MECONIUM ASPIRATION SYNDROME (MAS)
Meconium0stained amniotic fluid aspirated by fetus d/t response
to fetal hypoxia or fetal stress during L&D
Amniotic fluid = greenish/yellowish
Greenish stains on NB skin & umbilical cord
Meconium in lungs--- allows air IN, but cannot be exhaled =
ALVEOLI OVER-DISTENT
HYPERINFLATION & RUPTURE ----- l/t PNEUMOTHORAX
l/t chemical pneumonitis & 2ndary bacterial pneumonia
!!!!RESUSCITATION immed to estab adequate respiratory
effot!!!!!!
Mechan vent may be necessary
S/S o MAS:
Rapid breathing
Retractions
Grunting
Cyanosis
HYPEREXTENDED CHEST
FOLIC ACID— (B vitamin)
Helps prevent neural tube defects in NB
Most effective—mom takes 6 months before getting preg
Folate & Vit B12 needed for formation o’ RBC and synthesis o’
DNA
Folate needed for normal development of fetus’s nervous system.
Folate deficiency in preg woman = ^RF defects of spinal cord or
brain of fetus
BREAST FEEDING—
Pt edu:
Mother should awaken baby at LEAST Q 3 HR during day to feed; Q
4 HR at night
On demand
8 to 12 feed/24 hr
REPORT TO MD---- sacral dimple
For further eval
May be CB: spina bifida occulta—neural tube defect in which
bones surround the meninges and spinal cord fail to close during
gestation.
OTHER S/S o’ spina bifida occulta:
Hairy patch

Hemangioma
Dark red spot
Hypopigmented spot near sacrum
To meet MAJOR DEVELOPMENTAL need o’ 4 day old NB who just
returned from SX:
PROVIDE WITH PACIFIER
--oral needs are primary during infancy
Giving paci will help the infant meet this need
NB with cold stress (HYPOthermia) who is being monitored for
HYPOglycemia.
Best explanation of the cause o’ HYPOglycemia d/t cold stress?
INCREASED METABOLIC RATE
Cold stress = excessive heat loss resulting in the USE OF
COMPENSATORY MECHANISMS to MAINTAIN A STABLE BODY TEMP
Bodily heat loss can be d/t …….
Touching, feeding positioning, and assessing the NB pt
PREDISPOSSES a certain amt o’ heat loss.
Complications o’ cold stress:
HYPOglycemia
Occurs d/t ^ metabolic rate or demand from bod
^ metabolic demand = ^ O2 consumption = ^ utilization o’ glucose
L/T HYPOglycemia
PP pt had RUBELLA at time o’ delivery.
WHY IS NB PLACED IN ISOLATION?
ISOLATION IS MANDATORY B/C BABE HAS VIRUS THAT CAN INFECT
OTHERS
Babes born with rubella continue to SHED RUBELLA VIRUS for 18 MO
AFTER DELIVERY
ISOLATION MANDATORY
Until infant’s URINE and PHARYGEAL MUCOUS are free of
infection
S/S o’ congenital rubella syndrome:
Hearing loss (MOST COMMON)
Glaucoma
Cataracts
Cardiac defects
Coartcation of the aorta
Patent ductus arteriosus

Pulmonary atery stenosis
Hypotonia
Microcephaly
Brain abnorms
IRON LEVELS WNL for NB: 100 to 250 mcg/dL…..children: 50 – 120
mcg/dL
HEP B VAX—
HEP B virus is transmitted through BLOOD and BODILY FLUIDS
Children that get Hep B have ^RF premature death from liver
disease
CDC recommends: day babe born; 1 month later; and then 6 months
later
RESPONSE TO COLD STRESS:
NB burn brown fat = ^ utilization of glycogen and cal
stores
------ HYPOglycemia may occur d/t cold stress
Constriction of superficial blood vessels to maintain heat in
core & prevent transmission o’ heat to periphery
Superficial vasocontstriction results in a MOTTLED appearance
If NB is NOT warmed…… L/T COLD STRESS
Resulting in:
^ metabolic rate L/T ^ O2 & ^ cal consumption & decreased
glycogen stores
L/T--- HYPOglycemia
Development o’ acidosis d/t pulmonary
vasoconstriction
Thermal shock
DIC disseminated intravascular coagulation
PROGRESSING TO DEATH
NON-SHIVERING THERMOGENISIS = main source o heat production in
NB
= refers to production o’ heat by metabolism o’ brown fat
Which is deposited AFTER 28 wk gestation
NB will CRY to try and generate heat *******
NB may have MILD BENIGN TRANSIENT UTERINE WITHDRAWAL BLEEDING
AKA pseudomenstruation

