Test 2: High Risk Newborn Complications Associated With GA Flashcards by Jade Ring

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

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Describe bilirubin in later preterm infants…

Hyperbilrubin

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Interventions to prevent preterm birth. (4)

Folic acid
Prevent infection
Recognize signs of labor early
Dehydration

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Reason why a baby maybe born preterm….

Elective / medical CS
Preterm labor / ROM

preE
Multiples
Obesity
ART
AMA
Inaccurate EDC

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Define date for preterm infants

<36.6 weeks

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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

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Percent of babies who weight 500 - 600g that survive

85 - 90%

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1500 - 2499g baby has this many times increase of dying…

<1500 this many times risk of dying…

1500 - 2499 = 5x

<1500 = 92x

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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

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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

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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

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What are retractions the result of …

Excessive compliance (Elasticity) of the chest cage, bone are pliable

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Apenic breathing baby

First intervention / Following intervention…

Stimulation

Bag mask breathing

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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)

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Respiratory equipment in order of severity

Canual
Oxygen hood
Intubation/ Ventilador

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To promote respiration use these posistion in a preterm baby…

Side lying & prone

Avoid in full term babies

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Teach mom to use prone posistion upon discharge to help baby with respiratory issues

T F

Only use in hospital with monitoring

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Babies fluid needs are increased with supplemental oxygen use.

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Ambubag can cause this problem in an infant…

Pneumothorax

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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

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Skin probe on abdomen? (Ask)

Normal temp for preterm…

36.3 - 36.9

97.3 - 98.6

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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

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Describe mottled skin.

A sign of inadequate thermoregulation in preterm

lacy or net-like pattern of discoloration under the skin

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Interventions for thermoregulation

Neutral thermal environment
Radiant warmer
Warmed oxygen
Open crib
Dressed
Doubled wrapped with warmed blankets

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No blanket under radiant warmer

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

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