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High Risk Newborn - Maternal
Terms in this set (149)
what factors are high-risk infants classified according to?
predominant pathophysiologic problems
what is an extremely low birth weight?
1000 g or less (2.2 lbs)
how is the age of a preterm infant corrected?
adding gestational age and postnatal age
how long is the infant's milestones corrected for?
age 2 1/2
what is very low birth weight?
1500 g or 3.3 lbs, increased risk for neurologic or cognitive disability
how do we help infants with maintaining body temperature?
use the incubator
what can rapid changes in body temperature cause?
what can cold stress cause?
a respiratory crash
what is continuous positive airway pressure therapy?
gives oxygen under pressure through a mask and nasal prongs
what should you give as far as oxygen supply if other methods fail?
what type of oxygenation method is able to give smaller volumes of oxygen at a higher rate?
why should you watch the pressure of oxygen?
the pressure can damage eyes and lungs
what are signs of respiratory distress?
grunting, nasal flaring, retractions, cyanosis
when do we give surfactant?
to keep alveoli open (respiratory care), if given a chance, we may have given mom steroids before birth to speed up infants production of surfactant)
how does nitric oxide therapy help with respiratory care?
vasodilates and increases pulmonary circulation
how does extracorporeal membrane oxygenation help with respiratory care?
machine that shunts blood to act as artificial lungs and allows baby's lungs to rest
what are the types of nourishment?
human milk or formula
what are the different feeding methods?
oral feeding, gastrostomy feedings, parenteral nutrition (IV), advancing infant feedings
what is nonnutritive sucking?
giving a pacifier while getting tube feeding
what soap should not be used on newborns?
alkaline based soaps
what are environmental concerns for newborns?
NICU, exposed to high levels of sound, light
how can we minimize environmental concerns for newborns?
keep NICU quiet, cover incubators, uses eye patches and ear muffs, cycle light
what are some ways to help with developmental care?
positioning, reducing stimulation, infant communication, infant stimulation (touch), kangaroo care (skintoskin)
prepare ahead of time if know outcome is likely death
This complication is caused by lack of pulmonary surfactant, which leads to progressive atelectasis, loss of functional residual capacity, and vetilation-perfusion imbalance- we look for meconium aspiration or high-risk mom like diabetic//twin, male infant, causation at greater risk- we hear crackle- needs an xray, blood cultures
respiratory distress syndrome
complex multifactorial disorder (developmental/oxygen pressure) that affects the developing retinal vessels of preterm infants- can be mild and fix itself or can lead to blindness. More of an issue with infants earlier than 31 weeks
retinopathy of prematurity
chronic pulmonary condition occurring most commonly in preterm infants requiring mechanical ventilation
connects aorta and pulmonary artery and should close at birth but if it does not oxygenated blood gets recirculated in lungs and increases pressure in lungs (cyanosis, murmur at left sternal border/active precordium, tachycardia splenomegaly, trouble breathing, may need to restrict fluids and give ibuprofen and indomethacin which inhibit prostaglandins and causes PDA to constrict may need surgery if severe
Patent ductus arteriosus
most common type of intracranial hemorrhage (brain bleed), usually occurs in infants less then 34 weeks, history of hypoxia, birth asphyxia
germinal matrix hemorrhage
acute inflammatory disease of the GI mucosa can cause necrosis and perforation
what are the three causes of necrotizing enterocolitis?
how does intestinal ischemia causes necrotizing enterocolitis?
baby had issue with asphyxia or hypoxia and shunted blood away from GI
what does bacterial colonization have to do with necrotizing enterocolitis?
baby does not have normal flora yet
what does enteral feeding have to do with necrotizing enterocolitis?
tube feeding can cause increase in bacterial growth-breastfeeding can help decrease risk with probiotics in breast milk
what are consequences of untreated pain?
physical characteristics of post-maturity
loss of muscle mass, subcutaneous fat, dry skin, old person look, no vernix, long nails, skin may be meconium stained, often have placental insufficiency
persistent pulmonary hypertension of the newborn
various causes such as congenital, RDS, MAS, hernia- does not allow enough blood in lungs because of right to left shunting
less oxygen to baby, may be from placenta issues, smoking, infections, pre-elcampsia often have meconium
what happens as a result of hypoglycemia?
poor feeding, hypothermia, diaphoresis, tremor, jittery, weak cry, floppy, seizures, coma
if baby has less oxygen in utero makes more rbcs, may not be symptomatic or may need exchange transfusion or bilirubin treatment
what is large for gestational age?
