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408 Maternity Exam 2 > Newborn Complications > Flashcards

Newborn Complications Flashcards

1
Q

Describe newborn complications in term infants.

When do they occur? What are some common complications?

A
  • 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)

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2
Q

What are causes of preterm complications?

(contributing factors)

A
  • Assistive reproduction
  • Genetics
  • Maternal disease processes
  • OB history
  • Placental insufficiency
  • Socioeconomics
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3
Q

What is Transient Tachypnea of the Newborn (TTN)?

A
  • 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
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4
Q

What are signs and symptoms of TTN?

A
  • Respiratory rate > 60 breaths/min.
  • Cyanosis
  • Grunting
  • Nasal flaring
  • Retracting
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5
Q

What are Nursing Care & Priorities for TTN?

A
  • Monitor respiratory rate
  • Minimal exertion
  • No oral feeding (or very limited)
  • Supplemental oxygen
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6
Q

What can contribute to TTN?

A
  • Cesarean delivery without labor
  • <39 weeks
  • Maternal diabetes
  • SGA/LGA
  • Traumatic delivery
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7
Q

Why do premature infants have respiratory problems?

A
  • 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
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8
Q

What is Respiratory Distress Syndrome (RDS)?

A
  • Breathing disorder caused by immature (premature) lungs
  • Lack of surfactant
  • The more premature (earlier the gestation) the higher the chance of RDS
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9
Q

What are signs and symptoms of RDS?

A
  • 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

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10
Q

Who does RDS affect?

A
  • 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
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11
Q

How do you decrease severity of RDS?

A

Prenatal corticosteroids (betamethasone, 2 doses given 24 hours apart)

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12
Q

How is RDS treated?

A
  • Exogenous surfactant
  • Mechanical support prn (CPAP, ventilator)
  • Warm moist oxygen
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13
Q

Describe Surfactant.

A
  • 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
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14
Q

Compare TTN and RDS.

Who does it effect and how should support be given?

A

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
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15
Q

Which infants are at risk for Hypothermia?

and why?

A

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
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16
Q

What are the signs and symptoms of hypothermia?

A
  • Acrocyanosis
  • Hypoglycemia
  • Mottled
  • Pale
  • Skin is cool to touch
  • Respiratory distress
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17
Q

What can hypothermia lead to?

A
  • apnea/respiratory distress
  • bradycardia
  • central cyanosis
  • hypoglycemia
  • acidosis
18
Q

What is nursing care for hypothermia?

A
  • 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
19
Q

What is Hypoglycemia?

A
  • Abnormally low blood sugar levels (lower than 40 in the first 72 hours)
  • Glucose levels stabilize by 2-3 days of life
20
Q

Which infants are at risk for Hypoglycemia?

A
  • 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
21
Q

What are the signs and symptoms of hypoglycemia?

A
  • Abnormal cry
  • Apnea
  • Hypotonia
  • Jitteriness
  • Lethargy
  • Poor feeding
  • Respiratory distress
  • Seizures
  • Temperature instability
22
Q

How to manage hypoglycemia?

A
  • Early and frequent feeds
  • Monitor blood sugar levels in at risk infants
23
Q

Describe Necrotizing Enterocolitis (NEC)?

A
  • 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
24
Q

What can cause NEC?

A
  • 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
25
Q

What are signs and symptoms of NEC?

A
  • 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
26
Q

How to treat NEC?

A
  • NPO - no oral intake
  • Antibiotics
  • May require surgery
27
Q

What is Newborn Jaundice/Hyperbilirubinemia?

A

an excess of bilirubin in the blood

28
Q

Describe the conjugation of bilirubin.

A
  • 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)
29
Q

Why are newborns at risk for hyperbilirubinemia?

A
  • 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
30
Q

Describe physiologic Hyperbilirubinemia.

Who does it effect? What are the causes?

A
  • Most common
  • After 24 hours of age
  • More common in LPI (late preterm) and preterm infants
  • Rapid breakdown of RBC
  • Immature liver
  • Dehydration
31
Q

Describe pathologic Hyperbilirubinemia.

Who does it effect? What are the causes?

A
  • Before 24 hours of age
  • Associated with bilirubin encephalopathy or kernicterus
  • ABO incompatibilities
  • Maternal infections
  • Maternal ingestion of sulfonamides, diazepam or salicylates near term
32
Q

What are the Nursing Care Priorities for Hyperbilirubinemia?

A
  • 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
33
Q

What is Neonatal Abstinence Syndrome (NAS)?

A

group of withdrawal symptoms that occur in newborns who were exposed to drugs in utero during pregnancy

34
Q

How does NAS occur?

A
  • 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
35
Q

What are the signs and symptoms of NAS?

A
  • High-pitched cry
  • Hypertonia & tremors
  • Irritable and hard to soothe
  • Sneezing
  • Sweating
  • Vomiting
  • Yawning
  • If severe - seizures
36
Q

How is NAS diagnosed?

A

Finnegan Scale

scoring system based on withdrawal signs (s/s)

37
Q

How to treat NAS?

A
  • IV hydration
  • Tapering down of narcotic to reduce withdrawal symptoms
  • Close observation for complications
  • Assistive feedings, prn
  • Skin to skin
38
Q

Patient education for NAS?

A
  • 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
39
Q

What are the long term implications from NAS?

A
  • Behavior and learning problems
  • Developmental delays
  • Motor problems
  • Problems with nutrition and growth
  • Speech and language problems
  • Sleep problems
  • Vision problems
40
Q

What are complications of NAS?

A
  • Feeding difficulties
  • Jaundice
  • Low birth weight (SGA)
  • Seizures
  • SIDS: sudden infant death syndrome

408 Maternity Exam 2 (5 decks)

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