HIGH RISK NEWBORN

Identification of High Risk Infants

 Assess for congenital anomalies  Determine Gestational Age Assessment

Priority Needs of Newborns

      Initiating and Maintaining Respirations Establishing Extrauterine Balance Fluid and Electrolyte Balance Temperature Regulation Adequate Nutritional Intake Parent-Infant Bonding

HIGH RISK NEWBORN

 GESTATIONAL AGE ASSESSMENT  MOST COMMON PROBLEMShypoglycemia, hypocalcemia, resp. distress, hypothermia  SGA  AGA  LGA

Small for Gestational Age

 <2500 g (5 1/2 lbs)  Commonly due to placenta abnormality, decreased blood flow, smoking, narcotics  Appearance

SGA INFANTS- COMMON COMPLICATIONS

 PERINATAL ASPHYXIA-deprivation of o2 due to difficult birth process  ASPIRATION SYNDROME-meconium present in lungs during and before delivery  HEAT LOSS
 HYPOGLYCEMIAA plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter constitutesia in the newborn  .

complication
 HYPOCALCEMIA Hypocalcemia is defined as a total serum calcium concentration of less than 2.1 mmol/L (8.5 mg/dL) in children, less than 2 mmol/L (8 mg/dL) in term neonates, and less than 1.75 mmol/L (7 mg/dL) in preterm neonates.

LGA INFANTS
 Causes:  a. Diabetic Mother  b. Babies with Transposition of the Great
Vessels(In transposition of the great arteries, the aorta is connected to the right ventricle, and the pulmonary artery is connected to the left ventricle - the exact opposite of a normal heart's anatomy.

 c. Multiparous Mothers

Hypoglycemia
    Threat to Brain Cells Less than 30 mg/100 ml of blood = harmful After birth levels fall Infants prone to hypoglycemia

Appropriate for Gestational Age

 Healthiest Babies  Between 3000 - 4000 g

Preterm Infant
    Less than 37 weeks Less than 3500 g = LBW 1000 - 1500 g = VLBW 500 - 1000 g = Extremely VLBW

PRETERM INFANTS
 SMALL  LARGE HEAD  TRANSLUCENT SKIN, VISABLE BLOOD VESSELS  ABUNDANT Lanugo  SOLES OF FEET- minimal creases  MALES- few scrotal rugae, & testes undescended

Preterm
interventions Respirations are irregular Body temp below normal Newborn has poor suck Bowel sounds diminished Altered urine output Minimal subcutaneous fat pads  Jaundiced skin  Testes undescended in boys               Monitor vital signs Cardiopulmunary functions Admin o2 Intake output Daily weight In warming device Position every 1 to 2 hours Appropriate stimulation like touch

PRETERM INFANTS- Potential Complications

 Anemia  Kernicterus
 Persistent Patent Ductus ArteriosusDuring fetal development, this shunt protects the right ventricle from pumping against the high resistance in the lungs, which can lead to right ventricular failure if the DA closes in-uter0

PRETERM INFANTS-Nursing Diagnosis

       Impaired Gas Exchange Risk for Fluid Volume Deficit Risk for Altered Nutrition Risk for Infection Risk for Altered Parenting Diversional Activity Deficit Risk for Disorganized Infant Behavior

POSTERM INFANTS
      Neonate after 42 weeks of gestation ABSENT LANUGO LITTLE VERNIX CASEOSA ABUNDANT SCALP HAIR SKIN CRACKED & PARCHMENTLIKE WASTED APPEARANCE

 Hypoglycemia  Parchment like without lanugo  Fingernails long  Profuse scalp hair  Long and thin body  Wasting of fat and muscle in ext

 Meconium stains on nails and umbilical cord

interventions
     Provide normal newborn care Monitor for hypoglycemia Maintain newborn temp Monitor For meconium aspiration

