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Nursing Obstetrics & Pediatrics > health challenges in the newborn > Flashcards

health challenges in the newborn Flashcards

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1
Q

what are common complications for newborns?

A
  • prematurity
  • thermoregulation
  • respiratory distress
  • hyperbilirubinemia
  • hypoglycemia
  • sepsis
  • neonatal abstinence syndrome
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2
Q

what are some respiratory challenges a preterm infant may have?

A
  • lack of surfactant
  • respiratory distress syndrome
  • apnea
  • bronchopulmonary dysplasia (often caused by child needing to be on respirator)
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3
Q

what are some cardiovascular challenges a preterm infant may have?

A
  • patent ductus arteriosus
  • increased respiratory effort
  • CO2 retention
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4
Q

why may preterm infants have more challenges with thermoregulation?

A
  • have less brown fat
  • have less subcutaneous fat
  • have poor muscle development, less flexed tone meaning baby can’t contract limbs, creating greater surface area and losses
  • have thin skin
  • higher body surface area
  • may have increased exposure during resuscitation
  • last couple months of gestation is where laying down of fat occurs, so more premature means much less
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5
Q

what are gastrointestinal problems that may affect preterm infants?

A
  • small stomach
  • immature feeding reflexes, can make sucking difficulty
  • increased risk of necrotizing enterocolitis
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6
Q

what are renal challenges that may affect preterm infants?

A
  • decreased ability to concentrate urine

- decreased ability to excrete drugs

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7
Q

what are hepatic challenges that may affect preterm infants

A

-because of immature liver, have decreased ability to conjugate bilirubin, increasing the risk of hyperbilirubinemia

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8
Q

why are preterm infants at higher risk of hypoglycemia?

A
  • may have feeding challenges r/t difficulty breathing and immature feeding reflexes
  • less fat stores, means they are susceptible to hypothermia which goes hand in hand with hypoglycemia
  • have decreased glycogen stores and ability to produce/regulate glucose
  • lower metabolic rate than term infants
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9
Q

why are preterm infants more susceptible to anemia?

A

-they have limited iron stores

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10
Q

what are some neurological concerns that may affect preterm infants?

A
  • intraventricular hemorrhage
  • hydrocephalus
  • hearing loss
  • retinopathy of prematurity
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11
Q

why are corticosteroids given in preterm labour

A

-a single course of corticosteriods within 7 days of delivery reduces perinatal mortality, respiratory distress syndrome and intraventricular hemorrhage

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12
Q

why may betamethasone be given to a woman in labour or who may go into labour?

A

-if she is between 24-34 weeks pregnant, betamethasone is a corticosteroid that can help prevent respiratory distress, intraventricular hemorrhage, and perinatal dealth

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13
Q

what dose of betamethasone is given in preterm labour?

A

12mg IM q24hr x2

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14
Q

why may dexamethasone be given to a woman in labour?

A
  • if the woman is expected to deliver within 7 days and is between 24 and 34 weeks gestation
  • helps to prevent respiratory distress, intraventricular hemorrhage, and perinatal mortality
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15
Q

what dosage of dexamethasone may be given to a woman in preterm labour?

A

6 mg IM q12hr x 4 doses

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16
Q

why may magnesium sulfate (MgSO4) be given to a woman in preterm labour?

A

-because new evidence suggests that it has neuroprotective effects for infant and can prevent neurological complications associated with prematurity

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17
Q

when would magnesium sulfate be given to a woman in labour?

A
  • if she is at risk of or having seizure activity r/t high BP
  • if she is less than 32 weeks gestation for fetal neuroprotection
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18
Q

when giving MgSO4 for the neuroprotective effects for a preterm infant, how is it dosed?

A

4g IV loading dose over 30 minutes then 1g/hour maintenance until delivery

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19
Q

what are the preterm temperature control guidelines?

A
  • delivery room should be maintained around 25-26 degrees Celsius
  • babies less than 28 weeks should be placed wet, up to their neck, in a food grade polyethylene bag
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20
Q

what age range is considered “late preterm”?

A

34-36 weeks gestation

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21
Q

how does the size of a late preterm infants brain differ from that of a term infant?

