50.

49. Skin

Color : Generalized mottling of the skin is common

Acrocyanosis (blueness of hands and feet) with usual skin color on one side and blue on the
other. Acrocyanosis is a normal phenomenon in the first 24 to 48 hours after birth
central cyanosis, or cyanosis of the trunk, is always a cause for concern. Central cyanosis indicates decreased
oxygenation. temporary respiratory obstruction

Hyperbilirubinemia: jaundice, or yellowing of the skin

second or third day of life in about 50% of all newborns, as a result of a breakdown of fetal red blood cells
(physiologic jaundice).

45. Physical Growth

The physiologic changes that occur in the infant year reflect both the increasing maturity and growth of body
organs. The following sections will discuss the changes that are typically seen in the first year of life.
Weight
As a rule, most infants double their birth weight by 6 months of age and triple it by 1 year. During the first 6
months, infants typically average a weight gain of 2 lb per month. During the second 6 months, weight gain is
approximately 1 lb per month. The average 1-year-old boy weighs 10 kg (22 lb); the average girl weighs 9.5 kg
(21 lb). An infant’s weight, however, is relevant only when plotted on a standard growth chart and compared
to that child’s own growth curve (see Appendix E).
Height
An infant increase in height during the first year by 50%, or grows from the average birth length of 20 inches
to about 30 inches (50.8 to 76.2 cm). Height, like weight, is best assessed
if it is plotted on a standard growth chart. Infant growth is most apparent in the trunk during the early months.
During the second half of the first year, it becomes more apparent as lengthening of the legs. At the end of the
first year, the child’s legs may still appear disproportionately short and bowed. For accuracy, measure infants
lying supine on a measuring board (see Nursing Procedure 34.8, Chapter 34).
43. Phototherapy. An infant’s liver processes little bilirubin in utero because the mother’s circulation does this
for an infant. With birth, exposure to light apparently triggers the liver to assume this function. Additional light
supplied by phototherapy appears to speed the conversion potential of the liver. In phototherapy, an infant is
continuously exposed to specialized light such as quartz halogen, cool white
daylight, or special blue fluorescent light. The lights are placed 12 to 30 inches above the newborn’s bassinet
or incubator. Specialized fiberoptic light systems incorporated into a fiberoptic blanket also have been
developed and are ideal for home care. The infant is undressed except for a diaper so as much skin surface as
possible is exposed to the light (Fig. 26.12).
Term newborns are generally scheduled for phototherapy when the total serum bilirubin level rises to 10 to
12 mg/dL at 24 hours of age; preterm infants may have treatment begun at levels lower than this (Symons &
Mahoney, 2008).
Continuous exposure to bright lights this way may be harmful to a newborn’s retina, so the infant’s eyes must
always be covered while under bilirubin lights. Eye dressings or cotton balls can be firmly secured in place by
an infant mask.
Check the dressings frequently to be certain they have not slipped or are causing corneal irritation. A constant
concern is that suffocation from eye patches could occur.
The stools of an infant under bilirubin lights are often bright green because of the excessive bilirubin that is
excreted as the result of the therapy. They are also frequently loose and may be irritating to skin. Urine may be
dark-colored from urobilinogen formation. Monitor axillary temperature to prevent an infant from overheating
under the bright lights. Assess skin turgor and intake and output to ensure that dehydration is not occurring
from the warm environment.
Infants receiving phototherapy should be removed from under the lights for feeding so that they continue to
have interaction with their mother. In addition, supplemental feedings with additional formula may be
recommended to prevent dehydration. Remove the eye patches while the infant is with the mother to give an
infant a period of visual stimulation. To prevent a lengthy hospital stay, infants may be discharged and continue
therapy at home. Parents need an explanation of the rationale for phototherapy. Incubators are automatically
associated with seriously ill infants, but the use of lights does not seem scientific (almost a home remedy).
Parents can easily be confused by the two interventions, one seemingly serious and the other seemingly not
serious at all. Although the long-term effects have not yet been studied, there appears to be minimal risk to an
infant from phototherapy, provided the infant’s eyes remain covered and dehydration from increased
insensitive water loss does not occur. It is too early to predict if all infants who receive phototherapy need
follow-up in coming years to detect skin cancer that possibly could occur from the therapy (Newman & Maisels,
2007)