Class 10: Neonatal Complications Flashcards
how are high risk infants most often classified? (3)
according to:
- birth weight
- gestational age
- common pathophysiological problems
infants who are born considerably before term & survive are particularly susceptible to …
- development of sequelae related to preterm birth
what is considered preterm
- born before completion of 37 weeks of pregnancy (<= 36+6)
describe organ systems and physiological reserves w the preterm infant
- organ systems are immature
- & lack adequate physiological reserves to function in the extrauterine enviro
the lower the birth weight and gestational age, the ____ the chances of survival
the lower the chances of survival
what are causes of preterm birth (5)
- infection
- history of preterm birth
- poor prenatal care
- SDoH
- bleeding
what is considered extremely low-birth-weight infants (ELBW)
<1000 g
what is used for classification of NB according to size
- growth size
what is considered low birth weight
<2500 g
what is considered very low birth weight (VLBW)
<1500 g
what is considered extremely low birth weight (ELBW)
<1000 g
what is considered small for gestational age
- BW < 10th percentile
what is considered average for gestational age (AGA)
BW between 10th-90th percentile
IUGR = usually < ___ percentile
- usually <3rd percentile
what is considered large for gestational age (LGA)
> 90th percentile
what is considered late preterm
34+0 - 36+6 weeks gestation
what is considered term infants
38-42 weeks
what is considered postterm
> =42 weeks
define: live birth
- born with signs of life
define: fetal death (aka still birth)
- death of fetus prior to birth
- 20+ weeks gestational age
define: neonatal death
- death in 1st 28 days after birth
define: early neonatal death
- within the first 7 days
define: late neonatal death
- days 7-28
define: perinatal mortality
- combined fetal & neonatal deaths / 1000 live births
what are some resp complications of prematurity (3)
- resp distress
- apnea of prematurity
- bronchopulmonary dysplasia
what are some CVS complications of prematurity
- patent ductus arteriosus
what are some CNS complications of prematurity
- intracranial or intraventricular hemorrhage
what are some eye complications of prematurity
- retinopathy of prematurity
what are some GI complications of prematurity (2)
- feeding difficulties
- necrotizing enterocolitis
what are some hematological complications of prematurity (2)
- anemia
- infection
what changes to BW can occur d/t complications of prematurity (3)
- hypocalcemia
- hypoglycemia
- hypothermia
what are some hepatic complications of prematurity
- jaundice
what is assessed r/t prenatal record & obstetrical history (5)
- gestational age
- type of delivery
- trauma
- maternal complications
- risks for sepsis
what are risks for sepsis of the NB (9)
- STIs
- PROM
- fever in birther
- chorioamnionitis
- prolonged labor
- premature
- UTI in birth
- substance use in birth
- inadequate prenatal care
what type of infant is more at risk in terms of stress during the physical exam? what do we do to combat this?
- late preterm more at risk in terms of stress during the physical exam
= may need to break the physical exam into smaller pieces at separate times
what should be done if there is resp distress during the physical exam?
- assess this system and intervene as necessary to treate
what is an issue during physical assessment of the preterm infant? what do we do to combat this?
- thermoregulation
= consider the need to provide additional heat source, protect from cold stress during the exam
what is the New Ballard Score?
- score that looks at the physical and neuromuscular signs to categorize maturity
- estimates gestational age by maturity rating
- higher score = higher GA
the New Ballard Score can be used as young as?
- 20 weeks
what is the HR of premature infant
110-160
what is RR of a premature
- 30-60 breaths/min
describe measurement of BP in newborns?
- BP may be measured in preterm or sick newborns
describe findings in CVS assessment of premature infant
- murmur more common
describe findings in resp assessment of premature infant (2)
- apnea
- resp distress symptoms more common
describe T in premature infants (2)
- 36.5-37.5
- more instability
what is assessed in the premature infant (5)
- posture
- activity
- HC
- length
- weight
describe findings in the skin assessment of premature infant (5)
- thinner
- may be covered in vernix
- lanugo
- vessels may be easily seen over abdomen
- lack of plantar creases
what should be assessed first w NB VS? last?
- first = resps
- last = temp
when assessing newborn VS, we want to assess the NB at ___
rest if possible
what is the method of assessment of NB temp? average findings? normal variation?
