class 10 newborn complications Flashcards
What is jaundice?
elevated serum unconjugated bilirubin levels
What are the 2 types of jaundice?
physiologic
pathologic
which jaundice do MOST newborns experience?
physiologic jaundice
What causes increased unconjugated bilirubin levels?
RBC break down = unconjugated bilirubin
liver process it so = immature liver
Why is unbound bilirubin a bad thing?
it can leave the blood stream and go into tissues
can cross the blood brain barrier
what are the 5 reasons a newborn could have normal physiological jaundice?
- too many RBC at birth so they break down
- RBC don’t live as long - 60-90 days
- Newborn liver can’t make bilirubin water soluble in first few days of life
- not enough albumin to carry the bilirubin to the liver
- enterohepatic circulation is in overdrive so too much bilirubin is being absorbed - not filtered out well
What is the BEST method to help prevent jaundice?
Early
frequent
breast/chest feeding
what is a normal % of weight loss for newborns?
5-7% over first 3 days
regain within 10-14 days of life
what gestational age babies are at risk for jaundice?
35-38 weeks GA
How do we know if a newborn has neurotoxicity - acute bilirubin encephalopathy?
- lose startle reflex
- lethargic - not eating well
- high pitched cry
- irritable
- seizure
- coma
- death
what are the results of chronic bilirubin encephalopathy (kernicterus) ?
- long term brain damage
- hearing loss
- CP
- gaze abnormalities
What is the main difference between physiologic and pathologic jaundice ?
physiologic = AFTER 24 hours it appears - usually resolves without treatment in 2 weeks
- not due to underlying condition
pathologic = UNDER 24 hours it appears
- TBS increases more than 100 mcmol/L in 24 hours
TSB >256mcmol/L
- underlying condition
what is HDN (hemolytic disease of the newborn)?
erythoblastosis fetalis
- RBC broken down or destroyed tooo quickly
= anemia = increased bilirubin
What blood type is the newborn with risk for hemolytic disease (HDN)?
RH+ newborn
RH- birther
What are the 2 causes of HDN (hemolytic disease of newborn)?
- ABO incompatibility - blood/antibody issue in the newborn - coombs test (DAT) for antibodies
- Rh Isoimmunization - baby is Rh+ and mom is Rh- blood mixed and baby didn’t like it
How does WinRHO help the birther ?
it masks leftover fetal RBCs in maternal circulation so that 2nd fetus is protected regardless of Rh status
Which HDN is more severe, Rh Isoimmunization or ABO incompatibility?
Rh Isoimmunization
sometimes jaundice is neither pathological nor physiological. What is the other cause of jaundice?
Chest/breast feeding
When does chest/breast feeding jaundice occur and why?
(early)
days 2-5
insufficient feeding/stooling
(late)
days 5-10
good feeding/weight gain
compound in milk that inhibits the glucuronyl transferase so it can’t become water soluble and excreted
what do we do for early chest/breast jaundice?
suppliment feeding
support breast feeding better so baby gets more milk
As part of the newborn jaundice assessment what are 3 things nurses do as part of this assessment?
- routine inspection
- routine TcB - transutaneous bilirubin monitor (like a forehead thermometer)
- TSB - total serum bilirubin - IF
According to WRHA policy how often do newborns get screened for jaundice and when?
between 24-30 hours
q morning until discharge
Which is the first test that is done for jaundice, TcB or TSB?
TcB - think little c = less concerned
Where is the prefered place for TcB reading?
infant’s forehead
Where is a second place we can check jaundice with TcB if bruising or sun exposure is present?
sternum
What is the measurment range for TcB?
0-340 umol/L
If the TcB reading is >340 umol/L what type of jaundice is it probably?
pathological
At 24 hours what is an abnormal TcB reading and what do we do?
> 100 umol/L
send serum bilirubin to get exact level
What is the order of events if an infant is jaundiced <24 hours of age?
- TcB meter
- plot the TcB on the nomogram
- tell the infants doc the result
- Get order for TSB and DAT/coombs test
Which chart is more important, the Phototherapy implimentation threshold graph or the nomogram for evaluation screening?
Phototherapy implimentation threshold graph
What test determines level of risk for jaundice infant?
Phototherapy implimentation threshold graph
What 6 things do we want to continue to assess in jaundice babies?
- weight loss
- milk intake
- assessment of breat/chest feeding
- number of stools
- number of voids
- bilirubin levels- ongoing
how do we check neuro in newborns?
reflexes
once initiated, when do we stop phototherapy?
until the TSB decreases
how often do we check healthy infants Temp, RR, and HR receiving phototherapy?
Temp Q2 h
RR Q4 hr
HR Q4 hr
If phototherapy is not effective, what can be done?
exchange transfusion
what are the signs of encephalopathy?
decreased Moro reflex
hyperreflexia
hypotonia
lethargy
sleepy
poor feeding
vomiting
What are the 3 things that exchange transfusion does?
- takes out antibody coded RBCs
- takes out partially hemolyzed RBCs
- replaces blood with uncoated donor RBCs
what percentile is considered small for gestational age?
<10th percentile
what percentile is IUGR usually?
<3rd percentile
What percentile is considered large for gestational age?
> 90th percentile
how do we figure out weight loss?
birth weight minus current weight divided by birth weight times 100.
Does gestational age include birth weight?
No it does not
It is the completed weeks of birth since day one of the LMP of birther
how many weeks is late preterm?
34-36+6
How many weeks is term?
37-40 weeks
how many weeks is postterm?
> 42 weeks
if a baby has apnea >20 sec how do we intervene?
rub the back (stimulation)
What does an APGAR of <7 mean?
They had to work harder to transition
when do we care about infant blood glucose?
<2.6
what antihypertensive can affect hypoglycemia in baby?
labatolol
what is the glucose goal for baby?
> 2.6 mmol/L pre-feed
what is the most common infection in neonates?
PN
what are the 5 things we do if baby isn’t feeding well?
1.Check VS (if not already completed)
2.Blood glucose check
3.Review when the last feed occurred
4.Review when last void & bowel movement occurred
5.Perform a head to toe exam on the NB
