Newborn at Risk

Question 1

What is late preterm?

Answer 1

34-36 weeks

Question 2

Early preterm?

Answer 2

Before 34 weeks

Question 3

Classification of high risk infants

Answer 3

1. AGA
2. LGA
3. SGA
4. IUGR

Question 4

What is IUGR?

Answer 4

Intrauterine growth resolution
- Placenta was not sufficient
“They have grown as much as they can in utero”
- They have a lot of trouble staying warm

Question 5

Causes of IUGR

Answer 5

1. Chronic diseases (HTN)
2. Low socioeconomic status (poor nutrition)
3. Substance abuse

Question 6

Types of IUGR

Answer 6

1. Asymmetrical - head continued to grow in utero

2. Symmetrical - riskier; head grows at same rate as the rest of the body

Question 7

Possible Causes of preterm birth

Answer 7

1. Highest incidence in lower socioeconomic groups
2. Maternal infection
3. Multifetal pregnancy
4. Smoking
5. No prenatal care
6. Lack of birth spacing

Question 8

Risk for Preterm Infants

Answer 8

1. Respiratory distress syndrome
2. PDA and PFO
3. Suck, swallow, breathe
4. Premature renal systems
5. Highly susceptible to infections
6. Impaired thermoregulation
7. Intraventricular hemorrhage (IVH)

Question 9

Respiratory distress syndrome

Answer 9

1. Not enough surfactant

2. Apnea prematurity; “they forget to breathe”

Question 10

Premature Renal Systems

Answer 10

Its difficult for them to process all of the meds they get as well as TPN

Question 11

Why do premature infants have a difficult time thermoregulating?

Answer 11

Premature infants don’t have brown fat

Question 12

IVH

Answer 12

Intraventricular Hemorrhage

• A brain bleed in the ventricles
• Try to keep the environment unstimulated

Question 13

Risks for Late Preterm Infants (34-37 weeks)

Answer 13

1. Thermoregulation
2. Hypoglycemia
3. Feeding issues
4. Hyperbilirubinemia
5. Sepsis
6. Respiratory Distress
7. Apnea
8. Developmental delays

Question 14

Describe Postterm Infants

Answer 14

1. Born beyond 42 weeks
2. Cause unknown
3. Associated with placental insufficiency
4. Meconium staining
5. Long hair and nails
6. Absent vernix
7. Peeling skin

Question 15

What is transient tachypnea of newborn (TTN)?

Answer 15

TTN occurs when all amniotic fluid is removed slowly or incompletely from baby’s lungs
- Common after cesarean birth

Question 16

What does TTN look like?

Answer 16

1. Observe for s/sx of respiratory distress within few hours of birth
2. Within 6 hours, RR may be 100-140 bpm
   - IVF or enteral feedings until resolves

Question 17

How long does it take for TTN to resolve?

Answer 17

Should resolve by 72 hours

- They are always sent to the NICU because you can not PO feed a baby that is breathing so fast

Question 18

Risk factors for TTN

Answer 18

1. Smoking mom
2. Asthmatic mom
3. Macrosonia
4. C-section
5. Lower gestational age
6. Male sex

Question 19

Meconium Aspiration Syndrome (MAS)

Answer 19

Intrauterine fetal distress with passing of meconium before delivery

• Can be mild to severe
• May develop pneumonia and/or pneumothorax

Question 20

Mild MAS Symptoms

Answer 20

Tachypnea

Question 21

Severe MAS Symptoms

Answer 21

1. Poor PO intake
2. Respiratory distress
3. Weak
4. Floppy baby
5. Neuro deficits from hypoxia
6. Metabolic acidosis

Question 22

Necrotizing Enterocolitis (NEC)

Answer 22

Happens due to stress in utero or out where baby was hypoxic and the gut wasn’t getting oxygen.

Question 23

S/Sx of NEC

Answer 23

1. Abdominal distention
2. Bloody stools
3. Feeding intolerance
4. Bilious vomiting

Question 24

Lab tests to confirm NEC

Answer 24

An abdominal x-ray to demonstrate dilated bowel loops, abnormal gas patterns, air bubbles that occur from bacteria, and thickened bowel walls
- KUB to confirm air in bowel wall

Question 25

Treatment of NEC

Answer 25

1. Bowel rest (First thing - hold feeding) 2. Antibiotics 3. IV fluids 4. Surgery

Question 26

Normal BG after birth

Answer 26

50-60

Question 27

When to intervene with BG

Answer 27

If less than 30

Question 28

Treatment of hypoglycemia

Answer 28

1. Feedings | 2. IV dextrose

Question 29

S/Sx of hypoglycemia

Answer 29

1. Sweating 2. Poor feeding 3. Lethargy 4. Poor muscle tone

Question 30

What is the single most important factor influencing fetal well-being?

Answer 30

The euglycemic status of the mother

Question 31

Infants of Diabetic Mothers can result in what?

Answer 31

1. Macrosomia 2. RDS (4-6 times more likely) 3. Hypoglycemia 4. Hyperbilirubinemia

Question 32

Physiologic S/Sx Withdrawal

Answer 32

1. Hyperactivity and irritability 2. Nasal congestion with flaring 3. Tachypnea 4. Sweating 5. Temp greater than 37.5 C 6. Diarrhea 7. LBW 8. Seizures

Question 33

Withdrawal Symptoms (WITH)

Answer 33

W - wakefulness I - irritability T - temperature variation, tachycardia, tremors H - hyperactivity

Question 34

Physiological Jaundice

Answer 34

(Normal Jaundice) 1. Considered benign, manifests within 24 hours to 3 days 2. Bilirubin may lead to hazardous conditions 3. Increasing intake will aid to increase output 4. Kernicterus

Question 35

Kernicterus

Answer 35

Bilirubin-induced neurologic damage that is preventable

Question 36

ABO incompatibility

Answer 36

It occurs if the fetal blood type is A, B, or AB and the maternal type is O. - Results in physiological jaundice - Treated with phototherapy

Question 37

Phototherapy

Answer 37

1. Banked lights above infant or Bili blanket 2. Infant uncovered as much as possible 3. Cover eyes and genitals 4. Monitor temp and UOP closely