High Risk newborn

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Apnea

without breathing for longer than 20 sec. accompanied with cyanosis and bradycardia

premature

before 38 weeks

tocolytic agents

stops labor

Maternal risk factors

diabetes, HTN, drug use, smoking, age, nutrition, peridontal disease
hx of previous preterm births, infections, pre-eclampsia, chronic illness

Fetal risk factors

multiple gestation

placental risk factors

placenta previa, abruptio placenta

uterine risk factors

incompetent cervix, PROM(premature rupture of membranes) poly/oligohydramios (too much/too little amniotic fluid)

Premature infant characteristics

frail and weak, underdeveloped flexor muscles
large head in comparison to body
lack subcutaneous fat
vernix and lanugo plentiful
nipples and areola faintly visible

premature infant characteristics 2

plantar creases are absent
ears soft and flat, little cartilage
male- undescended testes, smooth scrotal sac

silverman-anderson index

related to respirations 10=bad

early signs of resp. distress

retractions and grunting

nursing interventions for baby in resp. distress

high frequency O2 ventilation
inhaled nitric oxide and liquid ventilation
(perfluorochemical fluid)
change positioning frequently.
normal newborn-on back
premature-side and prone

nursing interventions for baby in resp. distress 2

suction secretions
chest physiotherapy-using very light vibration to loosen secretions
maintain hydration - thinner=better

thermoregulation in premature infants

due to skin, less fat.
extended posture- dont have flex position
lack of O2

thermoregulation interventions

constant monitoring by a skin probe.
abdominal temp is ideally 36-36.5 degrees

normal BG in newborns

40-50

Dehydration symptoms

dry skin, poor skin turgor, fontanels depressed
elevated sodium and HCT levels
hypotension
weight loss, decreased urine output

Overload symptoms

edema, weight gain
bulging fontanels
decreased sodium and HCT levels
moist breath sounds
difficulty breathing

Skin problems

fragile, permeable, and easily damaged
dont use adhesive tape, benadine or alcohol

potential for infection

3-10 times greater in preterm infants

pain in infants

cry, vitals increase, high pitched cry, "cry face" O2 sats decrease, increased intracranial pressure

nutrition of preterm infants

do not have storage of calcium and iron
30-90% develop hypocalcemia
hypoglycemia develops rapidly
need average of 110kcal/day
freq swallowing/gulps=sign of trouble

nutritional interventions

parenteral nutrition-IV solutions
gavage used <34 weeks
oral feedings once they reach 34 weeks and are at least 1500 grams
provide carbs, amino acids, fatty acids, calories, vitamins and minerals

parental bonding

encourage touch-kangaroo care (skintoskin)

Respiratory distress syndrome

severe retractions, grunting
atelectasis and hypoxia, decreased blood flow
evident within a few hours of birth
nasal flaring, cyanosis

surfactant

plentiful by 34 weeks, produced by 22 weeks. without surfactant lungs become sticky

interventions for resp. distress syndrome

surfactant replacement
mechanical ventilation (cpap)
IV fluids
continuous airway pressure

periventricular-intraventricular hemorrhage

< 32 weeks with hydrocephalis
results from a rupture of blood vessels in the brain, associated with hypoxia
grade 1-4

peri-intra ventricular hemorrhage symptoms

lethargy, change in resp. status with cyanosis, decreased reflex, full or bulging fontanels and seizures

ventricular hemorrhage interventions

watch to see if head is getting bigger
measure head circumfrence
screening by US
may need shunting
handle the infant minimally and gently

Retinopathy of prematurity

can result in blindness or severe impairment
caused by damage to immature blood vessels in the retina of eye
can result from too much or not enough oxygen, acidosis, prolonged mechanical ventilation, sepsis
MONITOR pulse ox readings
at risk <28 weeks, 1500 grams

necrotizing enterocolitis (NEC)

necrotic lesions of the mucosa of the intestines
caused by interference with blood supply to the intestinal mucosa
decreased blood supply can be caused by hypoxia

symptoms of NEC

increased abdominal girth
increased gastric residual
decreased or absent bowel sounds
loops of the bowels seen through abd. walls
vomiting, bile stained residuals
blood in stools
change in VS, infection
x-ray shows gas in intestinal wall