4000 g or more at birth
exposure to RSV
respiratory syncytial virus (common cold) but issue for high-risk infants before age two
who can experience anticipatory grief?
parents who have an infant with a debilitating disease, impending death of an infant
how can you help with the loss of an infant?
involving the family in infant's are
preparing family for inevitability of death
emphasis on hospice and palliative care for infants and their families
what is birth trauma?
physical injury sustained by a neonate during labor and birth
what are risk factors for birth trauma>
maternal age <16 or >35
uterine dysfunction - overstretched with twins or macrocosmic (large) baby
preterm or postterm labor
CPD (cephalic pelvic disproportion)
abnormal or difficult presentation
obstetric birth techniques (forceps/vacuum extractions)
what are some soft tissue injuries?
erythema and ecchymosis
abrasions and lacerations
subconjunctival (scleral) and retinal hemorrhages
caput succedaneum and cephalhematoma
this fracture is a linear fracture or indentations (depressed) fractures
this bone is the most fractured during birth- shoulder gets stuck on the pelvic bone- shoulder dystocia
with this fracture immobilization may be necessary, fractures heal rapidly (may get a brace or other device)
humerus or femur fracture
who is at greater risk for fractures?
LGA over 4000 grams or 8 pounds 13 oz at greater risk
what is the most common peripheral nervous system injury, that is paralysis of arm or upper extremity and requires immobilization and gentle ROM therapy to treat?
brachial plexus injury
what is caused by upper plexus injury, shoulder and arm adducted and internally rotated and limp, wrist is flexed?
Erb - duchenne palsy
what is a lower plexus injury that is less common lower arm paralysis and wrist and arms flaccid?
what injury is the diaphragm paralyzed, and may need a vent?
phrenic nerve injury
what injury is caused by pressure on facial nerve but usually resolves quickly?
facial paralysis (palsy)
what are two types of intercranial hemorrhage?
subdural hemorrhage and subarachnoid hemorrhage
what hemorrhage is usually present with apnea, unequal pupils, tense fontanel, seizures, and even coma?
what hemorrhage occurs in term infants as a result of trauma and in preterm infants as a result of hypoxia?
what are the manifestations of spinal cord injuries?
clinical manifestations, treatment and prognosis depend on the severity and location of the injury
what condition involves increased amounts of glucose crossing the placenta and stimulates the fetal pancreas to release insulin so after birth the b.s. drops?
what is the probability of congenital anomalies among mothers with pregestational diabetes?
2-5 times that of pregnant women who do not have diabetes
what are the most frequent congenital anomalies>
cardiac, renal, musculoskeletal, and central nervous systems
what condition is described as excessive shoulder size in infants that often leads to shoulder dystocia?
what conditions occur more in infants of mothers with diabetes?
birth trauma and perinatal hypoxia
what can affect fetal lung maturity?
what is the lower limit for normal plasma glucose levels during the first 72 hrs after birth?
what are signs of hypoglycemia?
jitteriness, apnea, tachypnea, decreased activity and cyanosis
what is not usually present until 48 - 72 hrs after birth (maternal decreased renal function) and can cause jitteriness and hypoglycemia?
hypocalcemia and hypomagnesemia
what is a thickened myocardium?
what is a stretched out myocardium?
what increases the likelihood of hyperbilirubinemia and polycythemia?
increased number of red blood cells needing to be hemolyzed increases the potential bilirubin load that the neonate must clear
what is the most significant cause of neonatal morbidity and mortality?
systemic inflammatory response syndrome
what are the two types of neonatal sepsis?
early-onset sepsis - first 7 days
late-onset sepsis- 7 to 30 days
what kind of interventions are there for neonatal infections?
labs, cultures, iv meds, neutrophil increase more reliable for diagnosis than general wbc value- responds to bacterial infections
what is the most common virus, found in breast milk or through birth, there's a rash
what can happen if mother is infected with varicella in pregnancy?
can cause limb/eye issues/death
what can rubella cause?
hearing loss, eye issues (cataract/glaucoma, blindness, microcephaly, heart and brain issues
when should globulin be administered to prevent Hep B if positive mother?
within 12 hrs of birth
if mom has outbreak, antivirals end of pregnancy to mom, congenital infection rare but can be fatal or cause IUGR, microcephaly, infection, death
fecal oral common gi
what causes a slapped cheek appearance, malaise rash, fever, can cause miscarriage, IUGR, stillborn, fetal anemia, hydrops
microcephaly or miscarriage/mental/developmental issues
what is the leading cause of perinatal infections?
group B streptococcus
fecal oral, baby can get during delivery, from vagina, causes respiratory issues, rash, diarrhea, sepsis rare
what is the most common STI, and causes issues with conjunctivitis and pneumonia?
what is the second most common STI, causes eye infection, sepsis, and we use eye ointment?
what infection is foodborne, can cross placenta and causes chorioamnionitis or endometritis, brown stained amniotic fluid, still birth, miscarriage, sepsis?
what infections are nonbacterial?
toxoplasmosis - protozoan
candidiasis - fungal
what is the effect of tobacco on a baby?
low birth weight
fetal alcohol syndrome
thin upper lip, smooth philitrum, dev/growth issues, skeletal, cardiac, eye, neural issues
partial fetal alcohol syndrome
may lack facial issues, but will have developmental issues
what describes clinical signs that can be associated with withdrawal from opioids, occurs days to weeks after birth (CNS irritability and high pitched cry, cannot console, seizures, tremors, restlessness, feeding issues, exaggerated moro reflex, increased tone)
neonatal abstinence syndrome
what causes placental abruption (placenta rips from uterine wall), high risk of IUGR, low birth weight and preterm birth, associated with longer-term effects?
what also causes higher incidence of placenta abruption, preterm birth and SGA infants?
when are signs of withdrawal of benzodiazepines and barbiturates seen?
