Complications of Newborns Flashcards
Nonmodifiable Risk Factors for At-Risk Newborns
not tested
Previous preterm delivery
Multiple abortions
Race/Ethnic Group
Uterine/Cervical Anomaly
Multiple Gestation (twins, triples, quadruples)
Pregnancy Induced HTN (STRESS)
The short interval between pregnancies
Bleeding in the first trimester
The rule of thumb is having a pregnancy after another pregnancy is
wait at least a year or longer to have another baby
- Antepartum causes HTN and they are too stressed to deliver and will usually deliver earlier
Modifiable Risk Factors for At-Risk Newborns
Age at pregnancy <17 or >34 years of age (chromosome)
Unplanned pregnancy
Domestic violence – stress with trauma
Low pre-pregnancy weight - malnutrition
Obesity – T2DM
Infection – connection between baby
Substance abuse/Alcohol abuse – connection and no prenatal care
Cigarette Smoking – smaller without blood flow to the baby
Late or no prenatal care
Why do young and unplanned pregnancies cause risk for prematurity?
no prenatal care
hide or don’t know about it
Very premature
Neonates born at less than 32 weeks’ gestation
Premature
Neonates born between 32 and 34 weeks’ gestation
Late Premature
Neonates born between 34 and 37 weeks
-naughtiest and immediate to nicu
Normal Premature Assessment Findings
color
Usually pink or ruddy (support O2 at delivery - closing shunts)
maybe acrocyanotic (if no O2 supplemental)
Normal Premature Assessment Findings
skin
Reddened, translucent, blood vessels apparent; lack of sub-Q fat
Normal Premature Assessment Findings
lanugo
plentiful, widely distributed
- protect in amniotic
Normal Premature Assessment Findings
head size
large in relation to the body
Normal Premature Assessment Findings
skull
bones pliable
fontanels smooth and flat, sutures approximated or overriding
Normal Premature Assessment Findings
ears
minimal cartilage, pliable, folded over
- more premature the less cartilage they have
- put the ear backs so they don’t look dumbo
Normal Premature Assessment Findings
nails
Soft; short
- push in not enough Ca deposits
Normal Premature Assessment Findings
genitalia
Males:
-Nonrugated, small scrotum
- testes may or may not be descended.
Females:
-Prominent clitoris and labia minora
-Pseudomenstration not as much as term baby
Normal Premature Assessment Findings
posture
Flaccid (not flexed), froglike position
- lack of neurodevelopment
- need developmental aids
Normal Premature Assessment Findings
cry
weak, feeble
- depends on baby personality
Normal Premature Assessment Findings
reflexes
Poor suck, swallow, and gag
– affects eating (develops around 34 weeks they can eat)
The gag and swallow reflex develops around
34 weeks gestation then the neuro system develops
Normal Premature Assessment Findings
activity
Jerky, generalized movements
spastic
Determining gestational age in preterm newborns requires
knowledge and experience in administering gestational assessment tools
**Ballard Scale
Nursing Care for High-Risk Newborns
Continuous monitoring (pulse ox, HR, RR)
Establish and maintain respiration
Apply external warmth - lack of fat and small
Administer fluids and meds
Enteral feeding (gavage, nipple, breast)
Skincare - no baths and adhesive remover
Developmental and family-centered care
- bonding with family
If the premature high-risk infant is extremely sick, then what can be used to get their BP?
arterial line
What is the magic number for weaning a baby off of external warmth?
1800 grams
If the premature baby is under 34 weeks gestation, then how do you feed the baby?
gavage
- older they get to advance to nipple and breast
Do you bathe a baby straight away? why?
No, too weak for thermal regulation and skin tearing
5 Factors decreasing Thermoregulation in preterm infants
High ratio of BSA to wt
Very little SubQ fat
Thinner and more permeable skin
Posture flaccid
(no shivering) low ability to vasoconstrict superficial blood vessels and conserve heat in the body’s core
How do you maintain thermoregulation in a preterm baby?
reassess if still safe for a thermoneutral environment
temp every feeding time
maintenance of a Neutral Thermal Environment for minimizing
minimizes the oxygen consumption
- required to maintain a normal core temperature
prevents cold stress and facilitates growth
- by minimizing caloric and glucose expenditure to maintain body temperature
What should the baby’s temperature be for a preterm infant?
