Challenges in Newborn Flashcards
Complications of each body system in the preterm infant? Resp, CVS, thermoregulation, GI, renal, hepatic/blood, neuro
- Respiratory- poor developed alveoli (develop fully around 24-38 weeks), lack of surfactant (peaks at 35 weeks), RDS, apnea (drive to breathe is neurological so if they don’t have neuro development then its bad), bronchopulmonary dysplasia (need mechanical ventilation)
- CVS- patent ductus arteriosus (may not close if premature), increase resp effort, CO2 retention
- Thermoregulation- decreased brown fat/subcutaneous fat, poor muscle development/less flexed tone, inability to shiver, thin skin
- GI- small stomach, immature feeding reflex, NEC
- Renal- decreased ability to concentrate urine/excrete drugs
- Hepatic/hematologic- immature liver=decreased conjugate bilirubin=increased risk of jaundice, at risk for hypoglycemia limited iron stores=anemia
- Neuro- hydrocephalus, hearing loss, retinopathy of prematurity, periventricular-intraventricular hemorrhage
Delayed cord clamping for preterm babies?
Deferred cord clamping is recommended for 60-120 seconds b/c it decreases newborn mortality and improved blood related outcomes after the newborn period
Why are newborns at risk for ineffective temp control?
Less able to produce heat, lack of brown fat, thin skin causes water loss, lack of flexion increases heat loss,
Preterm temp control guidelines?
- Maintenance of delivery room temp around 25-26 degrees celcius
- To minimize heat loss babies <28 weeks should be immediately placed in wet plastic bag up to their neck (simulates a sauna/keeps them warm)
What is periventricular hemorrhage?
Immature cerebral vascular development that causes weak ventricular capillaries to easily rupture=hemorrhage. Most bleeds occur within 72 hrs after birth
What is NEC in preterm babies?
Necrotizing enterocolitis is inflammatory bowel disease r/t ischemic/necrotic injury, immature intestinal barrier, abnormal colonization, and formula feeding. Present between 3-12 days of life
What is a late preterm infant and problems?
34-36 completed weeks (this is largest proportion of preterm births). They don’t appear dramatically sick but still immature. Brain size at 34-35 weeks is 60% of that of infant at term. Some problems are temp, breathing, feeding, sleeping, infection, jaundice, and SIDS
How to discharge preterm infant and criteria?
Need 24 hrs of successful feeding before being d/c home. First time moms require supervision when leaving from NICU. D/C plan must take into account heath/parenting/feeding skills/support in the home. Then they need a spot discharge assessment in community and developmental follow up
S+S of resp distress in infants?
Tachypnea, apnea (>15 sec), cyanosis, grunt/coo, retractions/indrawing, nasal flaring, poor feeding, and accessory muscle use
Common causes of respiraotry distress?
RDS (lack of surfactant), meconium aspiration (or mec stained amniotic fluid), and transient tachypnea of the newborn
What is RDS?
Lack of sufficient surfactant causes breathing problems. Onset is at birth or within a few hrs after birth.
Risk vs protective factors for RDS?
Risk- prematurity/immature lung, C-section without labour, males, previous birth with RDS, maternal diabetes (insulin interferes with surfactant production), cold stress, perinatal asphyxia (lack of O2 getting to fetus)
Protective- prolonged ROM, GHTN, donor twin, physiological stress experiences by fetus in utero accelerates surfactant development, use of corticosteroids
How to manage RDS?
Use of antenatal corticosteroids, exogenous surfactant, CPAP, positive eve expiratory pressure (PEEP), fluid, and vital signs
What is mec stained amniotic fluid and aspiration? what to do
Mec stains the amniotic fluid. The fluid aspirated is thin/thick/chunky. Sometimes mec can be below vocal cords and that’s a bigger problem. Do suctioning with bulb
Risk factors for MSAF?
Overdue, positioning (breech babies), hypoxia (relaxes external anal sphincter)
How to prevent meconium aspiration?
Avoid post maturity, amniotic infusion, only bulb suction, can do endotracheal suction by trained professional if newborn has poor tone/significant respiratory distress
How to treat mec aspiration?
Assisted ventilation devices, surfaxin (exogenous surfactant), steroids, obverse for S+S of resp distress
What is transient tachypnea of the newborn? what to do
Excess fluid in lungs/delayed re-absorption of fetal lung fluid. Usually develops resp distress symptoms in 4-6 hrs after birth. Could be r/t aspiration of amniotic fluid, excess sections, or tracheal fluid. Resolves within 12-72 hrs (may need O2, fluid, restrict feeds)
What is hyperbilirubinemia, jaundice, and kernicterus?
