OB Exam 3

Less than 10th percentile, at risk for heat loss (decreased brown fat), hypoglycemia

Within 10 and 90th percentile

Greater than 90th precentile

Blood glucose <40 mg/dl. At risk (SGA, LGA, labor stress, cold stress, immature liver, premature, sepsis, insulin dependent diabetic mother (out of control A1C), late preterm). Prevention is early feeding

Respiratory rate and pattern, HR, O2 saturation

Extension of extremities or limp extensions

Transitions between states and stages of alert/sleep.

Focus and response

Lack of surfactant, pulmonary hypertension, increased musculature of pulmonary arteries, decreases blood flow to alveoli, which collapse. Will be on ventilator with nitric oxide (relaxes muscles, opens pulmonary arteries, 5 sec half life). Will oxygenate best prone position (butt up)

Suck/swallow/breathe not developed. Trophic feeds, 0.5 ml/hr, prime gut with breast milk.

Must be >36 wk gestation with blood gas <7.0. May have eperienced hypoxic insult. Cool to 34 C for 72 hrs (to stop brain cell death, gradually increase temp 1.5 C over 6 hr)

Brain damage, "yellow brain". High levels of bilirubin cross blood brain barrier and stain ganglia. Causes cerebral palsy.

Assess jaundice. Light 6-8 in from baby, conjugates bilirubin in skin capillaries, measure blue light, wear eye protection, rotate skin surfaces, and maintain skin integrity

Skin is very thin, poor phagocytosis, IgG and IgM can't cross placenta. E coli is #1 infection, group B strep #2. Steroids decrease chance of getting infection.

At 24 hrs of age (when ductus arteriosus closes), compare right hand to foot O2 sat. Repeat in one hour if 94 or less. Assess upper and lower pulses.