Complications of Preterm & Post-term Newborns Flashcards
These infants are born before 37 completed weeks of pregnancy.
Preterm infants
Usual birthweight of preterm infants
Less than 2,500 grams (5.8 lbs)
Causes of Prematurity
- Low socio-economic level
- Lack of prenatal care
- Multiple pregnancy
- Closely spaced pregnancy
- Maternal age
- Order of birth
- Abnormalities on the mother’s reproductive system (ex.cerivical insufficiency)
- Obstetric Complications - PROM or premature separation of placenta
- Infections
- Cigarette Smoking
- Previous early delivery
- Early induction of labor
- Gestational Hypertension
- History of preterm birth
- PPROM, Placenta Previa, Placental abruption
Potential Complications of Preterm NBs
- Anemia of Prematurity
- Kernicterus
- Hydrocephalus
- Persistent Patent Ductus Arteriosus
What is the cause of AOP in preterm NBs?
Due to low RBC production since the bone marrow does not increase its production until the end of 32 weeks AOG
- Latrogenic cause (caused by medical examination or treatment) : frequent extraction of blood sample for monitoring or evaluation
Management of AOP
- Iron supplements
- Blood transfusion
It is a rare preventable brain damage caused by the build up of too much bilirubin in their blood caused by an immature liver (cannot eliminate too much bilirubin)
Kernicterus
What is the normal indirect bilirubin in newborns within the first 24 hours of birth.
Under 5.2 mg/dL
At what level of indirect bilirubin does jaundice happen?
greater than 7mg/dL
At what level does indirect bilirubin rises for kernicterus to happen?
greater than 20 mg/dL
At what level of indirect bilirubin is treatment usually considered?
10-12 mg/dL
Is treatment with a special type of light (Bili lights)
- treats neonatal jaundice through a process called photo-oxidation
Phototherapy
A process that adds oxygen to the bilirubin so it dissolves easily in water.
Photo-oxidation
Nursing Responsibility for Phototherapy.
Ensure to place proper eye shield & cover genitals (with diaper) while on phototherapy
- Infant’s clothes should be removed
Another cause for increased bilirubin in the newborn
Cephalohematoma
Is a collection of blood under the periosteum of the baby’s skull.
Cephalohematoma
Why are babies born with cephalohmatoma at an elevated risk for jaundice?
Blood accumulated in cephalohematoma can cause the RBCs to destruct which eventually increases levels of bilirubin in the baby’s blood stream.
- Elevated bilirubin levels = trigger jaundice
Signs & Symptoms of Jaundice
- Yellow discoloration of the skin, mucous membranes & scleara
- Light-colored stool
- Lethargy / excessive sleepiness
- Poor feeding
Kernicterus Signs & Symptoms
- Sleepiness / lethargic
- High-pitched crying
- Poor / decreased feeding / appetite
- Inconsolable crying / Irritability
- Floppy or limp body
- Missing reflexes (Startle reflex absent)
- Arching of the head & heels back
- Lack of wet or dirty diapers
- Fever
What causes hydrocephalus
Intracentricular Hemorrhage
Chambers in the brain that hold the CSF. It cushions the brain & circulates nutrients, remove wastes from the brain.
Ventricles
How is Intraventricular Hemorrhage diagnosed?
Cranial UTZ
- done after few days of life & again at different intervals to determine if bleeding has occured
If IVH is detected, a grade of 1-2 (mild) indicates?
May not cause any problem to the NB - good prognosis
If IVH is detected, a grade of 3 indicates?
Bleeding causes enlarged ventricles, may require treatment
If IVH is detected, a grade of 4 indicates?
Bleeding in the ventricles may cause development of hydrocephalus if bleeding persists
A condition in which there is excessive CSF in and around the brain.
Hydrocephalus
Causes of Hydrocephalus
- Blockage of the CSF flow inside of the brain (IVH, PVH or tumor)
- Congenital causes
- Infection
- Overproduction of CSF
Signs of Hydrocephalus
- Increased head circumference
- Prominent scalp veins
- Increased intracranial pressure
- Bulging eyes & inability of the baby to look upward with the head facing forward
- Lethargy & Irritability
- Separated suture lines
- Enlarged fontanelles
- Bossing of forehead
Treatment Procedures for hydrocephalus
- Lumbar Puncture
- Ventriculoperitoneal shunt
This treatment procedure involves inserting a needle into the space between two lumbar vertebrae to remove a sample of CSF for diagnostic & therapeutic procedure.
