High Risk Newborn Flashcards
ELBW =
Extremely Low Birth Weight 1000grams or 2.2 pounds
Risks and signs of ELBW?
Risks ELBW & Pre-terms: All systems are underdeveloped, respiratory, CNS, renal, maintaining adequate nutrition, low body temperature, decreased hematologic status, immune system, retinopathy, decrease in growth and development milestones
Signs of ELBW & Pre-terms: transparent skin, low APGAR, periodic breathing, bradycardia, inadequate muscle mass, fragile capillaries, weak or absent suck reflex, unable to excrete toxins
discussion about quality of life, long term care, $$, everyone involved,
Post-term infants =
infant born after 42 weeks regardless of weigh
Post-term infants risks and signs?
Risks: Meconium aspiration, fetal distress, placental disfunction
Signs of Post-term: little to no vernix caseosa, no lanugo, abundant scalp hair, long fingernails, wasted physical appearance, depletion of subcutaneous fat
ELBW & Preterm + Respiratory =
decreased functional alveoli, decreased surfactant levels, trouble maintaining body temperature (Body fat), chances of brain bleed, hypoglycemia, heart may have deformities or lack of development, may have brain bleeds due to fragile capillaries, nutrition will be hard to maintain because CNS is not developed for infant to have suck swallow response, renal system underdeveloped & unable to excrete metabolites and toxins, decreased maternal immunoglobins to help fight infection. Risk for retinal damage. Retina capillaries are not completely developed until about 42 weeks gestation – on a term infant that would be 2 weeks after delivery. Ventilator & O2 settings are monitored closely – partially from the pressure of the o2 on the eyes and also because blood fluctuations carrying O2 can cause this. At risk for neurological and cognitive delays. G&D = baby born at 33 weeks gestation and now it is 4 weeks later, it should have G&D of a baby born at 37 weeks, at 6 months it will have G&D of 4 months
What kind of decels do you think you would see in ELBW?
Lates
What is the care of the pre-term infant?
Have airway – with warmed humidified O2 (Especially if there was meconium aspiration)
May be on ventilator, under a O2 hood or have bi-nasal cannula
Wrap in polyethylene
As the baby improves care is advanced SLOWLY
– Kangaroo care
– Gavage feedings
– Continue glucose monitoring
Warm humidified air keeps airways mucosa from drying out and warmth decreases cold stress – monitored very closely.
NRP = CPR for the newborn
Decrease heat loss poly bag or saran wrap, keeps baby from losing heat
Temp monitor in infant at all times
Bassinets are covered and lights dimmed to reduce stimuli.
Pain meds & sedatives are administered to keep infant calm. Calmness is what this infant needs, Kangaroo and gentle massage for SHORT periods of time can help reduce stress, Kangaroo care – infant is placed on parent’s bare chest, infant will only have on a diaper, infant placed in vertical position, then both are usually covered with a warm blanket. It allows eye to eye and skin to skin contact.
Gavage feedings – allows for nutrients for the infant that is compromised by respiratory depression, inadequate suck/swallow reflex, or the infant that is easily fatigued by sucking. Gavage feeding tube is measured from tip of nose to the earlobe and then down to midpoint between xiphoid process and umbilicus. Tape place at this mark, The orogastric route is used, The tube is checked for placement. Feedings start very small amounts and usually by gravity. A small amount of milk is placed in a syringe, and is placed on a holder above the infant. Breast milk or formula is used. In some instances moms that don’t want to breastfeed or can’t breastfeed will opt for “banked” breast milk. This is breastmilk that other women donate. It is processed and then sold. Mothers are asked to pump while in the hospital because of the need for the colostrum to help the immunity system. Some are intermittent others are continuous. It will depend on how the infant is tolerating the feedings and neonatologist orders. Preterms will have glucose levels checked to insure adequate nutrition is happening and baby is getting the energy stores it needs
Respiratory Distress Syndrome?
RDS = caused by lack of pulmonary surfactant -> progressive atelectasis -> loss of functional residual capacity ->ventilation-perfusion imbalance. Seen immediately after birth or within 6 hours. TX support establishing adequate ventilation & O2, (monitored & adjusted,) good nutrition, daily monitoring of electrolytes
Retinopathy of prematurity
ROP= Discussed earlier. No mask O2 can damage the retinas
Broncho-pulmonary Dysplasia?
