gain – 5% to 10% after birth normal. Wt loss of > 7% in the first 3 days should be investigated
  • jaundice – encourage freq breastfeeding to prevent breastfeeding-asso jaundice
  • preterm – human milk is best. Encourage pumping Fresh unrefrigerated milk should be used within 3-4 hrs; refrigerated milk can be stored for 72hr. breastmilk can be frozen and used within 6mon Weaning: introduction of foods other than milk Nutrition for breastfeeding mom: add 450-500 cal/day. Excessive consumption of water or other fluids does not increase milk supply. Overdehydration can decrease milk production. Breast care:
  • avoid washing the nipples with soap.
  • Wear breast shells in her bra if nipples flat or inverted. Helps with sore nipples support her breast manually express a

PHYSIOLOGIC CHANGES 2023 A+

Engorgement: occurs 3-5 days after birth when the milk comes in

  • Usually resolved within 24hr
  • Feed q2h, and pump.
  • Use ice packs, cabbage leaves. Sore nipples: assess latching and nipples for cracking
  • Instruct mom to express a few drops of colostrum or breast milk and rub it into the nipples if there is any break in the skin
  • Wipe the nipples with water after feeding
  • Topical antibiotics on damaged nipples may help reduce the risk for infection and promote healing. Insufficient milk supply: encourage frequent emptying of the breasts, rest, healthy diet, and stress reduction.
  • Use of galactagogues – metoclopramide and domperidone – most commonly used.
  • Plugged milk ducts. Mastitis: infection of the breast – treated with cephalexin or dicloxacillin for 10-14 days, analgesic and antipyretics. Mother advised to rest, breastfeed or pump frequently, and to apply warm compresses before feeding or pumping

Chapter 25: the high-risk newborn

Skeletal injuries

  • Clavicular fracture due to shoulder dystocia – no tx, gentle handling and containment of the limb against the chest Peripheral NS injuries: Erb’s palsy – Moro reflex absent on affected side; facial paralysis High risk newborn: NB who have a greater than avg chance of morbidity and mortality regardless of gestational age or birth wt. Drug-exposed infants: narcotics cross the placental membrane to the fetus.
  • Unborn child may become chemically dependent or passively addicted when a mother is a habitual abuser of OxyContin, heroin, or methadone
  • Neonatal abstinence syndrome is the set of behaviors exhibited by infants exposed to narcotic in utero AE of intrauterine drug exposure:
  • Alterations in fetal breathing movements, IUGR, fetal death, structural malformations, behavioral problems, cognitive impairment
  • May appear normal at birth and demonstrate no immediate untoward effects.
  • Infants exposed only to heroin may begin to exhibit signs of drug withdrawal within 12-24hr

PHYSIOLOGIC CHANGES 2023 A+

o Early id and dx is key Infants of diabetic mothers (IDMs): IDMs are at risk and share same complications as infants born to women with gestational diab

  • Fetal wellbeing is influenced by the euglycemic status of the mother
  • Elevated levels of hgb A1c during the preconception period is asso with a higher incidence of congenital malformation
  • Complications: hypoglycemia (<40mg/dl), large baby (LGA), small bab y (SGA), IUGR, shoulder dystocia and birth injury (clavicular fracture), macrosomia, increased risk for congenital anomalies (CNS anomalies such as anencephaly, spina bifida, and haloprosencephaly), resp distress syndrome due to hyperinsulinemia and hyperglycemia reducing fetal surfactant synthesis
  • Care management: introduce carb feedings early, maintain adequate thermoregulation; symptomatic infants unable to feed should be started on Dextrose 10% at 4-6 mg/min/kg if glucose level is < 20mg/dl, followed by a maintenance dose. Preterm infants: organ sys are immature placing infant at risk for a variety of complications such as resp distress syndrome (RDS) – lack of surfactant, hyperbilirubinemia, intellectual and motor delays.
  • Characteristics: appear scrawny and very small; minimal subcut fat deposits or none in some cases; proportional large head in relation to body; bright pink, smooth and shiny skin with small BV clearly visible; lanugo hair; ear cartilage is soft and pliable; soles and palms with minimal creases; few scrotal rugae and undescended testes; prominent labia and clitoris; maintains attitude of extension and remain in any position in which they are placed; may be inactive and listless; reflexes are partially dev; periodic breathing, hypoventilation, and freq periods of apnea due to immature lung tissue, intraventricular hemorrhage (IVH) Respiratory distress syndrome (RDS): immaturity of the surfactant sys plays a central role in the dev of RDS; exogenous surfactant is admin to prevent RDS
  • Neurologic impairement f/ intraventricular hemorrhage; increased susceptibility to infection Maintaining body temp: transepidermal water loss is greater. Should be transferred f/delivery in a prewarmed incubator; rapid changes in body temp may cause apnea Resp care: neonatal resuscitation, o2 therapy, cont positive airway pressure (CPAP), mechanical/use of high-freq ventilation, surfactant admin Skin care: Braden Q or neonatal skin condition scoring (NSCS); avoid the use of soap Postterm infants: born at gestational age that extends beyond 42wks calculated from mom’s last menstrual period regardless of birth wt.
  • Characteristics – absence of lanugo, little or no vernix caseosa, abundant scalp hair, long fingernails, cracked skin, wasted physical appearance (common finding), deep yellow or green stained skinfolds
  • Complications: fetal distress due to decreasing efficiency of the placenta, macrosomia, meconium aspiration syndrome (MAS), persistent pulmonary htn of the NB (PPHN), RDS,

PHYSIOLOGIC CHANGES 2023 A+

  • Complications asso with o2 therapy: retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA) Germinal matrix hemorrhage – intraventricular hemorrhage (GMH-IVH): usually occurs in infants < 34 wks. Hx of hypoxia, birth asphyxia. Necrotizing enterocolitis (NEC) – intestinal ischemia, bacterial colonization, enteral feeding
  • Clinical manifestation: lethargy, poor feeding, hypotension, vomiting, apnea, decrease urine, unstable temp, jaundice, distended often shiny abd, bloody stools or in gastric contents, gastric retention (undigested formula), localized abd wall erythema, bilious vomitus
  • Med tx: discount of all oral feedings, abd decompression via NG suction, IV antibiotics, correction of extravascular vol depletion, electrolyte imbal, hypoxia, abd radiographs
  • Surg tx: surg resection and anastomosis for progressive deterioration and evidence of perforation
  • Dx confirmed by pneumatosis intestinalis from radiographic study Large for gestational age (LGA): wting 4000g or more at birth; LGA despite gestation when the wt is greater than the 90 th%; can be preterm, postterm, or infants of diabetic moms