Maternal & Newborn Lecture 11 Flashcards
Maternal NEW born Cherie.
AT RISK NEWBORNS
The most importnat when giving birth for a mom is to at a place where she can be given care
Classification According to Size
- Classification of At-Risk
Newborns Based on Size:- Low-birth-weight (LBW) infant: We consider infants weighing less than 2500 grams (5.5 pounds) as LBW, regardless of gestational age. This is a straightforward guideline.
- Very low-birth-weight (VLBW) infant: Infants weighing less than 1500 grams (3.3 pounds) are classified as VLBW.
- Extremely low-birth-weight (ELBW) infant: Infants weighing less than 1000 grams (2.2 pounds) fall into the ELBW category.
- Appropriate for Gestational Age (AGA): Babies with birth weights that fall between the 10th and 90th percentiles on intrauterine growth curves. This is the most common category for newborns.
- Small for Date (SFD) or Small for Gestational Age (SGA): Infants whose birth weights fall below the 10th percentile on intrauterine growth curves.
- Large for Gestational Age (LGA): Infants whose birth weights exceed the 90th percentile on intrauterine growth curves.
Ballard
Gestational
Scoring Tool
Maybe watch a youtube video. Min 7 cherie.
It was used before we could use ultrasounds to determine the gestation age. This test was done on every infant that was born.
SMALL/LARGE FOR GESTATIONAL AGE.
- Example: If a baby is born at 38 weeks but weighs 2100 grams, it falls below the 10th percentile on the intrauterine growth curve, classifying it as Small for Gestational Age (SGA).
- Another example: If a baby is born at 30 weeks and weighs 2100 grams, it exceeds the 90th percentile on the intrauterine growth curve, categorizing it as Large for Gestational Age (LGA).
7
SMALL FOR GESTATIONAL AGE.
- Reasons for Assessing Newborns and Associated Concerns:
- Asphyxia: This can result from breathing difficulties at birth.
- Aspiration: Coordination issues between sucking and breathing can lead to aspiration. The sucking reflex typically develops around 32 weeks, but full development occurs at 36 weeks. Infants born between 32-36 weeks require close monitoring of their feeding ability.
- Hypoglycemia: Babies born small for gestational age may not have received enough glucose in the womb and can be at risk for low blood sugar levels. They may also be insulin resistant.
- Temperature instability: Newborns in this category struggle to regulate their body temperature due to the absence of a shivering reflex and limited fat stores. Skin-to-skin contact and warm clothing are essential to prevent rapid temperature loss.
- Polycythemia: These infants can have abnormally high red blood cell (RBC) counts, increasing the risk of blood clots. Hemoglobin (hgb) levels exceeding 20 and hematocrit levels greater than 65% are common. Their skin may appear maroon or reddish due to the excess RBCs.
- Small for Gestational Age (SGA): SGA is not necessarily pathological, but Intrauterine Growth Restriction (IUGR) can lead to SGA. IUGR may present with asymmetrical growth, such as variations in head and abdominal measurements and long bone lengths. An association exists between SGA and maternal factors like smoking, poor nutrition, alcohol or drug use, uterine infections, chronic maternal diseases (e.g., thyroid issues, diabetes, chronic hypertension), and multiple gestations. Identifying SGA early allows for intervention and support for the mother before delivery.
- Note: SGA refers to birth weight below the 10th percentile for gestational age.
- Less Glucose in the Womb: Babies born small for gestational age (SGA) often receive less glucose and other nutrients in the womb due to various factors, such as placental insufficiency or maternal conditions. This limited nutrient supply can result in slower growth and development during fetal development.
- Reduced Insulin Production: In response to the lower glucose levels in the womb, the developing baby’s pancreas may produce less insulin. Insulin is a hormone that helps regulate blood sugar by facilitating the uptake of glucose into cells. If there is less glucose available during fetal development, the baby’s pancreas may produce less insulin.
- Insulin Resistance: After birth, when the baby begins to receive regular feedings, their body may not be accustomed to handling the sudden increase in glucose intake. This relative lack of exposure to high glucose levels during fetal development, combined with potential alterations in insulin sensitivity, can contribute to insulin resistance.
