complications of newborn Flashcards
RDS
○ Due to lung prematurity
○ 60-80% of <28 weekers will develop
■ Due to lack of production of surfactant
○ CXR shows atelectasis (hazy lung fields)
common predictors of RDS
■ Prematurity
■ C-section without labor
■ IDM
■ 2nd twin
antepartum complications with RDS
■ Hemorrhage
■ Asphyxia
Consequences of RDS
■ Lung scarring ■ Increased risk of asthma ■ Bronchopulmonary dysplasia (BPD) ● High O2 for long periods of time ● Chronic lung condition ● Greater risk for URIs and permanent bronchial changes
S/S of respiratory distress with RDS
RETRACTIONS!
complications associated with premature infant
○ Defined as an infant that is delivered at less than 37 weeks gestation
○ Infant’s ability to survive is dependent on degree of prematurity and infant’s own strengths and weaknesses
○ In general, infants born at less than 24 weeks are not viable
○ At delivery, if eyes are fused and infant weighs less than 500g, generally resuscitation is not done
■ Eyes fused= extreme prematurity
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○ Alteration in thermoregulation
■ Hypothermia
○ Alteration in GI physiology
○ Alteration in renal physiology
○ Alteration in immunologic physiology
■
prematurity alterations in respiratory and cardiac physiology
Alteration in respiratory and cardiac physiology
■ Apnea of prematurity
● > 20 sec → leads to bradycardia → color changes
■ Patent ductus arteriosus (PDA)
■ Respiratory distress syndrome (RDS)
■ Bronchopulmonary dysplasia (BPD)
■ Intraventricular hemorrhage (IVH)
■ Anemia of prematurity
● Exaggerated response from hypoxic state in utero to hyperoxic state after birth
● Normocytic, normochromic, hyporegenerative
● Low serum erythropoietin
● Spontaneously resolves in 3-6 months
■ Aspiration
prematurity alterations in GI
Hypoglycemia
■ Necrotizing enterocolitis
● Baby is fed, sweet component to food is not moving through GI system as it should → bacteria accumulate → gas formation → abdominal distention
● Gas bubbles in lining of intestine → risk of perforation
● Shows bradycardia, periods of bradypnea, color changes
● High dose antibiotic- no more feedings
● Caused by feedings too close together
alteration in immunologic physiology
Neonatal infection
○ Alteration in neurological physiology
■ Reactivity periods and behavioral states
○ Alteration in ocular physiology
■ Retinopathy of prematurity
● Vessels grow into vitreous humor → fingerlike projections → engorgement
● Rupture → blindness?
phototherapy risks
- positive combs test –> phototherapy needed, lots of bilirubin as byproduct
- can cause permanent bronzing
- can develop a dark grey-brown discoloration of the skin, urine and serum
- development of purpura or bullae in infants with cholestatic jaundice or congenital erythropoietic porphyria
- infants who have familial history of porphyria this is an ABSOLUTE CONTRAINDICATION!
Hyperbilirubinemia (jaundice)
○ The yellowing of the skin d/t the accumulation of bilirubin in the skin and the brain
○ Bilirubin is the byproduct of heme from the breakdown of hemoglobin
○ One of the components of bile, yellow in color
○ Occurs when the breakdown of RBCs happens faster than the liver and GI tract can remove them
○ 60-70% of term and near term infants will become visibly jaundiced
○ 100% of preterm infants will become jaundiced
○ The leading cause of hospital readmission in the first 2 weeks of life
○ Major reason for prolonged hospitalization in otherwise healthy newborn
causes of hyperbilirubinemia
physiologic
hemolytic
physiologic causes of hyperbilirubinemia
● Increased load of RBC breakdown ○ Cephalohematoma ○ Suction or forceps delivery ○ Other bruising ● Liver immaturity ● Breast feeding ● Infant of diabetic mother ● Hepatic or bowel abnormalities
hemolytic causes of hyperbilirubinemia
● Blood group incompatibilities
● Rh negative moms
● ABO incompatibility
● Glucose-6-phosphate dehydrogenase (D6PD) deficiency
○ Helps body process carbs and protects RBCs
○ → inherited condition passed on X chromosome
complications of extreme jaundice
■ Neurological complications ■ Seizures ■ Poor suck reflex ■ Irritability ■ Abnormal muscle tone
what happens if bilirubin passes BBB
--> kernicterus ■ Long term complication ■ Seizures ■ Hearing loss ■ Motor deficits ■ Vision loss ■ Learning difficulties ■ Death
when to treat jaundice
■ Premature infants need to be treated at lower levels than term infants
■ The total bilirubin level must be evaluated in reference to how old the infant is, in terms of hrs
■ Complicating factors, such as hypoglycemia and sepsis, will affect the decision to treat
how to test jaundice infants
■ Observation ● Cephalocaudal progression ● Easy, but unreliable ■ Transcutaneous bilirubinometry ■ Blood draws from a heal stick (definitive way) ● Neonatal or total bilirubin level ● Direct bilirubin level ● Measured in mg/dL
treatment options for jaundice
■ Phototherapy ● High direct - cannot be done ● Can cause permanent bronzing ■ Hydration ■ Feeding- breast or bottle ■ IV ● Hydrated to pass the stool ■ Exchange transfusion ● Partial- blood is removed, saline put in to dilute blood ● Full- take blood out, put blood in, take blood out ○ PKU test before ○ Have 75% of blood or more exchanged
complications associated with SGA <10%tile
■ Asphyxia ■ Aspiration syndrome ■ Hypothermia ■ Hypoglycemia ■ Polycythemia
asphyxia
chronic hypoxia in utero - little reserve during delivery
■ Test the cord blood
■ Cord pH < 7.2 = increased morbidity
aspiration syndrome
- utero hypoxia can cause infant to gasp → aspiration of amniotic fluid
■ Relaxation of anal sphincter → passage of meconium → aspiration
hypothermia
less brown fat which is thermal subQ fat that helps keep them warm - poor thermoregulation
■ Stay in flexed position to decrease surface area
hypoglycemia
working harder to stay warm → increased metabolic demand (already have inadequate glycogen stores in the liver)