- axillary
- average finding: 37
- normal variation: 36.5-37.5
what is the normal variations of temp for preterm infants
36.3-37.5
what is the method of assessment of NB HR
- auscultation
- palpation
what are average findings for NB HR? normal variation?
- average finding: 110-160
- 80-100 bpm when asleep
- up to 180 when crying
what are normal variation for HR of preterm infants
- 110-160 bpm
what is the method of assessment of RR in NBs? (2)
- observe effort
- auscultate
what are average findings for NB RR? normal variations?
- average findings: 30-60 breaths/min
- normal variations: short periodic breathing episodes (no apnea > 20 sec)
stabilization of NB RR occurs when?
- by day 1-2 —> usually then 30-40 breaths/min
BP monitoring may be required for?
- some preterm & other high risk NBs
what is late preterm VS protocol at SBH
- usually shortly after birth
- then q30min x4 (2hrs)
- then q4h x 24 h
what is considered late preterm
34 to 36+6
what is often the size & weight of a late preterm infant
- often the size & weight of term infant
late preterm infants have risk factors for: (7)
- thermoregulation
- hypoglycemia
- hyperbilirubinemia
- resp distress
- poor feeding & discharge delays
- neurodevelopmental problems
- infection
for late preterm infants, how often is T assessed?
- q30 min in immediate PP until stable
- then q1-4h
what is the normal variation of temp in late preterm infants
36.5-37.5
cold stress can lead to (3)
- hypoxia
- metabolic acidosis
- hypoglycemia
LBW increases..
- vulnerability of neonates to cold stress
LBW increases.. therefore preter, infants may require?
- vulnerability of neonates to cold stress
- may require additional heat source, try to minimize heat loss, maintain neutral thermal enviro
late preterm infants have an increased risk for?
- resp distress
describe the presence of surfactant & functional alveoli in late preterm infants
- decreased amt of surfactant
- decreased # of functional alveoli
what RR at rest is considered abnormal in late preterm infants
<30 or >60 breaths/min
what are early signs of resp distress (3)
- nasal flaring
- tachypnea
- and/or frunting w expiration
what are signs of an airway obstruction in the late preterm infant (3)
- stridor
- gasping
- with or without suprasternal or subclavicular indrawings
central cyanosis?
…
seesaw breathing?
…
apnea >20 secs is considered..
- abnormal
what are signs of resp distress syndrome (2)
- tachypnea >= 60 breaths/min
- central cyanosis lasting beyond the 1st hour or 2 after birth
what are some causes of apnea in the late preterm infant? (5)
- hypo or hyperthermia
- resp distress
- fever
- hypoglycemia
- infection
apnea is considered.. what does it require?
- abnormal
- requires further investigation
what should be assessed r/t the CVS system of the late preterm infant (6)
- skin color
- BP (if required)
- cap refill
- peripheral pulses
- O2 sat
- HR & rhythm
what is normal HR variation in late preterm infant
110-160
what cap refill is considered normal in the late preterm infant
<= 3 secs
what should be assessed r/t cap refill in the late preterm infant (3)
- central vs peripheral
- bilat
- upper vs lower body
what are signs of hypovolemia in the late preterm infant (6)
- cap refill >3 secs
- pale
- hypotonia
- lethargy
- tachycardia or bradycardia
- signs of resp distress
describe the ductus arteriosis in the preterm infant
- may not close right after birth
describe murmurs in the preterm infant
- a murmur may be heard at the Left upper sternal border
- should be documented & communicated to provider
in the preterm infant, assess for… (5)
- difficulty feeding
- apnea
- cyanosis
- pallor
- dyspnea
late preterm infants may be challenged in…
- may be challenged in coordinating the suck-swallow-breathe reflex
what is the best source of nutrition for the late preterm infant
- breastmilk
describe how breastmilk should be given to late preterm infants
- indiv should be encouraged to continue to pump & provide breastmilk until infant is able to feed at the breast
breast fed infants tend to have… (3) than their bottle-fed counterparts
- fewer desaturations
- warmer skin temp
- better coordination of breathing, sucking, and swallowing
hyperbilirubinemia occurs in ___% of preterm infants
80%
what should be assessed d/t the increased risk of hyperbilirubinemia in the preterm infant (4)
- assess for signs of jaundice
- close monitoring of weights
- ins & outs closely monitored
- support w breast feeding
there is an increased risk of hypoglycemia if.. (5)
- born premature (<37 weeks)
- small for gestational age infants
- infants of diabetic mothers (IDM)
- large for gestational age
- infants at risk of having carnitine palmitoyl transferase -1 (CPT-1), including those w known family history & all neonataes of Inuit familie
what is the goal for late preterm infants glucose
> = 2.6 mmol/L pre-feeds
who should be assessed for S*S of hypoglycemia ? when?
