Week 12 - Newborn Complications Flashcards
Potential sources of stress in newborns
separation from caregiver
unresponsive or inconsistent care
overwhelming sensory environment
Examples of trauma informed care for newborns
keep dyad together*
respond to care in a timely manner*
managing pain in a timely manner*
protecting sleep* cluster care
supportive environment* minimize stimulus
being led by infant’s communication
skin to skin
teach parents about infant’s cues
Short-term risks of cannabis
restricts growth
increased risk for neural tube defects
fetal anemia
developmental delays
Long-term risks of cannabis
0 to 3 - difficulties with regulation, calming down, sleep, exaggerated startle reflex
3 to 6 - memory, attention span, impulsive, less able to follow instructions
6 to 10 - increase in hyperactivity, impulsiveness, depression, anxiety
14 to 18 - poorer school performance, more likely to try cannabis
Neonatal Abstinence Syndrome (NAS)
in utero exposure to substances
withdrawal symptoms
can be from opioids, stimulants, SSRIs, alcohol, cannabis, barbiturates, cigarette smoking etc.
T or F: Symptoms of Neonatal Abstinence Syndrome (NAS) will appear right away.
FALSE
depends on substance and amount consumed
Symptoms of Neonatal Abstinence Syndrome (NAS) (many)
initial: 24 - 48 hours to 5 - 10 days after birth
tremors
irritability/excessive crying
sleep problems
muscle rigidity
high-pitched crying
seizures
hyperactive reflexes
yawning, stuffy nose, sneezing
vomiting, diarrhea
dehydration
sweating
difficulties regulation temperature
-high or low
Eat, Sleep and Console (ESC) Care Tool
for infants going through withdrawal
aims to support the achievement of developmentally normal eating, sleeping, consoling, and weight gain milestones
What does the ESC care tool monitor for?
excessive weight loss >10%
feeding difficulties r/t fussiness, tremors, uncoordinated suck, excessive rooting
inability to sleep greater than 1 hour after feeding r/t fussiness, restlessness, increased startle, tremors
unable to console within 10 minutes and/or stay consoled for longer than 10 minutes
Non-pharmacological interventions for NAS
rooming – in parent/caregiver presence
protect sleep-wake cycles
optimal feeding at early hunger cues
cue based newborn-centered care
skin-to-skin
baby held by parent/care giver
safe swaddling
quiet, low light environment
non-nutritive sucking/pacifier
rhythmic movement (rocking motion)
additional help/support in room
parent/caregiver self-care and rest
deep pressure
Most common cause of infant morbidity and mortality
sepsis
Early-onset sepsis
usually occurs in first 24-48 hours
rapid cascade
acquired through contact with maternal GU/GI tract
prolonged labour, rupture of membranes, chorio
E.coli, GBS, Haemophilus influenza, HSV, chlamydia
Late-onset sepsis
usually occurs between day 7 and 30 days of age
from environment - hospital or community
skin or mucous membranes
Staphylococci, Klebsiella, enterococci, E. coli, pseudomonas, candida
Risk factors and causes for perinatally acquire infections
Group B strep
early membrane rupture
maternal fever > 38 degrees
receiving antibiotics for an infection before delivery
untreated maternal UTI
preterm newborns
no prenatal care
intrauterine infection
TORCH acronym
Toxoplasmosis
Other (Parvovirus, Varicella zoster, measles, mumps, syphilis)
Rubella
CMV
HSV
Toxoplasmosis
parasite, often from animals (cat feces)
mom: muscles aches, fever, sore throat, skin rash
fetus: vision loss, developmental considerations
Syphillis adverse effects
miscarriage
stillbirth
newborn anemia
jaundice
hearing loss
vision loss
Rubella adverse effects
can result in early miscarriages, stillbirth
congenital rubella syndrome - deafness, heart defects, LBW, skin rash
CMV adverse effects
cytomegalo virus
pregnant person - may be asymptomatic
swab newborn
hearing loss, cognitive impairments, rash
Neonatal signs of sepsis
respiratory distress - WOB
low or high RR
low or high HR
apnea (> 20 secs)
delayed cap refill
pallor, cyanosis
mottling of extremities
decreased LOC
lethargy
hypotonic or hypertonic
poor temperature regulation
poor feeding/excessive weight loss
dehydration - decreased urine output
jaundice
vomiting, diarrhea
petechia all over body
Signs of hypoglycemia
lethargy
temperature regulation difficulties
poor tone
seizures
tremors
jittery** —> check baby’s blood sugar
weak cry
respiratory distress
apnea
eyes roll back
Risk factors for hypoglycemia
preterm (antenatal corticosteroids)
SGA or LGA
IUGR
maternal diabetes
maternal use of labetalol
perinatal asphyxia
metabolic conditions or syndromes associated with hypoglycemia
Common complications of late preterm infants
34 - 36 ^ 6 weeks
respiratory distress
hypoglycemia
temperature instability
poor feeding
jaundice
infections
Hypoglycemia for infants of diabetic mothers
at least 12 hours
stop if BG greater than 2.6mmol/L
Hypoglycemia screening for preterm and small for gestational age (SGA)
at least 24 hours
stop if feeding is well established and BG greater than 2.6mmol/L
What to do if infant is demonstrating signs of hypoglycemia
immediate glucose testing
Hypoglycemia management
skin to skin
maintain thermoregulation (env)
feeding
dextrose 40% gel in cheek
IV administration of D10W
Critical Congenital Heart Disease (CCHD)
group of heart defects within the structure or greatervessels of the heart
interfere with effective circulation of oxygenated blood
Signs of critical congenital heart disease
central cyanosis
tachycardia
poor feeding/sucking
LBW or delayed weight gain
tachypnea or increased WOB
Checking for critical congenital heart disease
pulse oximeter on R hand
and either foot
pre-ductal: R hand
post-ductal: either foot
Heart disease screening
both values must be over 90
at least 1 of the valuesmust be 95 or over
difference between the 2values must be 3% or less
value under 90 –> refer immediately!*****
Physiological jaundice
normal, transient
appears AFTER 24 hours
levels do not get to point of high concern
delayed elimination of bilirubin
Pathological jaundice
within first 24 hours
increased production of bilirubin through HEMOLYSIS
Breastfeeding associated jaundice
early onset between day 2-5
lack of effective breastfeeding
dehydration
Breastmilk jaundice
later - 5-10 days
feeding well and gaining weight appropriately
Risk Factors for Hyperbilirubinemia
maternal-newborn blood group incompatibility
prematurity
liver immaturity
delayed feeding
birth trauma causing bruising (e.g. cephalohematoma)
metabolic disorders
sepsis
congenital red blood cell abnormalities
Interventions for hyperbilirumia
bili blanket
under lights
exchange transfusion
IV IgG
Risk factors for SIDS
preterm
LWBW
multiples
low Apgar scores
CNS disturbances
family history
