Newborn at Risk Flashcards
Weight <2500g (5.5lbs)
low birth weight (LBW)
Weight <1500g (3.3lbs)
very low birth weight (VLBW)
Weight <1000g (2.2lbs)
extremely low birth weight (ELBW)
Neonatal resuscitation is __________ focused
Neonatal resuscitation is respiratory focused. Not cardiac.
Babies are respiratory driven.
Weight below the 10th percentile for age
SGA: Small for gestational age
Weight between the 10th and 90th percentile for gestational age
AGA: Appropriate for gestational age
Weight above the 90th percentile for gestational age
LGA: Large for gestational age
SGA Characteristics
Wasted muscle tissue
Lack of brown fat
Scaphoid abdomen (sunken in)
Eyes appear large, “wise old man” look
Long fingernails
Meconium-stained thin cord often present
Conditions affecting SGA newborn
Cold stress/temperature instability- prolonged hypothermia with no brown fat reserves
Pain- if life-saving interventions indicated (ex. IV’s), they may be painful
Hypoglycemia- due to muscle wasting and low brown fat
Polycythemia- venous hematocrit ≥ 65% Red Baby!
LGA Characteristics
May be genetically large
More commonly exposed to imbalance of nutrients in utero
Ex. Infant of a diabetic mother
Conditions affecting LGA newborn
Hypoglycemia- chronic hyperglycemia in utero due to elevated maternal glucose levels (uncontrolled GDM)
Hypocalcemia- calcium levels should be > 7.5 mg/dL in preterm newborns and 8 mg/dL in term newborns. Low calcium levels can produce seizures in the newborn and may be present along with hypoglycemia
Birth injuries- one of two types: neurological injuries or bone fractures
Brachial plexus injuries (BPI)- occur when the nerves are stretched and leave the arm without function
Fractures- involve the clavicle, or long bones of the humerus or femur
Transient tachypnea of the newborn (TTN)- delayed clearance of fetal lung fluid
LGA newborns & shoulder dystocia
Nerve damage/paralysis:
-Brachial plexus injury (affects upper arm)
-Erb’s Palsy (affects upper and lower arm)
-Klumpke’s Palsy (affects hand and possibly eyelid on contralateral side)
Most completely recover. Follow up w/ therapy.
Born before 37 weeks
preterm
Born between 37-41 weeks
term
born on or over 42 weeks
post-term
-Born after 42 weeks’ gestation (3-14% of all pregnancies)
-Most are of normal size and healthy, may or may not be LGA
-Large fetus may have a difficult time passing through birth canal
-Potential problems: cephalopelvic disproportion and shoulder dystocia
post-term newborn
Post-term complications
Polycythemia (red baby!)
Meconium aspiration
Oligohydramnios
Congenital anomalies
Seizures
Hypoglycemia
Cold stress
Baby gets stressed during birth and poops, inhales meconium which is sticky and blocks airways/atelectasis develops (collapse portions/entire lung) leading to hypoxia
meconium aspiration
Post-term assessment findings
Dry, cracked skin without vernix or lanugo
Long fingernails
Profuse scalp hair
Long, thin body with loose skin and nonexistent fat layers
Meconium staining, tinting the nails, skin, and umbilical cord green
Preterm newborn - systems affects
· Resp: surfactant deficiency
· Thermogenesis: Low. No brown fat > insensible H2O loss
· Gastrointestinal: poor oral feedings, high caloric needs
· Renal: Low GFR, bad kidneys
· Immune: no passive IgG antibodies
· Neuro: brain bleeds and delayed reactivity
Preterm newborn complications
intracranial hemorrhage, respiratory distress syndrome, apnea of prematurity, anemia of prematurity, retinopathy of prematurity, necrotizing enterocolitis
Related to rapid birth and birth trauma
Fragile blood vessels in highly vascularized areas
Can cause changes in activity level, seizures, decreased HCT, full anterior fontanelle
intracranial hemorrhage (ICH)
Lack of surfactant and underdevelopedalveoli
Atelectasis with congestion and edema in lung spaces
S/S: grunting, retractions, nasal flaring, cyanosis, tachypnea, decreased breath sounds, respiratory acidosis, apnea
Respiratory distress syndrome (RDS)
Spontaneous pause in breathing that can be accompanied by pallor, hypotonia, cyanosis, bradycardia, O2 desaturation
Continuous cardiorespiratory and O2 saturation monitoring
Treat with caffeine
Apnea of prematurity
Due to multiple blood draws, rapid growth, and erythropoietin release
Assess HCT level, blood transfusions, replace erythropoietin
Anemia of prematurity
Due to immature retinal vasculature followed by hypoxia
Can lead to blindness
The longer O2 exposure the higher the risk
Wean off O2 as soon as possible (limit amount of O2)
Prevent O2 fluctuations
Routine checks by an ophthalmologist
Retinopathy of prematurity (ROP)
Due to an ischemic bowel episode, might see bloody stools
Check abdominal circumference, bowel sounds, stool hematest, stool frequency, stop feedings immediately
Necrotizing enterocolitis (NEC)
Nursing care of preterm newborn
Maintain respiratory function
Maintain thermoneutral environment
Balance fluids and electrolytes
Provide adequate nutrition
Prevent infection
Promote parent-infant attachment
Hyperbilirubinemia: Yellow discoloring of the skin and sclera
Newborns produce more bilirubin than adults do because of greater production and faster breakdown of red blood cells in the first few days of life. Normally, the liver filters bilirubin from the bloodstream and releases it into the intestinal tract. A newborn’s immature liver often can’t remove bilirubin quickly enough, causing an excess of bilirubin.