LARGE FOR GESTATIONAL AGE
-
Large for Gestational Age (LGA):
- Refers to babies born with a birth weight above the 90th percentile for their gestational age.
- Often called “macrosomic,” indicating excessive fetal growth.
-
Causes:
- Multiple factors contribute to LGA, including genetics, maternal conditions, and maternal health.
- Common causes include maternal diabetes (especially poorly controlled during pregnancy), excessive maternal weight gain, and genetic factors.
-
Health Implications:
- LGA itself is not a medical condition but can lead to birth complications.
- Risks include shoulder dystocia (difficulty delivering the baby’s shoulders), birth injuries, and potential need for a cesarean section (C-section).
- Some LGA babies may experience hypoglycemia (low blood sugar) and other health issues.
-
Monitoring and Management:
- Healthcare providers closely monitor pregnancies with LGA babies to assess fetal well-being.
- Interventions may include better management of maternal diabetes, birth plan adjustments, or induction of labor if fetal size becomes a concern.
-
Postnatal Care:
- After birth, LGA babies are at risk of certain issues due to their size, such as hypoglycemia and jaundice.
- Healthcare providers monitor these infants and provide necessary care.
-
Long-Term Outlook:
- The long-term outlook for LGA babies depends on factors like the cause of their size and any associated health problems.
- With proper care and monitoring, most LGA babies lead healthy lives.
LARGE FOR GESTATIONAL AGE
- Birth Trauma: Birth trauma can occur when the baby is too large and may result in:
- Brachial plexus injury
- Facial palsy, typically caused by prolonged pressure on the baby’s face during a long second stage of labor, leading to temporary nerve damage.
- Hypoglycemia: Babies born to mothers with gestational diabetes or those who produced excessive glucose in the womb may experience hypoglycemia due to an abundance of insulin and insufficient glucose at birth.
- Asphyxia: Asphyxia during birth can lead to acidosis. Increased variability on monitoring graphs indicates a well-oxygenated baby. Decreased variability, unless caused by baby’s sleep or medication, can be an early sign of fetal distress, which may progress to late decelerations.
- Cardiac Anomalies
- Large for Gestational Age (LGA): LGA infants are often associated with diabetic mothers, particularly those who are insulin-dependent or have gestational diabetes. Multiparity, having multiple pregnancies, can also contribute to LGA. Incorrect gestational age assessment may be a factor.
- Polycythemia and hyperviscosity can be associated with fine and gross motor skill delays and speech delays. Polycythemia may require increased fluid intake to alleviate viscosity. Excess glucose in the blood can lead to stickiness, impairing blood circulation and causing neuropathies in the extremities, leading to infections and tissue damage.
A term newborn was born 30 minutes ago. The newborn required positive pressure ventilation but responded quickly to resuscitation. Apgar Scores were 1 and 7. The newborn’s birth weight is 4250 grams. Vital signs now are: T 35.6C (96F), P158 and RR 56. Based only on this information, which of the following nursing diagnoses would have the highest priority for this newborn?
Risk for altered parenting
Risk for alteration in nutrition, < body requirements
Risk for injury, CNS
Risk for ineffective tissue perfusion
C
Classification According to Gestational Age
- Preterm (premature): These are babies who are born before 37 weeks of pregnancy are completed. They are born early.
- Late preterm: These babies are born between 34 weeks and 36 weeks and 6 days of pregnancy. They are a bit closer to full term but still born a little early.
- Early term: Babies born between 37 weeks and 38 weeks and 6 days of pregnancy are considered early term. They are almost at full term but not quite.
- Full term: Babies born between 39 weeks and 40 weeks and 6 days of pregnancy are considered full term. This is when most babies are born.
- Late term: Babies born between 41 weeks and 41 weeks and 6 days of pregnancy are considered late term. They are born a bit after the usual due date.
- Post term (postmature): These are babies born after 42 weeks of pregnancy. They are born later than expected and are considered overdue.
