Module 10: Care of the Newborn with Special Needs (Adelante) Flashcards
This newborn, regardless of gestational age or birth weight, has greater chances of morbidity or mortality than a normal neonate.
HIGH RISK NEWBORN
What are the classifications of high-risk newborns according to birth weight?
(A) Small for Gestational Age (SGA)
1. Low birth weight
2. Very low birth weight
3. Extremely low birth weight
(B) Large for Gestational Age (LGA)
What are the classifications of high risk newborns according to maturity?
(A) Preterm Infant (born <37 weeks)
(B) Post-Term Infant (born >40 weeks)
What is the main cause of SGA?
Most cases of SGA are due to Intrauterine Growth Restriction (IUGR), though some are small due to genetics.
This condition occurs when the fetus does not receive adequate nutrients and oxygen needed for proper growth and organ development.
Intrauterine Growth Restriction (IUGR)
What are the maternal factors that contribute to SGA and IUGR?
(A) Malnutrition, anemia
(B) High blood pressure
(C) Advanced diabetes
(D) Chronic kidney disease
(E) Heart or respiratory disease
(F) Infection
(G) Substance use (alcohol, drugs)
(H) Cigarette smoking
What placental and uterine anomalies contribute to SGA and IUGR?
(A) Decreased blood flow in the uterus and placenta
(B) Placental abruption (placenta detaches from the uterus)
(C) Placenta previa (placenta attaches low in the uterus)
(D) Vasa previa (infection in the tissue around the fetus)
This condition occurs when the placenta detaches from the uterus.
Placenta abruption
This condition occurs when the placenta attaches low in the uterus.
Placenta Previa
This condition occurs when there is an infection in the tissue around the fetus.
Vasa Previa
What are the different fetal factors contribute to SGA?
(A) Multiple gestation (twins, triplets, etc.)
(B) Infection
(C) Birth defects
(D) Chromosomal abnormalities
How is SGA identified before birth?
Through fundal height measurement and ultrasound.
How does fundal height help diagnose SGA?
(A) 12 weeks – Fundus above symphysis pubis
(B) 20 weeks – At the umbilicus
(C) 36 weeks – At the xiphoid process
If the fundal height progressively becomes smaller, SGA is suspected.
This is a test that uses sound waves to create a picture of internal structure. This is the most accurate method of estimating fetal size.
ULTRASOUND
How does ultrasound help diagnose SGA?
(A) Measures fetal head and abdomen size.
(B) Compares measurements to a growth chart to estimate fetal weight.
How does fetal abdominal circumference help diagnose SGA?
It is a helpful indicator of fetal nutrition.
This is an ultrasound study that evaluates blood flow in vessels. This uses sound waves to measure the amount and speed of blood flow.
DOPPLER FLOW
What is Doppler Flow, and how does it help in diagnosing SGA?
Helps determine if blood vessels are open or blocked.
What are other indicators of SGA during pregnancy?
(A) Mother’s weight gain: Decreased
(B) Gestational assessment: Birth weight is compared with gestational age after birth.
What tests are used to assess placental function?
(A) Fetal Nonstress Test (NST)
(B) Placental grading
(C) Amniotic fluid amount
(D) Ultrasound
This is used to measure fetal movement and heart rate for 20 top 30 minutes. It also ensures that fetal oxygenation is adequate.
Fetal Nonstress Test (NST)
What is the normal heart rate?
120 to 140 bpm
Low oxygen levels may indicate what?
It may indicate placental or umbilical cord problems.
What are the common physical characteristics of an SGA infant?
(A) Wasted appearance
(B) Below average weight, length, and head circumference
(C) Large head in proportion to the small body (not hydrocephalus)
(D) Widely separated skull sutures due to poor bone growth
(E) Dull, lusterless hair
(F) Poor skin turgor
(G) Sunken abdomen (normal infants have a globular abdomen)
(H) Dry umbilical cord, possibly stained yellow
How does an SGA infant’s development compare to their weight?
(A) Despite low weight, they may have:
1. More developed neurologic responses
2. Sole creases, ear cartilage, and firmer skull
3. Unusually alert and active for their size
(B) However, all SGA infants need a careful assessment for congenital anomalies.