37C or 98.6F
Nursing Interventions of Neutral Thermoregulation
Allow skin to skin between parents and newborn - body temp rises for baby
Warm and humidify oxygen to minimize evaporative heat loss and decrease oxygen consumption
Place baby in a double-walled incubator (Isolat); Use Plexiglas heat shield with a single-walled incubator; Use radiant warmer and pipe in humidity
Avoid placing infants on cold surfaces. Use warmers during procedures; Pre-warm mattresses; warm hands and stethoscopes
Warm and humidifying Oxygen is used on preterm babies because
minimize evaporative heat loss and decrease oxygen consumption
Renal Alterations for Preterm Babies
limited in their ability to concentrate urine or to excrete excess amounts of fluid
affects ability to excrete drugs
The drugs of preterm babies is on what side of the recommended ranges for medication nd why?
lower and titrate up to function lowered because the kidney function is still developing and can not concentrate the urine
The preterm baby should have a bowel mvmt when?
within 24 hours
You should have a wet diaper when?
after every feeding
At birth, glycogen is stored in what organ?
liver
The glycogen of the preterm baby is used ________ leading to
rapidly for energy
- high risk for hypoglycemia
Iron is stored in what organ?
liver
Iron is stored in the liver when? If premature?
3rd trimester
- premature has low iron stores because mom never transferred the iron
Babies have how many mL of blood per Kgof body weight
80 mL, ONLY NEED 1 mL of blood from them
The more blood out of the baby for test means
more blood they need to infuse because the baby can not start making their RBCs yet
- they do not have functioning kidneys to make erythropoietin
The liver in preterm babies affects what
iron
glycogen
bilirubin
The conjugation of bilirubin in a preterm baby is treated by
radiation lights sooner
Due to liver impairment
Immune system of Preterm babies
IgG is acquired in the last trimester so babies have only a few antibodies at birth
IgA is found in _______ BUT
breast milk and because of preterm infants inability to feed-
they do not get sufficient IgA
What places the baby at great risk for nosocomial infections?
skin is easily excoriated
with multiple invasive procedures
Prevention of Infection in Preterm Babies
minimizing preterm’s exposure to pathogenic organisms
Strict hand washing
no jewelry
Use separate equipment for each infant (same with twins)
Standard Precautions recommended by CDC of isolating every baby
Short-trimmed nails and no artificial nails
2 to 3 min scrub using antimicrobial solutions
TPN for Preterm Babies used for when feeding is
contraindicated through the GI Tract
In TPN, what is separated from other liquids?
lipids
TPN provides
complete nutrition for metabolic requirements and growth to the infant intravenously
Gavage feeding
lack or have a poorly coordinated suck-swallow-breathing pattern, are ill or ventilator-dependent
- with nipple
3-4 hours (slowly or continuous
- minimal enteral nutrition for gavage
PICC and PCVC are used with
low birth weight babies to deliver higher concentrations of glucose
carefully monitor
How to prevent fatigue during feedings?
passive methods (pacifiers)
- Never feed if under stress
- only to 30 minutes (if over 30 minutes then gavage
conserve energy and calories
replaced with nipple
Signs of readiness for nipple feedings
Strong gag reflex
Presence of non-nutritive sucking
Rooting behavior: looking for food
Bottle Feedings for Premature
Need suck-swallow breathing coordination
Readiness to feed behaviors include:
- remain engaged in feeding,
- Able to organize oral-motor function,
- can maintain physiologic stability
Infant fed in semi-sitting position and burped after each 15ml
Feeding should take no longer than 15 to 30 minutes
Start with one session a day and increase slowly
Breastfeeding in Premature
Should be put to the breast as soon as there is a coordinated suck-swallow-breathe coordination, consistent weight gain, and control of body temperature without a heat source
Preterm infants tolerate breastfeeding with better transcutaneous oxygen pressures and body temperature maintenance than with bottle feeding
flexible feeding schedule
Mothers can pump and milk be given by gavage
Before breastfeeding, you should do what
try bottle feeding to see what they do
How do you do strict I&Os for breastfeeding?
