The neonatal period - ANS-from birth through the first 28 days of life Approximately _______ of amniotic fluid is forced out of the lungs in the delivery process. - ANS-30mL Ductus venous - ANS-Clamping of the cord causes constriction of the vessels and closure of the ductus venous immediately. - closes by the 3rd day of life Foramen ovale - ANS-opening between the right atrium and the left atrium - closes when the left atrial pressure is higher than the right atrial pressure Ductus arteriosus - ANS-connects the pulmonary artery with the descending aorta - usually closes within 15 hours post birth Signs of Respiratory Distress - ANS-Cyanosis Apnea/tachypnea Retractions Grunting Flaring of nostrils Hypotonia Apgar scoring - ANS-Taken at 1 and 5 minutes after birth Neutral thermal environment [NTE] - ANS-An environment that maintains body temperature with minimal metabolic changes and /or oxygen consumption. Factors that negatively affect thermoregulation - ANS-Decreased subcutaneous fat Decreased brown fat in preterm infants Large body surface Loss of heat from convection, radiation, conduction, and/or evaporation Brown fat / Non-shivering thermogenesis - ANS-Located in the neck, thorax, axilla, scapular areas, around adrenal glands and kidneys. It increases metabolism, heat production once used it is not replenished. Neonates are at higher risk of thermoregulatory issues because of higher body surface area to body mass ratio, higher metabolic rates, and immature thermoregulatory abilities. Evaporation - ANS-Loss of heat through conversion of liquid to vapor Directly after birth or bathing Convection - ANS-Loss of heat from infant's warm body to cooler air currents. Drafts from windows, AC or oxygen masks Conduction - ANS-Transfer of heat from cooler surface by direct contact. Cold hands, cold equipment Radiation - ANS-Transfer of heat to a colder solid object not in contact with infant. Cold wall of isolette or cold equipment near infant Temperature that indicates cold stress - ANS-Less than or equal to 36 C / 97.6 F Who is at risk for cold stress - ANS-Premature infants, SGA, hypoglycemia, prolonged resuscitation efforts, sepsis , neurological, endocrine or cardiorespiratory problems Signs and symptoms of cold stress - ANS-Cool skin, lethargy, pallor, tachypnea, grunting, hypoglycemia, hypotonia, jitteriness, weak suck Blood glucose that indicates hypoglycemia - ANS-Less than 40 Who is at risk for hypoglycemia - ANS-Diabetic moms, LGA, post/ preterm infants, SGA, hypothermia, infection, respiratory distress, resuscitation, birth trauma Signs and symptoms of hypoglycemia - ANS-Jitteriness, hypotonia, lethargy, irritability, apnea, temperature instability Indirect Bilirubin - ANS-Fat soluable, produced from breakdown of RBC Direct Bilirubin - ANS-Water soluble, converted from indirect bilirubin by liver enzymes Hyperbilirubinemia - ANS-Jaundice occurs in the 2nd-3rd day of life in about 50% of newborns as the results of the breakdown of RBCs. Vitamin K - ANS-Given at birth. IM 0.23-0.5 ml. Infant doesn't have the intestinal flora to produce this vitamin in the first week of life. Promotes formation of clotting factors, 11,7,9, and 10. Meconium Stool - ANS-Begins to form during the 4th gestational month and is the first stool eliminated by the neonate. It is sticky, thick, black, and odorless. It is first passed within 24-48 hours. Transitional Stool - ANS-Begins around the 3rd day and can continue for 3-4 days. The stool transitions from black to greenish black, to greenish brown, to greenish yellow. Breastfed Stool - ANS-Yellow and semi formed. Later it becomes golden yellow with a pasty consistency and has a sour odor. Formula Fed Stool - ANS-Drier and more formed that breastfed stools. It is a paler yellow or brownish yellow and has an unpleasant odor. Diarrhea - ANS-Loose and green stools