What precaution should be taken when handling SGA infants?
Do not use bandage scissors when taking care of SGA infants.
This is an infant whose weight is above the 90th percentile for newborns of the same gestational age.
Large of Gestational Age (LGA)
Can LGA newborns be preterm, term, or post-term?
Yes, an LGA newborn can be preterm, term, or post-term.
What maternal condition is commonly associated with LGA?
Maternal diabetes, which leads to abundant nutrient supply in utero.
How can multiple pregnancies contribute to LGA?
A large abdomen in an LGA newborn may be linked to multiple gestations (e.g., twins, triplets), requiring further assessment.
What are the prenatal signs of an LGA infant?
(A) Unusually large uterus for gestational age
(B) Ultrasound shows rapid and abnormal fetal growth
What perinatal complication is associated with LGA infants?
Difficult labor due to shoulder dystocia (wide shoulders that cannot pass through the birth canal)
How do LGA infants appear at birth?
(A) May look healthy but have immature development (“fragile giants”)
(B) May have extensive bruising or birth injuries, such as:
- Broken clavicle
- Erb-Duchenne Paralysis (nerve damage causing arm weakness)
(C) May have head-related conditions, including:
- Prominent caput succedaneum
- Cephalhematoma
- Molding
What metabolic and respiratory issues can LGA infants experience?
(A) Polycythemia (excess RBCs in the body)
(B) Hypoglycemia
(C) Lung problems, especially in newborns of diabetic mothers delivered via C-section
When does the high risk period begin for high risk newborns?
At the time of viability up to 28 days of birth,
Characterize the lung development among newborns.
Lung development is delayed in newborns whose mothers have diabetes. When these newborns are delivered by cesarean, they are at risk of developing lung problems.
This is a live born infant born before 37 weeks of gestation with a birth weight less than 2,500g.
PRETERM INFANT
What is the difference between a preterm and an SGA baby
(A) Preterm: Immature and small, but proportioned to gestational age.
(B) SGA: Small, can be mature or immature, but weight is not proportionate to age.
(C) Preterm labor: Labor was activated too early due to unexplained reasons.
How many percent of pregnancies end in preterm birth?
7%
What are some maternal risk factors for preterm birth?
(A) Low socioeconomic status (e.g., teenage pregnancy)
(B) Poor nutrition
(C) Lack of prenatal care
(D) Multiple pregnancies
(E) Race (higher in non-whites than whites)
(F) Substance use (cigarettes, alcohol)
(G) Young maternal age (below 20 years old)
(H) Closely spaced pregnancies
(I) Infections (especially UTI)
(G) Obstetric complications (placental abruption, PROM)
(H) Early induction of labor
What are the key physical characteristics of a preterm infant?
(A) Small, underdeveloped head (head is disproportionately larger than the chest by 3 cm)
(B) Ruddy, almost transparent skin with visible veins due to little subcutaneous fat
(C) Vernix caseosa:
- Present in 24-36 weeks
- Absent if <25 weeks (not yet formed)
(D) Extensive lanugo (fine hair)
(E) Myopic appearance
(F) Absent sucking & swallowing reflexes
(G) Weak deep tendon reflexes
(H) Less active, rarely cries; if crying, it is weak and high-pitched
How does ear cartilage differ between term and preterm infants?
(A) Term: Well-formed, ear springs back when folded
(B) Preterm: Flat, shapeless; ear remains folded
How do the extremities differ between term and preterm infants?
(A) Term: Fully flexed
(B) Preterm: Limp and flaccid
How does elbow movement differ between term and preterm infants?
(A) Term: Resists crossing midline
(B) Preterm: Easily crosses midline
How does the scrotum appearance differ in term and preterm male infants?
(A) Term: Many rugae, testes in inguinal canal
(B) Preterm: Few rugae, testes high in canal
How does the sole of the foot differ between term and preterm infants?
(A) Term: Deep creases
(B) Preterm: Swollen, minimal wrinkles
How does the female genitalia differ between term and preterm infants?
