Chapter 28. Newborn Nursery

Thermoregulation

• Heat loss: Evaporation, radiation, conduction, convection.
• Heat production: Mainly through nonshivering thermogenesis (lipolysis of brown adipose tissue).

Gas Exchange

• From placenta to lungs.
• Fetal Hb allows fetus to maintain lower arterial oxygen tension (greater affinity for oxygen binding than adult Hb).

Effective Breathing and Pulmonary Inflation

• From sporadic breathing to continuous breaths.
• Replacement of fetal lung fluid with air (decreased production and increased absorption).

Circulation

• In fetus: ↑ PVR, ↓ SVR.
• At birth: SVR increases with removal of placenta; PVR decreases with replacement of fetal lung fluid with oxygen and endogenous nitric oxide production, causing vasodilation.
• Mixed circulation persists during this “transition” secondary to ductus arteriosus (closes within 2 wk, but flow decreases within a few hours of birth) and foramen ovale (right-to-left flow reverses soon after birth).

Vital Signs

• Temperature (36.5°C–37.4°C)
• Respirations (<60 breaths/min with no signs of respiratory distress)
• HR (100–160 beats/min)

Head Circumference, Length, Weight, and Assessment of Gestational Age

General Appearance

• Activity, color, abnormalities

Skin

• Color, normal rashes (erythema toxicum, pustular melanosis), mongolian spots, abnormalities (nevi, hemangiomas)

• Swelling (caput, cephalohematoma, subgaleal hemorrhage), trauma (forceps marks, scalp electrode marks), scleral hemorrhage, symmetric pupillary response, presence of red reflex, choanal atresia, cleft lip/palate, ear pits/tags, facial symmetry

Neck

• Clavicles, cysts, webbing, masses

Chest

• Equal breath sounds, respiratory distress (grunting, retracting)
• Nipples (supernumerary), sternal abnormalities (ie, pectus excavatum or carinatum)

Heart

• S1/S2 , rate, murmur, PMI, brachial and femoral pulses

Abdomen

• Bowel sounds, defects, organomegaly, masses, appearance, cord vessels (two arteries, one vein)

Genitals/Anus

• Patent anus, ambiguous genitalia, abnormal anatomy (hypospadias, epispadias)
• Boys: Descended testicles, penile length
• Girls: Perforate hymen, clitoral length

Extremities

• Tone, equal movement, perfusion, digits, Barlow and Ortolani maneuvers for hip dysplasia