*Preterm (premature):born before completion of 37 weeks of gestation
*Late preterm:from 34 0/7 through 36 6/7 weeks of gestation
*Early term:from 37 0/7 through 38 6/7 weeks of gestation
*Full term:from 39 0/7 weeks through 40 6/7 weeks of gestation
*Late term:from 41 0/7 through 41 6/7 weeks of gestation
*Post term (postmature):born after 42 weeks of gestation,
PRETERM
- Brain Development: A baby’s brain at 35 weeks weighs only about 2/3 of what it will weigh at 39 to 40 weeks of gestation.
- Four Main Suggested Etiologies for Preterm Deliveries:
- Infection and Inflammation
- Maternal or Fetal Stress
- Bleeding
- Stretching of Uterine Cells: The uterus doesn’t gain more cells but stretches and enlarges to accommodate fetal growth. Excessive stretching, especially in the early stages, is believed to potentially trigger labor.
PRETERMRisks of
- Risks Associated with Preterm Birth:
- Respiratory Distress Syndrome: The respiratory system is one of the last systems to develop in a fetus, leading to respiratory problems in premature infants. This is often due to a lack of surfactant, a substance that prevents the collapse of the lungs between breaths. Insufficient surfactant forces premature babies to take deep breaths to keep their lungs open, sometimes resulting in grunting sounds during respiration.
- Temperature Regulation: Premature infants may struggle to regulate their body temperature due to limited fat stores and an underdeveloped ability to generate heat.
- Intraventricular Hemorrhage: Preterm infants have fragile veins, and any increased pressure in the brain can lead to vein rupture and bleeding within the brain.
- Jaundice: Premature infants often experience jaundice because their livers are not yet fully functional, and they receive limited nutrition.
- Sepsis: The immature immune system of preterm infants leaves them vulnerable to infections.
- Feeding Problems: Coordination issues with sucking reflex, which starts developing around week 32 and fully matures at week 36, can cause feeding difficulties. Their underdeveloped bowels can also rupture if fed too early, leading to necrotizing enterocolitis.
- Retinopathy of Prematurity: Excessive oxygen administration to preterm babies can result in retinopathy of prematurity, a condition where the retina detaches due to the accumulation of oxygen in the blood vessels, potentially leading to blindness. This phenomenon occurs exclusively in preterm infants.
The neonate was born 2 hours ago, birth weight is 2475 grams. By Ballard exam, the gestational age is 41 weeks. Which of the following nursing diagnoses has the HIGHEST priority for this neonate?
A. Ineffective thermoregulation related to decreased brown fat reserves
B. Ineffective breathing pattern related to surfactant deficiency
C. Risk for infection, related to immature white blood cells
D. Risk for injury, related to fragile cerebral blood vessels
A
The nurse is caring for a late preterm infant (LPI). The infant was born by Cesarean Birth 15 minutes ago. Which of the following assessment findings would alert the nurse to possible complications associated with late preterm infants?
A. Irregular respirations.
B. Acrocyanosis.
C. Tachypnea.
D. Coarse breath sounds.
C
The nurse is preparing to care for a neonate soon to be born at 26 weeks gestation. The nurse anticipates which of the following medications may be given to this neonate as soon as possible following birth?
A. Betamethasone (Celestone)
B. Surfactant (Exosurf)
C. Nifedipine (Procardia)
D. Brethine (Terbutaline)
B
The nurse is caring for an infant 2 hours of age. By Ballard exam, the gestational age is 29 weeks. The nurse will incorporate the parents in this infant’s care by;
A. encouraging Kangaroo care.
B. limiting visiting in the NICU to only the infant’s
mother and father.
C. allowing the parents to hold their infant after the
first crucial 48 hours of life
D. making a social work consult.
A
Blood Glucose
- Blood Glucose:
- Post-term infants are at as much risk as preterm infants for various complications.
- Post-term infants may exhibit dry skin, and if they remain in utero for too long with a deteriorating placenta, they can develop emaciated extremities. The body might begin breaking down its own tissues, primarily muscle, for sustenance.
- Prolonged gestation can lead to thinning of the umbilical cord, meconium staining, and the possibility of polycythemia (abnormally high red blood cell count) once again.
- Neonatal hypoglycemia is the major cause of brain injury
The newborn is an infant of a diabetic mother at 36 weeks gestation. The newborn was born 15 minutes ago, birth weight of 4200 grams (9#5oz). Which of the following nursing actions will be included in the plan of care for this infant?