BPD=cause- (multifactorial) lung immaturity, surfactant deficit, lung injury or stretch, inflammation from O2 exposure. SNS tachypnea, retractions, nasal flaring, activity intolerance, retractions, TX o2 therapy, nutrition, fluid restriction, meds (Bronchodilators, diuretics, corticosteroids. (This is why we give mom betamethasone before delivery and have surfactant available at delivery for the preterm infant
Patent Ductus Arteriosus?
PDA = when the ductus arteriosus fails to close at birth, SNS can be asymptomatic, or can be mottling or cyanosis of the skin, systolic murmur, active oericordium, bounding peripheral pulses, tachycardia, tachypnea, crackles or hepatomegaly. X-rays can show enlarged heart, & pulmonary edema, ABGs show metabolic acidosis & hypercapnia. Definitive DX is echocardiogram showing amount of blood shunting across the PDA
Necrotizing Enterocolitis?
NE= an acute inflammation disease of the GI mucosa, commonly complicated by bowel necrosis, & perforation. Possible causes: 1. intestinal ischemia cause by hypotension, hypovolemia or stress resulting from hypoxia/asphyxia or event making the blood flow away from the GI tract. 2. bacterial colonization in the initially sterile GI tract like E coli and others. 3. associated with enteral feedings – feeding caused a possible substrate for bacterial proliferation or increase O2 demand in the intestine during absorption resulting in tissue hypoxia. Dx thru x-ray of bowel loop seeing abnormalities of the intestines and their contents. TX: rest the GI – no enteral feedings only IV, low suction to GI tube to decompress the GI system, TPN is then started slowly via gastric tube. ABX are started to kill the bacteria. Can be bad enough to perform a bowel resection and in the hardest cases there have been intestinal transplants performed.
What is Macrosomia?
The babies have appearance of being bigger everywhere, but in essence their brain is not. Because maternal glucose does not cross over the blood-brain barrier. It’s the only organ that it does not reach. Once the cord is cut , the organs still want/need that sugar so the body uses what it had stored and then BS drop dangerously low. You’ll need to keep that baby warm, may need to give o2, check it’s BS often, check for birth injuries. They can have trauma to the clavicle or brachial plexus. Tell about 13.10 baby
What is hyperbilirubinemia?
Hyperbilirubinemia is a condition in which the total serum bilirubin level in the blood is increased. Characterized by yellow discoloration of the sclera, skin and mucous membranes. The yellow color is called icterus or jaundice. It is un-conjugated bilirubin in the skin. (Read chapters 23 & 24 for more information) an immature liver function slows the metabolic process of excreting the bilirubin. Physiologic is usually benign, begins AFTER 24 hours, usually peaks in 3 days, as the baby urinates and defecates it will start to decrease. Pathologic jaundice results of an increased level of total serum bilirubin. Cord blood > 5mg/dl, Clinical jaundice evident in the first 24 hours, a serum Bili that exceeds 12.9 mg/dl (Term) 15mg/dl )Preterm) . Causes Rh & ABO incompatibility, maternal infections or diabetes, oxytocin administration during labor or maternal ingestion of sulfonamides, diazepam, or salicylates near the time of birth. Fetal factors: prematurity, liver damage by drugs or infection, neonatal hyperthyroidism, polycythemia, meconium illeus, pyloric stenosis, biliary atresia, G6PD.
Breast jaundice. Mothers are sometimes asked to take their babies outside in the sunshine or place near a window where the sun shines, being careful not to let the baby’s tender skin get sunburned The UV lights help in the process of the bilirubin excretion
What are the 3 types of hyperbilirubinemia?
Physiological
Pathologic
Breastfed – benign and begins at 2-5 days of age (early onset) or 5-10 days of age (late onset), caused by inadequate or poor breastfeeding leading to decreased hepatic clearance. Treatment = good breastfeeding. Usually declines at week 2 but can persist 3-12 weeks. No signs of hemolysis or liver disfunction. Meaning the infant has wet &/or dirty diapers after each feeding.
