Newborn at Risk Flashcards
What is late preterm?
34-36 weeks
Early preterm?
Before 34 weeks
Classification of high risk infants
- AGA
- LGA
- SGA
- IUGR
What is IUGR?
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
Causes of IUGR
- Chronic diseases (HTN)
- Low socioeconomic status (poor nutrition)
- Substance abuse
Types of IUGR
- Asymmetrical - head continued to grow in utero
2. Symmetrical - riskier; head grows at same rate as the rest of the body
Possible Causes of preterm birth
- Highest incidence in lower socioeconomic groups
- Maternal infection
- Multifetal pregnancy
- Smoking
- No prenatal care
- Lack of birth spacing
Risk for Preterm Infants
- Respiratory distress syndrome
- PDA and PFO
- Suck, swallow, breathe
- Premature renal systems
- Highly susceptible to infections
- Impaired thermoregulation
- Intraventricular hemorrhage (IVH)
Respiratory distress syndrome
- Not enough surfactant
2. Apnea prematurity; “they forget to breathe”
Premature Renal Systems
Its difficult for them to process all of the meds they get as well as TPN
Why do premature infants have a difficult time thermoregulating?
Premature infants don’t have brown fat
IVH
Intraventricular Hemorrhage
- A brain bleed in the ventricles
- Try to keep the environment unstimulated
Risks for Late Preterm Infants (34-37 weeks)
- Thermoregulation
- Hypoglycemia
- Feeding issues
- Hyperbilirubinemia
- Sepsis
- Respiratory Distress
- Apnea
- Developmental delays
Describe Postterm Infants
- Born beyond 42 weeks
- Cause unknown
- Associated with placental insufficiency
- Meconium staining
- Long hair and nails
- Absent vernix
- Peeling skin
What is transient tachypnea of newborn (TTN)?
TTN occurs when all amniotic fluid is removed slowly or incompletely from baby’s lungs
- Common after cesarean birth
What does TTN look like?
- Observe for s/sx of respiratory distress within few hours of birth
- Within 6 hours, RR may be 100-140 bpm
- IVF or enteral feedings until resolves
How long does it take for TTN to resolve?
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
Risk factors for TTN
- Smoking mom
- Asthmatic mom
- Macrosonia
- C-section
- Lower gestational age
- Male sex
Meconium Aspiration Syndrome (MAS)
Intrauterine fetal distress with passing of meconium before delivery
- Can be mild to severe
- May develop pneumonia and/or pneumothorax
Mild MAS Symptoms
Tachypnea
Severe MAS Symptoms
- Poor PO intake
- Respiratory distress
- Weak
- Floppy baby
- Neuro deficits from hypoxia
- Metabolic acidosis
Necrotizing Enterocolitis (NEC)
Happens due to stress in utero or out where baby was hypoxic and the gut wasn’t getting oxygen.
S/Sx of NEC
- Abdominal distention
- Bloody stools
- Feeding intolerance
- Bilious vomiting
Lab tests to confirm NEC
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
Treatment of NEC
- Bowel rest (First thing - hold feeding)
- Antibiotics
- IV fluids
- Surgery
Normal BG after birth
50-60
When to intervene with BG
If less than 30
Treatment of hypoglycemia
- Feedings
2. IV dextrose
S/Sx of hypoglycemia
- Sweating
- Poor feeding
- Lethargy
- Poor muscle tone
What is the single most important factor influencing fetal well-being?
The euglycemic status of the mother
Infants of Diabetic Mothers can result in what?
- Macrosomia
- RDS (4-6 times more likely)
- Hypoglycemia
- Hyperbilirubinemia
Physiologic S/Sx Withdrawal
- Hyperactivity and irritability
- Nasal congestion with flaring
- Tachypnea
- Sweating
- Temp greater than 37.5 C
- Diarrhea
- LBW
- Seizures
Withdrawal Symptoms (WITH)
W - wakefulness
I - irritability
T - temperature variation, tachycardia, tremors
H - hyperactivity
Physiological Jaundice
(Normal Jaundice)
- Considered benign, manifests within 24 hours to 3 days
- Bilirubin may lead to hazardous conditions
- Increasing intake will aid to increase output
- Kernicterus
Kernicterus
Bilirubin-induced neurologic damage that is preventable
ABO incompatibility
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
Phototherapy
- Banked lights above infant or Bili blanket
- Infant uncovered as much as possible
- Cover eyes and genitals
- Monitor temp and UOP closely
