Newborn Complications Flashcards
Describe newborn complications in term infants.
When do they occur? What are some common complications?
- Complications can still occur in term infants:
- If optimal transition does not occur
- Affected by maternal disease or IUGR (hypoglycemia, hypothermia, respiratory, hyperbilirubinemia etc.)
- Affected by maternal infection
- Traumatic birth
- More often seen in LGA, SGA or IUGR infants
- Common term complications:
- Transient tachypnea of the newborn
- Hyperbilirubinemia
LGA - large for gestational age
SGA - small for gestational age
AGA - appropriate for gestational age
IUGR - Intrauterine Growth Restriction (small, but still fetus)
What are causes of preterm complications?
(contributing factors)
- Assistive reproduction
- Genetics
- Maternal disease processes
- OB history
- Placental insufficiency
- Socioeconomics
What is Transient Tachypnea of the Newborn (TTN)?
- Delayed clearance of fetal lung fluid from lungs
- More likely to occur in babies delivered via c/s,
esp. if labor did not occur before birth
- More likely to occur in babies delivered via c/s,
What are signs and symptoms of TTN?
- Respiratory rate > 60 breaths/min.
- Cyanosis
- Grunting
- Nasal flaring
- Retracting
What are Nursing Care & Priorities for TTN?
- Monitor respiratory rate
- Minimal exertion
- No oral feeding (or very limited)
- Supplemental oxygen
What can contribute to TTN?
- Cesarean delivery without labor
- <39 weeks
- Maternal diabetes
- SGA/LGA
- Traumatic delivery
Why do premature infants have respiratory problems?
- Bones of thorax not calcified
- Decreased number of functional alveoli
- Deficient surfactant levels
- Greater collapsibility or obstruction of respiratory passages
- Greater distance between functional alveoli and the capillary bed
- Immature and friable capillaries in the lungs
- Small airways
- Weak or absent gag reflex
What is Respiratory Distress Syndrome (RDS)?
- Breathing disorder caused by immature (premature) lungs
- Lack of surfactant
- The more premature (earlier the gestation) the higher the chance of RDS
What are signs and symptoms of RDS?
- Decreased breath sounds
- Fine rales
- Generalized cyanosis
- Grunting
- Nasal flaring
- Retractions
- Rapid shallow breathing
- Shortness of breath
- Tachypnea then apnea
S&S generally present 4-24 hours of life
Who does RDS affect?
- Most common in premature infants born <34 weeks
- Infants of diabetic mothers
- Problems that reduce blood flow to infant
- Rapid labor, multiple pregnancy, asphyxiated infants
How do you decrease severity of RDS?
Prenatal corticosteroids (betamethasone, 2 doses given 24 hours apart)
How is RDS treated?
- Exogenous surfactant
- Mechanical support prn (CPAP, ventilator)
- Warm moist oxygen
Describe Surfactant.
- Fetus begins producing between 24-28 weeks
- Administered through the endotracheal (ET) tube
- Composed of lipids and proteins
- Equalizes pressure between large and small spaces
- Prevents alveoli from collapsing
- Reduces surface tension
Compare TTN and RDS.
Who does it effect and how should support be given?
TTN
- Unique to the term infant
- Generally time-limited with little respiratory support needed
RDS
- Affects preterm infants
- Requires aggressive support
- Can lead to complications such as BPD
Which infants are at risk for Hypothermia?
and why?
Infants at risk:
- Low birth weight infants
- Preterm Infants
- Birth asphyxia/trauma
- Due to limited ability to increase metabolic rate
- Immaturity of skin → Increased transepidermal water loss
What are the signs and symptoms of hypothermia?
- Acrocyanosis
- Hypoglycemia
- Mottled
- Pale
- Skin is cool to touch
- Respiratory distress
What can hypothermia lead to?
- apnea/respiratory distress
- bradycardia
- central cyanosis
- hypoglycemia
- acidosis
What is nursing care for hypothermia?
- Maintain a neutral thermal environment
- Pre-warmed isolette or radiant warmer
- Plastic bag for very low birth weight infants (VLBW)
- Skin to skin
- Warm infusions
- Monitor temperature, blood sugars
What is Hypoglycemia?
- Abnormally low blood sugar levels (lower than 40 in the first 72 hours)
- Glucose levels stabilize by 2-3 days of life
Which infants are at risk for Hypoglycemia?
