Newborn Complications Flashcards
SGA causes
Small Gestational Age
causes:
- maternal factors/disease/smoking
- environmental, placental and fetal factors
Complications of SGA & IUGR
- fetal hypoxia, asphyxia
- aspiration syndrome
- hypothermia
- hypoglycemia
- polycythemia
- hyperbilirubinemia
Care for SGA is aimed…
at promoting growth (feeding and NTE) and caring for complications
IUGR
intrauterine growth restriction
- advanced gestation
- extremes of maternal age
- lack of prenatal care
- low socioeconomic status
IUGR associated with…
- hypoglycemia (very common)
- congenital malformations
- intrauterine infections
future:
- growth difficulties
- cognitive delays
Differentiating SGA and IUGR
-not synonymous
SGA NB is constitutionally small but otherwise normal
IUGR is a fetus with delayed growth late in gestation. May not have a reduction in birth weight significant enough to be classified as SGA
Prognosis for SGA
-symmetric SGA most likely stay small
Prognosis for IUGR
- often catch up by 2nd year
- greater risk for impaired school performance, behavior problems, and poor fine motor control
- as adults, IUGR infants are at a greater risk for obesity, type 2 DM and cardiovascular dz
Post-maturity syndrome
cause: unknown, more common in certain ethnicities (Australian, Greek and Italian)
complications:
- higher risk for morbidity
- hypoglycemia and cold stress
- meconium aspiration
- polycythemia
- seizure activity
- congenital anomalies
Post-term infant
Assessment:
- dry, cracking skin
- no vernex/lanugo
- scalp hair profuse
- body long, thin
nursing care:
- most adapt well
- monitor blood glucose frequently
- assess respiratory status (risk - meconium aspiration)
- neutral thermal environment - provide warmth
Pre-term infant
- less than 37 weeks gestation
- 12 percent of all US births, 17 percent of all AA
- common in single mothers and adolescents
- rise in multiple births from IVF
- main problem is the variable immaturity of all body systems. Function is dependent on length of gestation
Thermoregulation
- glycogen and brown fat not available
- lose heat from blood vessels close to skin
- high ratio of body surface area to body weight
- extended position increases body surface area
- decreased vasoconstriction ability of superficial blood vessels
Nursing Care of the Preemie
- maintain respiratory function
- cluster care to promote rest
- maintain neutral environment
- balance fluids and electrolytes
- prevent infection
- provide adequate nutrition - breast milk is best and may fortified and given as slow continuous feed via pump. Donor milk if needed
- promote parent-infant attachment
Respiratory Distress Syndrome
- inadequate surfactant production
- pulmonary blood vessels aren’t fully developed
- decreased pulmonary vascular resistance
- left-to-right shunting through ductus arteriosus
- increased blood flow back to lungs
- surfactant required for alveolar stability
- instability causes atelectasis
- atelectasis causes hypoxemia and acidosis
Nursing care for the infant with RDS
- before birth (prevent preterm birth, admin glucocorticoids)
- after birth (surfactant replacement therapy, assess for signs of distress, cluster care)
- monitoring blood gases and pulse oximetry
- respiratory support includes nasal cannula, CPAP or intubation with ventilator
Feeding infants
- bottle feeding/breast feeding
- requires suck-swallow-breathing patterns
- gavage feeding for infants
- with poor suck-swallow-breathing patterns
- on ventilators
- who tire easily
- losing weight
- supplementation with fortifiers common
Pre-term infant short term complications
- apnea of prematurity
- hypoglycemia
- patent ductus arteriosus
- respiratory distress syndrome
- intraventricular hemorrhage
- hyperbilirubinemia
- necrotizing enterocolitis
- sepsis
Long term complications of the Preemie
- higher rate of SIDS
- retinopathy of prematurity
- broncho-pulmonary dysplasia
- speech defects
- neurologic defects
- auditory defects
- abuse and neglect
Asphyxia
-neonatal emergency can lead to hypoxia and possible brain damage or death if not correctly managed
newborn asphyxia
defined as a failure to start regular respiration within a minute of birth
perinatal asphyxia
leads to multi-organ system dysfunction
CV
alterations in blood volume, redistribution of cardiac output and a syndrome of transient myocardial dysfunction
Management of Asphyxia
- adequate ventilation
- perfusion and BP management
- fluid management
- avoid extreme glucoses
- avoid hyperthermia
- tx of seizures
- hypothermia therapy followed by slow and controlled rewarming for infants with mod to severe HIE
Meconium Aspiration Syndrome Nursing Care
- tracheal suctioning
- umbilical arterial line
- umbilical venous catheter
- high levels of O2
- exogenous surfactant
- prophylactic antibiotics
Meconium in the lungs…
- mechanical airway obstruction
- chemical pneumonitis
- vasoconstriction of pulmonary vessels
- inactivation of surfactant
Meconium assessment
- apnea
- pallor
- bradycardia
- barrel chest
- distress yellow-green skin
- nail discoloration
The key to meconium…
prevention
-suction oropharynx and naspharynx before first breath. May need to intubate to aggressively suction
-if aspiration is significant, will need ECMO
Pulmonary HTN
- Failure of the normal circulatory transition that occurs after birth
- Breathing and increase PO2 is altered so that the normal mechanisms for transition are altered
- Marked pulmonary hypertension that causes hypoxemia secondary to right to left shunting of blood
Symptoms of Pulmonary HTN
- tachypnea, respiratory distress
- loud, single second heart sound (S2)
- harsh systolic murmur (secondary to tricuspid regurgitation)
- cyanosis
- poor cardiac function and perfusion, hypotension
Management of Pulmonary HTN
- continuous monitoring of oxygenation, blood pressure, and perfusion
- maintaining a normal body temp
- correction of electrolytes/glucose abnormalities and metabolic acidosis
- nutritional support
- minimal stimulation/handling of the newborn
- minimal use of invasive procedures
Physiologic Jaundice Review
-very common most resolve with fluids only
- normal process due to:
- infant’s shortened RBC lifespan
- slower uptake of bilirubin by liver
- lack of intestinal bacteria
- poorly established hydration especially if breast fed
Total bilirubin level peaks
4-5 days old
Physiologic Assessment
- Yellowish coloring of skin/sclera
- Deposits of bilirubin in tissues
Pathologic Hyper-bilirubinemia
- appears within first 24 hours
- evidence of RBC destruction is increased retic count
- serum bilirubin rises rapidly
- conjugated bilirubin greater than 2mg
- clinical jaundice persists in term infant
Causes/risk factors for Pathologic Hyper-bilirubinemia
- ABO incompatibility
- Rh
- Asphyxia
- Neonatal/maternal drugs
- hypothermia and hypoglycemia
- prematurity