A. Begin an IV of dextrose per MD order stat
B. Delay first feeding until respiratory distress syndrome is ruled out
C. Immediately obtain a heel stick blood sample to screen for polycythemia
D. Assess infant for jitteriness and lethargy
D
This action is important because infants born to diabetic mothers are at risk of hypoglycemia (low blood sugar), which can manifest as symptoms such as jitteriness and lethargy
ASSESSMENT OF INFANT OF DIABETIC MOTHER.
- Macrosomia:
- Macrosomia increases the risk of anomalies, particularly in the heart, brain, and neural tube. Possible anomalies include spina bifida, congenital heart disease, and cognitive disorders that may manifest later in life.
- Additional Risks for Infants of Diabetic Mothers (IDM):
- Respiratory Distress Syndrome (RDS)
- Hypoglycemia: IDM infants are prone to low blood sugar levels due to their exposure to high blood glucose levels in the womb, which stimulates their pancreas to produce excess insulin.
- Hypocalcemia: Abnormal intracellular calcium regulation affects insulin sensitivity and, therefore, insulin release. Consequently, IDM infants with hypoglycemia may also experience hypocalcemia because these conditions are interrelated.
- Hyperbilirubinemia: IDM babies are susceptible to hyperbilirubinemia due to polycythemia, an increase in red blood cell count. The breakdown of excess red blood cells can lead to elevated bilirubin levels, causing jaundice.
HYPOGLYCEMIARisk Factors
Risk Factors for Hypoglycemic Infants:
1. Late Preterm Infants (LPI): Babies born between 34 to 36 6/7 weeks of gestation may have limited glycogen reserves, making it challenging to maintain normal blood glucose levels.
2. Intrauterine Growth Restriction (IUGR): Infants with growth restriction in the womb may have underdeveloped pancreases, which can affect their glucose regulation.
3. Small for Gestational Age (SGA) or Large for Gestational Age (LGA): Babies significantly smaller or larger than expected for their gestational age may have increased energy demands, affecting glucose homeostasis.
4. Birth weight less than 2500 grams: Low birth weight babies may be at risk of hypoglycemia due to limited energy stores.
5. Infants of Diabetic Mothers (IDM): Babies born to mothers with insulin-dependent diabetes or gestational diabetes are at risk due to potential glucose level fluctuations.
Screening Protocol for Hypoglycemic Infants:
1. Symptomatic Infants: If symptomatic and less than 40 weeks gestation, initiate IV glucose.
2. Initial Feeding: The first feeding is important, with glucose levels checked 30 minutes later to ensure proper digestion and glucose distribution.
3. Initial Screening: If the initial screen is less than 25 mg/dL, a repeat screen is done in 1 hour. If still under 25 mg/dL, IV glucose is administered.
4. Glucose Levels Between 25 and 40 mg/dL: If glucose levels fall within this range, a repeat check is performed, and the need for IV glucose is considered within the first 4 hours.
5. Monitoring After 24 Hours: After 24 hours, feeds continue, and glucose levels are screened before each feed.
6. Glucose Levels Less Than 35 mg/dL: If the screen is less than 35 mg/dL, feeding is initiated, and glucose levels are checked after 1 hour.
7. Glucose Levels Between 35 and 45 mg/dL: Consideration is given to providing glucose supplementation if blood sugar cannot be adequately raised, possibly using glucose gel based on the baby’s weight.
8. Target Glucose Level Before Routine Feeding: The target glucose level before routine feeding is greater than or equal to 45 mg/dL. However, levels down to 35 mg/dL may be tolerated with close monitoring.
HYPOGLYCEMIA: Symptomatic
- To assess blood glucose levels in symptomatic hypoglycemia, obtain a blood drop from the heel tip and measure it using a glucometer.
- Concerning Symptoms in Hypoglycemic Infants:
- Seizures (no glucose = no energy to brain)
- Lethargy or decreased responsiveness
- Hypotonia: Infants may exhibit weak muscle tone, causing their arms to fall when picked up.