Physiological response to estrogen exposure through
placenta
---reassure rents IT OKAY
Other findings in NB:
Leukorrhea: non-purulent vag discharge
Enlargement o’ mammary glands
POSTPARTUM HEMORRHAGE
Blood loss > 500mL after vag delivery
> 1000 mL after c section
Occurs primarily D/T: uterine atony where there is ABSENCE o’
uterine contraction
Norm homeostasis after delivery involves UTERINE CONTRACTIONS
that occludes the open sinuses that brought blood to the
placenta
…a relaxed or uncontracted uterus will NOT close the open
sinuses…
L/T HEMORRHAGE or gradual blood loss
Resulting in: BLOOD POOLING & changes in VS
Causes:
Retained placenta
Failure to progress during 2nd stage o’ labor
Placenta accrete
Lacerations
Instrumental delivery
LGA
HTN disorders
Induction o’ labor
Augmentation o’ labor with oxytocin
FUNDAL MASSAGE to contract uterus may resolve uterine atony in
cases where fundus is NOT FIRM after delivery o’ placenta
MULTIPLE GESTATIONS stretch the uterine musculature causing LESS
CONTRACTION
Fetus stores glycogen during pregnancy to use during TRANSITION
PERIOD
NB period WNL glucose > 30 mg/dL; optimal levels 70-100 mg/dL
Glucose levels rise and stabilize by 2-3 HOURS AFTER BIRTH
NEONATAL HYPOGLYCEMIA can l/t:
Neuro damage manifested by cog developmental delay
Recurrent seizure activity

Personality disorders
S/S o’ NEONATE HYPOGLYCMIA--
MAY BE ASYMPTOMATIC******
Hypotonia
Lethargy
Poor feeding
Jittery
Seizures
CHF
Cyanosis
Apnea
Hypothermia
MULTIGRAVIDA pt is schedule for dx test to measure fetal lung
maturity:
LECITHIN and SPHINGOMYELIN RATIO
Fetal lung capacity is an indicator of viability of neonate/nb
Mature lungs enable NB to adapt to extrauterine life
Surfactant lowers tension of alveoli when a NB exhales
LECITHIN and SPHINGOMYELIN are components o’ surfactant
***at 35 weeks gestation: ratio is 2:1
=== this ratio = LOW RF RDS
NB with tetralogy of fallot; pt is cyanotic since birth
Which defect is COMMON for this—
PULMONARY INFUNDIBULAR STENOSIS
Tetralogy o’ fallot = common congenital heart defect with
general cyanosis (BLUE BABY SYNDROME)
Oxygenation o’ bod is SHIT d/t abnorm anatomical structures
of heart
4 abnorm anatomical features with tetralogy o’ fallot:
Pulmonary infundibular stenosis
Ventricular septal defect
Overriding aorta
Right vent hypertrophy –

HIV + MOM pt edu---
Breastfeeding contraindicated
PREVENT TOXOPLASMOSIS pt edu to moms—
AVOID CAT SHIT!!!!!!!!! MEOW MEOW MEOW
OR ingesting undercooked contaminated meat
IM into VASTUS LATERALIS MUSCLE o’ NB
Well-developed muscle that is SAFE FOR NB, infants, and
small children
DX WITH TRANSIENT TACHYPNEA AT 2 HOURS POST BIRTH---
PROVIDE WARM, HUMIDIFIED O2 IN A WARM ENVIRONMENT
S/S O’ TRANSIENT TACHYPNEA:
RR as high as 150
Retractions
Flaring
Cyanosis
Tx === supportive, included warm humified O2
**it is a COMMON cause o’ respiratory distress in NB within
first hours after birth--- usually resolves within 72 hours.