TIME (minutes)
You should breastfeed for how long until the bottle at the end for satisfaction guaranteed
20-30 minutes
Parent-Infant Attachment interventions
positive parental feelings toward infant
Involve parents early in care and decisions
- and siblings if not infectious season
skin to skin
point out the infant’s patterns of behavior and unique characteristics and responses
infant’s sleep/wake states and optimal times for interacting with infants
- cluster all feedings around eating
** Teach caregiving skills** and assist in understanding premature infant behavioral characteristics
daily participation regardless of the hour and difficult decisions
parents bonding time
skin to skin (kangaroo)
rooming-in
Developmentally Supportive Care
Family-centered care improves the outcomes of critically ill
- containment when moving like suctioning
- gentle touches
- not postural
- self-consoling “nesting”
- swaddle in flexed extremities and hands can meet the face
- soft or fleece-like blankets and gel beds
- silence alarms, lower voice, an islet with darkness, cluster care
- non-nutritive sucking (pacifiers)
- grasp objects
Signs of Stress or Fatigue in Neonates
hr drop
stop breathing
instability
fluctuating tone
lack of control over mvmt
disorganized
closed eyes and sleeplike withdrawal (opossum)
Thermoregulation aka
Cold stress
Cold stress occurs when what happens and leads to this chain of events
low environ. temp
low body temp
high HR and RR
High O2 consumption
low glucose
low surfactant (coating of lungs)
respiratory distress
lead to needed glucose and O2
Risk Factors of Cold Stress
- premature
- decrease sub Q fat
- hypoglycemic (no fuel)
- small for gestational age (lower 10th percentile)
S/S of Cold Stress
- low temp (below 36.5 C)
- Cold to touch
- Lethargic
- Pale
- Weak sucking
- increase respiration
- grunting
- Nasal flares
- Flaccid tone
Nursing Actions to decrease risk for cold stress
Dry after birth, increase room temp., skin-to-skin contact, stocking cap, socks, warm clothing, warm equipment, and hands
Actions when neonate displays signs of cold stress
Same as decreasing risking
Radiate warmer (only in the nude with a diaper)
- Monitor with temp robe
- Check every 30 minutes
Care of the Post mature Newborn
Post mature Newborn
born after 42 weeks
4-14% of pregnancies
result of inaccurate estimated date of birth (EDB)
normal sie and health over 4 kg
greek, Italy, australia
Complications of Post-mature Infant
Postmaturity syndrome
- low placenta function
low placenta function in post-mature syndrome leads to
hypoglycemia
hypoxemia
Physical Characteristics of Post-mature Syndrome
Dry, cracking, parchment-like skin. Long fingernails, absence of lanugo
Appears long and thin, fat layers are non-existent, frequently meconium stained
dry = no vernix
What type of staining can occur in utero when post-mature babies and what can it lead to
Meconium staining - stressed poop too soon
- leads to respiratory issues
Interventions for postmaturity Syndrome
similar to cold stress
- tx hypoglycemia
- thermoregulation
- O2 for respiratory illness
Jaundice in Baby’s patho
RBCs die off in large #s after birth (because of Rh factor is different from mom’s)
Bilirubin is created
Liver not mature processes it slowly
very little bilirubin leaves the body
excess of unprocessed bilirubin to build up
If the baby is jaundice in 1st 24 hour, what is occurring?
Hemolytic Hyperbilirubinemia
Hyperbilirubinemia within the first 24 hours is most often the result of
Hemolytic disease of the newborn.
What needs to be checked if the baby has jaundice within 24 hours?
Type and Cross for
ABO incompatibility
Rh incompatibility
ABO example for incompatibility
Mother has blood type O and a newborn with A or B blood
Rh Factor incompatibility
Develops when an Rh negative conceives a Rh Positive infant
What happens to the mom when she delivers a baby with a different Rh factor?
shot of Rh factor to prevent rejection of another baby
Physiologic Jaundice
Not associated with any pathologic process
Immature hepatic function
Increased bilirubin load due to RBC hemolysis
Onset after 24 hours typically peaks around 3 – 4 days
Physiology Jaundice Tx
under lights
feedings increased
- poop out
Hyperbilirubinemia Dx eval
yellow eyes to toes
Transcutaneous bilirubin
- put on head 3 times
If abonormal, then lab vlaues
Hyperbilirubinemia Tx
Bili lights off during blood draws when doing care
IV IgG
Baby needs eye protection on
Expose different parts of the body so change positioning
If they have birth trauma could affect the breakdown and influence of
hyperbilirubinemia
Prognosis of hyperbilirubinemia
good if early, if not could lead to the yellowing of the brain
Neonatal Sepsis
-Prenatally acquired (mom to placenta to baby)
-During labor (prolonged rupture membranes)
- GROUP B STREPTOCOCCUS Normal flora can lead to sepsis if ingested by the baby
If mom is showing digns of infection, then concern
sepsis for baby
Early sepsis (1-3 days of age)
Prenatally
labor
Strept
Late sepsis (1-3 weeks)
nosocomial staph and e. coli
Sepsis s/s
early on subtle clinical signs to
Increased episodes of apnea and bradycardia
Color changes (greenish gray)
Temperature instability (hypothermic)
Feeding intolerance; vomiting, diarrhea, abdominal distention (bloated)
The nurse should immediately inform clinician of changes and implement the ordered treatment plan
When a nurse notices sepsis on a neonate
The nurse should immediately inform clinician of changes and implement the ordered treatment plan
Dx eval of Infections
Cultures of blood, urine, cerebrospinal fluid
Complete blood count, hemoglobin, hematocrit
C reactive protein - inflammatory response
What test is run for inflammatory response and to show a late sign of sepsis?
