high risk infant Flashcards
what is included on the ballard score?
-posture
-square window
-arm recoil
-popliteal angle
-scarf sign
-heel to ear
supplies checklist for preterm delivery
-radiant warmer preheated
-room temp at 80
-suction
-cracked heat pad
-plastic wrap/bag
-hats/blankets
-intubation kit
-ventilator/CPAP/nasal O2/ambu bag
-pulse ox, stethoscope
-emergency meds: epi and saline
-supplies for umbilical lines
-warmed transport isolette
methods of O2 therapy
-hood therapy
-nasal cannula
-CPAP
-manual ventilation
-nitric oxide therapy (“INO”)
-extracorporeal membrane oxygenation (ECMO)
what is adverse effect of too much oxygen in preterm infants
blindness
*oxygen L/min and O2%
(above 36 weeks it doesn’t matter as much)
-clear plastic hood over infants head
-nurse controls O2 conc
hood therapy
-delivers set pressure in spontaneously breathing infants
-keeps alveoli open
-measured by centimeters 5-10
CPAP (continuous positive airway pressure)
what number CPAP can result in a pneumothorax
8 cm
-delivers some breaths in spontaneously breathing infants on CPAP
-no ET tube
NIPPV
(non-invasive positive pressure ventilation)
-oxygen delivery needed for hypoxemia, hypercapnia, or persistent apnea
-set to provide a predetermined amount oxygen during spontaneous respirations and in absence of spontaneous respirations
mechanical ventilation
3 functional modes ventilation
-pressure ventilation
-volume ventilation
-high frequency ventilation
-pressure ventilation: constant flow
-volume ventilation: predetermined volume of inspiratory pressure
-high frequency ventilation: smaller volumes of O2 at more rapid rate (>300/min, jet/oscillator)
-oxygen delivery device
-vasodilator, decreases pulmonary vascular resistance
-used for persistent pulmonary HTN, meconium aspiration, congenital heart disease
nitric oxide therapy
“INO”
risk with nitric oxide therapy
nitric oxide binds to Hgb resulting in production of methemoglobin which can’t bind to O2 (methemoglobinemia)
what is emergency drug given for methemoglobinemia (from nitric oxide therapy)
methylene blue
PPHN
pulmonary HTN of the newborn
-treatment for pts with life threatening heart/lung problems
-long term breathing and support support
-adds O2 to blood and remove CO2 and return it to infant
ECMO
extracorporeal membrane oxygenation
can preterm infants receive ECMO
no
increases risk brain bleeds
S+S pain in newborn
-increased HR
-increased BP
-rapid and shallow respirations
-decreased O2
-pallor and sweating
-increased muscle tone, dilated pupils, increased ICP, metabolic and endocrine changes
-crying, grimacing
N-PASS
neonatal pain, agitation and sedation scale
what is included in NPASS
-cry/irritability
-behavioral state
-facial expression
-extremities tone
-VS
-premature pain assessment
highest score on NPASS
10
(+1 if <30 wks EGA)
pain management meds used in NICU
-morphine
-fentanyl
-methadone
-precedex
-midazolam (versed)
-lorazepam (ativan)
when should babies be back to their birthweight after birth
2 weeks
equivalent between grams and mL
1 g = 1 mL
mostly weigh diapers for babies on IV fluids
when does suck-swallow-breath develop
32-34 wks
limit time for PO feeding babies
30 mins
how much milk should babies get per day (formula)
150-160mL/kg/day
risk with long term (1 yr+) TPN
liver failure
IDM issues
RDS
hypoglycemia
hyperbilirubinemia
potential problems in LGA infants
-hypoglycemia
-birth trauma
-pulmonary HTN
-poor feeding
can preterm babies be cooled
no. have to be full term
potential problems in IUGR infants (<10% for gestational age)
-hypoglycemia
-hypothermia
-polycythemia
-infection (increased risk NEC)
potential problems in postterm infants
-meconium aspiration
-asphyxia
-shoulder dystocia
syndrome caused by lack of pulmonary surfactant which prevents the alveoli from collapsing
respiratory distress syndrome
RDS
S+S RDS
-crackles
-poor air exchange
-color changes: pallor/cyanosis/mottling
-increased work breathing: tachypnea, nasal flaring, grunting, retractions
-apnea
when might babies not need surfactant administered
moms who received steroids before birth
Tx RDS
give surfactant
O2 therapy
-very low lung volumes
-stiff and difficult to ventilate
hypoplastic lung
what are babies with hypoplastic lungs at high risk for
pneumothorax
what babies might have hypoplastic lungs
-moms water broke early (around 20 wks)
-congenital diaphragmatic hernia
-chronic lung disease
-develops when premature infants with RDS need mechanical ventilation for long time, causing inflammation and scarring in lungs making it difficult to extubate