A

it is 60% of the size of a term infant

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22
Q

what is perinatal asphyxia?

A

-poor tolerance to stress of labour, frequently leading to acidosis and hypoxia

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23
Q

what are signs of neonatal respiratory distress?

A
  • tachypnea
  • apnea
  • cyanosis - first often circumoral
  • grunting/cooing
  • nasal flaring
  • retractions/indrawing
  • poor feeding
  • accessory muscle use
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24
Q

why may and infant grunt or coo?

A
  • having difficulty breathing
  • sound is created by trying to force air through partially closed glottis, which is closed to try and keep alveoli open to get more oxygen
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25
Q

what are some common causes of respiratory distress in neonates?

A
  • respiratory distress syndrome
  • meconium aspiration
  • transient tachypnea of the newborn
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26
Q

what percentage of neonatal deaths are related to respiratory distress syndrome?

A

20%

27
Q

what causes respiratory distress in neonates?

A

-insufficient amounts of surfactant

28
Q

what are risk factors for an infant developing respiratory distress syndrome?

A
  • prematurity/immaturity of lungs
  • C/S without labour
  • males
  • caucasians
  • maternal diabetes
  • twin B
  • perinatal asphyxia
29
Q

why may having a c/s without labour put an infant at risk of respiratory distress syndrome?

A

-infant did not get squeeze from labouring and delivery through birth canal to help expel fluid

30
Q

why could maternal diabetes put an infant at greater risk of respiratory distress syndrome?

A

-high insulin production in fetus can interfere with surfactant production

31
Q

how is respiratory distress managed in neonate?

A
  • antenatal corticosteriods
  • exogenous surfacant -(endotracheal)
  • continuous positive airway pressure (CPAP)
  • positive end-expiratory pressure (PEEP)
  • fluids and other supportive care
  • BGM
32
Q

why does meconium stained amniotic fluid occur?

A
  • could be caused by baby in breech position causing expelling of feces
  • fetal compromise (stress, hypoxia…) can cause release of anal sphincter
  • post-term
33
Q

what is meconium aspiration syndrome?

A

when an infant aspirates meconium during delivery

-happens in about 2-9% of cases where there is meconium stained amniotic fluid

34
Q

how to prevent meconium aspiration

A
  • avoid post maturity
  • amniotic infution, routine suctioning of nose and pharynx
  • endotracheal suction by trained individual
35
Q

how can meconium aspiration be treated?

A
  • suctioning may be appropriate
  • surfaxin (exogenous surfactant)
  • steroids
  • close observation and support
36
Q

what is transient tachypnea of newborn?

A
  • sometimes called wet lung syndrome

- excess fluid in lungs or delayed re-absorption of fetal lung fluid

37
Q

what is hyperbilirubinemia?

A

-excessive concentration of bilirubin in the blood

38
Q

what is jaundice?

A

bile pigment deposited in skin, mucous membranes, and sclera

39
Q

what is kernicterous?

A

when bilirubin levels rise too high, can be deposited on the brain and cause encephalopathy

40
Q

what causes jaundice/hyperbilirubinemia in newborns?

A
  • primary mechanism is increased RBC volume, short RBC lifespan leading to increased RBC hemolysis after birth which increases bilirubin laod
  • additionally, decreased clearance of bilirubin from plasma because of immature liver conjugating bilirubin
  • bruising during birth can increase risk
41
Q

when does jaundice/hyperbilirubinemia usually peak?

A

3-5 days after birth and typically resolves after 8 days

42
Q

what are some possible assessment findings that may indicate jaundice/hyperbilirubinemia?

A
  • yellowing of skin and/or sclera
  • poor feeding
  • sleepiness, difficult to rouse
  • fever
  • wt loss or slow wt gain
  • change in number of soiled or wet diapers
43
Q

what is TSB test for?

A

total serum bilirubin

44
Q

what is the TCB test for?

A

transcutaneous bilirubin

> 340 micromol/L at any time during first 28 days of life is severe hyperbilirubinemia

> 425 is critical

45
Q

what is bilirubin encephalopathy?