7-21 days of age
what has been associated with preterm birth, low birthweight, and NICU admission if taken late in pregnancy?
selective serotonin reuptake inhibitors (SSRIs)
what SSRI should be avoided during pregnancy?
Paroxetine, causes cardio defects, ventricular septal defects
what is the key to the identification of newborns who are at risk with substance abuse?
urine and meconium screening
what disorders occur when maternal antibodies are present naturally or form in response to an antigen from the fetal blood crossing the placenta and entering the maternal circulation?
what incompatibilities are most common with hemolytic disease of newborn?
ABO incompatibility - most common
Rh (D) incompatibility - second most common
mother forms antibodies that then destroy fetal red blood cells (hemolysis)
what are the results of Rh positive offspring of a Rh negative mother?
mild, fetal jaundice or severe, erythroblastosis fetalis, hydrops fetalis
What is ABO incompatibility?
fetal blood type is A, B, or AB and maternal type is O
naturally occurring anti A and anti B antibodies are transferred across the placenta to the fetus
what deficiency is common among neonates whose genetic heritage comes from africa, asia, the mediterranean, and middle east
lack of G6PD enzyme that protects red blood cells from reactive oxidative species and destruction
male offspring are affected more often than females
hyperbilirubinemia can be severe?
glucose-6-phosphate dehydrogenase (G6PD) deficiency
also called hemolytic disease of the newborn, type of anemia in which red blood cells of a fetus are destroyed in a maternal immune reaction resulting from a blood group incompatibility between the fetus and its mother
when should Rhogam be administered?
28 weeks of gestation, within 72 hrs after delivery, and anytime there is risk of fetal maternal hemorrhage
what test looks for antibodies floating in liquid part of maternal blood?
indirect Coomb's test
what test is done on the mother's blood to see the severity of Rh incompatibility / isoimmunization?
Anti D liter
what test is done on the cord at birth to look for antibodies on baby's RBSs serial bilirubin?
direct coombs test
what test is done using a doppler on the cerebral artery to look for anemia?
what is a congenital anomalie?
structural or functional abnormality that occurs during intrauterine life and is identified prenatally, at birth, postnatally, during infancy or thereafter
what factors are related to the incidence of congenital anomalies?
maternal health factors (nutritional status, diabetes, infections)
what are the most common, major congenital anomalies that cause serious problems in neonates?
congenital heart disease
neural tube defects
cleft lip or palate
developmental dysplasia of the hip
what are structural abnormalities of the heart or intrathoracic vessels that are present at birth and affect cardiac function? (leading cause of death from congenital anomalies)
congenital heart defects
what should you look for when assessing for heart defects?
listen for murmurs, look for cyanosis or respiratory distress
what are acyanotic congenital heart defects?
left to right shunting,
what are cyanotic congenital heart defects?
right to left shunting
transposition of great vessels
what is encephalocele?
herniation of the brain
What is anencephaly?
absence of a brain
what is incomplete close of the spinal cord?
how can you prevent spina bifida?
what spina bifida can have a dimple but there isn't a sac on the outside
what spina bifida has a sac outside
what spina bifida has meninges and fluid?
what spina bifida has spinal cord?
what intervention should you provide with spinal bifida?
placing baby in prone position
what is the most common congenital anomaly of the nose, congenital blockage of the posterior nares by a bony or soft-tissue obstruction, associated with other anomalies like cardiac?
what defect causes a problem with the formation of the diaphragm
causes interference with the development of the lungs, severe and bowels push up on lungs and push to the right side, hear heart sounds on the right side?
congenital diaphragmatic hernia
what abnormality causes the palate or lip to not be fused correctly?
cleft lip and palate
what defect causes the esophagus to end in blind pouch and the baby has coughing or choking, frothy bubbles in mouth, drooling, respiratory difficulty, cannot pass ng tube?
what defect connects the esophagus and trachea
what causes thickening in the stomach and small intestine, forceful vomiting, dehydration, weight loss
what defects involves the bowel outside of the abdomen and should be kept moist with sterile gauze over it until surgery?
omphalocele (membrane covers bowel)
gastroschisis (no membrane covering
what defect causes meconium ileus (blockage), often associated with cystic fibrosis, green emesis, put ng tube in to decompress?
what defect imperforates the anus - if no stool 48 hrs after birth suspect this
what is used to treat developmental dysplasia of the hip?
pavlik harness (6-12 weeks)
what are foot deformities?
what anomalie encompasses a range of penile anomalies with an abnormally located urinary meatus
what defect involves the bladder on the outside, surgery, may never work and have to have urinary diversion place?
what defect is not distinctly male or female involving genitalia?
deficient in enzyme phenylalanine hyrdoxylase that breaks down the amino acid phenylalanine, need phenylalanine free formula and foods and low protein diet
with this anomalie you cannot breastfeed, cannot process galactose
with this anomalie, baby is deficient in thyroid hormones, need meds, some will regain function
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