In addition to s/s respiratory distress—characterized by HYPOXIA
and need for supp O2
& MAY REQUIRE GAVAGE FEEDING til tachypnea resolves adequately
for feedings
BULGING FONTANELS = could be meningitis
SUNKEN – dehydration
NEONATES HAVE IgG ANTIBODIES FROM MOM
Cross placenta to provide passive acquired immunity (3rd
trimester)
AND PRODUCE IgM IN UTERO
Fetus also produced IgM antibody by end o 3rd trimester
IgG & IgM are only antibodies babe has AT BIRTH
BUT--- IgA is supplied through BREASTFEEDING
NB NURSING CARE 3 phases during INITIAL MINUTES and HRS after
deliver—
Phase 1: initial resuscitation and stabilization o’ baby &
thermoregulation
Phase 2: initial assessments in first few min to an hour after
birth (APGAR & physical exam)
Phase 3: items that can be performed later after birth—bathing
the infant or performing NB screen
Hip dysplasia—Pavlik harness
Monitoring NB 1 hour after uncomplicated spontaneous vag birth—
EXPECTED FINDINGS:
RR o’ 50
Mongolian spots: Bluish purple pigmented spots on the back or
neck
Vernix
Milia
Fine, soft hair (lanugo)
At home birth—what to do help EXPEL THE PLACENTA?
--- have mom BREAST FEED THE NB

Suckling will induce neural stimulation of the posterior
pituitary gland--- release oxytocin and cause UTERINE
CONTRACTRATIONS
SCARF SIGN—neuromuscular tone
TERM INFANT WITH NORM MUSCLE TONE = ELBOW WILL NOT REACH
MIDLINE
ADMIN TOCOLYTIC TX TO WHO?
PT EXPERIENCING PRETERM LABOR AT 26 WEEKS GESTATION
Tocolytic meds: used to RELAX the uterus in pt in preterm labor
Terbutaline
Indomethacin
Nifedipine
PLACENTA PREVIA—
causes SGA
due to deficiency in fetal circulation,
because the placenta is not implanted correctly or fully
attached to the uterus.
SGA can result from maternal diseases such as hypertension;
environmental factors such as exposure to X-rays; maternal
malnutrition; or substance abuse.
PERIODS O’ REACTIVITY--
first 30 minutes after birth: alert and attentive and typically
nurses with strong suck.
may be tachycardic and tachypneic
can demonstrate irregular respirations with possible flaring,
retractions and grunting
2ND PERIOD O’ REACTIVITY—
4 to 8 hours after birth and can last from 10 minutes to several
hours
GREATEST RF NECROTIZING ENTEROCOLITIS—
==== PRETERM LABOR OR BIRTH
NEC affects the intestines; inner mucosal lining of intestines
becomes inflamed = DECREASED BLOOD SUPPLY to bowel, necrosis,
and death to infected portion o bowel

D/T NB has unstable vital signs & color changes and may expel
meconium. The neonate will nurse and is alert in most cases, and
will experience brief periods of tachypnea and tachycardia,
often with increased mucus production
Preterm infants can have a weak immune system, hypoxia, and
other complications that could predispose them to this
condition.
Manifestations are associated with inflamed and infected bowels:
abdo swelling,
V/D
poor feeding,
bloody stools
TX FOR NEC DEPENDS on SEVERITY—
keep the child NPO,
give IVF for hydration
administer enteral feedings via NG tube or parental nutrition if
needed.
Sx could be warranted to remove the infected portion of the
intestines.
S/S acute pain in infants—
• Tachycardia
• Shallow respirations
• Decreased oxygen saturation
• Increased blood pressure
• Dilated pupils
• Chin quivering
• Tightly closed eyes
• Crying
• Rigidity
• Irritability
• Increased intracranial pressure
The two hormones that control milk production are prolactin and
oxytocin.
SPINA BIFIDA OCCULTA--neural tube defect that is associated with
a low intake of folic acid during the first trimester of
pregnancy.
A pigmented nevus at the base of the spine with a tuft of hair

usually asymptomatic, but neurologic complications may occur and
early recognition is important.
Signs of spina bifida occulta may include:
sacral dimple
pigmented nevus at the base of the spine
and/or a tuft of hair at the base of the spine.
Folic acid is recommended for women during pregnancy to reduce
the risk of neural tube defects, including spina bifida and
anencephaly.
Neonates have immature nervous systems and do not have adequate
muscle tissue to generate heat by shivering.
They are able to increase the metabolic rate and generate heat
by:
nonshivering thermogenesis,
using brown adipose tissue developed during the third
trimester.
After depletion of brown adipose tissue, nonshivering
thermogenesis becomes less effective, resulting in cold stress
in the neonate that can may result in death.
PRETERM newborns have less brown adipose tissue stores than term
infants,
= so theyre ^RF for cold stress.
The nurse should frequently monitor T to determine if the infant
is cold.
Cold stress causes ^ O2 and glucose demand and ^ release of
norepinephrine
TO GENERATE HEAT
Hypoxia and acidemia occur when oxygenation is inadequate.
Glucose stores DEPLETED
= hypoglycemia will develop if the repletion of stores is
impaired by poor intake and slow motility in the GI tract.
Cold stress is manifested by:
neurologic,
cardiovascular,
respiratory,
gastrointestinal,

