The High-Risk Newborn

Question 1

High-risk neonate

Answer 1

-Newborn under 28 days
-Greater than average chance of morbidity or mortality, usually bc of conditions superimposed on normal course of events associated w/ birth and adjustment to extrauterine existence

Question 2

Developmental outcomes

Answer 2

-Improved survival rate w/ use of technology and EBP practice
-Decreasing mortality and morbidity rates have remained stable
-Developmental assessment: synactive theory of infant development, individualized development care

Question 3

Cardiovascular and hematologic complications

Answer 3

-Patent ductus arteriosus (PDA)
-Anemia
-Hemorrhage can cause permanent damage
-Baby can stroke while in uterus
-Polycythemia
-Retinopathy of prematurity (ROP_

Question 4

Neurological disturbance

Answer 4

-Perinatal hypoxic-ischemic brain injury (may cause perm damage)
-Intraventricular hemorrhage (typically in preemies)
-Intracranial hemorrhage (subdural, subarachnoid, intracerebellar)
-Strokes and seizures

Question 5

Hypoxic-ischemic brain injury

Answer 5

-Most common cause of neurologic impairment
-D/t infection, trauma, metabolic issue
-May occur simultaneously or separately
-Brain damage from decrease in blood flow systemic BP, O2 and nutrients such as glcuose
-Subsequent reperfusion after event may result in bleeding of fragile capillaries and tissue ischemia

Question 6

IVH

Answer 6

-Infants < 32 weeks gestation
-Result in CNS/motor problems like cerebral palsy and seizures
-Most occur during 1st day of life

Question 7

IVH grading and prognosis

Answer 7

-Higher number = poorer outcome
-Graded as I - III +
-Neurologic consequences
-Unpredictability

Question 8

Seizures characteristics

Answer 8

-Underlying condition (usually hypoxic ischemic encephalopathy)
-Rarely well-organized tonic-clonic seizures
-Caused by metabolic, electrolytes, infection, trauma at birth, malformations

Question 9

Seizures dx

Answer 9

-Glucose and electrolytes
-CSF for blood, cell count, protein, glucose, culture
-EEG
-CT or echo
-Spinal tap

Question 10

Seizures tx

Answer 10

-Treat underlying cause
-Respiratory support
-Phenobarbital (IV or PO)
-Phenytoin (dilantin)
-Lorazepam
-Diazepam (valium)

Question 11

Hypoglycemia s/s

Answer 11

-Irritability
-Jitteriness
-Eye rolling
-Seizures
-Cyanosis
-Poor feeding
-Hypotonia
-Apnea

Question 12

Hypoglycemia tx

Answer 12

-Bolus of IV glucose if unable to feed immediately
-If using D-15 or D-25, must infuse via central cath (UAC or UVC)

Question 13

Drug-exposed infants

Answer 13

-Opiate
-Cocaine
-Marijuana
-Methamphetamine
-Alc
-Tobacco
-Methadone
-Polydrug exposure
-Baby suffers from withdrawal after birth

Question 14

Withdrawal s/s

Answer 14

-Irritability, tremors
-Shrill cry
-Hypertonic muscles
-Poor feeding
-Vomiting, diarrhea
-Seizures
-Sleep disturbances
-Fever, temperature instability
-Diaphoresis
-Nasal stuffiness, sneezing
-Tachypnea
-Hyperactive