(A) Term: Well-developed labia majora (covers labia minora & clitoris)
(B) Preterm: Prominent clitoris, small & widely separated labia majora
This complication during prematurity occurs due to the non-production of RBC by the bone marrow (32 weeks).
ANEMIA
What causes anemia in preterm infants?
(A) Non-production of RBCs by bone marrow (before 32 weeks)
(B) Increased RBC destruction due to low vitamin E
(C) Immature kidney cannot produce erythropoietin
Anemia in preterm infants can result to what?
PALE LETHARGIC AND ANOREXIC
This condition occurs due to the destruction of brain cells due to indirect bilirubin invasion.
KERNICTERUS
What is the nursing intervention or treatment for kernicterus
(A) Phototherapy to degrade excessive bilirubin
(B) Blood transfusion
(C) Vit E. and iron through preterm formula
What is Patent Ductus Arteriosus (PDA) in preterm infant
(A) Ductus arteriosus should close within 12-24 hours after birth
(B) Complete sealing occurs by 3 weeks
(C) Preterm babies lack surfactant, making PDA closure difficult
This condition is characterized as the bleeding in the brain due to fragile capillaries. This is cased by rapid changes in cerebral pressure.
Periventricular or Intraventricular hemorrhage
Periventricular or Intraventricular hemorrhage can lead to what?
(A) Hydrocephalus
(B) Cerebral palsy
(C) Developmental delay
(D) Seizures
What is the main cause of respiratory distress syndrome (RDS) in preterm infants?
Lack of surfactant in the lungs.
What are other complications of prematurity?
(A) Apnea
(B) Retinopathy of prematurity (ROP)
This is a neonate born after 42 weeks of gestation.
POST TERM INFANT
Why is postmaturity dangerous?
(A) Placenta only functions effectively for 40 weeks
(B) Leads to nutrient deficiency → post-term syndrome or fetal death
What are the physical characteristics of a postterm infant?
(A) Dry, cracked, leather-like skin (poor skin turgor)
(B) Absent vernix caseosa
(C) Less amniotic fluid, possibly meconium-stained
(D) Long fingernails
(E) Low birth weight due to placental insufficiency
(F) Respiratory difficulty (risk for meconium aspiration)
What are common illnesses in newborns?
(A) Respiratory Distress Syndrome (RDS)
(B) Sudden Infant Death Syndrome (SIDS)
(C) Transient Tachypnea of the Newborn (TTN)
(D) Meconium Aspiration Syndrome (MAS)
(E) Hyperbilirubinemia
(F) Sepsis
(G) Apnea
(H) Twin-to-Twin Transfusion Syndrome (TTTS)
(I) Retinopathy of Prematurity (ROP)
What is another name for Respiratory Distress Syndrome (RDS)?
Hyaline Membrane Disease.
This condition is known as the most common lung disease of preterm babies. This occurs due to deficiencies of surfactant in the lungs.
Respiratory Disease Syndrome (RDS)
(The earlier the baby is born, the less developed the lungs are, the higher the chance of RDS).
Which infants have the highest risk of RDS?
Babies born before 28 weeks.
At what gestational week does surfactant production begin?
34th week of gestation (thus premature infants are born with inadequate amounts of this, may experience RDS and may die).
This essential fluid is produced by Type II alveolar cells and lines inside of the lungs. It also keeps air sacs open.
SURFACTANT (it prevents lung collapse).
What happens if a baby is born with insufficient surfactant?
(A) Lung collapse
(B) Infant struggles to breathe.
(C) Oxygen deprivation may damage the brain and organs.
What is the normal Lecithin/Sphingomyelin (L/S) ratio?
2:1 (Indicates mature lungs)
What are the signs of Respiratory Distress Syndrome (RDS)?
(A) Tachypnea
(B) Retractions
(C) Nasal flaring
(D) Grunting
(E) Cyanosis
What are the treatments for RDS?
(A) Oxygen therapy (to prevent tissue hypoxia)
- Oxygen hood
- NCPAP (nasal continuous positive airway pressure)
- Mechanical ventilation
(B) Surfactant Replacement Therapy
Given via intubation (sprayed into the lungs)
This pertains to the unexplained sudden death of an infant after all possible causes are ruled out.