and musculoskeletal changes as listed in the table below
**Low body temperature is characteristic of cold stress** < 36.5
or 97.7
Cardiovascular: Bradycardia
Respiratory: Tachypnea, progressing to apnea and hypoxia
Neurological: Irritability or lethargy.
Gastrointestinal: Emesis, hypoglycemia, decreased motility,
increased gastric residuals
Musculoskeletal: Weak suck or cry, hypotonia
NB DO NOT have adequate muscle mass to generate heat by
shivering.
They ^ metabolic rate and generate heat by using brown adipose
tissue developed during the 3rd trimester.
PREMATURE NB have LOW stores of brown adipose tissue,
which places them at greater risk of cold stress.
Infection is associated with ^RF of preterm birth.
Infection results in a release of prostaglandins:
= promote contractions and increase cervical
softening.
Other RF include:
use of illicit drugs,
Hx of a prior cervical procedure like a cone biopsy or loop
excision
Hx of a spontaneous preterm birth (which is the most significant
risk factor).
< 37 weeks' gestation = PRETERM
Preterm labor refers to cervical changes and uterine
contractions that occur at 20-37 weeks of gestation and may
occur without preterm birth.
A short length of gestation is a more serious risk to the
newborn than low birth weight, as the intrauterine time
correlates with the maturation of body systems.
Tobacco smoking has a dose-dependent relationship with increased
risk.
PRE-TERM RISK FACTORS-- < 37 weeks
include previous history of spontaneous preterm birth,

infection,
maternal use of tobacco or illicit drugs,
maternal diabetes,
Hx o’ cervical procedure, such as a cone biopsy.
Length of gestation is closely correlated with maturation of
body systems.
Respiratory complications: result from failure of the lungs to
fully mature--
respiratory distress syndrome,
bronchopulmonary dysplasia,
apnea,
and chronic lung disease,
Respiratory complications are a significant cause of morbidity
and mortality of in the preterm infant.
Other complications:patent ductus arteriosis, retinopathy of
prematurity, necrotizing enterocolitis, and intraventricular
hemorrhage.
Some of the nursing interventions for phototherapy include:
• Assess the skin frequently for skin breakdown.
• Reposition Q 2 hr to ensure all areas of the skin are exposed
to light therapy.
•Only a diaper to expose the entire body to light therapy.
•Eye mask: prevent exposure to the UV light of phototherapy.
•Remove the eye mask during feeding time to assess the eyes and
promote stimulation.
• Avoid using lotion d/t cause burns and increased tanning of
the skin.
• Monitor T every Q hr because hypothermia or hyperthermia can
occur while receiving therapy.
• Document I/Os to ensure that phototherapy is effective.
• Ensure phototherapy is set up correctly to prevent
complications from occurring.
The CNS of NB is immature.
Reflexes demonstrate this immaturity.
Some of these reflexes are protective, such as the blink and gag
reflexes.
Rooting and sucking reflexes are feeding reflexes that aid in
the client's adjustment to body needs. Trunk incurvation or
Galant reflex occurs when a NB is positioned in prone and the
pelvis turns to the side where the spine is stimulated.