RESPIRATORY DISTRESS SYNDROME

 CAUSE- Surfactant Production  WORK HARDER- Use more O2 & expend more energy, get hypoxic, hypercapnia, metabolic acidosis, vasoconstriction  RISK- <2500g, <28 weeks, male, IDM  SIGNS  DIAGNOSIS  TREATMENT & PREVENTION

Assessment
       Tachypnea Flaring nares Expiratory grunting Retractions Decreased breath sounds Pallor n cyanosis Hypothermia,poor muscle tone

interventions
 Monitor color rr and degree of effort in breathing  Support respi  Monitor arterial blood gas to give o2 at lowest as possible  Eye exam on o2 support  Suction evry 2 hours 

interventions
 Position new born side and back with neck slightly extended  Surfactant replacement on endotracheal tube  Percussion with small padded plastic cup or small o2 mask  Nutrition, parental participation

ILLNESS IN THE NEWBORN

     TRANSIENT TACHYPNEA MECONIUM ASPIRATION SYNDROME SUDDEN INFANT DEATH SYNDROME PERIVENTRICULAR LEUKOMALACIA HEMOLYTIC DISEASE OF THE NEWBORN

MANAGEMENT OF HIGH RISK INFANT

 PHYSICAL ASSESSMENT  THERMOREGULATION- need neutral thermal environment, use brown fat  CONSEQUENCES OF COLD STRESShypoxia, metabolic acidosis, hypoglycemia  GLUCOSE & CALCIUM  PROTECT FROM INFECTION

MANAGEMENT OF HIGH RISK INFANT

 HYDRATION- IVF for calories, electrolytes & H2O  NUTRITION- no coordination of sucking until 32-34 weeks; not synchronized until 36-37 weeks; gag reflex not developed until 36 weeks  EARLY FEEDING- within 3-6 hours  BREAST FEEDING  GAVAGE FEEDING- <32 wks. or <1500g

MANAGEMENT OF HIGH RISK INFANT

 SKIN CARE OF PREMATURE- increased sensitivity & fragile  MEDICATION - caution  DECREASE STRESS

DEVELOPMENTAL INTERVENTION
 BEFORE 33 WEEKS- minimum stimulation  34-36 WEEKS- stimulate senses but dont tire out

NURSING CARE
 PAIN CONTROL  FACILITATE PARENT-CHILD RELATIONSHIP  NEONATAL LOSS- see, hold, photo; support groups, baptize

PRETERM INFANTS
 GIRLS- labia and clitoris prominent  INACTIVE & LISTLESS- extremities remain in any position placed  IMMATURE LUNGS, SUCK, TEMP

Bilirubin
 t is normal to have some bilirubin in your blood. Normal levels are:  Direct (also called conjugated) bilirubin: 0 to 0.3 mg/dL  Total bilirubin: 0.3 to 1.9 mg/dL

HYPERBILIRUBINEMIA
 INCREASED UNCONJUGATED FORM (0.2-1.4mg/dl)  JAUNDICE WITHIN 24 HOURS  AFTER 1-2 WKS. TERM; 2 WKS PRETERM  TOTAL > 12-13 mg/dl  INCREASE >5 mg/dl/day  DIRECT >1.5-2 mg/dl

 Bilirubin (formerly referred to as hematoidin) is the yellow breakdown product of normal heme catabolism  . Heme is found in hhemoglobin, a principal component of red blood cells. Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases

 . It is responsible for the yellow color of bruises, the yellow color of urine (via its reduced breakdown product, urobilin), the brown color of faeces (via its conversion to stercobilin), and the yellow discoloration in jaundic

HYPERBILIRUBINEMIA
 DIRECT COOMBS TEST- ABO/Rhdetect the infants antibodies coating the RBS (circulating erythrocytes)

TYPES OF HYPERBILIRUBINEMIA
 PHYSIOLOGICAL JANUDICE  BREAST-FEEDING ASSOCIATED JAUNDICE  BREAST MILK JAUNDICE  HEMOLYTIC DISEASE- Blood antigen incompatibility  a. Treatment- phototherapy, exchange transfusion, prevention (RhoGAM)  b. Nursing Care

