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Newborn pinking up

Newborn pinking up. APGAR scores. Each category can rate either 0, 1, or 2, with the higher numbers being better. Scores can range from 0 to 10 Babies are assessed 1 minute and 5 minutes after birth Score of 7 or greater at 5 minutes—baby is in good shape. 4-6: baby needs help breathing

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Newborn pinking up

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  1. Newborn pinking up

  2. APGAR scores • Each category can rate either 0, 1, or 2, with the higher numbers being better. • Scores can range from 0 to 10 • Babies are assessed 1 minute and 5 minutes after birth • Score of 7 or greater at 5 minutes—baby is in good shape. • 4-6: baby needs help breathing • 3 or lower: baby needs emergency medical attention.

  3. More about APGAR • The most unreliable of the signs is color, especially for non-Caucasian babies. • APGAR is especially good at 2 things: • Identifying high-risk babies who need resuscitation • Assessing the newborn’s ability to respond to the stress of delivery & its new environment.

  4. Breathing • Fluid fills lungs before birth • Fluid is absorbed into lymph and bloodstream immediately after birth • Lungs start filling with air, and baby takes first breath • Babies who can’t breathe well go to NICU—neonatal intensive care

  5. Cutting the cord • Umbilical cord is still attached to placenta when baby is born. • Continues to pulse for several minutes, supplying baby with oxygen until baby takes first breath • Once pulsing stops, cord is cut. Then the stump is clamped for 24-48 hours.

  6. Picture of the umbilical cord

  7. Preventing eye disease • Gonorrheal eye infections were leading cause of blindness until early 20th century, when it became mandatory to treat newborn’s eyes. • Until 1970s, silver nitrate was used, but solution was irritating. Also doesn’t protect against chlamydia. • Today either tetracycline or erythromycin is used.

  8. Vitamin K injections • Babies receive vitamin K injections to stop blood from clotting. Babies have low levels of vitamin K for the first few weeks after birth. • Injection prevents serious bleeding inside the skull. • Unrelated to hemophilia; only occurs in baby’s first year of life.

  9. Newborn’s appearance • Newborn is slippery, wet, covered with blood and mucus. • Might be covered in vernix/lanugo. • Head may be cone-shaped from birth (this is called “molding”) • Eyelids are puffy; nose is flattened • Baby’s eyes are slate blue or dark bluish-brown.

  10. The newborn appearance

  11. Vernix on the newborn

  12. Bonding • There’s a sensitive period for bonding in the first hour after birth; baby is alert and responsive then • Early research (Klaus & Kennell, 1976; 1982) suggested that first 6-12 hours after birth was a critical time for bonding. • Later research said that bonding can occur at any time; bonding in the first few hours only increases maternal responsiveness toward baby for the first 3 days.

  13. “Rooming In” with baby • Mid-twentieth century: American hospitals did not offer the option to have the baby in the room with you. • Today you can choose to “room in” with the baby or have the baby sent to the nursery. • Pros of rooming in: increased bonding with baby, helps with breastfeeding • Cons: Mom doesn’t get as much sleep. • Lamb (1994): Whether you room with baby or not does not affect bonding or harm baby emotionally.

  14. Bonding

  15. Three threatening conditions • Low birth weight (less than 5 lbs. at birth) • Very low birth weight – less than 3 lbs. • Extremely low birth weight—less than 2 lbs. • Preterm birth—born 3 weeks or more before due (in 2009, 12.2% of U.S. infants were premature; among African-Americans, the rate was 17.5%) • Being small for date • Weigh less than 90% of all babies of same gestational age • May be preterm or full term • Have a 400% greater risk of death

  16. Classifications of Prematurity • “Very Preterm”—born at less than 33 weeks gestational age • “Extremely Preterm”—born at less than 28 weeks gestational age • Survival rates for these infants have risen but have come at a price of increased rates of severe brain damage

  17. Consequences of Low Birth Weight and Prematurity • Most are healthy but have more developmental & health problems as a group than normal-weight babies • More likely to develop… • ADHD • Asthma or other breathing problems • Learning disabilities • 2012 study linked it with autism • 50% are in some kind of special education program

  18. Incidence of Low Birth Weight • Varies from country to country • In developing countries where poverty and malnutrition are rampant, up to 50% of babies are low birth weight. • U.S. rate is 8.1% as of 2011, much higher than that of many other developed countries. • Recent research is focusing on the role of progestin as a buffer against low birth weight

  19. Kangaroo Care • Involves 2-3 hours of daily skin-to-skin contact with baby held upright against parent’s bare chest • Helps baby regulate temperature, heartbeat, and breathing • Kangaroo care babies gain more weight and have a lower risk of dying than babies that don’t receive such care.