Cephalohematoma
=collection of blood between the skull and periosteum
usually caused by prolonged labor and instrumental
delivery.
**Providing reassurance and stating that the cephalohematoma
will resolve after three weeks is appropriate.
During such time, the blood clot is slowly reabsorbed from the
periphery towards the center of the affected area.
At birth, any cranial nerve abnormality is concerning.
Eyelids should sit symmetrically above the pupils, with the
irises visible.
Ptosis refers to drooping of the eyelid below the level
of the pupil
---may indicate paralysis of the oculomotor nerve.
Infants should blink to light and should be able to close both
eyes tightly when crying.
The corneal reflex can be tested by gently touching the cornea
with a tissue paper.
Sucking, swallowing, and tongue movement should be observed to
test cranial nerves V, VII, IX, X, and XII.
NB void shortly after birth.
Until they do, dullness to percussion over the bladder is a
normal finding.
Immediately after birth, a NB must transition to extrauterine
life.
This includes a transition from:
the fetal cardiovascular system.
NB may have fluid in the lungs immediately after birth
before the transition to extrauterine life is complete
Rales or wheezes should clear within a few hours after
birth.
A neurological assessment of a newborn after delivery includes:
assessment of level of alertness,
muscle tone,
cranial nerves and
reflexes.
Facial asymmetry, including drooping eyelid, is concerning for a
cranial nerve impairment.

Clients who have cystic fibrosis have an ^ of sodium and
chloride in both saliva and sweat.
===sweat chloride test can confirm a dx of cystic fibrosis.
CF = most common lethal genetic condition among non-Hispanic
white children, adolescents, and young adults.
Inherited as an autosomal recessive trait.
Affect:
respiratory system,
gastrointestinal tract, and
reproductive and integumentary systems.
MAT/NB EXAM 1–
ERYTHROBLASTOSIS FETALIS—
Moms blood doesn’t like fetus blood
(Rh OR ABO incompatibility)
Fetus RBC blasted (hemolysis)
= severe fetus anemia
(LOW RBC, LOW H&H)
L/T CHF of fetus in uteri
….babe born with ANASARCA (whole bod swelling)
….babe born with HEMOLYTIC JAUNDICE d/t hemolysis
Rh incompatibility:
Mom is - and fetus is +
(If mom was previously exposed to + then she’ll builD the
antibodies that will murder fetus RBC)
….admin RHOGAM
ABO incompatibility:
Mom is O (blood type that is antigen negative)
Will produce anti A &/or B antibodies
***babe attacked by HEMOLYSIS will result in a + DIRECT COOMBS
TEST
= tests to see if babes blood has moms antibodies in it
= hemolysis o RBC
= JAUNDICE
MOM is tested with INDIRECT Coombs to see if she carries the
antibodies against her babes blood
BILI LIGHTS/PHOTO THERAPY—

Rotate Q 2 hours = max skin surface exposure = more
efficient/effective at DECREASING bili levels
Babes shit is loose and green?
——-> NORM d/t excreting bili
BUT very ouchy to babes bum = monitor skin integrity & cleanse
Phototherapy = ^RF DEHYDRATION d/t evaporation
WNL WET DIAPERS
Days 1-4 = marched # o’ WD
> 5+ days = 6 WD
HEEL STICK—
Lateral aspect
D/t contains NO major nerves/vessels
Cover tootsie with warm wrap to draw blood to area
Blot site with dry gauze AFTER rubbing with alcohol— d/t alc can
irritate puncture site and cause HEMOLYSIS
Jaundiced > 36 hrs— (physiological)
Have mom feed baby frequently
More consumes = more stools = more bili excreted
Bili is Shat out
———————-
NEVER NARCAN NEONATES
d/t can send babe into severe withdrawal
Neonatal abstinence S/S—
Sneezing
Hyperactivity
Hyperreflexia
Yawning
Loose D stools
Hyperphagia: constant hunger signs
Persistent shrill cry
Meds used—
Morphine: control D
Opium: severe symptoms
Phenobarbital: control seizures
Interventions—
Low stimulation environment

Tightly swaddle: control hyperreflexia
Small feq feeds
——————
FAS—
Behavioral S/S:
Poor suck reflex
Irritable
Tremors
Seizures
Intact CNS & + Moro reflex
——
Baby born addicted to COKE—
Meds:
Paregoric-
helps control D
Cause drowsy
Relieves craving
———-
TREMORS �⬇️⬇️⬇️ GLUCOSE
————
Mom got no prenatal care
NB sneezing tremors mouthing for food shrill cry, BG WNL…
request order for:
URINE DRUG TOXICOLOGY SCREEN
——
MAS can L/T PNEUMOTHORAX
RN should advise the mother that if the infant is unable to
breathe, reflexes will cause the infant to move the head and
pull back in order to get a breath.
NB should be awakened at least every three hours during the day
and every 4 hours at night, until they are feeding well and
gaining weight. Neonates require 8-12 feedings every 24 hours.