EXCHANGE TRANSFUSION
 CRITERIA- + Direct Coombs, Hg<12g/dl, Bilirubin > 20 mg/dl  AMOUNT - 2X blood volume of infant  UMBILICAL VEIN  CHECK FOR HYPOCALCEMIA  MONITOR VS, RADIENT WARMER

assessment
      Jaundice Elevated serum bilirubin levels Enlarged liver Poor muscle tone Lathargy Poor sucking reflex

Monitor presence of jaundice

 Skin color in natural light  Press finger on tip of bony prominences  Tip of the nose to ptress out capillaryblood frommthe tissues  Note jaundice head part, chest, abdomen, arms and legs, hands and feet

 Keep newborn well hydrated  Facilitate early freq feding to hasten passage of meconium excretion of bilirubin  Reports signs of jaundice in ist 24 hours  Phototherapy florescent light to dec bilirubin levels

phototherapy
 Eyedamage dehydration and sensory depri  Cover genital area for breakdown  Eye shiels and patch makesure newborn eyes are closed  Measure quantity of light every 8 hours  Increase fluds  Expect green loose stools and urine

 Monitor skin color with florescent light every 4 to 8 hours  Monitor 4 bronze color skin  Reposition every 2 hours  Monitor for bilirubinemia

HYPOGLYCEMIA
 SGA, LGA, IDM, STRESSED, INTERUTERINE MALNUTRITION  JITTERY, HIGH-PITCHED CRY, LETHARGIC  Dx- glucose <40 1st 24 hours or <50 after 24 hours, heel stick  PREVENTION- early feedings

HYPOCALCEMIA
 RISK- preterm with hypoxia, IDM, hypoglycemic  Dx- serum calcium <7 mg/dl  Tx- increase milk feedings, cal. supplements, Vit D

SEPSIS
 SUSCEPTIBLE- Diminished nonspecific and specific immunity  ETIOLOGY- Infected amniotic fluid, +BGS  DIAGNOSIS- Cultures  TREATMENT- Ampicillin & Gentamycin

Assessment
     Pallor Tachypnea Poor feeding Abdominal distention Temperature instability          Respirations O2 as prescribed Vital signs Warm in an isollette Isolation Fever Intake output Sucking reflex Jaundice, antibiotics

Meconium aspiration syndrome

 , alternatively "Neonatal aspiration of meconium") is a medical condition affecting newborn infants.  I present in their lungs during or before delivery.  Meconium is the first stool composed of materials ingested during the time the infant spends in the wombterus

 greenish or yellowish appearance of the amniotic fluid. The infant's skin, umbilical cord, or nailbeds may be stained green if the meconium was passed a considerable amount of time before birth . These symptoms alone do not necessarily indicate that the baby has inhaled in the fluid by gasping in utero or after birth. After birth, rapid or labored breathing, cyanosis, slow heartbeat, a barrel-shaped chest listen for abnormal lung sounds (diffuse crackles and rhonchi), performing blood gas tests to confirm a severe loss of lung function, and using chest Xrays to look for patchy or streaked areas on the lung

Sudden infant death syndrome (SIDS)

 is marked by the sudden death of an infant that is unexpected by medical history, and remains unexplained after a thorough forensic autopsy and a detailed death scene investigation. An infant is at the highest risk for SIDS during sleep, which is why it is sometimes referred to by the terms cot death or crib deat

causes
 B4 birth  teenage mother (SIDS rates decrease with increasing maternal age)[10] lack of prenatal care (SIDS rates increase with increasing delay in starting pre-natal care)[10] exposure to nicotine by maternal smoking (SIDS rates are higher for infants of mothers who smoke during pregnancy)[10

 mold (can cause bleeding lungs plus a variety of other uncommon conditions leading to a misdiagnosis and death). It is often misdiagnosed as a virus, flu, and/or asthma-like conditions

 exposure too smoke[15] prone sleep position (lying on the stomach  elevated or reduced room temperature[19] excess bedding, clothing, soft sleep surfaces and stuffed animals[2  0] co-sleeping with parents or other siblings may increase risk for SIDS, but the mechanism remains unclear[21]

 infant's age (incidence rises from zero at birth, is highest from two to four months, and declines towards zero after one year  Anemia, premature,gender

