ch. 35 acquired problems of the newborn Flashcards
acquired problems of the newborn: overview
1) acquired problems refer to those conditions resulting from environmental vs. genetic factors
2) focus is on the following:
- birth trauma
- infant of a mother with diabetes
- neonatal infections
- effects of maternal substance abuse on the fetus and neonate
- effects of maternal use of benzodiazepines, barbiturates, and antidepressants medications during pregnancy
birth trauma
1) physical injury sustained by a neonate during labor and birth
2) birth injuries are a source of neonatal morbidity despite improvements in obstetric techniques
3) some birth injuries are avoidable, but some are unavoidable despite skilled and competent obstetric care
- ex: vacuum assit, foceps, breech
4) care of the infant with a birth injury is individualized based on the type of injury
birth trauma RF
- maternal age <16y or >35y
- primigravida (first time mothers)
- uterine dysfunction (dystocia, power - not effective muscle)
- preterm or post term labor <37 weeks or >42 weeks
- CPD (pelvic disproportion, relationship between passage way/passenger)
- macrosomia (8/13 or 9/4, >4000g)
- multifetal gestation (twin, triplet)
- abnormal or difficult presentation
- obstetric birth techniques
birth trauma soft tissue injuries
- erythema/ecchymosis
- petechiae
- abrasions/lacerations
- edema
- forceps injury
- accidental lacerations (bladder, nail <1.5in)
- subconjunctival (sclera) and retinal hemorrhages (d/t mom pushing Q2-3H on baby head, hemorrhage newborn eyes)
- caput succedaneum (cone head, molding -> fluid accumulates along suture lines (swelling) that comes down in a few days) and cephalhematoma (blood pooling, can’t cross suture line)
- subgaleal hemorrhage
birth trauma (skull)
1) skeletal injuries: the newborn’s immature, flexible skull can withstand considerable deformation (molding) before fracture results
(a) skull fracture: linear fractures or indentations
(b) clavicle fracture: bone most often fractured during birth
(c) humerus/femur fracture: immobilization may be necessary, fractures in newborns heal rapidly
birth trauma (PNS injuries)
1) brachial plexus injury
(a) Erb-duchenne palsy
- upper plexus injury
(b) klumpke’s palsy
- lower plexus injury
(c) phrenic nerve injury
- component of brachial plexus injury
(d) facial paralysis (palsy)
- one side or entire face
birth trauma (CNS injuries)
1) intracranial hemorrhage (ICH)
(a) subdural hemorrhage (hematoma)
- usually present with apnea, unequal pupils, tense fontanel, seizures, and even coma
(b) subarachnoid hemorrhage
- occurs in term infants as a result of trauma and in preterm infants as a result of hypoxia
2) spinal cord injuries
(a) clinical manifestations, treatment, and prognosis depend on the severity and location of the injury (when, where?)
3) care mgmt:
- individualized
infants of diabetic mothers
1) pathophysiology
- hyperinsulinemia: increased amounts of glucose cross the placenta and stimulate the fetal pancreas to release insulin
2) congenital anomalies:
- incidence of congenital anomalies among mothers with pregestational diabetes is three to five times that of pregnant women who DO NOT have diabetes (type 1/2)
- most frequently occurring anomalies involve the cardiac, renal, musculoskeletal, central nervous systems, and GI anomalies
TIP: uncontrolled DM -> increased risk cong. anomalies
infants of diabetic mothers problems
1) macrosomia
- excessive shoulder size in these infants often leads to dystocia
2) birth trauma and perinatal hypoxia
- occur more often in infants of mothers with diabetes
3) respiratory distress syndrome
- maternal hyperglycemia can affect fetal lung maturity
4) hypoglycemia
- the lower limit for normal plasma glucose levels during the first 72H after birth is often cited as 40-45 mg/dL (60-70 after 3-4 days, heel stick lateral)
- signs: jitteriness, apnea, tachypnea, decreased activity and cyanosis
5) hypocalcemia/hyomagnesemia
- not usually present until 48-72H after birth
- most gone home already!!
6) hypertrophic cardiomyopathy
- an increase in the thickness of the interventricular septum and the right/left ventricular free walls
- estimated to complicate about 33% diabetic pregnancies
7) hyperbilirubinemia/polycythemia
- increased number of RBC to be hemolyzed increases the potential bilirubin load that the neonate must clear, thus increasing the likelihood of hyperbilirubinemia (inconjugated -> conjugated)
8) nursing interventions:
- increased feeds to extra fluid -> voids -> removes bilirubin via urine
- phototherapy/go outside (put by window)
neonatal infections
1 prevention: maternal health key!!
the newborn infant is susceptible to infection because of the immature immune system
1) sepsis: one of the most significant causes of neonatal morbidity and mortality (SIRS)
(a) 2 types of neonatal sepsis
- early onset sepsis: chorioamnionitis, LT ruptured membranes, GBS
- late onset sepsis: preterm, bacterial infection not present at first
(b) care mgmt:
- assessment
- interventions
- nursing considerations
- preventative measures
neonatal infections (viral infections)
1) cytomegalovirus
2) varicella
3) rubella: congenital rubella syndrome
4) hep B
5) Human immunodeficiency virus (HIV)
6) herpes simplex
7) enteroviruses
8) parvovirus B19
9) influenza
10) zika
tip:
toxoplasmosis: can get from pets/cat feces - risk
- wear gloves/someone else change liter
neonatal infections (bacterial infections)
1) group b streptococcus
2) escherichia coli: stool (wipe front to back)
3) staphylococcus aureus
4) chlamydia
5) gonorrhea
6) syphilis (blood stream)
7) listeriosis (bacteria)
TIP:
- PCN (frontline) 5mu (2.5my Q4 until birth), x2 doses before amniotic sac goes if not ruptured yet
neonatal infections (protozoal infection, fungal infection)
1) protozoal infection:
- toxoplasmosis
2) fungal infections
- candidiasis/yeast
substance misuse
1) tobacco:
- low birth weight if the most widely recognized effect of maternal tobacco use
- other adverse perinatal outcomes
- smoke clogs lungs -> O2 transport to fetus decreased FGR
2) alcohol:
(a) adverse effects of alcohol on the fetus are related to the gestational are at exposure, maternal age, the amount of alcohol consumed, the pattern of consumption, and maternal alcohol metabolism
(b) fetal alcohol spectrum disorders (FASDs):
- fetal alcohol syndrome (FAS)
- partial fetal alcohol syndrome
- alcohol related neurodevelopmental disorder
- alcohol related birth defects
- neurobehavioral disorder associated with prenatal alcohol exposure (PAE)
fetal alcohol syndrome features
- low nasal bridge
- minor ear abnormalities
- indistinct philtrum
- micrognathia (small jawline)
- epicanthal folds
- short palpebral fissures
- flat midface and short nose (flat nose)
- thin upper lip
