Newborn Complications Flashcards
What are some predictive risk factors associated with high risk infants?
Low socioeconomic level e.g.
Exposure to environmental dangers e.g. smoking
Pre-existing maternal conditions e.g. kidney failure, diabetes
Maternal factors e.g. low-socioeconomic status
Medical conditions related to pregnancy e.g. pregnancy-induced hypertension
Pregnancy complications e.g.
preterm labour
What are the parameters for “preterm”, “term”, and “postterm” infants?
Preterm = is <37 weeks gestation Term = is 37-40 weeks gestation Postterm = >42 weeks gestation
What is considered “appropriate for gestational age” in size? (AGA)
Between the 10th and the 90th percentile
What are the two types of small gestation age babies?
SGA symmetric
SGA asymmetric
What is symmetric small gestational age? (what causes it)
Chronic hypertension, severe malnutrition, chronic intrauterine viral infection, substance abuse, genetic anomalies
What is asymmetric small gestational age? (what causes it)
Placenta infarcts, preeclampsia, poor wt. gain in pregnancy
What is the difference between symmetric and asymmetric small gestational age babies?
Symmetric:
Long term maternal condition Noted early 2nd trimester Chronic, prolonged restriction Decrease # and size of cells Everything is small
Asymetric:
Assoc. with acute compromise
Noted in 3rd trimester
Restriction in 3rd trimester
Decrease size of cells
Wt decreased but head & length are not
What are some physical findings of small gestational age babies?
Small size, decreased fat & muscle mass
poor skin tugor, loss of vernix
Full term nails, dull hair, separate skull bones
Sunken abdomen, small liver
Developed creases & cartilage
Often a thin, meconium stained cord
Alert, wide eyed, developed reflexes
What is the appearance of large gestational age babies?
Increased body fat, macrosomic, ruddy, large placenta and cord
What are the reasons for large gestational size?
Poorly controlled diabetes, genetics, multiparity, male
What causes the IDM to typically be large? (What is going on inside with the glucose and the insulin)
Mother- high blood sugars (glucose)
Fetus has ↑glucose in blood, muscle & fat
Fetus converts fat to glycogen & stored
Fetus becomes large (macrosomic)
Fetus produces ↑ levels of insulin in utero
What causes hypoglycemia in IDM after delivery?
Fetus produces increased levels of insulin in utero.
Infant has minimal intake (colostrum) and is producing increased insulin = hypoglycemia
What are some common complications and potential nursing diagnoses for an IDM?
- Respiratory distress syndrome
Risk for impaired gas exchange (rt. Decreased surfactant, aspiration). - Hypoglycemia
Risk for unstable blood sugars (related to hyperinsulinemia (increased insulin)) - Hypocalcemia
Risk for imbalance in calcium homeostasis (related to hypoparathyroidism) - Hyperbilirubinemia
Risk for neonatal jaundice (related to increased RBC breakdown, trauma) - Birth trauma
Risk for injury related to LGA status - Congenital anomalies
Risk for anomalies related to IDM status
What level of blood glucose is considered normal/too low in a newborn?
Normal = above 2.6
What should be done for an infant with a blood glucose of 1.8 to 2.5? (nursing actions)
Feed small frequent feeds & check BS @ 1hr. Continue to monitor
What are the objective data that indicate hypoglycemia in a newborn? (Signs and symptoms)
Lethargy, apathy, hypotonia Poor feeding/sucking reflex, vomiting Pallor, cyanosis Hypothermia or temperature instability Apnea, irregular respirations, RDS (tachypnea) Tremors, jerkiness, seizure activity Weak or high-pitched cry
What is the typical behaviour of a postterm infant?
Wide eyed, alert
What is the appearance of the postterm infant?
long & thin, wasting (↓subcutaneous tissue)
Skin- loose, dry, cracking, parchment like, absence of lanugo & vernix
Fingernails long, hair profuse
Meconium stained nails, skin & cord
What are some potential nursing diagnoses for postterm infants?
- Impaired gas exchange related to in utero hypoxia or meconium aspiration
- Unstable blood sugar levels (hypoglycemia) related to deprived nutrition and limited glycogen stores in utero
- Hypothermia related to loss or poor development of subcutaneous fat
- Neonatal jaundice related to polycythemia in utero hypoxia
What is transient tachypnea of the newborn? (TTN)
Progressive respiratory distress
What is the etiology of TTN (transient tachypnea of the newborn)?
Infant fails to clear airway of lung fluids/mucous. May be caused by aspiration.
What is the incidence of TTN?
11/1000 live births
Which babies are at an increased risk for TTN (transient tachypnea of the newborn)?
C-section, LGA, late preterms, intrauterine or intrapartum asphyxia
What are the signs and symptoms of TTN?
Shortly after birth - grunting (expiratory), nasal flaring, mild cyanosis after birth
Tachypnea usually within 6 hours
Rate >60-120 per min