- Apnea: A temporary pause in breathing. (brainstem controls breathing= no glucose = brainstem can’t work properly)
- Cyanosis: A bluish discoloration of the skin, indicative of poor perfusion and oxygenation.
HYPOGLYCEMIA: Symptomatic
“Possible” meaning not always.
Jitteriness
Irritability
Exaggerated Moro reflex
High Pitched Cry
Poor feeding
Excessive sleepiness and drowsiness
Administration guidlines of glucose in infants
- Administration Guidelines for Oral Glucose in Infants:
- Dose: Administer 0.2 grams of glucose per kilogram of the infant’s body weight per dose.
- Administration Method: Use an orange syringe specifically designed for oral medication delivery.
- After administering the glucose, monitor the infant’s condition and check their glucose levels 30 minutes later to assess the response and effectiveness of the treatment.
HYPOGLYCEMIAInterventions: Symptomatic. Iv guidlines.
- Hypoglycemia Interventions: Symptomatic. Follow IV guidelines.
- IV Dextrose Administration in Infants:
- Initial Bolus: Administer 0.2 grams of dextrose per kilogram (0.2 g/kg) over 5 to 15 minutes. This is typically done with 2 milliliters per kilogram (2 mL/kg) of 10% dextrose in water (D10W).
- Continuous Infusion: Following the initial bolus, initiate a continuous infusion at an initial rate of 5 to 8 milligrams per kilogram per minute (5-8 mg/kg/min).
- Adjustment: If hypoglycemia persists, increase the infusion rate as necessary.
- Note: The dextrose concentration used in infants is 10%, which is more concentrated than the 5% typically used in adults. It’s administered as a titratable medication, starting at a low rate and increasing as necessary for each infant. The feet are a preferred site for IV access.
HYPOGLYCEMIAInterventions: Asymptomatic.
- “They have low blood sugar readings but they look fine and they don’t have any other symptoms. So we are just gonna keep with Early Frequent Feedings.”
- “Thermoregulation: make sure that they stay nice and warm. Not too much cause that would cause a fever, remember that they can’t regulate their temp and they won’t be able to get rid of that heat. In this case, the body is going to think that they have a fever.”
- “Assess all newborns for signs and symptoms of hypoglycemia.”
- “Follow unit protocol for high-risk newborns.”
HYPERBILIRUBINEMIA OF THE NEWBORN
- Hyperbilirubinemia (Jaundice) Types:
-
Pathologic Jaundice:
- Onset: Occurs within the first 24 hours of age.
- Causes: Typically attributed to conditions such as polycythemia (an abnormally high red blood cell count), ABO incompatibility, systemic acidosis, or the presence of the Rh factor.
-
Physiologic Jaundice:
- Onset: Develops after 24 hours of age.
- Prevalence: Approximately 60% of newborns will exhibit physiologic jaundice within the first few weeks of life. It often becomes noticeable on the third or fourth day after birth.
- Causes: Physiologic jaundice can result from factors such as dehydration, inadequate feeding, or delayed passage of meconium (the baby’s first stool). (indicate a slower transition to normal digestive processes.)
Pathologic Jaundice. Means that there something wrong in the body.
- Serum bilirubin concentrations greater than 5 mg/dL in cord blood.
- Clinical jaundice evident within 24 hours of birth.
- Total serum bilirubin levels increasing by more than 5 mg/dL in 24 hours or increasing at a rate of 0.5 mg/dL per hour.
- A serum bilirubin level in a term newborn that exceeds 12.9 mg/dL at any time.
- A serum bilirubin level in a preterm newborn that exceeds 15 mg/dL at any time. Preterm infants may have slightly higher acceptable levels due to their expected differences.
- Any case of visible jaundice that persists for more than 14 days of life in a term infant.
Which of the following newborns is at the HIGHEST risk for pathological jaundice?
A. A newborn @ 16 hours of life and breastfeeding with a LATCH score of 5
B. A post-term newborn at 8 hours of life with a caput succedaneum
C. A newborn @ 20 hours of life with a heel stick hematocrit of 56%
D. A preterm newborn at 4 hours of life with an initial Apgar score of 3, 7.
D
The risk factors for pathological jaundice include prematurity, a low Apgar score, and other factors that may indicate an underlying medical condition. Here’s why Option D represents the highest risk:
Preterm newborn: Preterm infants have an underdeveloped liver, which may not be able to process bilirubin as efficiently as full-term infants. This makes them more susceptible to jaundice.