HB- excessive concentration of bilirubin in the blood
J- bile pigment deposited in skin/mucous membranes/sclera which causes yellow
K- bilirubin levels rise greater than accepted levels at a given age/rate of rise is high enough to be deposited in brain which leads to encephalopathy
Risk factors for hyperbilirubinemia?
Preterm, poor feeding or excessive weight loss, bruising or cephalohematoma (breaks down RBC), appearance of jaundice 24 hrs post birth, need for phototherapy in 72 hrs of age, hemolysis evidence, fam hx of RBC disorders/hyperbilirubinemia
Cause of jaundice?
Increased RBC volume/short RBC life span=increased RBC hemolysis after birth which increase bilirubin load. Also decreased clearance of bilirubin from plasma, and decrease ability of liver to excrete bilirubin. So basically RBC breakdown in the main reason
T or F: clinical evidence of janudice in first 24 hrs of life is pathological?
True
S+S of jaundice?
Yellow skin/sclera, poor feeding, refuse feeding, weight loss, changes in # of wet/soiled diapers, slow weight gain, sleepiness, difficult to awaken, and fever. Not all babies appear jaundiced tho
Tests and results for jaundice?
TcB (tanscutaneous bilirubin), tsb (total serum bilirubin). Severe hyperbilirubinemia- TSB >340 umol/L during first 28 days and critical hyperbilirubinemia TSB >425 umol/L
Guidelines for testing jaundice levels?
TSB or TcB concentration should be measure between 24-72 hrs of life
What is bilirubin encephalopathy?
Neuro effects of bilirubin in brain cause problems- deep yellow staining of neurons and neuronal necrosis of basal ganglia and brain stem nuclei (kernicterus)
What is phototherapy and how to use it?
Light helps breaks down high bilirubin levels. Baby should be in diaper, have eye protection, and turn them regularly to get max exposure of skin. Can be treated under a light or with a phototherapy blanket. Placing baby in sunlight is natural way to treat jaundice
Treatments for high bilirubin levels?
Phototherapy, early/frequent feedings (increase intentional transit time to assist with excretion), prevention of dehydration (may needs fluids), blood exchange transfusion (for severe- rare), IV immunoglobulin when BET cant be performed
How to care for substance exposed newborn?
Assess NAS scoring (neonatal abstinence syndrome), eat/sleep/console, be aware of common withdrawal symptoms, and give info to parents
S+S of NAS or neonatal opioid withdrawals?
Wakefulness, irritability, inability to consoled, tremors, temp instability, tachypnea, diaphoresis, hyperactivity/high pitch cry, resp distress, apnea attacks, weight loss, respiratory alkalosis, and lacrimation
What does concaine use increase risk of in pregnancy? and impact on withdrawal symptoms
Placental problems, risk of miscarrage, preterm labour, and SIDS. But it has decreased severity of withdrawal symptoms in newborn
NAS care?
Nonpharm- skin to skin, safe swaddling, gentle waking, minimal stimulation/low lighting, BF and nutrition support
Also manage complications/reduce withdrawal symptoms, teach family/support them, social service referral
Antidepressants use during pregnancy?
Benefits outweigh risk of use during pregnancy. SSRIs or SNRIs recommended. May cause neonatal adaptions syndrome in 1/3 of newborns exposed in utero (mild symptoms- feeding issue, unstable temp, neuro-behavioural, usually resolve within 2 weeks).
Treating withdrawal in babies?
If affected by morphine/methadone then we wean them very slowly. Narcan not used because it can exacerbate withdrawal and cause seizures
Developmental positioning for opioid withdrawal babies?
Reduce stimulation (decrease light/noise, soother, avoid eye contraction, take cues from babe). Swaddle to help control body temp/tremors nad position them to feed/cuddle (use c position- gentle cradle technique)
Newborn sepsis symptoms?
Behaviour changes (infant not doing well, lethargic, irritable, feeding intolerance), temp instability, tachycardia, seizures, poor circulation (pallor, dusky, cyanosis), resp distress, and hyperbilirubinemia
What are sick/preterm babies more likely to have?
Delayed/lack of periods of reactivity d/t poor condition of newborn and more disorganized sleep-wake cycle