Sudden Infant Death Syndrome (SIDS)
How can SIDS be prevented?
(A) Use pacifiers (keeps baby stimulated)
(B) Avoid excess pillows around the baby
This condition pertains to the rapid breathing (80-120 bpm) due to retained fluid in the lungs.
Transient Tachypnea of the Newborn (TTN)
What are the characteristics of TTN?
(A) Mild chest retractions
(B) No marked cyanosis
(C) Difficulty feeding (due to rapid breathing
Which babies are at higher risk of TTN?
Infants born via C-section (due to lack of vaginal compression).
What causes Meconium Aspiration Syndrome (MAS)?
Fetal hypoxia in utero, leading to relaxation of the rectal sphincter → meconium-stained amniotic fluid.
How does meconium cause respiratory distress?
(A) Lung inflammation (if inhaled)
(B) Bronchiole obstruction (causes difficulty breathing)
(C) It can decrease surfactant production.
What are the key assessment findings in MAS?
(A) Difficulty establishing respiration at birth
(B) Low APGAR score (tachypnea, cyanosis, retractions)
(C) Coarse bronchial sounds upon auscultation
(D) Barrel chest
(E) Coarse infiltrates in lungs on chest X-ray
What are the therapeutic management strategies for MAS?
(A) Amniotransfusion (to dilute meconium-stained amniotic fluid)
(B) Emergency C-section
(C) Antibiotic therapy
(D) Intubation & O₂ administration
(E) Chest physiotherapy
This pertains to elevated indirect bilirubin levels in the blood. This occurs due to normal or abnormal RBC destruction.
Hyperbilirubinemia
Hyperbilirubinemia leads to what.
JAUNDICE (yellow skin discoloration)
What are the therapeutic management strategies for Hyperbilirubinemia?
(A) Early feeding
(B) Phototherapy
- Blue fluorescent light 12-30 inches above crib/incubator
- Helps the liver convert bilirubin faster
(C) Exchange transfusion (in severe cases)
What are the nursing care considerations during phototherapy?
(A) Undress the baby (to expose skin to light)
(B) Cover the eyes (to protect retina)
(C) Monitor stool color (dark green)
(D) Monitor I&O & skin turgor (prevent dehydration)
(E) Remove infant from lights during feeding (for mother-infant bonding)
(F) Explain treatment to parents
What is Sepsis in Newborns?
Generalized bloodstream infection in neonates.
Why are preterm infants at higher risk for sepsis?
(A) Premature loss of placental barrier (increases vulnerability)
(B) Low levels of maternal IgG antibodies (due to early birth)
(C) Immature leukocytes (poor immune response)
This condition occurs in monozygotic twins (identical twins sharing one placenta). This pertains to the abnormal areteriovenous shunts direct more blood to one twin.
Twin-to-Twin Transfusion Syndrome (TTTS)
Twin-to-Twin Transfusion Syndrome (TTTS) occurs in _ of all identical pregnancies.
1/3
What are the blood conditions of each twin in TTTS?
One twin has anemia, while the other has polycythemia and is prone to hyperbilirubinemia.
How do the skin colors of the twins differ in TTTS?
The donor twin is pale, while the recipient twin has ruddy skin.
What diagnostic tool helps confirm TTTS?
Ultrasound shows a noticeable size difference between the twins.
What is the treatment for the donor twin in TTTS?
Blood transfusion
What is the treatment for the recipient twin in TTTS?
Exchange transfusion.
This is an acquired ocular disease that may lead to total or partial blindness in children.
Retinopathy of Prematurity (ROP)
What causes ROP?
Vasoconstriction of retinal blood vessels due to high oxygen exposure.
What severe complication can ROP lead to?
RETINAL DETACHMENT
Which newborns are at the highest risk for ROP?
The most immature and critically ill infants who receive high oxygen levels.
What should nurses check to help prevent ROP?
Oxygen therapy equipment.
What are the treatments for ROP?
Cryosurgery or laser therapy.
What is the most common risk factor for neonatal herpes infection?
Mothers with multiple sex partners (Transmitted through the placenta or vaginal secretions during birth).
What skin manifestation is seen in an infant with herpes?
Clustered, pinpoint vesicles on a reddened base.