bronchopulmonary dysplasia (BPD)
S+S BPD
-increased work breathing
-tachypnea
-retractions
-nasal flaring
-tachycardia
-intolerance to stimuli and feeds
Tx BPD
-O2 therapy
-nutrition
-fluid restriction
-meds (diuretics, steroids, bronchodilators)
-time for lungs to heal
classic signs congenital diaphragmatic hernia
-resp distress
-scaphoid abdomen
-bowel sounds in chest
Tx congenital diaphragmatic hernia
-ET intubation
-OG tube placement
-often ECMO
-minimize bag mask ventilation
-surgery to correct
intestines are outside stomach through hole in abdomen
gastroschisis
intestines, liver and other organs remain outside stomach in sac
omphalocele
-open defect of spinal cord
-failure of closure of neural tube
mylomeningocele
how should babies with mylomeningoceles be positioned
on the stomach (decubitus positioning)
sterile plastic covering over it
risk factors for retinopathy of prematurity (ROP)
preterm birth when vessels aren’t fully developed and require supplementary oxygen
Tx ROP
-sometimes self resolve
-avastin injection
-laser therapy
S+S PDA
-murmur
-active precordium
-bounding pulses
-tachycardia
-tachypnea
-crackles
-hepatomegaly
-wide pulse pressures
-high O2 requirement
-unable to wean off resp support
what do you give to keep PDA open
prostaglandins
Tx PDA
-vent support
-fluid restriction and diuretics (decrease CV volume overload)
-indomethacin, ibuprofen or tylenol causes PDA to constrict
-surgical ligation
side effect use of indomethacin to treat PDA
NEC
tissue in small or large intestines is injured or dying causing it to become inflamed or even perforate
necrotizing enterocolitis (NEC)
risk factors NEC
-premature birth
-decreased blood flow to intestines
-infection
-umbilical lines
-congenital heart disease
S+S NEC
-distended and discolored abdomen
-bilious residuals
-feeding intolerance
-no stool and/or dark/bloody stools
-lethargic
-increased apnea and bradycardia
Tx NEC
-NPO
-give fluids
-NG suction decompression (repogle)
-surgery
maternal risks for NN sepsis
-untreated GBS
-STDs
-chorio
-prolonged ROM
risk factors intraventricular hemorrhage (IVH)
premature
hypoxia
ischemia
unstable BP
S+S IVH
apnea
bradycardia
frequent transfusions
boggy head/full fontanels
lethargy
consequences of IVH
midline shift
hydrocephalus requiring shunt
cerebral palsy
developmental delays
4 criteria for whole body cooling
-infant >36 wks and <6 hrs old
-need for resuscitation at birth or Dx of encephalopathy
-moderate to severe encephalopathy
-1 of 3: (pH <7 or base deficit >16, acute event and assisted ventilation at birth >10 mins, acute perinatal event and 10 min apgars at 5 or below)
what is temp lowered to during body cooling
33.5 C (95 F)
how long is baby cooled for
72 hrs
S+S neonatal abstinence syndrome
-tremors
-seizures possible
-overactive reflexes and hypertonia
-excessive crying
-poor feeding
-tachypnea
-fever and sweating
-diarrhea
-inability to sleep for prolonged periods
neck muscles contract causing head to be turned to one side
torticollis
criteria for cooling therapy in newborn
-infant >36 wks EGA and <6 hrs old
-need for resuscitation at birth secondary to poor resp effort or Dx of encephalopathy
-moderate to severe encephalopathy
-one of following 3: (pH <7 or base deficit >16; acute event and assisted ventilation at birth for 10+ mins; acute perinatal event and 10 min apgar score <5)
why would nitrous oxide be given to newborn
vasodilator: relaxes pulmonary smooth muscle and decreases pulmonary resistance
Tissue in the small or large intestines is injured or dying causing it to become inflamed or even perforate
NEC
S+S NEC
-distended and discolored abdomen
-visible bowel loops
-bilious residuals and feeding intolerance
-no stool and/or dark or bloody stools
-lethargic
-increase in apnea and bradycardia
Tx NEC
-NPO
-give fluids
-repogle for gastric decompression
-Abx
-x-rays
-surgery
S+S PDA
-murmur
-active precordium
-bounding peripheral pulses
-tachycardia
-tachypnea
-crackles
-hepatomegaly
-wide pulse pressures
-high oxygen requirement
-unable to wean off respiratory support
Tx PDA
-ventilatory support
-fluid restriction and diuretics to decrease cardiovascular volume overload
- Indomethacin, ibuprofen, acetaminophen which causes the PDA to constrict
-surgical ligation
S+S RDS
-crackles
-poor air exchange
-color changes (pallor/cyanosis/mottling)
-increased work breathing (tachypnea, nasal flaring, grunting, retractions)
-apnea
Tx RDS
-adequate ventilation
-admin surfactant
-oxygen therapy