  20. Baby receiving kangaroo care

  21. Massage in Preterm Infants • Substantial research by Tiffany Field et al. • 1st study: Babies got firm massage with palms of hands 3 times a day for 15-minute increments. • Led to 47% greater weight gain than standard medical treatment; more active & alert; did better on developmental tests • Experiments show benefits to children born from depressed adolescent moms, moms with HIV, and babies born addicted to cocaine

  22. More on massage therapy • Two consistent findings • Increased weight gain as a result of massage therapy due to stimulation of the vagus nerve (one of the 12 cranial nerves leading to brain) and in turn the release of insulin • Discharge from the hospital 3-6 days earlier.

  23. Jaundice • A yellow color of the skin that is common in newborns because they have too much bilirubin (a pigment produced as red blood cells break down) in their blood • Either too much bilirubin is produced or the immature liver doesn’t get rid of it quickly enough. • Starts at the head and goes downward (face appears yellow before the rest of the body)

  24. 2 kinds of jaundice • Physiological jaundice—not harmful; very common in newborns; seen during first 3-5 days of life; disappears as liver matures. • Pathological jaundice—this type is harmful; occurs when the bilirubin levels are too high • Can affect brain cells, cause baby to be less active • Can result in seizures, deafness, cerebral palsy, & mental retardation

  25. Treatment for Jaundice • Phototherapy—exposing baby to light • In mild cases, you can simply put the baby in sunlight for a time each day. • Sometimes it is done in the hospital, with the baby’s eyes protected by eye patches. • Loose bowel movements and skin rashes can occur with phototherapy. • Blood transfusions may be necessary.

  26. Risk Factors that make Jaundice More Harmful • Babies born at less than 37 weeks • Babies who weigh less than 5 lbs. 8 oz. (2500 grams) • Babies whose blood group is incompatible with Mom’s (Rh factor) • Babies who have an infection • Babies who needed resuscitation at birth • Babies who displayed jaundice within the first 24 hours of life

  27. Call Doctor If… • Baby won’t take breast or bottle (jaundice is especially common in breastfed babies before Mom’s milk comes in) • Baby is sleepy all the time • Baby has lost more than 10% of birth weight • Baby’s arms, legs, or eyes look yellow • Rectal temperature is greater than 100 degrees F (37.8 degrees C).

  28. Metabolic Disease Screening • The March of Dimes recommends screening for 29 different metabolic diseases. • How many are actually screened varies by state. (Georgia screens for all 29.) • All newborns in Georgia get the “heel stick test” in which 9-10 drops of blood are collected. • This test is mandatory, even for parents who can’t afford the $50 fee.

  29. Benefits of Metabolic Screening • Metabolic diseases can cause mental retardation, seizures, hyperactivity, intellectual delays, smaller head size, a “musty” odor, and other health problems. • Benefits of screening entire newborn population outweigh the costs.

  30. Circumcision • A procedure in which the foreskin of the penis is surgically removed, exposing the glans. • Usually performed some time during the first 2-3 weeks of birth and usually within first 488 hours. • Commonly done in the United States, Canada, Israel, and the Middle East. • Less common in Europe, Asia, South America, and Central America.

  31. Current Circumcision Rates in U.S. • Latest statistics (from 2010) show declining rates of circumcision in the U.S. with a current rate of 58.3% being circumcised. • This varies by region • Highest is in Midwest with 71% and Northeast (66%) • Rate in the South is 58% and in the West is 40%. --Figures are from the National Center for Health Statistics

  32. American Academy of Pediatrics’ stance • In 1999, AAP reversed its previous decision recommending routine circumcision. • They now say that there is not sufficient medical evidence to recommend circumcision OR argue against it. It is up to the parents.

  33. Pros and Cons Pros Cons Risk of meatitis (inflammation of penis opening) and meatal stenosis (disorders related to urination) may be as high as 8-21%. Injury to the penis such s partial amputation. Some say it results in decreased sensation during sexual intercourse. • Prevents retraction problems with the foreskin and inflammation of glans & foreskin. • May result in decreased incidence of urinary tract infections. • May result in lower incidence of STDs and HIV. • May decrease risk of penile cancer and cervical cancer in women (sexual partners).

  34. Pain Control During Procedure • Until the 1980s, it was felt that infants didn’t feel pain, and anesthesia during surgery was not used. • Brain scans, heart rate measures, & cortisol tests show that newborns DO feel pain. • AAP now recommends anesthesia, but only 45% of doctors (usually obstetricians) routinely use it. • Babies who get no anesthesia during circumcisions show increased pain responses to vaccinations later compared to girls, non-circumcised boys, and boys who received anesthesia.

  35. Types of Anesthesia Available • 55% of doctors only use a pacifier dipped in sugar water (NOT effective) • An injection of lidocaine into the base of the penis or around the penis shaft is the most effective, but it’s painful. • A numbing cream can be applied to the head of the penis. Not as effective as the nerve block. • No anesthesia is effective at controlling post-operative pain.

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