High Risk Newborn Flashcards
what are some risk factors associated with greater neonatal morbidity and mortality?
- low socioeconomic status
- no prenatal care
- exposure to teratogens
- preexisting maternal conditions
- age and parity
- pregnancy complications
what classifies small for gestational age?
less than 10th%ile for weight
what does IUGR lead to?
advanced gestation with limited fetal growth
what are the 2 IUGR classifications?
symmetrical and asymmetrical
describe symmetrical IUGR
restricted growth in size of organs, body length, and head circumference d/t long-term conditions
describe assymetrical IUGR
birth weight under 10th%ile. however, head/body length remain noral. d/t impaired uteroplacental bloodflow
what are complications of SGA/IUGR newborn
- hypoxia
- aspiration syndrome (meconium)
- hypothermia
- hypoglycemia
- polycythemia (inc. immature RBCs from stress)
what classifies LGA?
weighs more than 90% (top 10)
what are correlations with LGA?
- diabetes
- genes
- multiparity
- male infants
what are complications of LGA?
- trauma (cephalopelvic disproportion)
- induction
- c/s
- hypoglycemia
- polycythemia
- hyperviscosity
why would a baby be SGA/LGA with a diabetic mother?
SGA= renal disease, has sugar settling in vasculature
LGA= high gluc levels
is SGA or LGA more common with diabetic mothers?
LGA
what are complications of a baby with a diabetic mother?
- hypoglycemia
- hypocalcemia
- hyperbilirubinemia
- trauma
- polycythemia
- resp distress syndrome (RDS)
- congenital malformation
what classifies hypoglycemia in a baby?
less than 40-45
what are s/sx of hypoglycemia in babies?
- tremors/seizures
- apnea
- cyanosis
- temp instability
- poor feeding
- hypothermia/lethargy
When will blood sugar be checked with possible hypoglycemia?
at 1 hour
what is done when baby has a sugar less than 40-45?
feed
IV dextrose
recheck after
what classifies a premature baby?
prior to 38 weeks (need 37 completed weeks)
what % of babies are premature
12%
what is the concern with prematurity
prematurity of all body systems
what is RDS from involving prematurity?
- inadequate surfactant
- pulmonary vessels not fully developed
what are cardio complications from prematurity
- at risk for PDA (patent ductus arteriosis)
what causes problems with thermoregulation involving prematurity?
- great body surface area
- little sub cue fat
- thin skin
- less flexion
what are GI/GU complications from prematurity?
- poor sucking/swallowing
- poor gag
- small stomach, can’t absorb fat
- calcium/phos deficient
- inc. BMR/oxygen needs
- **immature kidneys
- GFR dec., cant concentrate urine**
what is necrotizing enterocolitis (NEC)
GI/GU complication of prematurity, infection = lose intestine
what are the implications for feeding premature newborns?
TPN, NG, oral
what hepatic complication comes from prematurity
hypoglycemia
what hematologic complications come from prematurity
-low iron stores
-risk for hyperbilirubinemia
what immunologic complications come from prematurity
risk for infection
what neuro complications is the baby at risk for from prematurity?
- intraventricular hemorrhage (IVH)
- intracranial hemorrhage (ICH)
- apnea (cessation for at least 20 sec)
what are possible long term complications from prematurity
- SIDS
- resp infection
- neuro probs
- auditory probs
- speech probs
- retinopathy of prematurity
what qualifies as postmaturity?
born after 42 completed weeks (43 weeks 1 day)
complications of postmaturity?
- hypoglycemia
- meconium aspiration
- seizures
- polycythemia r/t hypoxia
- congenital abnormalities
- cold stress
complications of substnace-abusing mother?
- congenital anomalies
- developmental probs
what is the appearance of someone with fetal alcohol syndrome
- short stature
- flat nasal bridge
- microcephaly
- thin upper lip/flat
- thin appearance
long term complications of fetal alcohol syndrome (substance abusing mother)
- impulsive
- cognitive involvement
- speech probs
- learning disabilities
what are risks to the baby from drug abuse?
- asphyxia
- infection
- SGA/LGA
- low APGAR
- resp distress
- congenital anomalies
- behavioral probs
- withdraw
what is phenylketonuria (PKU)
phenylalanine amino acid disorder (can’t convert excess phenylalanine to tyrosine)
what is galactosemia?
carbohydrate metabolism problem
what is homocystinurea?
deficiency of cystathionine beta synthase
what is RDS from?
prematurity and low surfactant
what are complications from RDS?
hypoxia
resp acidosis
metabolic acidosis
what are s/sx of RDS?
- high resp rate
- high resp effort (Grunt, Flare, Retract)
- low pulse ox (low 90’s)
what is management of RDS?
- prevent preterm birth
- administer celestone
- administer surfactant
- resp support: vent, CPAP, O2
what kind of births does transient tachypnea of the newborn (TTN) effect?
often term, LGA, and late preterm babies
what are risk factors of transient tachypnea of the newborn (TTN)?
- maternal diabetes
- macrosomia
- c/s delivery
- lung fluid
- male sex
- fetal hypoxia
s/sx of TTN?
- G,F,R breathing
- cyanosis
- tachypnea
- mild resp/met acidosis
- sx usually resolve in 24 hr
describe meconium aspiration syndrome
- fetal relaxation of anal sphincter (d/t lack of o2), results in meconium stool in amniotic fluid
- may be aspirated during first breaths
what are risks of meconium aspiration syndrome
- obstruction of airway
- pneumonia
- inactivation of surfactant
- pulmonary HTN
how is meconium aspiration syndrome managed?
- light meconium= not a ton of management
- thick meconium= baby will not be dry/stim to cry, take to the warmer for suction
what is excessive heat loss resulting in compensatory mechanisms to maintian adequate body temperature?
cold stress
what are the compensatory mechanisms for cold stress?
- increased resps
- nonshivering thermogenesis
are LGA,AGA,or SGA babies most at risk for cold stress
SGA
what can cold stress result in?
- dec. surfactant
- metabolic acidosis
- hypoglycemia
- hyperbilirubinemia
is physiologic jaundice occuring after 24 hours normal?
yes
when is jaundice concering?
when it is detected before 24 hours of life
what is unconjugated bilirubin deposited in the brain
kernicterus
what is anemia, severe edema, and organ failure associated with maternal antibody
hydrops fetalis
when is jaundice most frequently seen?
with alloimmunization, ABO sensitivity
management of jaundice?
- phototherapy
- exchange transfusion
