Final: Neonatal Complications Flashcards
Infants having thin skin, less subcutaneous fat and a greater body surface, are factors that affect what complication?
Hypothermia.
This causes them to lose body heat faster.
- Preterm babies lose heat even faster.
** Infants have poor compensatory mechanisms.
Ways of losing heat: conduction, convection, evaporation, and radiation
Convection: flow of warmer heat rising and cooler falling. Like in a convection oven.
Conduction: direct transfer of heat through touch.
Radiation is the transfer of heat by means of electromagnetic waves. To radiate means to send out or spread from a central location
What is “cold stress” in a newborn?
Hypothermia.
What happens to the newborn if they are not receiving adequate heat? (On a physiological level)
They begin to burn their brown fat stores. Brown fat is more vascular and easy to burn; it surrounds their internal organs.
The metabolic waste byproduct of this exchange leads to metabolic acidosis.
What causes a newborn to experience respiratory distress (secondary to hypothermia)?
By burning their brown fat stores increases their need for oxygen. (and can result in hypoxemia)
This leads to increased respiratory rate and the need for more calories.
This also hampers their surfactant production, leading to respiratory distress.
Why does a hypothermic baby experience hypoglycemia?
Because they are burning more calories due to needing to breath faster to keep up with their oxygen demand needed while they are burning their brown fat.
Explain the process of the hypothermic baby experiencing hyperbilirubinemia:
- Increased acid production as a byproduct of the brown fat being metabolized.
- This leads to metabolic acidosis.
- Metabolic acidosis leads to hyperbilirubinemia (jaundice). This is toxic to the nervous system and can lead to brain damage.
Why is hypoglycemia so dangerous for a newborn?
What are some common risk factors for it to occur?
It can cause brain damage.
Risk factors:
* Pre/Post Maturity
- LGA / SGA
- Asphyxia (lack of oxygen, d/t working harder to breath)
- Hypothermia
- Maternal DM
- Maternal terbutaline (tachycardia = increased work)
- Infection (increased metabolic workload)
- Drug withdrawal
Signs and Symptoms for newborn hypoglycemia:
– Jitteriness
– Poor muscle tone
– Diaphoresis (babies don’t normally sweat)
– Poor suck/ feeding
– Dyspnea/ Apnea
– Cyanosis/ pallor
– Tachycardia
MORE signs and symptoms of hypoglycemia in the newborn:
- Low temperature
- High pitched cry
- Exaggerated moro
- Lethargy
- Seizures (because it’s hard on the CNS)
- May NOT have any signs and symptoms… so watch ALL babies!
What is the weight, in grams, of a LBW baby?
Anything under 2,500 g
About 5.5 pounds.
This baby is at or below the 10th percentile of normal weight for gestational age:
SGA
Can be preterm, at term, or post-term.
Babies who are SGA AND premature are at greatest risk for problems.
This rate of growth is a reflection of something else going on… the rate of growth doesn’t fit the usual pattern:
IUGR
Implies that the placenta is not working well (usually not genetic)… may be from drugs/tobacco/ alcohol or sickle cell anemia, infection, or high blood pressure.
What are the populations at risk for having an SGA baby?
- Ages <16 or greater than 40 (not able to create as good of a placenta, too young = immature, AMA = decreased circulation)
- Preeclampsia, HTN, chronic renal or heart disease, DM
- Women who abuse substances
- Infants with intrauterine infection (maternal body fighting the infection = leaves less calories for fetus)
- Placental insufficiency
- Genetic conditions
What is diagnostic for SGA?
Decreased fundal height for gestational age.
Ultrasound. Can check size, development, blood flow and circulation, and any placental calcifications.
What is the appearance of an SGA baby?
- Wasted appearance w/loose skin folds (decreased or zero SQ fat)
- Poor skin turgor, dry skin
- Increased Hct = d/t polycythemia bc decreased O2 supply from poor placental perfusion so they’re trying to compensate.
MORE regarding SGA appearance:
- Relatively thin arms
- Sunken abdomen
- Thin, yellow, dry umbilical cord
- Sparse hair (including lanugo bc using glucose for other things).
What are the most common problems associated with SGA?
Hypothermia: d/t less SQ fat
Hypoglycemia: d/t less glycogen stores.
Plycythemia: r/t chronic hypoxia.
May have impaired mental development.
Greater incidence of heart disease later in life.
MORE problems associated with SGA:
- Poor catch-up ability. Tend to follow the growth curve.
- Increased risk for congenital malformations: cardiac being the biggest.
- Increased morbidity/ mortality
- Often won’t void for up to 24 hours after birth: bc of their dehydration.
Nursing care for SGA:
- May need resuscitation at birth (decreased O2, dehydration, energy spent on RBC production, low glycogen levels all lead to possible difficulty with respirations). Watch for meconium aspiration (when baby is stressed, their anal sphincter relaxes=meconium released.
- Accu checks, gavage for hypoglycemia; need early and frequent feedings
- Temperature regulation
- Parents need support to provide a supportive environment. They don’t realize the possible implications involved with an SGA baby.
At or above 90th percentile of normal weight for gestational age:
LGA - Large for Gestational Age
May be deceptive at birth by appearing to be full term when they may not be.
- Gestational test (“cricket test”)
What is the normal BG level?
Above 40
What population is at risk for LGAs?
- Women with DM
- Multiparas: babies tend to get bigger w/each pregnancy
- Women who gain more than 35 pounds during pregnancy or are large before pregnancy.
- Genetic conditions
Respiratory Distress Syndrome, birth injuries / trauma, and asphyxia all are possible problems with what type of baby?
LGA
If mom has DM, can interfere with surfactant production (d/t the increased insulin from the increased glucose environment).
Asphyxia - if baby gets stuck, lower O2.
CNS injury: Brachial-plexus palsy, facial palsy, Intracranial hemorrhage, and other risks are problems associated with what type of baby?
LGA
Intracranial hemorrhage d/t prolonged labor.
Other risks:
Hypoglycemia
Polycythemia and hyperviscosity
Hyperbilirubinemia (which leads to brain damage)
At this week of gestation, this Syndrome implies that the placenta is deteriorating and may not be able to sustain fetus or function adequately through labor:
42 weeks gestation.
Postmaturity Syndrome.
Leads to hypoxia and malnutrition of the baby. Very rarely will they let someone carry to 42 weeks.
How postmaturity syndrome diagnosed?
Ultrasound measurements of fetal size and placental grade.
How is the appearance of a postmature infant?
- Absence of vernix
- Dry, cracked, leathery skin (dehydrated d/t placental deterioration).
- Increased level of alertness: this is a symptom of chronic intrauterine hypoxia.
- Longer fingernails
- Decreased weight: d/t decreased perfusion and the malnutrition d/t placental deterioration.
These are potential problems from Postmaturity Syndrome:
- Increased fetal distress: d/t hypoxia. This can lead to meconium in the amniotic fluid and risk of aspiration.
- Hypoglycemia from depleted glycogen stores.
- Oversize baby. This can lead to risk of birth trauma, prolonged labor, hemorrhage, and uterine atony.
- Cold stress: d/t decreased SQ fat.
- Polycythemia: d/t hypoxia. Leading to viscous blood.
- Seizure: d/t hypoxia
- Mother often fatiqued, frustrated, angered over the prolonged pregnancy.
What gestation is considered preterm?
Between 20 weeks and 36 weeks 6 days.