Initial Apgar score of 3: An Apgar score is a quick assessment of a newborn’s overall health immediately after birth, with scores typically ranging from 0 to 10. A score of 3 at 4 hours of life indicates a significant compromise in the newborn’s condition at birth. This could be due to a variety of factors, including respiratory distress, birth trauma, or other medical conditions, which can increase the risk of pathological jaundice.
While the other options (A, B, and C) involve various factors like breastfeeding, caput succedaneum, and hematocrit levels, they do not present as high a risk for pathological jaundice as the preterm newborn with a low initial Apgar score. Prematurity and a low Apgar score are strong indicators of increased susceptibility to pathological jaundice, which requires careful monitoring and management to prevent complications associated with high bilirubin levels.
ConjugationofBilirubin
RBC have hemoglobin and hemoglobin is made of: heme and globin.
The heme in turn is made of iron and billirunin. The billiruben portion hooks onto a plasma protein which transports it to the liver. In the liver the glucoronly transferase conjugates the billiruben by adding glucorionic acid. Now the conjugated billiruben glucuronite becomes water soluble and it can be excreted through feces.
And this is why if the liver is not working you can’t get rid of the billiruben.
The baby’s mother is blood type O, Rh positive, indirect Coomb’s positive. The nurse understands that the baby is at risk for pathological jaundice if the baby’s tests results are;
A) O negative
B) A positive
C) Direct Coombs negative.
B) RhoGAM positive
B
JAUNDICE RISK FACTORS
These are various factors and conditions that can contribute to elevated bilirubin levels and jaundice in newborns:
- ABO Incompatibility: Incompatibility between the blood types of the mother and baby can lead to increased breakdown of red blood cells and subsequent bilirubin production.
- Sepsis: Infection in the newborn can cause the breakdown of red blood cells, leading to higher bilirubin levels.
- Delayed Meconium Passage: Delayed passage of meconium, the baby’s first stool, can hinder normal bowel movements and the excretion of bilirubin.
- Bruising: Trauma or bruising during birth can cause the breakdown of red blood cells, contributing to bilirubin buildup.
- Asphyxia/Hypoxia: Oxygen deprivation during birth, known as asphyxia or hypoxia, can affect various body processes, including the metabolism of bilirubin.
- Hypothermia: Low body temperature can slow down metabolic processes, potentially affecting bilirubin clearance.
- Hypoglycemia: Low blood sugar levels may impact bilirubin metabolism.
- Prematurity/Small for Gestational Age (SGA): Premature infants and those born with a lower birth weight may have underdeveloped liver function, leading to difficulties in processing bilirubin.
- Hepatitis: inflammation of the liver (not hepatitis A, B, or C), can impair liver function and bilirubin processing.
NURSING CAREFOR NEONATAL JAUNDICE
- When assessing and managing newborns for risk factors and jaundice:
- Obtain Maternal and Delivery History: Gather information on the mother’s medical history, the delivery process, and any factors that could contribute to jaundice.
- Promote Frequent Breastfeeding: Encourage frequent breastfeeding to help expel meconium and promote intestinal function.
- Prevent Kernicterus: Be vigilant in monitoring for signs of severe jaundice, as bilirubin can potentially cross the blood-brain barrier in the first few days of life, leading to cognitive brain damage.
- Assess Visual Jaundice: Examine the baby for visible jaundice, which often starts at the head and progresses downward.
- Monitor Bilirubin Levels: Use transcutaneous monitors and/or serum bilirubin tests to assess bilirubin levels before discharge from the hospital. This helps determine if further intervention is needed.
- Communication: Notify the primary caregiver of any findings related to jaundice and bilirubin levels. Early detection and management are key to preventing complications.
- Kernicterus:
- Kernicterus is a severe consequence of untreated or inadequately treated jaundice in newborns, especially those with additional risk factors for jaundice.