- SGA (Small for Gestational Age)
- LGA (Large for Gestational Age)
- preterm
- low birth weight
- Infant of Diabetic Mothers (IDM)
- Infants who experience perinatal stress
- asphyxia, cold stress or respiratory distress
- those with active infection
What are the signs and symptoms of hypoglycemia?
- Abnormal cry
- Apnea
- Hypotonia
- Jitteriness
- Lethargy
- Poor feeding
- Respiratory distress
- Seizures
- Temperature instability
How to manage hypoglycemia?
- Early and frequent feeds
- Monitor blood sugar levels in at risk infants
Describe Necrotizing Enterocolitis (NEC)?
- Acute inflammatory disease of the GI mucosa, commonly complicated by bowel necrosis and perforation
- Most of the time, this is a pre-term baby issue
- Breastmilk is gold standard for protection against NEC
What can cause NEC?
- Intestinal ischemia occurs as a result of asphyxia/hypoxia or redistribution of blood flow away from GI tract
(hypotension, hypovolemia, stress etc.) - Bacterial colonization of the GI tract with harmful organisms
- Enteral feeds
What are signs and symptoms of NEC?
- Abdominal tenderness and distension
- Apnea/Bradycardia
- Decreased activity/movement
- Decreased oxygen saturation
- Decreased perfusion
- Erythema of abdominal wall
- Grossly bloody stools
- Hypotension
- Hypotonia
- Pallor/cyanosis
- Oliguria
- Temperature instability
How to treat NEC?
- NPO - no oral intake
- Antibiotics
- May require surgery
What is Newborn Jaundice/Hyperbilirubinemia?
an excess of bilirubin in the blood
Describe the conjugation of bilirubin.
- The liver is responsible for the conjugation of bilirubin
- Bilirubin needs to be conjugated to be excreted from body
- Bilirubin that is not conjugated can cross the blood-brain barrier (can lead to brain damage)
Why are newborns at risk for hyperbilirubinemia?
- They have a higher RBC mass at birth
- Neonatal/fetal RBCs have a shorter life span
- At birth, the liver cannot meet the demands of the extra bilirubin
Describe physiologic Hyperbilirubinemia.
Who does it effect? What are the causes?
- Most common
- After 24 hours of age
- More common in LPI (late preterm) and preterm infants
- Rapid breakdown of RBC
- Immature liver
- Dehydration
Describe pathologic Hyperbilirubinemia.
Who does it effect? What are the causes?
- Before 24 hours of age
- Associated with bilirubin encephalopathy or kernicterus
- ABO incompatibilities
- Maternal infections
- Maternal ingestion of sulfonamides, diazepam or salicylates near term
What are the Nursing Care Priorities for Hyperbilirubinemia?
- Increase oral intake
- Frequent feedings
- Skin care-will need frequent diaper changes
- No ointments or lotions on skin
- Strict diaper count, bilirubin is excreted through stool and, to a lesser degree, urine
- Phototherapy: position light at least 10cm from infant
- Use a bili-blanket
- Protect eyes and genitals
- Observe for lethargy, hyperthermia
What is Neonatal Abstinence Syndrome (NAS)?
group of withdrawal symptoms that occur in newborns who were exposed to drugs in utero during pregnancy
How does NAS occur?
- Opioids readily cross the placenta and affect the fetus
- Neonates exposed in utero → drug withdrawal
- Withdrawal are worse with larger amounts of drugs for longer periods
- Severity related to timing of maternal drug use
What are the signs and symptoms of NAS?
- High-pitched cry
- Hypertonia & tremors
- Irritable and hard to soothe
- Sneezing
- Sweating
- Vomiting
- Yawning
- If severe - seizures
How is NAS diagnosed?
Finnegan Scale
scoring system based on withdrawal signs (s/s)
How to treat NAS?
- IV hydration
- Tapering down of narcotic to reduce withdrawal symptoms
- Close observation for complications
- Assistive feedings, prn
- Skin to skin
Patient education for NAS?
- Anticipatory guidance: provide education regarding care, warning signs, feeding, difficulty soothing
- Referrals for support services
- Benefits of skin to skin, creating and maintaing a peaceful environment
What are the long term implications from NAS?
- Behavior and learning problems
- Developmental delays
- Motor problems
- Problems with nutrition and growth
- Speech and language problems
- Sleep problems
- Vision problems
What are complications of NAS?
- Feeding difficulties
- Jaundice
- Low birth weight (SGA)
- Seizures
- SIDS: sudden infant death syndrome
