Module 10: Complications of the Newborn

Question 1

Describe the potential effects of maternal diabetes on the newborn

Answer 1

• large amounts of glucose are transferred to the fetus
• causes fetus to become hyperglycaemia
• fetal pancreas produces large amount of fetal insulin
• leads to hyperinsulinsim along with production of protein and fatty acids; often results in LGA newborn weighing 4000g or more (macrosomia)
• assess bgl for 2 days (48 hrs), until they’ve stabilized or continue to assess more frequently still

Question 2

preterm

Answer 2

• less than 36 weeks
• is the cause of more deaths during the first year of life than any other single factor
• high percentage of birth defects
• the less a preterm weighs at birth, the greater the risk to life during delivery and immediately thereafter
• Causes: multiple births, maternal illness, hazards of actual pregnancy, placental abnormalities
  - placenta previa
  - placenta abruptio
• Preterm infants are placed on the side or prone with head of mattress slightly elevated
  
  • decreased respiratory effort; improves oxygenation
  • promotes more organized sleep pattern and lessens physical; activity that burns up energy needed for growth and development
• should be compatible with drainage of secretions and prevention of aspiration
• do not leave infant in one position for a long period of time because it increases the risk of skin breakdown
• prognosis for preterm infant
  
  • growth rate nears the term infants about the second year of life, but very low birth weight infants may not catch up especially if chronic illness, insufficient nutritional intake or inadequate caregiving has occurred
  • growth and development of preterm infants are based on
    
    • current age minus the number pf feels before term of infant was born
    • this calculation helps prevent unrealistic expectations

Question 3

Family Reaction to preterm Infant

Answer 3

• Family reaction to preterm infant
  
  • parents will need guidance throughout the infants hospitalization
  • parents may believe they are to blame for infants condition
  • parents may be concerned for their ability to care for such a small infant
  • parents are taught how to provide appropriate stimulation without overtiring their infant

Question 4

Postdates

Answer 4

• beyond 42 weeks gestation
• placenta does not function well as it ages
• can result in fetal distress
• mortality rate of later-term infants is higher than that of term newborns
• Problems associated with posters delivery
  
  • asphyxia
  • meconium aspiration
  • poor nutritional status
  • increase in red blood cell production
  • difficult delivery because of increased size of fetus
  • birth defects
  • seizures
• Physical characteristics of postterm newborn
  
  • long and thin
    
    • weight may have been lost
    • skin is loose (especially around buttocks and thighs)
  • Little lanugo or vernix cases
    
    • desquamation (skin is peeling)
    • nails are long and may be stained from meconium
  • Thick head of hair and looks alert

Question 5

hypoglycemia

Answer 5

• blood glucose below 2.2 mmil/L in a term infant indicates hypoglycemia
  
  • preterm of posters
  • diabetic mother
  • LGA, SGA (large for gestational age, small for gestational age)
  • IUGR (intrauterine growth restriction)
  • asphyxiated
  • cold stress
  • mother and tocolytics during labor process
• S&S:
  
  • jitteriness, poor muscle tone, sweating, respiratory difficulty, low temperature, poor suck, high-pitched cry, lethargy, seizure

Question 6

meconium aspiration

Answer 6

• in utero
  
  • fetus expels meconium into amniotic fluid
  • cord compression or other condition interrupts fetal circulation
  • if asphyxia or acidosis occurs, fetus may have grasping movements that cause meconium-stained amniotic fluid to be drawn into the lungs
• at delivery
  
  • can occur if newborn inhales before nose and mouth have been suctioned

Question 7

sepsis

Answer 7

• sepsis in preterm infant
  
  • generalized infection of the bloodstream
  • at risk because of immaturity of many body systems
  • liver is immature; poor formation of antibodies
  • body enzymes are inefficient
  • some symptoms include:
    
    • low temperature, lethargy or irritability, poor feeding, respiratory distress
• Treatment of sepsis
  
  • administration of IV antimicrobials
  • maintenance of warmth and nutrition
  • close monitoring of vital signs
  • care should be organized to help infant conserve as much energy as possibly
  • following standard precautions, including strict hand hygiene is essential

Question 8

necrotizing enterocolitis

Answer 8

• acute inflammation of the bowel that leads to bowel necrosis (NEC)
  
  • diminished blood supply to the bowels related to hypoxia or sepsis
• S&S: abdominal distention, bloody stool, diarrhea, bilious vomitus
• Observing Vital signs
  
  • measuring abdomen
  • auscultating for bowel sounds
• carefully resuming fluids as ordered TPN
• maintaining infection prevention and control techniques
• surgical removal of the necroses bowel may be indicated

Question 9

jaundice

Answer 9

• Assessment: skin and sclera develop a orange-yellow cast
• Physiological: the liver is immature and unable to clear the blood of bile pigments that result from normal postnatal RBC destruction
• Pathological: serious, occurs within 24 hours after birth and is secondary to an abnormal condition like ABO-Rh incompatibility
• Breast milk jaundice: breastmilk may inhibit conjugation of bilirubin and formula may be used for 24-48 hours to reduce bilirubin levels

Question 10

fetal alcohol exposure

Answer 10

• growth restriction
• intellectual impairment
• facial abnormalities
• no safe level during pregnancy

Question 11

neonatal abstinence syndrome

Answer 11

• caused by fetal exposure to drugs in utero
• S&S: high pitched cry, tremors, seizures, disturbed sleep-wake cycle
• many ilicit drugs cross the placental barrier; therefore an infant born to a woman who is an addict will suffer drug withdrawal after birth
  
  • agitation, cramps, diarrhea, rhinorrhea (runny nose)
• infant may also have long-term developmental and neurologic deficits

Question 12

transient tachypnea of newborn

Answer 12

• characterized by:
  
  • tachypnea
  • may also include, chest retractions, grunting, mild cyanosis
• often referred to as respiratory distress syndrome type II
• typically resolved suddenly after 3 days
  
  • may be cause by slow absorption of fluid in lungs after birth
• supportive nursing and medical care

Question 13

respiratory distress syndrome

Answer 13

• Respiratory distress syndrome can happen due to preterm
• also called hyaline membrane disease
  
  • results of lung immaturity
  • deficient amount of surfactant
• S&S: RR 60/min or greater, grunting, nasal flaring, cyanosis, intercostal and sternal retractions
• Treatment: pre-delivery, administration of corticosteroid to the mother (betametasone), administration of surfactant via ET tube

Question 14

Thermoregulation and incubators

Answer 14

• thermoregulation: stable body temperature
• a stable body temperature essential to survival and management of preterm infants
• it is important of the nurse to know how to use the various types of incubators

Question 15

Nursing Care related to Nutrition

Answer 15

• observe and record bowl sounds and passage of meconium stools
• for garage feeding, aspiration of gastric contents prior to feeding is important
• if no residual received, it is safe to start the feeding
• if a higher - than - ordered limit of gastric contents is received, feeding may need to be held and the health care provider notified