A
  • neurological effects of unconjugated bilirubin in the brain
  • causes staining of deep-yellow to neurons and neuronal necrosis of basal ganglia in brainstem nuclei
46
Q

what is phototherapy used to treat in newborns?

A
  • hyperbilirubinemia

- found to help conjugate unconjugated bilirubin (which makes it water soluble and decreases load on liver)

47
Q

what should a newborn be dressed in during phototherapy?

A
  • just a diaper
  • should wear eye protetion
  • then wrapped with phototherapy blanket
48
Q

what is neonatal abstinence syndrome?

A

-condition caused by infant withdrawaling from a substance mother had been on for extended period during pregnancy

49
Q

-what are some signs of neonatal abstinence syndrome?

A
  • high pitched cry
  • sweating
  • vomiting
  • diarrhea
  • excessive mucus
  • sneezing three or more times in an interval
  • hyper flexion
50
Q

what are some risks associated with maternal cocaine use?

A
  • placental problems, especially abruption
  • risk of miscarriage
  • risk of preterm labour
  • risk of sids
  • infant withdrawal symptoms severe
51
Q

when may narcan be appropriate to give to a newborn?

A
  • if it has respiratory distress related to narcotic use during labour
  • not appropriate if mother was long-term opiate user during pregnancy because it can cause serious withdrawal problems
52
Q

what are some therapeutic ways of handling infants affected by neonatal abstenance syndrome?

A
  • keep environment calm and subdued, decreasing light and noise
  • avoid eye contact
  • provide soother
  • take cues from baby
  • swaddling to help control body and tremors
  • hold in C position to feed and cuddle (baby’s back against you, face out, legs bent)
53
Q

what infants are at higher risk of hypoglycemia?

A
  • small for gestational age
  • large for gestational age
  • preterm infants
  • infants of mothers with diabetes
  • infection and stress also increases risk
54
Q

how often should blood glucose be taken for infants at high risk of hypoglycemia?

A

q1-4h until nomograph criteria has been met

55
Q

how is a poke done to take a blood glucose measurement on an infant?

A
  • thumb is placed on bottom of the foot
  • from heel towards toes
  • poke is done on sides of heels to prevent hitting nerves or major veins/arteries
56
Q

what are some symptoms of hypoglycemia in an infant?

A
  • jitteriness/tremors
  • apathy
  • episodes of cyanosis
  • convulsions
  • intermittent apneic spells
  • tachypnea
  • weak/high-pitched cry
  • limpness, lethargy
  • difficulty feeding
  • eye rolling
  • episodes of sweating, sudden pallor, hypothermia
  • cardiac arrrest
57
Q

what is considered hypoglycemia for an infant?

A

anything at or below 2.5 mmol/L

58
Q

for an infant with asymptomatic hypoglycemia and a blood glucose level above 2 mmol/L what are some possible interventions?

A
  • increase frequency of breastfeeding

- supplement with BM fortifier or formula

59
Q

for an infant with hypoglycemia or a blood glucose of less than 2 mmol/L what are some interventions?

A
  • IV infusion of glucose

- continue to feed and re-evaluate

60
Q

why does sepsis occur in a newborn?

A
  • they have immature immune systems
  • haven’t had opportunity to develop natural flora to protect
  • have been exposed to a bacteria (GBS most common)
  • may have had chorioamnionitis (an infection between two layers of amniotic sac)
61
Q

what are symptoms of sepsis in a newborn?

A
  • subtle behavior changes
  • lethargy
  • irritability
  • feeding trouble
  • temperature instability (more likely than fever)
  • tachycardia
  • poor peripheral circulation
  • respiratory distress
  • hyperbilirubinemia
62
Q

what are some indications of poor peripheral circulation in a newborn?

A
  • cyanosis
  • duskiness
  • pallor
63
Q

what are some considerations for parents of a newborn with complications?

A
  • promote care, which parents may be hesitant to give because of medical equipment
  • assess for stress, especially in mom
  • consider financial strain, especially if hospital is away from home community
  • mom may have ptsd r/t delivery

Nursing Obstetrics & Pediatrics (26 decks)

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