When do herpes symptoms typically appear in a newborn?
4 to 7 days after birth.
What systemic symptoms may develop in severe neonatal herpes?
Dyspnea, jaundice, convulsions, and shock (In this, cesarean section (CS) to avoid exposure to infectious vaginal secretions).
What is the treatment for neonatal herpes?
Acyclovir (Zovirax).
What is the main cause of neonatal GBS infection?
Group B Streptococcus, a gram-positive bacterium found in the female genital tract.
(Those born after prolonged rupture of membranes or to mothers with a positive vaginal culture for GBS are at higher risk for GBS infection).
What is the most common sign of GBS infection on the first day of life?
PNEUMONIA
What respiratory symptoms are seen in newborns with GBS?
Tachypnea, apnea, and signs of shock.
What other symptoms may indicate GBS infection in newborns?
Pallor, decreased urine output, lethargy, fever, and loss of appetite.
What finding may appear on a chest X-ray in GBS pneumonia?
Ground-glass appearance.
What serious neurological complication can result from GBS infection?
Increased intracranial pressure (ICP), shown by bulging fontanelles.
What are the possible long-term effects of GBS infection in a newborn?
Neurologic consequences, even if the baby survives.
What antibiotics are used to treat GBS infection in newborns?
(A) Gentamicin
(B) Ampicillin
(C) Penicillin
This is an eye infection occurring at birth or within the first month of life.
Opthalmia Neonatorum
What are the two (2) main causative organisms of Opthalmia Neonatorum?
Neisseria gonorrhoeae and Chlamydia trachomatis.
What is the serious consequence of untreated N. gonorrhoeae infection in newborns?
Corneal opacity and severe vision impairment.
How does Ophthalmia Neonatorum typically present?
Bilateral eye infection, red fiery conjunctiva, thick pus, and edematous eyelids.
What antibiotics are used to prevent gonococcal Ophthalmia Neonatorum?
Ceftriaxone (Rocephin) and Penicillin.
What is the treatment for Chlamydial Ophthalmia Neonatorum?
Erythromycin solution and eye irrigation with sterile NSS.
What is the typical birth size of an infant born to a diabetic mother?
Larger than normal (macrosomia).
(This is deceptive because the baby may appear big but is often immature and prone to Respiratory Distress Syndrome (RDS)).
What congenital anomalies are common in infants of diabetic mothers?
Cardiac anomalies and Caudal Regression Syndrome (sacral agenesis).
What is the typical birth size of an infant born to a drug-dependent mother?
Small for gestational age (SGA).
What is the term for withdrawal symptoms in a newborn exposed to drugs?
Neonatal Abstinence Syndrome (NAS).
What are common withdrawal symptoms in NAS?
Irritability, disturbed sleep, tremors, frequent sneezing, shrill cry, convulsions, tachypnea, vomiting, and diarrhea.
What substances can cause Neonatal Abstinence Syndrome?
Opiates, stimulants, sedatives, and antidepressants.
What environmental interventions help soothe a baby with NAS?
Swaddling and keeping the baby in a dark, quiet environment.
Why should a drug-dependent mother avoid breastfeeding?
To prevent passing drugs to the infant through breast milk.
What are the drugs used to manage NAS symptoms?
Paregoric, Phenobarbital, Methadone, Thorazine, and Diazepam (Valium).
What is an important therapeutic intervention for NAS babies?
Maintain fluid and electrolyte balance through IV fluids.
How common is Fetal Alcohol Syndrome (FAS)?
It appears in about 2 per 1,000 births.
(It crosses the placenta at the same concentration as in the maternal bloodstream).
What are the growth characteristics of an infant with Fetal Alcohol Syndrome?
Pre- and postnatal growth restriction
What are the behavioral symptoms of an infant with FAS?
Irritability in infancy, hyperactivity in childhood, sleep disturbances.
What are some CNS complications associated with FAS?
Cognitive impairment, microcephaly, cerebral palsy, mental and motor retardation.
What are the facial features of an infant with FAS?
Short upturned nose.
What are the general growth deficiencies seen in infants with FAS?
Mental and motor retardation, overall growth restriction.
