Test 2: High Risk Newborn Complications Associated With GA Flashcards
Late preterm infants describe GA
Describe needs…
Health problems…
34 - 36 weeks (8% of infants)
Needs similar to preterm
Hypo thermia/glycemia
Feeding difficulties
Hyperbillrubinemia
Resp distress
Sepsis
Describe bilirubin in later preterm infants…
Hyperbilrubin
Interventions to prevent preterm birth. (4)
Folic acid
Prevent infection
Recognize signs of labor early
Dehydration
Reason why a baby maybe born preterm….
Elective / medical CS
Preterm labor / ROM
preE
Multiples
Obesity
ART
AMA
Inaccurate EDC
Define date for preterm infants
<36.6 weeks
Birth weights for any GA
LBW low birth weight….
VLBW Very low birth weight….
ELBW Extremely Low birth weight…
LBW low birth weight
<2500 g 5lbs 8oz
VLBW Very low birth weight
<1500 3lb 5 oz
ELBW Extremely Low birth weight
<1000 g 2lbs 3oz
Percent of babies who weight 500 - 600g that survive
85 - 90%
1500 - 2499g baby has this many times increase of dying…
<1500 this many times risk of dying…
1500 - 2499 = 5x
<1500 = 92x
Causes of Prematurity
Poor
No prenatal care
<18 or >40 years old
Smoker / Coccaine
Unmarried
Stress
Multiple gestation/ Over distention of uterus
Frequent, closely spaced pregnancies
Poor nutrition
Describe major features of a preterm babies appearance
Frail / weak
Limp
Large head
Small nipples
Lots of Vernix / lanugo
Pinna is soft
PLANTAR CREASES ABSENT
Large clit & labia minora Uncovered
Undescended testes, smooth sac
Preterm have immature lungs due to lack of surfactant (Keeps alveoli from collapsing)
Describe difference between Periodic & Apneic breathing…
Periodic = Stops for 5 -10 secs WITHOUT OTHER CHANGES followed by 10 - 15 secs of rapid breathing
Apneic = >15 seconds Accompanied by Cyanosis/ Bradycardia- prevalence increases woth level of prematurity
What are retractions the result of …
Excessive compliance (Elasticity) of the chest cage, bone are pliable
Apenic breathing baby
First intervention / Following intervention…
Stimulation
Bag mask breathing
Silverman-Anderson Index
Chest movements….
Intercostal Retraction…
Xyphoid Retraction…
Nasal Flaring…
Expiratory Grunting…
Chest movements
0 Equal, 1 Respiratory lag, 2 Seesaw
Intercostal Retraction
0 None, 1 Minimal, 2 Marked
Xyphoid Retraction
0 None, 1 Minimal, 2 Marked
Nasal Flaring
0 None, 1 Minimal, 2 Marked
Expiratory Grunting
0 None (With /Without Stethoscope),
1 (Audible with Stethoscope),
2 (Audible without Stethoscope)
Respiratory equipment in order of severity
Canual
Oxygen hood
Intubation/ Ventilador
To promote respiration use these posistion in a preterm baby…
Side lying & prone
Avoid in full term babies
Teach mom to use prone posistion upon discharge to help baby with respiratory issues
T F
F
Only use in hospital with monitoring
Babies fluid needs are increased with supplemental oxygen use.
T
Ambubag can cause this problem in an infant…
Pneumothorax
Reason for thermoregulation problems in preterm infants. (5)
Thin skin
Blood vessels near the surface
Lack of subQ fat <Brown Fat
Extended limp posistion allows more heat loss
Underdeveloped brain center for thermoregulation
Skin probe on abdomen? (Ask)
Normal temp for preterm…
36.3 - 36.9
97.3 - 98.6
Normal temp for preterm is 36.3 - 36.9
Normal temp for term 36.5 - 37.5
What are signs of inadequate thermoregulation
Poor feeding
Lethargy
Irritability
Poor muscle tone
Cool skin
Mottled skin (lacy or net-like pattern of discoloration under the skin)
Hypoglycemia
Resp difficulty
Describe mottled skin.