Jaundice
Risk factors for jaundice
bruising, neonatal hypoxia, congenital infection, Rh incompatibility, inadequate oral intake
Encourage feeding with human milk to encourage stooling
Complications of jaundice
Kernicterus – bilirubin in the basal ganglia
Cerebral palsy
Developmental delays
Hearing loss/perceptual impairment
Delayed speech development
Hyperactivity
Muscle incoordination
Learning difficulties
Death
-Can occur if the mother is Rh negative or has blood type O
-Rh incompatibility (erythroblastosis fetalis)
Rh-negative mother
Rh-positive fetus
-Maternal antibodies cross the placenta and destroy fetal red blood cells
-Treated with RhoGAM around 28 weeks
Hemolytic Disease of the Newborn
Med that stops your blood from making antibodies that attack Rh-positive blood cells.
RhoGAM
O mother
A or B fetus
Results in jaundice
Rarely results in severe hemolytic disease
ABO Incompatibility
-Incidence: 55-95% of substance exposed infants become symptomatic
-Withdrawal: depending on substance of choice and its half-life, withdrawal can become evident between 6 hours to 8 days of life
-Increased risk of premature delivery, low birth weight, microcephaly (small head), long term cognitive/behavioral problems
Substances: cocaine, heroin, methadone, oxycodone, fentanyl, buprenorphine, Xanax
Withdrawal signs/onset vary depending on substance
Neonatal abstinence syndrome (neonatal opioid withdrawal syndrome)
NAS/NOWS
Signs of withdrawal
Neurological Excitability
-Irritability
-High, pitched crying
-Excessive/continuous crying
-Difficulty sleeping
-Tremors (disturbed and undisturbed)
-Excoriation
-Exaggerated Moro
-Hypertonicity
-Myoclonic jerks
-Excessive sucking
-Seizures
Signs of withdrawal
Autonomic Dysregulation
Tachypnea
Nasal flaring
Increased RR
Stuffiness
Hyperthermia
Sweating
Sneezing
Mottling
Yawning
Signs of withdrawal
GI dysfunction
Diarrhea –> diaper rash
Hyperphagia
Regurgitation
Vomiting
Poor feeding
Scoring tool for NAS/NOWS
-Finnegan
-Eat, sleep, console (ESC)
Treatment goals of NAS/NOWS
Relieve signs of withdrawal
Improve feeding & weight progress
Prevent seizures
Mitigate poor neurological outcomes
Blood infection in infants younger than 90 days old
sepsis
Early-onset sepsis – first week of life
Late-onset sepsis – between days 8 and 89
-Acquired while the infant is in the NICU
-Two most common: MRSA & Candida
-Related to invasive procedures and the infant’s immature immune system
-Presents as sepsis, UTIs, meningitis, or pneumonia
-Preventing infections: WASH HANDS, clean phones, no jewelry, do not visit if sick
Nosocomial Infections
S/Sx of sepsis
Respiratory distress
Lethargy or irritability
Hypotonia
Pallor, duskiness, or cyanosis
Cool and clammy skin
Temperature instability
Feeding intolerance
Hyperbilirubinemia
Tachycardia followed by apnea/ bradycardia
Tx of sepsis
Control the infant’s environment
Prevent the spread of infection
Antibiotic treatment
-Broad-spectrum before septic workup
-Specific antibiotics after workup
Physiologic supportive care
Encourage parental interaction
-Typically diagnosed in utero
-Intestines herniate through abdominal wall
-Monitor color of bowel (should be beefy red)
-Omphalocele: covered by sac
-Keep abdominal contents sterile
-Positioned in silo above the defect to reduce over a few days
-Give fluids, antibiotics, surgical repair
-pain management
Gastroschisis
End of Life Care
Palliative care
Home with hospice care
Lift visitor restrictions
Pain management
Spiritual/religious care
Memory boxes/keepsakes
Organ donation
Grief support for parents
Let parents be involved w/decisions
May need ethics committee involved