all newborns –> immediately and ongoing
what are mild symptoms of hypoglycemia (60
- jitteriness or tremulousness @ rest (may notice as they get ready to feed)
- limpness
- mild lethargy
- difficulty feeding
- eye rolling
- weak or high-pitched cry
what are severe symptoms of hypoglycemia in newborns (7)
- apnea or tachypnea
- seizures
- cyanosis
- cardiac failure/arrest
- episodes of sweating
- pallor
- hypothermia
if any symptoms of hypoglycemia are noted in the preterm infant, what should be done?
- check BG
- use algorithm to determine next steps in care based on BG result
if the infant is at risk for hypoglycemia, >= 35 weeks gestation at birth, what should we ensure is done?
- ensure infant is put skin to skin & feed (breast or formula [5-10 ml/kg] or expressed human milk)
for NB >= 35 weeks, when is BG checked?
~2h after birth, after first feed
what is done if the NB BG is >= 2.6 mmol/L, and no symptoms of hypoglycemia, what is done?
- monitor BG q3-6h before feeds
if BG is 1.8-2.5 or mild symptoms of hypoglycemia present in the NB, what is done? (2)
- glucose gel AND feed infant
- repeat BG 1 hr after feed
what is done if the NB BG is <1.8 (2)
- call to neonatology
- treat based on symptoms
what concern is there r/t the renal system in the late preterm infant
- immature renal system
due to the concern of immature renal system in late preterm infants, what needs careful attention?
- strict I&Os
NB should have at least __ void(s) in the first 24 hrs of life
1
meconium stool should be passed within ?
- 24 hrs of life
how often should weights be done on the late preterm infant
- OD weight at minimum, q24 h
what is imp to note r/t the signs of electrolyte imbalance & hypoglycemia in late preterm infants
signs can overlap
abdomen of the late preterm infant should be…(3)
- soft
- round
- no masses
describe neuro assessment in the late preterm infant (7)
- observe muscle tone ( should be equal)
- flexion
- symmetry of mvmts
- reflexes
- cry (should not be high pitched)
- check fontanelles
- signs of seizures
which reflex is not well coordinated in the late preterm infant
suck-swallow-breathe reflex
what neuro concerns are there in the late preterm infant (2)
- potential trauma
- immature development & functioning
what is imp to assess for r/t fontanelles of the late preterm infant ? why?
- bulging –> can indicate increased ICP
what are signs of seizures in the late preterm infant (3)
- nystagmus
- repetitive chewing motions
- twitching at corner of mouth
what type of tremors are abnormal in the late preterm infant
- tremors at rest or when calm
what is included in nursing care for the late preterm infant (5)
- hydration
- hematological support
- infection prevention (immunity)
- skin care (more thin & fragile)
- enviro concerns
what is included in hydration for the late preterm infant (3)
- calculate weight loss/gain
- review feeding
- signs of hydration
what is included in hematological support for the late preterm infant (2)
- signs of bleeding
- anemia
what is included in caring for enviro concerns w the late preterm infant (2)
- maintain neutral thermal enviro
- reduce stimuli
what nursing care plays a role in developmental care for late preterm infants (5)
- skin-to-skin contact
- minimal stimuli in enviro
- slow, gentle mvmts
- consider swadlling for physical exam
- take breaks
what is included in family support & involvement for late preterm infant (4)
- psychological tasks of parents of a high-risk infant
- facilitate parent-infant relationships
- encourage & reinforce parents during caregiving activities
- get parents to demonstrate back how to care for infant
what is included in nursing care r/t growth & developmental potential in late preterm infants (2)
- corrected age
- signs of stress or fatigue in newborn
parent education for late preterm infants should be given regarding (3)
- SIDS
- CPR
- proper position of infant when put to sleep