A sign of inadequate thermoregulation in preterm
lacy or net-like pattern of discoloration under the skin
Interventions for thermoregulation
Neutral thermal environment
Radiant warmer
Warmed oxygen
Open crib
Dressed
Doubled wrapped with warmed blankets
No blanket under radiant warmer
T
Describe reasons for electrolyte imbalances in preterm (3)
Large surface area in proportion to body weight (Big Head) - Epidermal water loss
Radiant heat & Bili lights
Immature kidneys - unable to balance fluid overload / dehydration
Electrolyte balance
Monitor I & O
Plastic bags secured to perineum = PUC peri urine collector (For Drug Screen)
Weigh diapers: 1 g = __ ml of urine
Weight daily
Measure specific gravity of urine - use cotton ball on perineum
1 g = 1 mL
Urine output associated with dehydration in a preterm
<1ml/kg per hr
Dry skin
Sunken anterior fontanel
Poor tissue turgor
Tachycardia
Elevated sodium, protein, and hematocrit
Hypotension
Weight loss
Urine output <1ml /kg per hr
Are all assessments for…
Dehydration
Edema
Bulging fontanel
Decreased sodium, protein, and hematocrit
Moist breath sounds / difficulty breathing
Urine output >3mL /kg/ hr
Nursing assessments for…
Over hydration
Describe urine output for overhydration…
Urine output >3mL /kg/ hr
Skin is fragile
Avoid Alcohol/Iodine
Use ___ water for bathing - avoid drying agents
Use ____ in incubators
Sterile
Humidity
Why might a blanket be put over a babies basenet…
To block light and stimulation
Relaxation is needed for growth
Baby sleeps 90% of time inutero
Over stimulation signs…
Increases / decrease pulse/ resp rates
Stiff extended limbs
No eye contact
Yawn, coughs, regurgitation
Which GA can start to recieve oral feedings
Aprox 34 weeks
RR of ____ may require gavage (Feeding Tube) feeding due to increased risk of aspiration
70 or above
Feeding has a goal for preterm.
What happens if baby >34 weeks cannot meet their goal…
Gavage feeding the rest to meet goal
Rooting
Sucking on gavage tube, finger, pacifier
Able to tolerate holding
RR <60
Presence of gag reflex
Signs of…
Readiness to nipple
Drink milk
Adverse signs of feeding
Feeding time is…
> 25 - 30 mins
Why is feeding longer than 25 - 30 mins contradicted…
Burns too many calories
Premature babies need ___ support when feeding.
Jaw
Leading cause of all premature deaths in US
RDS Respiratory distress syndrome
Or
Hyaline membrane disease
Cause of RDS or hyaline membrane disease, #1 cause of infant death in US
Insufficient surfactant- causes collapse of alveoli upon exhalation
Atelectasis (collapse) / hypoxia occur
Signs of RDS
TX…
Tachypnea
Nasal Flaring
Retraction
Cyanosis
Audible Grunting on expiration
Decreased breath sounds
Abnormal chest x-ray
Tx: Surfactant instilled into infants, O2, CPAP, Vent, IV, Antibiotics
BPD
Bronchopulmonary Dysplasia
Major sign: infant cannot be weaned from ventilator
Prevention… (3)
May a child go home on a ventilation…
Maternal steroids to enhance lung maturity
Minimum exposure to O2 or ventilator
Avoid fluid overload.
Yes, a child can go home on ventilation
Periventricular - Intraventricular Hemorrhage (PIVH)
BLOOD VESSELS LEAK INTO CARNIAL CAVITY
RISK factors (5)
4 grades…
Resuscitation
Infusion of hyperosmolar solutions
Apnea/ Bradycardia
Mechanical ventilation
Pneumothorax
1st is least severe
Necrotizing Enterocolitis (NEC)
Usually in <1500 g
Breakdown of intestinal mucosa barrier - DUE TO BACTERIA
SS…
Feeding intolerante/ Bile colored vomiting
Abdominal distention
Septic or Hypovolemic shock
Blood in stool
Temp instability
Necrotizing Enterocolitis (NEC)
Breakdown of mucosa barrier - DUE TO BACTERIA
SS:
Feeding intolerante/ Bile colored vomiting
Abdominal distention
Septic or Hypovolemic shock
Blood in stool
Temp instability
TX….
Prebiotic
Breastfeeding
Antibiotics
Parental nutrition to allow bowels to rest
Ostomy
Short Bowel Syndrome
Causes….