NECROTIZING ENTERCOLITIS
     SICK PRETERM & HIGH-RISK ISCHEMIA & NECROSIS OF GI TRACT RELATIONSHIP WITH FORMULA SIGNS- Abdominal Distention, etc. TREATMENT- D/C oral feedings, Antibiotics, Observations

BULLOUS IMPETIGO
 STAPHYLOCOCCUS AUREUS- red moist denuded area with very little crusting  WARM SALINE COMPRESSES,  ANTIBIOTICS  PREVENT SPREAD

INFANTS OF DIABETIC MOTHERS(IDM)

 BLOOD SUGAR- Hypoglycemic <40 in 1st 24 hours, 40-50 later  TRANSIENT HYPERGLYCEMIA  LGA- Fat deposits & excessive growth  HYPOGLYCEMIA- Within 1/2-4 hours  CHECK BLOOD SUGAR

NARCOTIC-ADDICTED INFANTS
 WITHDRAWAL  AUTONOMIC NERVOUS SYSTEMHyperirritability, suck vigorously but poor suckers  TREATMENT- Sedative/Hypnotic, Antianxiety  PROGNOSIS- Neuro and growth problems  NURSING- Decrease stimuli, nutrition, snuggle, protect skin

COCAINE EXPOSURE
CNS STIMULANT RISK SIDS NEURO DEPRESSION/EXCITABILITY SMALL HEAD CIRCUMFERENCE, LBW, LOWER BIRTH LENGTH  TREATMENT- Supportive, occ. sedative    

FETAL ALCOHOL SYNDROME

 MOM CHRONIC ALCOHOLIC  MENTAL RETARDATION  CHARACTERISTICS- Growth retardation, CNS manifestations, facial characteristics, fail to thrive

MATERNAL SMOKING
 GROWTH RETARDATION  INCREASED ABORTION  EMOTIONAL DEFICITS  INCREASED SIDS

MATERNAL INFECTION
T- Toxoplasmosis O- Other ( hepatitis, measles, mumps, HIV) R- Rubella- pregnant no contact C- Cytomegalovirus infection-pregnant no contact  H- Herpes simplex- Stop transmission  S- Syphilis (Gonococcal conjunctivitis & chylamydial conjunctivitis)    

CONGENITAL ABNORMALITIES
 DOWNS SYNDROME- Extra chrosome 21  a. GREATER RISK IN WOMEN >35  b. CHARACTERISTICS- Mental retardation, low set ears, head round, short stubby fingers, bridge of nose flat, tongue thick, heart defects

CONGENITAL ABNORMALITIES
 CHEMICAL AGENTS  a. BETWEEN 15-90 DAYS OF GESTATION  b. PREVENTION

CONGENITAL HYPOTHYROIDISM
 INADEQUATE THYROXINE (T4)  CLINICAL SIGNS- Hypotonia, widespread fontanelles, large thyroid, prolonged jaundice  TREATMENT- Thyroid hormone replacement

PHENYLKETONURIA
 ABSENSE OF PHENYLALANINE HYDROXYLASE  AFFECTS DEVELOPMENT OF BRAIN AND CNS  SCREENING OF NEWBORNS, REPEAT SCREENING  TREATMENT- Diet restricts phenylalanine (Lofenalac), meat and diary products restricted

GALACTOSEMIA
 DISORDER OF GALACTOSE METABOLISM  GLACTOSE ACCUMULATES IN BLOOD ORGANS  SIGNS- Lethargy, hypotonia, diarrhea  TREATMENT- Eliminate galactose (Prosobee)