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High Risk Newborn

The Preterm Newborn

Delivery prior to 37 weeks gestation

Factors
Multiple gestation
PROM
incompetent cervix
Maternal disease

Preterm Newborn Complications


Patent

ductus arteriosus (PDA)

Apnea
Respiratory

Distress Syndrome
Intraventricular hemorrhage (IVH)
Retinopathies of prematurity (ROP)
Auditory, speech & neurologic defects

Postdates Newborn

Born after 42 weeks

Postdates are prone to:

Hypoglycemia
Meconium aspiration
Polycythemia
Congenital anomalies
Seizures
Cold Stress

Nursing management for postdates


Serial
O2

Glucose Testing

therapy

Thermoregulation
Lab

work

techniques

Large for Gestational Age (LGA)


Infants

>90th percentile for weight at birth

Factors

Maternal diabetes
parental obesity
male infants,
multiparous
Genetics
Erythroblastosis fetalis

Large for Gestational Age (LGA)


Complications

Difficult delivery, birth trauma, hypoglycemia,


polycythemia high risk for cesarean births due to
CPD and breech

Nursing

implications

Assess for birth injury


Vital signs
Monitor for hypoglycemia
Educate the family

Small for Gestational Age (SGA)


At

or below the 10th percentile

Contributing

factors:

Genetics
Malnutrition
Vascular changes in PIH/DM
Maternal factors
Environmental factors
Placental factors
Fetal factors

SGA Complications
Perinatal

asphyxia
Aspiration Syndrome
Hypothermia
Hypoglycemia
Polycythemia

Hypothermia (Cold Stress)

Excessive heat loss that requires a newborn to use


compensator mechanisms to maintain core body
temperatures
Who is at risk?

Preterm and SGA newborns

Signs and Symptoms

Decreased temperature
Increased respiration
S/S of hypoglycemia

Hypoglycemia
Blood

glucose is less than 40 mg/dL


Signs & Symptoms

Lethargy/jitteriness
Poor feeding
Vomiting
Pallor
Apnea
Tremors
High pitched cry
Exaggerated moro reflex

Nursing Interventions for


Hypoglycemia
Check

blood glucose levels:


Q1H x 4hrs then Q4H x 24 hrs
If high risk infant- 2,4,6,12,24,48hrs
Early feeds
IV D10W based on body weight

Sepsis in the Newborn


Immature

immune system and lack of


factors for phagocytosis put neonates at
risk for infection

Signs & Symptoms


Pallor/dusky

looking

Lethargy
Temperature

fluctuations - hypothermia
Decreased intake - vomiting, poor feeding
Hyperbilirubinemia

Treatment
Preventative

Strict hand washing


Reverse isolation
Individual equipment
Limited visitors
Turning, ROM

Labwork

treatment includes:

- cultures, WBC

Spinal tap
Double antibiotic therapy (amp & gent)

Jaundice
Yellow
Two

pigment deposited in lipid tissue.

types:

Physiologic jaundice

Pathologic jaundice

Types of Jaundice
Physiologic

Seen in second or third day of life


Treated with phototherapy

Pathologic

Jaundice

Jaundice

Seen in first 24 hrs. Level above 12 mg/dL


May require exchange transfusion &/or
phototherapy

Care of the Neonate


Phototherapy
Exposure to high intensity light decreases the serum
bilirubin levels in the skin.

High volume feeds. Increase fluids


Cover newborn eyes, genital area
Monitor I & O
Provide stimulation
Hydration status
Skin care
Safety - burns

RDS Respiratory Distress


known

as hyaline membrane disease.

Caused

by the absence of surfactant


which prevents alveolar collapse on
expiration.

Respiratory Distress

Early symptoms
include:
Hypothermia
Nasal flaring
Expiratory grunting
Sternal and/or
subcostal retractions
Tachypnea(>60
respirations)

Worsening symptoms
include:
See saw breathing
Decreased urinary
output
Pallor/ ashy grayish
color
Periods of apnea(>15
secs)
Bradycardia

Managing RDS
Surfactant

replacement and/or steroid

therapy
Oxygen

administration and monitoring

Ventilator
Prevent

management (CPAP,HFOV)

hypothermia, hypoglycemia, stress


during care of infant - minimal touch
therapy

Drug/Alcohol abused infants


Common Complications
Respiratory Distress
Jaundice
Congenital abnormalities
Growth retardation
Behavioral abnormalities
Withdrawal

Metabolic Conditions
Hereditary

disorders - increased
metabolites toxic to the newborn
PKU - phenylketonuria
Galactosemia
Hypothyroidism
Others
MST - Done in first 72 hrs of birth