Problem Short Bowel Syndrome causes…
Common symptoms…
TX…
Congenital malformation
Surgical resection
Problem: Inadequate absorption due to Inadequate surface area
SS: Diarrea/ failure to thrive
TX: Balance fluid & Electrolytes
Possible TPN
Retinopathy of Prematurity
Occurs in infants <1000g
Caused by damage to imature blood vessels in the retina, hemorrhage, permanet.
Results from (What causes the blood vessels in the retina to hemorrhage)….
Requires close monitoring of…
Too much oxygen- (Some rsh indicates from too much oxygen)
Acidosis
Prolonged mech vent
Sepsis and shock
Close monitoring of Pulse Ox
Dev milestones and Prematurity
Explain when they meet their milestones…
If premature baby is born at 33 weeks (1 month early) they will be a month behind
SGA is defined as…
<10th percentage
Congenital malformation
Chromosomal abnormalities
Genetic
Multiple gestation
Fetal infection (Rubella / cytomegalovirus)
Poor placenta function
Maternal illness preE, DM
Smoking, drug, alcohol
Lead to…
SGA
SGA
After birth monitor closely for…
Hypoglycemia
Are LGA 90th Percentile babies always Macrosomia (>4,000g) babies…
No, if they are born preterm they can be in the 90th percentile but still under 4,000g
LGA are most at risk for…
Other risk on the slide…
Increased birth trauma.
Non reassuring FHT during 2nd stage
Neonatal respiratory depression at delivery, require resuscitation
Birth trauma is associated with LGA
A generalized swelling of the soft tissues of the scalp caused by pressure during vaginal delivery, particularly prolonged labor or vacuum-assisted delivery.
Key Features:
Location: Diffuse swelling that crosses suture lines.
Cause: Pressure from the uterus or vaginal walls during delivery, causing edema (fluid accumulation).
Appearance: Soft, boggy swelling that may have a bruised or discolored appearance.
Timeframe: Present at birth and usually resolves within a few days without intervention.
Complications: Rare, as it is generally benign.
Caput Succedaneum
LGA may experience birth trauma
Definition:
A collection of blood between the periosteum (the membrane covering the skull) and the skull bone itself, caused by trauma during delivery.
Key Features:
Location: Localized swelling that does not cross suture lines, because the blood is confined to one bone (e.g., parietal or occipital).
Cause: Rupture of blood vessels due to pressure during delivery, often associated with the use of forceps or vacuum extractors.
Appearance: Firm, well-defined swelling that develops hours to days after birth.
Timeframe: Resolves gradually over weeks to months as the blood is reabsorbed.
Complications: Can lead to jaundice (due to breakdown of blood), anemia, or rarely calcification if severe.
Cephalohematoma
Caput Succedaneum
Cephalohematoma
Facial nerve damage
Brachial plexus injury, over extension & torsion of the neck, damage to cervical nerves. (ERBS PALSAY, FRACTURE OF CLAVICAL / HUMERUS)
BESURE TO CHEXK CLAVICLE POST DELIVERY FOR FRACTURE
IMMOBILIZE BY PINNING INFANTS SLEVE TO SHIRT
Hypoglycemia/ Hypocalcemia
Resp distress
Associated with…
LGA
LGA
Be prepared for resuscitation at delivery
T or F
T
Monitor for Jaundice RT bruising / Trauma in…
LGA
Higher risk in Post Term infants (2)
Meconium passage
Amniotic fluid decrease (Increased Variable Decelerations)
Posterm skin care maybe needed why?
Lack of vernix / Lanugo and macerated skin
Why might a posterm infant need help with thermoregulation…
Same reasons as SGA
Low fat stores, due to decreased placental function
PRETERM
GA assessment should be done when…
ASPA <8 Hrs
Silverman- Anderson Index
Give values
Severe Respiratory distress…
Impending Respiratory failure…
No Respiratory distress….
Severe Respiratory distress: 10
Impending Respiratory failure: 7 or below
No Respiratory distress: No Respiratory Distress
Risk for altered growth and development rt stress from over stimulating environment
Does this make sense?
Yes
Bradypnea is associated with RDS…
False
Tachypnea
Flaring
Retraction
Cyanosis
Decrease breath sounds
Ab norm x ray
What is the Silverman Anderson index used for…
Give values for the index
Evaluate Respiratory distress
0 indicates no respiratory distress
1–3 indicates mild respiratory distress 4–6 indicates moderate
7–10 indicates severe respiratory distress
