- 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

- Exogenous surfactant - Mechanical support prn (CPAP, ventilator) - Warm moist oxygen

- 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

Newborn Complications Flashcards by Megan Lam

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)

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What are causes of preterm complications?

(contributing factors)

Assistive reproduction
Genetics
Maternal disease processes
OB history
Placental insufficiency
Socioeconomics

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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

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What are signs and symptoms of TTN?

Respiratory rate > 60 breaths/min.
Cyanosis
Grunting
Nasal flaring
Retracting

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What are Nursing Care & Priorities for TTN?

Monitor respiratory rate
Minimal exertion
No oral feeding (or very limited)
Supplemental oxygen

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What can contribute to TTN?

Cesarean delivery without labor
<39 weeks
Maternal diabetes
SGA/LGA
Traumatic delivery

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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

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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

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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

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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

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How do you decrease severity of RDS?

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

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How is RDS treated?

Exogenous surfactant
Mechanical support prn (CPAP, ventilator)
Warm moist oxygen

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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

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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

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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

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What are the signs and symptoms of hypothermia?

Acrocyanosis
Hypoglycemia
Mottled
Pale
Skin is cool to touch
Respiratory distress

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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