If bilirubin is slightly elevated try to correct it

if bilirubin is slightly elevated, try to correct it through breast feeding
! vitamin K shot IM help prevent babies from bleeding out; 25 G 5/8 needles (similar to insulin needles); 90 degrees in the
thigh
o synthesized in intestinal flora which is absent in neonates
! GI system in newborns are slow; bowel sounds can be hypoactive
! Characteristics of stools
o Meconium – sticky, thick, black, odorless; may take up to 2 days for newborn to pass
o Transitional – little bit of meconium and little bit of how stool will look like in the future; day 3-4 of life

12
o Breastfeed – pasty stool, golden yellow, semi-formed stool
o Formula feed – pale yellow, formed stool
o DIARRHEA IS NEVER NORMAL " loose and green
o * * BREASTFED NEONATES TEND TO HAVE MORE STOOLS PER DAY THAN FORMULA-FED NEONATES * *
! glomerular filtration rate is initially low but doubles by 2 weeks of age
! Delay/decrease urinary output " mothers received magnesium sulfate during labor (blocks neuromuscular transmissions
and can cause urinary retention)
! Will lose 5%-10% of birth weight within first week of life; will regain weight within 10 days
! Active immunity – acquired type through vaccinations; body produces antibodies
! Natural immunity– exposure to antigens after which the individual produces antibodies (flu)
! Passive immunity – obtain from mothers via uterine
! Lymphocytes function at immature level
! Colostrum – IGA
! Head to toe assessment in newborn –latex gloves, measuring tape, thermometer, weighing scale, stethoscope, warm
environment, 14 French catheter
o Mother’s history – Magnesium sulfate(baby will be sleepy)
o How long did bag of water rupture – would like to deliver within 12 hours
o Normal for newborns to have irregular breathing, apnea (under 15 seconds is normal), O
2
sat can stay under 90%
for first 10 minutes
o Flexed posture, best time to do assessment is after feeding when baby is more calm
o Assess skin for color, birthmarks, birth trauma
# Swollen eyes for chemical pressure
o Hypertonic, can be hypoglycemic
o Head circumference : above ears and eyebrows (33 cm – 35.5 cm)
# Microcephaly: head circumference is below the 10
th
percentile
# Macrocephaly: head circumference is above 90
th
percentile
o Chest circumference – across nipple line (2 cm – 3 cm lesser than head circumference " 30.5 cm - 33 cm)
o Length (19-21 inches; 45 cm – 53 cm)
o Weight (2500 - 4000 g is normal)
o Thermoregulation – assessed in 15 minutes interval for first hour
o Respirations may be irregular; can hear crackles due to amniotic fluids; 30-60 normal range
o Blood pressure is usually never done in postpartum setting; usually in NICU
o Milia will go away on its own
o Lanugo – fine downy hair; usually seen mostly in premature babies
o Mongolian spots – similar to a bruise; will go away within couple of years
o Pilonidal dimple - right dimple above the sacrum; associated with sinus problems
o Molding
o Fontanels – anterior ( diamond )/posterior( triangle ); anterior takes longer to close
# Will be sunken if dehydrated
# Bulging may indicate intracranial bleeding
o Caput succedaneum
#