Lumbar Puncture
This treatment procedure involves draining the excess CSF directly from the ventricles of the brain to the peritoneum to relieve pressure in the brain
Ventriculoperitoneal shunt
Occurs when the hole or the Patent DA fails to close after birth
Persistent Patent Ductus Arteriosus
Why is there a Patent DA in a fetus?
In utero, fetal blood does not need to go to the lungs for oxygenation
- DA allows the bypass the lungs
Why is a persistent patent DA a problem in newborn?
If the DA does not close, then extra blood will go into the lungs & the lungs have to work harder to handle the extra volume of blood in the lungs
- interfere with breathing & feeding, heart failure
Failure of the DA to close shortly after birth up to how many months is termed persisten patent ductus arteriosus?
3 months
Symptoms of Large PDA
- Cyanosis
- Fatigue
- Full, bounding pulses
- Heart palpitations
- Shortness of breath ( reduced fxn & fluid build-up in the lungs)
Requires surgery - Close DA by stitches or clips
Medication for PDA
Indomethacin IV
This stimulates the muscles inside the PDA to tighten / constrict to close the connection between the aorta & pulmonary artery.
Indomethacin IV
Surgical interventions for PDA
- Using sutures or metal clips
- Occlusion device via cardiac catheterization
Nursing Care Management for Preterm Newborns
- Provide Respiratory Ventilation
- Monitor vital sigs; O2 sat & presence of abnormal heart sounds
- Provide adequate fluids, electrolytes & nutrition
- Maintain a neutral thermal environment - KMC
- Prevent infection
- Promote parent-child bonding
Why must IV infusions administered carefully?
To prevent rapid change in BP which may cause capillary rupture (IVH /PVH)
Refers to infants born after 42 completed weeks of pregnancy
Post-term infants
What causes post term pregnancy?
- Inaccurate dating based on the LMP - most common cause
Why are post term infants considered at risk?
Because the placenta functions effectively for only 40 weeks.
A fetus who remains in utero with a failing placenta develops?
Post term syndrome - weight gain in the uterus after due date has stopped
True or False
Post term newborn shows characteristics of an SGA infant
True
Assessment findings of a post-term newborn
- Dry, cracked, peeling, leather-like skin to the loss of the protective effect of vernix caseosa
- Malnourished / wasted appearance / weight loss
- Advanced maturity - open eyed & alert baby
- Overgrown curved nails
- Visible creases on palms & sole
- Hypoglycemia
- Polycythemia
- Little / No Vernix Caseosa
- Meconium-aspiration
- Meconium-stained amniotic fluid, skin, cord & nails.
Why does a post term newborn develop hypoglycemia?
Due to low glycogen levels which were used for nourishment during the last weeks of intrauterine life.
Is the first stool passed by a newborn soon after birth, but in some case it is passed while in utero. This can happen when babies are “under stress” due to a decrease in blood & oxygen supply.
Meconium
Why do these adverse consequences happen in a post term pregnancy?
- Due to placental senescence / insufficiency / aging
- Decreased placental oxygenation secondary to placental aging
Management options for post term pregnancy
- Labor induction
- Expectant management with fetal surveillance - amniotic fluid volume assessment
This management option is a more popular option and can be down w/ complications
Labor induction
What bishop score is ideal for labor induction?
Greater than or equal to 8
Nursing Care Management of Post term newborns
- Manage meconium aspiration syndrome
- Obtain serial blood glucose measurements
- Provide early feeding to prevent hypoglycemia
- Maintain skin integrity
How to manage meconium aspiration syndrome
- Suction immediately and thoroughly mouth & nares before infant’s first breath to prevent aspiration of meconium that is already in the airway.
- Perform CPT with suctioning to remove excess meconium & secretions.
- Provide supplemental oxygen & respiratory support as needed