NEC interventions

antibiotics, d/c oral feedings, surgery
enteral feedings, ostomy

post-term infant

those born after the 42 week of gestation

SGA

fall below the 10th percentile
IUGR due to many reasons-often poor placental functioning

LGA

above the 90th percentile
weigh more than 4000g-8lbs,13 oz
longer labor
injury common during birth
look for injuries,hypoglycemia,polycythemia(abnormal # erythrocytes)
c-sections are common

Meconium aspiration syndrome(MAS)

10-15%
occurs in infants who have decreased amniotic fluid and are prone to cord compression
rare before 38 weeks
results in obstruction of the airways, pneumonitis, and persistant pulmonary hypertension

MAS causes

most often seen when hypoxia causes increased peristalsis and relaxation of the anal sphincter previous to or during labor
meconium in the amniotic fluid enters the fetuss lungs during episodes of hypoxia

MAS assessments/treatment

dark staining, x ray findings=patchy infiltrates of adelectasis, barrel chest
-clear the airway
scope is passed and infant is suctioned before its first breath, ET tube is placed if needed
extracorporeal membrane oxygenation

hyperbilirubinemia

pathologic jaundice
bilirubin level 5-7mg jaundice is visible
incapitibiltiy between blood of mother and fetus. rh- mom/rh+ baby

kernicterus

deposits of bilirubin in the basal ganglia, cerebellum and hippocampus
(bilirubin encophalogy)

nursing interventions for hyperbilirubinemia

diagnose babys blood type-coombs test
follow bilirubin levels closely
phototherapy-special fluorescent lights
exchange transfusions

phototherapy

bilirubin in the skin absorbs the light and is changed into water soluble products-limirubin
then limirubin is excreted in stool and urine
side effects- eye damage, frequent loose stools , green stools
at risk for dehydration

exchange transfusions

done when phototherapy isnt working
removes antibodies,bilirubin, and sensitized RBCs before they breakdown
type O rh neg blood is used to replace blood removed

vertical infections

rubella, CMV, alovirus, syphilis, toxoplasmosis, group B streptococci, hep B and herpes

horizontal infections

nosocomial infections or from family

sepsis infections

bacteria in blood stream during or after birth
collect many cultures. CBC, c&s
pre terms at risk
be vigilant-watch behaviors and temp
CRP C-reactive protein=sign of inflammatory process going on.

infant of diabetic mother

may be SGA if mom has had DM for a long time and has vascular changes
congenital anomalies are more common
high risk for asphyxia and RDS
HYPOGLYCEMIA!
BG levels need to be at least 45

IDM interventions

infants need to be fed immediately if hypoglycemia occurs
gavage if infant is not sucking well or has tachypnea
use of formula or breast milk-prevents rapid rise in BS that comes from dextrose in water feedings

Hypocalcemia

serum blood levels less than 7 mg
be alert for tremors,irritability,poor feeding,high pitched cry, apnea, muscle twitching, seizures, tachycardia,jitters,EKG changes
IV- calcium gluconate-watch for bradycardia or arrythmias

drug exposed infant

most drugs cross placenta
abuse in first 2 months can cause congenital anomalies, later interferes with development
assess for neonatal abstinence syndrome

cocaine exposed infants

experience neurotoxicity but not withdrawal

S&S of drug babies

jittery, exaggerated rooting reflex, freq vomiting, weak uncoordinated sucking, resp. signs, nasal stuffiness, sneezing, tachypnea, retractions. high pitched cry

nursing care for drug babies

collect ordered specimans-urine , blood
look for co-morbid conditions
administer meds as ordered
may need gavage or IV nutrition-increase Kcal.
referrals are needed

Phenylketonuria

genetic disorder that causes toxic levels of amino acid-phenylalbumin in blood.
deficiency in liver enzymes
"heel stick"

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