C reactive protein
The nurse on a Neonate gets how many sticks on a patient
1
Tx of Neonate Sepsis
Vigorous antibiotic therapy (broad spectrum) 7-10 days
Supportive therapy (O2, transfusions)
NPO need TPN and fluids
Prognosis is variable (longer the wait the poor the outcome)
After the 3rd day of antibiotics with no symptoms and negative for infection, then
stop antibiotics
Prognosis of Sepsis for Neonates
Prognosis is variable (longer the wait the poor the outcome)
Infant Care of a Diabetic Mother
considered at high risk and require close observation the first few hours - first few days of life
severe diabetes or diabetes of long duration associated with renal, retinal, cardiac, or vascular disease may give birth to an SGA infant
Typical IDM, when diabetes is poorly controlled or gestational is LGA
IDM Charcteristics
Macrosomia (big), ruddy (Red)
Has excess adipose tissue
Umbilical cord thick, placenta large
Decreased total body water, particularly in extracellular spaces
Excessive weight due to increased weight of visceral organs, cardiomegaly (hypertrophy) and increased body fat
What is not affected by IDM?
brain
IDM babies progress to hypoglycemia why?
The baby is exposed to sugars and learn to produce insulin to regulate blood sugar
The cord is cut but the baby still produces insulin with no sugar from the mom
With IDM babies need what intervention
early and frequent feedings
Complications of IDM
Hypoglycemia
Hypocalcemia – DM mom don’t have calcium (might have tremors)
Hyperbilirubinemia - BIG
Birth Trauma
Polycythemia – extra insulin production effects O2 consumption
Respiratory Distress Syndrome – deactive cerfactant production
Congenital Malformations – cardiac and renal defects
Nursing Mgmt of IDM
Early detection and ongoing monitoring for hypoglycemia, polycythemia, respiratory distress, and hyperbilirubinemia
- glucose hourly after feedings q4
if not maintained, IV glucose (D10W)
assess for birth trauma and congenital anomalies
Babies are not born addicted to substances they are
dependent
- will kill if an abrupt stop gives Methadone
neonatal abstinence syndrome:
physiologic dependence that we must
help them through
- COMBINATION GASTROINTESTINAL, PHYSIOLOGY AND NEUROLOGICAL S/S
chart decision of the court or CPS
Substance Abuse Exposure Tx
Methadone
Substance Abuse Exposure drug testing for accuracy
SAMPLE meconium and blood screen the cord
Hair and urine sample
Assessment findings of Neonatal abstinence syndrome
Signs of neonatal withdrawal
Fetal alcohol syndrome (FAS)
Alcohol-related birth defects (ARBD)
Alcohol-related neurodevelopmental disorders (ARND)
Neurological withdrawal s/s of neonates
Irritability
Seizures
Hyperactivity
High – pitched cry
Tremors
Exaggerated Moro reflex
Hypertonicity of muscles
GIl withdrawal s/s of neonates
Poor Feeding
Diarrhea
Dehydration
Vomiting
Frantic, uncoordinated suck
Gastric Residuals
autonomic withdrawal s/s of neonates
Diaphoresis
Fever
Mottled Skin
Nasal Stuffiness
Misc withdrawal s/s of neonates
Disrupted sleep patterns
Diaphoresis
Tachypnea (>60)
Excoriations
Temperature instability
The more s/s of withdrawal the
more likely they are
What is the best way to help the withdrawal babies?
prevention
What should a nurse make sure to prevent from doing to the family?
not be judgemental and compassionate with resources
What drugs are they using for NAS?
Methadone
Versed
Morphine
minimal stim room and want love and affection
hold when awake
Failure to Thrive r/o
neglect
FTT result of
Physical
- calories need more
- cystitic fibrosis
- cardiac
Psychosocial Issues
- means for formulas
Poverty
- home care
Health Beliefs
- older child fasting
-fasting
-eating behaviors
Family Stress
- The older they get
Feeding Issues
- assess how they are and watch them mix
FTT is what percentile
5th
FTT pattern
Pattern Of Consistent Deviation In Growth Pattern
- FTT Usually The Result Of Mixed Causes
INadequate Calorie Intake
Incorrect Formula Prep, Neglect, Fad Foods, Poverty, Behavioral Problems Affecting Eating, CNS Issues
Inadequate Absorption
Cystic Fibrosis, Celiac Disease, Biliary Atresia
Increased Metabolism
Hyperthyroidism, Congenital Heart Defects
FTT Assessment
History (Especially Diet History) Daily Schedule
Parent Height
Physical full assess
Assessment Of Mealtime Rituals, Behaviors (no distractions)
Parent-child interaction or concerns
R/O Lead Toxicity, Anemia, Ova & Parasites, Etc.
Nursing Mgmt for FTT
Provide A Positive Feeding Environment
Document the Child’s Feeding Behavior And The Patient-Child Interaction During Feeding
Provide Primary Core for nurses
Avoid Distractions
Introduce New Foods Slowly
