Newborn Health Challenges Flashcards
Acquired and Congenital Problems
Conditions or circumstances associated with birth and adjustment to extrauterine existence
- Congenital: born with, developed in utero
- Acquired: gets it after birth
Complications of Prematurity
- Respiratory distress syndrome (RDS): infants that are struggling to breathe. The earlier they are the more underdeveloped their lungs are going to be
- Patent ductus arteriosus
- pertiventricular-intraventricular hemorrhage (not tested)
- necrotizing enterocolitis (not tested)
Preterm Infant
Born before 37 weeks
- Extremely Low Birth Weight (< 1000g)
- organ systems are immature
- lack of adequate physiological reserves to function in extrauterine environment
- lower birth weight & gestational age = lower chances of survival
- responsible for 40% of infant deaths
High Risk Infants
- Size:
- Gestational Age:
Higher Risk of:
A. Size: LBW, ELBW, AGA, SFD, Sym/Assym IUGR
B. Gestational Age: preterm, late preterm, early preterm, full term, late term, post term
Higher Risk of:
- respiratory distress
- cold stress/thermoregulation
- hypoglycemia
- hyperbilirubinemia
- feeding concerns
- sepsis
High- Risk Newborn
- Born before completion of 37 weeks of gestation
- Organ systems are immature and lack adequate physiological reserves to function in the extrauterine environment
- The lower the birth weight and the gestational age, the lower the chances of survival
- causes of preterm birth
- practical and ethical dimensions of resuscitation of ELBW infants (<1000 gms)
- assess other possible complications
Feeding Premature Infants
- fatigue easy
- uncoordinated suck & swallow reflex (and breathing) - bradycardia
- do not have the energy stores to keep up
- hypoglycemia
- need for supplementation
preterm and LBW likely to have feeding issues, which leads to jaundice, which makes it more tired, which makes feeding difficult -> compounding issues
Gavage Feeding
intermittent tube feed.
A. measurement of gavage feeding tube from tip of nose to earlobe and to midpoint between end of xiphoid process and umbilicus. Tape may be used to mark correct length on tube
B. Insertion of gavage tube using orogastric route
C. In-dwelling gavage tube, the infant is propped on right side or placed prone (preterm infant) for 1 hour to facilitate emptying of the stomach into the small intestine. Note rolled towel for support
Thermoregulation
Less brown fat - utilize for heat production - no shiver
- higher ratio of surface area to body weight
- lower glycogen stores
Risk for Respiratory Distress
- Few alveoli
- lower levels of surfactant
- smaller lumen in the airways
- greater collapsibility of airway
- weak gag reflex
- potential for aspiration
Maternal Infections Leading to Neonatal Sepsis: TORCH acronym (5 common ways that neonates get infections)
Transplacental transfer of infectious agents
To determine causative agent in symptomatic infant
T: toxoplasmosis
O: other (syphilis, varicella, parovirus, HIV, West Nile)
R: Rubella (low titer would be an issue)
C: Cytomegalovirus (CMV)
H: Herpes Simplex Virus (important to know about because it can have bad consequences if it gets into the genital area. Causes cervical cancer)
Cervical Cancer and HIV
Cervical Cancer: symptoms are easy to overlook and it progresses quickly. once it is caught it usually stage 3-4
HIV: so treatable now that it is removed from the WHO list of chronic infections. Some countries allow people who have HIV to have life insurance
- it is possible for babies of mothers who are HIV positive to not have HIV. all about publicity and money hat when into that. More women than men globally have it. women are given it by positive male partners
Risk Factors for Neonatal Infection and Sepsis
Review antenatal Record:
- PROM
- Chorioamnionitis (Caused by PROM)
- intrapartum maternal temp of > 38.0
- Delivery at < 37 weeks gestation
- Maternal GBS colonization
- Positive GBS swab
- Previous infant with GBS disease
- Documented GBS bacteruria in pregnancy
- Membranes ruptures > 18 hours
Earliest clinical sins of neonatal sepsis are characterized by a lack of specificity
ASSESSMENT AND PREVENTION
Signs & Symptoms
- Apgar < 6 (and not improving. started low and didnt go up)
- lethargy and poor tone
- poor feeding
- unstable temperature
- respiratory distress (tachypnea, grunting, nasal flaring, use of accessory muscles)
Neonatal Resuscitation: everytime a baby is born this happens (rubbing down until they cry). always called that before they cry for the first time.
