First Newborn Assessment and Monitoring (Nursing)

00:01 Speaking of skin to skin.

00:04 And I mentioned the importance of skin to skin as a way to help the infant maintain temperature.

00:10 So let's talk about all the ways and all the things that can happen that may cause the baby to not be able to maintain temperature.

00:17 So there are four ways that babies can actually lose heat.

00:21 And it's important for the nurses to be aware, because these are things that we can do that actually cause the baby to be hypothermic, or the parents may cause the baby to be hypothermic if they don't pay attention.

00:33 So the first way that the baby can lose heat is called convection.

00:37 So if you think about it this way, maybe you've heard of a convection oven, or maybe you have a microwave somewhere in your existence.

00:46 And what happens in that situation is that the air around the food is warm.

00:51 And so then it warms up your food, right? So with the baby, if the baby is the warm object, and the air is cold, all that warmth from the baby will be transferred into the cold air and the baby will lose heat.

01:05 So that is via convection.

01:08 Now let's talk about radiation - losing heart via radiation.

01:13 So in this particular situation, the baby might be sitting next to a window that's outside and the sun is shining, and they will then lose their heat to the air.

01:23 but in this case, it's not the droplets in the air, it's the electromagnetic waves in the air.

01:29 So they're not touching an object and the heat is being transferred from baby to the air via the electromagnetic waves.

01:38 Radiation.

01:41 The next way that we can lose heat is by actually touching something cold.

01:45 So when you go to the nursery for your clinical experience, you may notice that before the baby is laying on any type of scale or any type of surface, they will either warm the surface or place a blanket there.

01:57 And that's because if the surface is cold, the heat from the baby will then be transferred to that surface.

02:03 So the difference between conduction and radiation has to do with touching.

02:07 In radiation, the baby's not touching the cold object.

02:11 In conduction, the baby and the cold object are together.

02:16 And then finally, evaporation.

02:18 Remember under skin to skin, we talked about drying the baby off just like you dry off when you get out of the shower.

02:24 You do that because if you don't, then as the water evaporates, it takes away your heat.

02:29 And so that's the same thing that happens.

02:31 So if you ever watched the stork team working on a baby after they deliver, they will dry and get rid of those blankets, because all of those wet blankets are ways that the baby can lose heat.

02:42 So we want to dry the baby off so that they don't lose heat.

02:46 And we want to get the wet blankets as far away as possible.

02:49 So these are the mechanisms of thermal regulation that we have to be mindful of and remind the parents of because the baby doesn't really shiver.

02:58 They don't really manage heat loss at all.

03:01 They don't have that ability yet, so we have to make sure that we protect them.

03:07 And our final assessment that we're going to talk about in terms of things that we do in the labor suite is monitoring the baby's glucose.

03:14 Now, for the healthy term infant that has an uneventful pregnancy and birth, then we're only going to monitor the baby's blood glucose in the case where we notice risk factors or in the case when the baby is symptomatic.

03:27 So if the baby's doing well, we may not get a glucose right away.

03:31 So keep that in mind.

03:32 If however, something pops up, and they're symptoms that make us believe, and we'll talk about those in just a second that the glucose might be low.

03:40 If the glucose is less than 45, an intervention is going to be required.

03:46 So infants at risk.

03:47 So these are going to be babies that are large for gestational age, or babies that are born from birthing persons who have had gestational diabetes.

03:56 Those babies are going to require close monitoring for 2 to 3 hours after birth, or until they are stable.

04:03 If their blood sugar is less than 35, then again, intervention is going to be required.

04:09 So thinking about symptoms of hypoglycemia, or low blood sugar.

04:15 So these are all the alarm bells that are going to go off for the nurse care team and the health care providers that something is amiss.

04:22 If the baby is irritable.

04:24 Now, the baby's not going to say bad things or be smart, obviously, but they'll be really jumpy and jittery and just fussy and unusually so.

04:34 That may be an indication of low blood sugar.

04:37 They may also have just general jitteriness, where they're shaking sort of like this, especially with their hands.

04:43 That's not Moro.

04:44 So moro should elicit and stop.

04:47 If it continues then that may be a sign of jitteriness, which goes along with hypoglycemia.

04:52 They may also experience a high pitched cry, or pallor meaning that their color is not pink, like it should be, or full.

05:01 It will be a little sort of grayish and off.

05:04 They may begin to sweat or they may experience lethargy.

05:08 Or they may not eat very well, or in really terrible cases where the blood sugar is extremely low, the baby may experience a seizure or have respiratory depression.