High Risk Newborn - Unit 4 Flashcards
How old is a late preterm infant?
Born between 34w 7d and 37w 6 days.
late preterm infant, are they similar to preemies?
Yes! They may look physically better but they are still immature.
LPI- temp check every __ to __ hours.
3-4 hours.
LPI’s - can they eat right way?
Maybe - they have immature suck and swallow reflexes, shorter awake periods, and increased caloric need.
Should LPI’s go home early?
NO - they need as much time as possible - and a car seat test.
With the car seat test, do we add time?
YES - so PRMC to huntington, they’d have to be in the seat for ~110 minutes (time + 30 min)
what major things are LPI’s at risk for?
Respiratory disorders, temperature maintenance, hypoglycemia, hyperbilirubinemia, feeding difficulties, acidosis, infection.
preterm infants - born before the beginning of the ___ week.
38th.
what are causes of preterm infants?
risk factors for pregnancy problems.
Are there specific appearance/behavioral things for preterm infants?
Yes
What should the axillary temp be for a preterm infant?
97.3-98.4
do preterm infants have problems with fluid and electrolyte balance?
YES
Should babies have non-specific fluid running, like 1ml?
NO - VERY specific, to the 0.1 ml/hr mark.
what are some skin problems for babies?
fragile, permeable easily damaged. We need to assess frequently.
preterm infants - 3-10 greater incidence in premature infants than term infants. T/F?
TRUE
pain - are preterm infants at risk?
YES - use the NIPS pain scale.
are preterm infants at risk for stimulus overload?
YES - so schedule care together, promote rest, promote motor development, individualize care, etc.
when are infants typically ready for nipple feeding?
34-35 weeks.
If the baby has to go to the NICU, how can we help the parents?
Let them tour before, give them info, etc.
what is kangaroo care?
let the baby be in a diaper on parents chest!
what is respiratory distress syndrome?
caused by insufficient production of surfactant in the lungs.
What are some manifestations of RDS? Treatment?
tachypnea, tachycardia, nasal flaring, retractions, grunting, cyanosis, acidosis. Might need CPAP, surfactant, high frequency ventilators (kind of shakes the chest)
what is bronchopulmonary dysplasia?
aka Chronic Lung Disease - - damage to the infant’s lungs requires prolonged dependence on supplemental oxygen.
How is bronchopulmonary dysplasia manifested? Treated?
inability to be weaned from respiratory support of oxygen. Treated with diuretics and such.
What is an intraventricular hemorrhage?
BLeeding into and around the ventricles - comes form the fragile blood vessels and pressure increase - Graded 1-4 (1 = smallest, 4 is horrible).
what is retinopathy of prematurity?
Injury to the blood vessels in the eye. might cause blindness. High level of O2 is a risk factor.
what is necrotizing enterocolitis ?
Serious inflammatory condition of the intestinal tract. May lead to cellular death of areas of intestinal mucosa.
How does necrotizing enterocolitis manifest?
increased abdominal girth, gastric residuals, decreased/absent bowel sounds, loops of the bowel, vomiting, bile stained emesis, abdominal tenderness, signs of infection, occult blood in the stool, etc.
what is short bowel syndrome?
A bowel that is shorter than normal. Caused by surgical or congenital malformations. Malabsorption, diarrhea, and failure to thrive are manifestations.
how old is a post-term infant?
born after the 42nd week of gestation.
What are some issues with a post-term infant?
large baby, placental function decreases, poor oxygen reserves, they might get stuck when coming out, etc.
what are some causes of a small for gestational age infant?
congenital malformation, chromosomal abnormalities, genetic factors, multiple gestations, fetal infections, poor placental function, diabetes, HTN, smoking/drugs/alcohol, severe malnutrition, etc
Is it better than the better be small all around or have a big head and small body?
Big head, small body. Shows the problem occurred later.
what causes an LGA baby?
multiparas, large parents, obese moms, ethnic groups, diabetes, etc.
what is asphyxia?
insufficient oxygen and excess CO2 in the blood and tissues - may occur at any point. Results in ischemia.
What are some maternal factors for asphyxia?
HTN, infection, drug use
what are some placental factors for asphyxia?
Placenta previa, abruptio placentae, post maturity, etc.