What happens after abnormal assessment findings that might indicate infection or sepsis
- Inform PCP and consult to Pediatrician
- transport (ITT)
- Admission to the nursery
- IV insertion with blood work (CBC, CRP, Blood cultures)
- Cardiorespiratory monitors, lumbar puncture
Neonatal Abstinence Syndrome - Neonatal Effects of Substances: Alcohol
FAS, craniofacial features, microcephaly (means smaller brain), hyperactivity, developmental delays, attention deficits
Neonatal Abstinence Syndrome - Neonatal Effects of Substances: Cocaine
preterm, SGA, microcephaly, poor feeding, irreg sleep patterns, visual attention, hyperactivity, difficult to console, hypersensitivity, developmental delays, congenital anomalies - they will have these side effects for the rest of their lives
Neonatal Abstinence Syndrome - Neonatal Effects of Substances: Heroin
LBW, SGA, irritability, tachypnea, feeding difficulty, vomiting, high-pitched cry, seizures. causes a lot of neurological issues.
Neonatal Abstinence Syndrome - Neonatal Effects of Substances: Tobacco
Preterm, LBW, risk for SIDS (because it effects development of lungs permanently, risk for bronchitis & pneumonia, develop delays, orofacial clefts.
Neonatal Abstinence Syndrome - Neonatal Effects of Substances: Marijuana
neonatal temors, LBW, IUGR, attention problems
Tobacco and Marijuana at any time during pregnancy will have similar permanent and long term effects as alcohol
Naloxone Nursing Alert
The use of naloxone (narcan) is contraindicated in infants born to women addicted to narcotics or on methadone therapy - because it makes the body over respond to the effects
The Post-mature Infant
- Gestation beyond 42 weeks, regardless of birth wt.
- meconium aspiration syndrome (MAS) d/t stress in utero, CLOSE MONITORING. can lead to Persistent pulmonary hypertension of newborn.
MAS: low apgars, difficulty breathing, amniotic fluid green, brown, or black or flecked.
Large for Gestational Age (birthweight > ninetieth percentile)
- Greater risk for morbidity, macrosomia, asphyxia, congenital anomalies
- risk of birth injuries
- infants of diabetic mothers
- risks: hypoglycemic, hypotonia, lethargic
- hypocalcemia, and hypomagnesemia. Cardiomyopathy, hyperbilirubinemia and polycythemia, RDS, congenital hyperinsulinemia
Nursing Care: LGA Infants
- astute assessment and early identification of problems
- serum blood glucose levels
- monitor for birth injuries, referrals
Birth Trama
Physical injury sustained during labour and birth.
- may be avoidable
- ultrasound enables antepartum diagnosis of certain fetal conditions that may be treated in utero or shortly after birth
- elective C/S to prevent significant birth injury
A small percentage of significant birth injuries are unavoidable despite skilled and competent obstetrical care
- difficult or prolonged labor
- abnormal presentation
Some injuries cannot be anticipated until circumstances are encountered during childbirth
Nursing Care:
skeletal injuries
peripheral nervous system injuries
- Erb palsy
- brachial palsy
- Facial nerve paralysis
- Phrenic nerve paralysis
Palsy: incomplete motor control
Paralysis: lack of feeling and lack of motor control
Hemolytic Disease of Newborn
ABO incompatibility - mat antibodies cross placenta and attach fetal RBC - hemolysis (can occur in 1st pregnancy)
Hyperbilirubinemia : rapid rate of RBC destriction
- maternal antibodies present naturally or form in response to antigen from fetal blood crossing placenta and entering maternal circulation
Rh incompatibility (isoimmunization)
- Only Rh-positive offspring of Rh negative mother is at risk
- if fetus is Rh positive and mother is Rh negative, the mother forms antibodies against fetal blood cells
- if they are both + it doesnt matter. and if both - it doesnt matter.
Prevention: admin of RhIG (Rhogam) to all unsensitized Rh-neg mothers after birth within 72 hrs
Congenital Anomalies
- the most common major congenital anomalies causing serious problems in neonate:
- Congenital heart disease (most complex organ in the body) - apply oxymeter
- abdominal wall defects
- imperforate anus
- neural tube defects
- cleft lip or palate
- clubfood
- developmental dysplasia of the hip
Nursing Care Management: Genetic Diagnosis and Newborn Screening
Phenylketonuria (PKU)
- caused by deficiency/absence of enzyme to metabolize phenylalanine (essential amino acid)
- accumulation of phenylalanine in blood stream & urine
- Clin manifest: failure to thrive, vomiting, irritability, hyperactivity, cognitive impairment
Hypothyroidism: iodine deficiency, cog impairment, thyroid hormone replacement (heel stick test)
Nursing Care: newborn - eliminate all milk and lactose hormone replace. Educate: information, guidance, and emotional support
