N113 - Care of the high risk newborn

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Premature

Infant born before completion of 37 weeks. Major problem of preterm newborn is immaturity of all systems.

Characteristics of preterm infant

Small & scrawny-minimal subq fat, large head, skin-bright pink, abundant fine lanugo hair, soft & pliable ear cartilage

Male preterm

Undescended testes, few scrotal rugae

Female preterm

Labia majora is under-developed, labia minora & clitoris are prominent.

Preterm reflexes

Sucking is absent or weak; swallowing, gag & cough reflexes are absent or weak.

Respiratory alteration in preterm

Lungs not fully mature, lack of sufficient surfactant, increased respiratory distress syndrome.

Thermoregulation in preterm

Heat loss is major problem - prone to cold stress. Little subq fat, thinner more permeable skin

Clinical problems of preterm newborn

Apnea, Patent ductus arteriosis, RDS, intraventricular hemorrhage, hypoglycemia, necrotising enterocolitis, anemia, hyperbilirubinemai, infection

Post-mature newborn

Born after 42 weeks

Post-mature associated factors

5 or more pregnancies, history of prolonged pregnancies

Post-mature infant characteristics

Absence of lanugo, little vernix, abundant scalp hair, long fingernails, cracked skin, wasted physical appearance (aging of placenta), depletion of subq fat

Large for gestational age (LGA)

Best known condition associated with LGA is maternal diabetes.

LGA complications

Birth trauma, increased chance of c-section & induction, hypoglycemia, polycthemia - increased # of RBC's

Small for gestational age (SGA)

Newborns at or below the 10th percentile, may be preterm or postterm, IUGR - intrauterine growth restriction

Maternal factors contributing to IUGR

Maternal factors - smoking, lack of prenatal care, age extremes (under 16 over 40) Maternal disease - heart disease, substance abuse, PIH

Environmental factors contributing to IUGR

High altitude, exposure to x-rays, excessive exercise, work related exposure to toxins

Placental factors contributing to IUGR

Small placenta, infarcted area, abnormal cord intersections, placenta previa

Fetal factors contributing to IUGR

Congenital infections, malformations, chromosomal syndromes

Complications of SGA newborn

Prenatal asphyxia, aspiration syndrome, heat loss, hypoclycemia, polycythemia

Prenatal asphyxia - SGA

Chronic hypoxia in utero

Aspiration syndrome - SGA

In utero - fetus can gasp during birth aspirating amniotic fluid into lower airways Hypoxia can lead to relaxation of anal sphincter & passage of meconium

Heat loss - SGA

Diminished subcutaneous fat, depletion of brown fat in utero, large surface area extremities not contracted

Hypoglycemia - SGA

Inadequate supplies of enzymes to activate gluconeogenesis, increase in metabolic rate in response to heat loss, infant will have routine one touch

Polycythemia - SGA

Increased # of RBC's - considered a physiologic response to hypoxic stress, produce more RBC's to carry O2, causes an increase in bilirubin

Nursing care for high risk newborn

#1-Support respiratory function, thermoregulation, protect from infection, hydration, nutrition

Respiratory distress syndrome (RDS)

Also known as Hyaline membrane disease. Result of absence or deficiency in the production of surfactant.

RDS manifestation

Scattered atelectasis, overinflation of some areas, grunting, cyanosis on room air, tachypnea, nasal flaring

RDS management

Ventilator support, surfactant replacement therapy, In severe RDS - partial liquid ventilation

RDS complication

Too much O2 can cause retina damage

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