high risk neonate Flashcards
below 10th percentile on intrauterine growth curve
small for gestational age (sga) newborn
premature newborn are at higher risk for
1.apnea (stops breathing >20 seconds
2. hyperglycemia
3.heart,intestinal, brain conditions
born between 33 and 37 weeks
late preterm
born between 24 and 34 weeks
early preterm
physical signs of prematurity
- less than 2500 grams
- Hypotonic
- Thin,shiny,pink able to see veins
4.abundant body hair (lanugo) - more vernix caseosa
6.abnormal breathing patterns - enlarged clitoris
8.small penis, undescended testis - soft,flexible ear cartilage
- small or absent nodules
11.subcutaneous fat is deficient
12.deep sole creases not present
Respiratory
manifestation: Premature
1.Tachypnea
2. Grunting
3. Nasal flaring
4. Retractions
5.Cyanosis
6. Decrease 02 saturation
7. Decrease 02 level
8. Abnormal ABG (arterial blood gas) values
cardiovascular manifestations
1.poor tissue perfusion
2.hypotension
3.patent ductus arteriosus
potential complications (premature)
1.anemia of prematurity
2.acute bilirubin encephalopathy (ABE)
3.persistent patent ductus arteriosus
4.periventricular hemorrhage or intraventricular hemorrhage
major complication premature
- bronchopulmonary dysplasia (BPD)
- periventricular leukomalacia
- retinopathy of prematurity (ROP)
4.Psychomotor retardation
destruction of brain cells by invasion of indirect or unconjugated bilirubin
Acute bilirubin encephalopathy (ABE)
A machine will help the baby to breathe, A machine that mechanically assists a patient in the exchange of oxygen and carbon dioxide, a process sometimes referred to as artificial respiration.
ventilator
oxygen may be given by:
• nasal prongs
• oxygen hood over the baby’s
head
• Oxygen by mask
the lost of heat through moisture (a major cause)
Ex. : wet newborn loss a great amount of heat when the amniotic fluid in their skin evaporates
evaporation
the lost of heat to cooler solid objects in the environment that are not in direct contact with the infant
Ex: window surfaces or examination
tables
radiation
loss of heat from the body because of direct contact of skin with a cooler solid object
• Ex- newborn is placed on a crib
conduction
is similar to conduction except that heat loss is aided by surrounding air currents;
as direct flow of air from air conditioner vent
Ex. Aircondition (nursery ambient temp - 24’C or 75’F)
convection
how can you prevent heat loss at the time of birth?
1.drying
2.wrapping
3.skin to skin
4. breast-feeding
infant core temp
36.5- 37.2 ‘C
above the 90th percentile of intrauterine growth curve
appears deceptively health with immature development
Large for gestational age (LGA)
more than 3800 or4400 g
Large for gestational age
Large for gestational age etiology
1.overproduction of growth hormone
2.multiparous women
3.congenital cardiovascular disorder
4.beckwith-wiedemann syndrome
5.omphalocele
bw greater than 4000 or 4500g
extreme macrosomia
lga appearance
prominent caput succedaneum, cephalohematoma, or molding.
- extensive bruising
• birth injury such as a broken clavicle or Erb-Duchenne paralysis from trauma to the cervical nerves
• immature reflexes
lga complications
• Prolonged vaginal delivery time
• Difficult birth
• birth trauma due to CPD
• increased incidence of cesarean births/labor inductions
• hypoglycemia
lga complications
Respiratory distress
Meconium aspiration
Hypoglycemia
Polycythemia
is a rare blood disorder that occurs when a newborn has too many red blood cells. This condition can cause the blood to thicken, making it difficult for blood to flow
Polycythemia
Any newborn born after 42 weeks gestation
post-term infant may be LGA, AGA, SGA, or dysmature, depending on placental function.
An Infant who stays in utero past 42 weeks is at special risk because a placenta appears to function effectively for only 40 weeks.
post term infant
post term assessment
•Less amniotic fluid and meconium-stained at birth.
• Vernix and lanugo. completely disappeared
• Dry, cracked, leather-like skin.
•Depleted subcutaneous fat.
•Hard nails extending beyond fingertips.
•Signs of birth injury or poor tolerance of the birth process
complications of post term
• Respiratory Distress Syndrome
• Hypoglycemia
• meconium aspiration
• Polycythemia
• congenital anomalies
• seizures due to hypoxic insult
• cold stress
fetal factors
• fetal distress
- associated with the decreasing efficiency of the placenta (aging placenta)
•insufficiency and continued exposure to amniotic fluid
• macrosomia
•meconium aspiration syndrome.
•stresses of labor and delivery
either in utero or with first breath at birth.
• Second release of meconium into amniotic fluid is possibly caused by pressure on buttocks
• Release of meconium into amniotic fluid is caused by:
1. Relaxation of rectal sphincter
2. Pressure on buttocks
meconium aspiration syndrome
causes severe rd in 3 ways
1.inflammation of bronchioles
2.block small bronchioles by mechanical plugging
3. decrease lung surfactant production through lung trauma
can be used to dilute the amount of meconium in the amniotic fluid inside the utero
amnioinfusion
ECMO
extracorporeal membrane oxygenation
peak age of incidence in SIDS
2 to 4 months of age
autopsy reveals sids
1.petechiae in lungs
2.mild inflammation
3.congestion in the respiratory tract
sids tends to occur at a higher than usual rate in infants
- of adolescent mothers
- of closely spaced pregnancies.
- who are underweight and preterm.
- with bronchopulmonary dysplasia.
- born twins.
- of Native-American and Alaskan parents.
- who are economically disadvantaged.
- of narcotic-dependent mothers
sids cause/etiology
•prolonged but unexplained apnea
•viral respiratory or botulism infection •pulmonary edema
•Possible lack of surfactant in alveoli •sleeping prone (respiratory muscles are restricted)
•impaired arousal responsiveness to increased carbon dioxide or decreased oxygen
newborn from diabetic mothers assessment
•greater chance of congenital anomaly (cardiac anomaly)
•caudal regression syndrome
•hypoplasia of lower extremities
•macrosomia
•cushingoid appearance
rare congenital abnormality in which a segment of the spine and spinal cord fails to develop.
caudal regression syndrome
complications (NFDM)
- birth injury
2.severe hypoglycemia
3.hyperbilirubinemia - hypocalcemia
Infants of drug-dependent women tend to be small for gestational age (SGA).
• Will show withdrawal symptoms upon birth but onset and duration varies among different substances, maybe in
24 to 48 hrs up to 10 days
characteristics of newborn from drug dependent mothers
- Prenatal and postnatal growth restriction.
- Central nervous system involvement such as cognitive challenge, microcephaly, and cerebral palsy.
- Distinctive facial feature of a short palpebral fissure and thin upper lip.
- During the neonatal period, an infant may be tremulous, fidgety, irritable, demonstrate weak sucking reflex, and have sleep disturbances.
- Behavior problems such as hyperactivity may occur in school-age.