What are some fetal factors for asphyxia?
cord problems, infection, premature birth, multifetal gestation
does anaerobic metabolism or aerobic metabolism occur for asphyxia?
Anaerobic, which produces lactic acid, thus causing metabolic acidosis/respiratory acidosis from CO2
Asphyxia - vasoconstriction doesn’t happen. T/F?
FALSE - it does, but it constricts so only the brain/heart/adrenal glands get perfused.
what are some manifestations of asphyxia?
Rapid respirations followed by no respirations.
What infants are at risk for asphyxia?
Complications during labor/birth/etc. Narcotics/naloxone as well.
what is the difference between primary and secondary apnea?
Primary = you can stimulate the babies and it’s all better.
Secondary - you can’t. Start resuscitation efforts.
what is transient tachypnea of the newborn?
Rapid respirations soon after birth from inadequate absorption of fetal lung fluid.
what causes TTN?
possible delayed absorption of lung fluid.
How does TTN manifest?
tachypnea within 6 hours of birth - - - grunting, flaring, retracting, mild cyanosis - - - Xrays show hyperinflation, streaking, fluid, etc.
How do we manage TTN?
O2, gavage feeding, antibiotics until sepsis is ruled out.
what is meconium aspiration syndrome?
Obstruction/chemical pneumonitis and air trapping caused by meconium in the lungs.
How does MAS manifest?
respiratory distress (tachy, cyanotic, retractions, nasal flaring, grunting, rales, barrel chest)
how do we manage MAS?
suctioning at delivery, respiratory support, ECMO
what is persistent pulmonary hypertension of the newborn/
pulmonary vasoconstriction after birth and causes increased vascular resistance in the lungs?
What causes PPHN?
term or post term, inadequate oxygenation due to vasoconstriction in the pulmonary artery/vessels/increased resistance in the lungs/rise in pressure of right side of heart. Right to left shunt of blood also happens, along with metabolic acidosis that also causes more vasoconstriction.
When does PPHN occur? signs?
within 12 hours of birth - manifests with tachypnea, respiratory distress, progressive cyanosis, decreased O2 sat, decreased ph, decreased pao2, increased PaC02
how do we manage PPHN?
fix underlying cause of poor oxygenation and relieve pulmonary vasoconstriction, sedation, inhaled nitric oxide or ECMO
what is pathologic jaundice?
Nonphyiologic jaundice - may be seen in first 24 hours of life. High bili!
What is the most common cause of hyperbili?
maternal/fetal blood incompatibility.
how do we treat hyperbili?
coombs or DAT test, TcB and TSB levels, phototherapy, exchange transfusions
what is the difference between early and late onset sepsis?
early - within first 23 hours.
Late = 8-90 days after birth!
Neonatal mortality rate is _ X higher than that of infants born to mothers without diabetes.
5
long term diabetes can cause vascular changes causing fetal growth restriction. T/F?
True
polycythemia - HgB level greater than 22g/dl and a hct greater than 65% - T/F/
TRUE
what are some manifestations of polycythemia? treatment?
plethoric color, lethargy, poor tone, tremors, abdominal distention, decreased bowel sounds, poor feeding, hypoglycemia, respiratory distress, hyperbili, etc
Support and treat with possible partial exchange transfusion.
what is hypocalcemia?
total serum concentration less than 7.
what is the difference between early and late onset hypocalcemia?
early = first 72 hours. Late = 1 week.
what causes early onset hypocalcemia?
Late onset?
early - asphyxia, IDM, maternal anticonvulsant therapy, delayed nutrition.
late = hyperpathyroidism, malabsorption, low mangesium levels, diuretic therapy, rickets.
what are some manifestations of hypocalcemia? management things?
irritability, jitteriness, poor feeding, high pitched cry, muscle twitching, apnea, seizures, electrocardiographic changes.
Treated with lab test of calcium serum level and IV calcium gluconate.
what is PKU?
Genetic disorder that causes CNS injury. Caused by issues with converting phenylalanine to tyrosine. musty odor of urine/vomting/etc are manifestations.
when is the PKU diet started?
3 weeks after birth and for life.
what are some manifestations of cardiac defects?
Cyanosis, murmurs, fatigue, tachypnea, slow weight gain, diaphoresis.
is PDA cyanotic or acyanotic?
Acyanotic.
transposition of the greater vessels - cyanotic or not?
CYANOTIC.