- It occurs when excessive bilirubin crosses a barrier and enters the brain tissue, where it is highly toxic.
- Bilirubin permanently stains the gray matter in the brain, which is essential for functions such as hearing, eye movement, balance, and coordination.
- Kernicterus often leads to cerebral palsy, with two common types being athetoid cerebral palsy (“without smooth or coordinated movements,) and dystonic cerebral palsy (abnormal muscle contractions)
- The Grading System for Jaundice Severity (Modified Kramer’s Scale):
- Level 1: Jaundice is noticeable from the top of the head to the neck.
- Level 2: Jaundice is observed from the neck to the belly button.
- Level 3: Jaundice extends from the belly button to the knees.
- Level 4: Jaundice covers the area from the knees to the ankles.
- Level 5: The entire body appears yellow due to severe jaundice.
.
TRANSCUTANEOUS BILIRUBIN MONITOR
we use it with 3 taps to the sternem.
- When obtaining a blood sample from a newborn:
- Use a heel warmer, as it promotes vasodilation, making it easier to obtain blood.
- The heel warmer should reach a maximum temperature of 105°F/40.5°C.
- Additionally, a convenient ankle strap can hold the warmer in place, eliminating the need for the clinician to hold it during the procedure.
Serum Bilirubin (TSB)
When collecting a blood sample, particularly for serum bilirubin (TSB) testing, it’s important to choose specific locations on the baby’s heel to avoid harming the sensitive nerves. These locations are typically slightly to the side of the center of each heel. Careful and precise collection ensures that the baby is not injured during the process.
The “Butani Nomogram” is a graphical tool used to assess the risk of severe hyperbilirubinemia (high levels of bilirubin) in newborns based on their total bilirubin levels and age in hours. It helps healthcare providers determine whether phototherapy or other interventions are necessary.
The nomogram typically includes different zones, which are defined based on bilirubin levels and the baby’s age in hours. These zones help categorize the risk as low, moderate, or high. The specific values for these zones can vary slightly between different nomograms, but the general concept remains the same.
Here is a simplified explanation of the zones:
- Low-Risk Zone: Newborns falling in this zone have bilirubin levels and age combinations that are considered low risk. No immediate intervention is typically required, and close monitoring may suffice.
- Intermediate-Risk Zone: Newborns in this zone have bilirubin levels and age combinations that are of moderate concern. Additional monitoring or phototherapy may be considered based on individual factors.
- High-Risk Zone: Newborns in this zone have bilirubin levels and age combinations that indicate a high risk of severe hyperbilirubinemia. Phototherapy or other interventions are often recommended.
The Butani Nomogram is a valuable tool to guide clinical decision-making and ensure timely intervention when necessary, helping to prevent complications associated with severe jaundice. Healthcare providers can use it to assess the risk and provide appropriate care for newborns.
51 msut learn how to interpret that graph
https://bilitool.org/ you can play and learn with it
PHOTOTHERAPY
- Goal: Reduce unconjugated bilirubin levels inside an incubator.
- Blue fluorescent spectrum used; Ultraviolet no longer employed due to reduced effectiveness.
- Equipment options: Lamp, fiberoptic pad, or LED mattress.
- Expected outcome: Bilirubin levels SHOULD decrease within 4 to 6 hours.
I
Phototherapy is the use of visible light for the treatment of hyperbilirubinemia in the newborn. This relatively common therapy lowers the serum bilirubin level by transforming bilirubin into water-soluble isomers that can be eliminated without conjugation in the liver.Then it gets to the intestine to be pooped out or peed out.
PHOTOTHERAPYNURSING CARE
- Ensure safety, including eye protection to prevent harm to the retina.
- Cover the baby’s genitals during phototherapy.
- Assess for signs of dehydration, weigh the baby before and after feeding, and after they defecate.
- Monitor the baby’s temperature.
- Track intake and output (I & O).
- Weigh diapers to assess fluid output.
- Limit the baby’s exposure time While phototherapy is essential for treating conditions like jaundice, prolonged exposure can lead to potential risks such as overheating or dehydration
- Monitor for signs of skin breakdown.
- Ensure regular feeding.