1. High Risk Newborn
Mary L. Dunlap MSN, APRN
Fall 10

2. Preterm Infant Infant born prior to the completion of the 37th week
Organs immature
Lack physical reserves
Survivability related to weight / gestational age

3. Preterm Infant Respiratory last to mature Surfactant deficiency-RDS
Unstable chest wall-atelectasis
Immature respiratory centers-apnea
Small passages-obstructions
Unable to clear fluid-TTN

4. Preterm Infant Cardiovascular
Difficulty transitioning from fetal to neonatal circulatory pattern
Congenital anomalies due to continued fetal circulation
Fragile blood vessels (brain)
Impaired regulation of B/P

5. Preterm Infant Gastrointestinal
Lack neuromuscular coordination suck- swallow-breath
Hypoxia shunts blood from the gut- ischemia and intestinal wall damage
Risk for malnutrition -wt. loss
Small stomach-compromised metabolic function

6. Preterm Infant Renal System Slow glomerular filtration rate
Reduced ability to concentrate urine
Risk: fluid retention, electrolyte imbalance, drug toxicity

7. Preterm Infant Immune system Deficiency of IgG
Impaired ability to produce antibodies
Thin skin- limited protection barrier

8. Preterm Infant Central nervous system
Long term disability due to injury
Difficulty maintaining temperature
Compounded by lack of brown fat

9. Preterm Infant Nursing Management
Varies with gestational Promote Oxygenation
Maintain body temperature
nutritional needs
Prevent infections
Provide stimulation
Pain management

10. Small for Gestational Age
SGA weight- less than 5lb 8 oz and below the 10th% at term
IUGR- High risk growth does not meet the norm and is pathologic
Symmetric IUGR- poor growth rate of head, abdomen and long bone
Asymmetry IUGR- head long bones spared

11. Small for Gestational Age Characteristics
Decreased breast tissue
Scaphoid abdomen (sunken)
Wide sutures
Thin umbilical cord
Head larger than body
Wasted appearance to extremities
Reduced fat stores

12. Small for Gestational Age Common Problems
Perinatal asphyxia
Hypothermia
Hypoglycemia
Polycythemia
Meconium Aspiration

13. Large for Gestational Age Characteristics
LGA weight- Larger than 9 lbs and above the 90th%
Large body-plump full face
Body size is proportionate
Poor motor skills
Difficulty in regulating behavioral state (arouse to quiet alert state)

14. Large for Gestational Age Common Problems
Birth Trauma-
Hypoglycemia
Polcythemia
Hyperbilirubinemia

15. Post term Infant Gestation > 42 weeks
Must determine if EDC is truly post term
After 42 weeks placenta loses ability to nourish the fetus

16. Post term Infant Characteristics
Newborn emaciated
Meconium stained
Hair and nails long
Dry peeling skin
Creases cover soles
Limited vernix and lanugo

17. Infant of Diabetic Mother
Mother can have pregestational or gestational diabetes
Increasing numbers of type 2
Related to increase in morbidity & mortality
Congenital abnormalities

18. Infant of Diabetic Mother
Congenital abnormalities- during first trimester due to fluctuations in BS and ketoacidosis
Macrosomia- develops last trimester due to maternal hyperglycemia- excessive fetal growth
Tight control over glucose levels needed ( less than 1-0mg/dl)

19. Infant of Diabetic Mother Common Problems
Congenital Abnormalities
Macrosomia
Birth Trauma
Perinatal Asphyxia
RDS
Hypoglycemia
Hyperbilirubinemia
Polycythemia

20. Infant of Diabetic Mother
Infant Characteristics
Rosy cheeks
Short neck
Wide shoulders
Excessive subcutaneous fat
Distended abdomen

21. Infant of Diabetic Mother Nursing Management
Monitor glucose level q. 3 to 4 hrs. level no above 40 mg/dl
Until stable monitor q. 3-4 hrs
Feed q. 2-3 hrs
IV glucose
Monitor serum bilirubin levels
Maintain thermal environment

22. Respiratory Distress Syndrome
RDS caused by lack of surfactant
Poor gas exchange & ventilation
Seen in preterm newborns
Cesarean births without labor
Infants of diabetic mothers

23. Respiratory Distress Syndrome Symptoms
Tachypnea
Expiratory grunting
Nasal flaring
Retractions
See-saw respiration
Chest x-ray- alveolar atelectasis (ground glass pattern) & dilated bronchioles ( dark streaks within granular pattern)

24. Respiratory Distress Syndrome Nursing Management
Thermoregulation
O2 administration
Mechanical ventilation if needed
Hold parenteral feedings
Monitor VS & O2 sats
Provide nutrition ( gavage feedings)

25. Transient Tachypnea Newborn TTN
Mild respiratory condition
Result of delayed absorption of fluid
Last about 3 days

26. Transient Tachypnea Newborn TTN
Symptoms
Respiratory rate as high as
Labored breathing
Grunting nasal flaring
Retractions
Chest x-ray shows lymphatic engorgement ( retained lung fluid)

27. Transient Tachypnea Newborn Nursing Care
Mainly supportive
Monitory VS & O2 Sats
Provide supplemental O2

28. Meconium Aspiration
Fetus inhales meconium into the lungs while in utero
Meconium blocks the airway preventing exhalation
Meconium irritates the airway making breathing difficult
Meconium aspiration related to fetal distress during labor.

29. Meconium Aspiration Symptoms
Cyanosis
Rapid breathing
Labored breathing
Apnea
X-ray patches or streaks of meconium & trapped air

30. Meconium Aspiration Nursing Management
Assess for risk factors prior to delivery
Suction at delivery prior to newborn crying
Supplemental O2
Mechanical ventilation
Antibiotic therapy

31. Hyperbilirubinemia
Excess of bilirubin in the blood-elevated bilirubin level > 5mg/dl
Heme from erythrocytes break down forms unconjugated bilirubin
Jaundice
Physiologic
Pathologic

32. Hyperbilirubinemia Causes
Drugs/Medical conditions disrupt conjugation and albumin binding sites
Decreased hepatic function
Increased erythrocyte production
Enzymes in breast milk

33. Hyperbilirubinemia Physiologic
Develops in 3-4 days after term birth
Develops3-5 days after preterm birth
Term birth resolves 7 days
Preterm birth resolves 9-10 days
Unconjugated bilirubin level < 12mg/100 ml

34. Hyperbilirubinemia Pathologic
Develop after first day
Persists beyond 7 days
Bilirubin > 12.9mg/100 term
Bilirubin > 15mg/100 preterm
Increases > 5mg/100ml in 24hrs

35. Hyperbilirubinemia Nursing Management
Phototherapy
Increase feeding to q 2-3 hrs

36. Phenylketonuria PKU
Inability to metabolize phenylalanine- amino acid found in protein
Affect brain and CNS development
Interferes with the production of melanin, epinephrine & thyroxine
Both parents must pass the gene on

37. Phenylketonuria PKU Symptoms
Seizures
Irritability
Tremors
Jerking movements arms & legs
Hyperactivity
Unusual hand posturing

38. Phenylketonuria PKU
Diagnosed with PKU screening prior to discharge from hospital

39. Hemolytic Disorders
Hemolytic disease occurs when blood groups of mother and newborn are different
Antibodies are present or formed in response to antigen from fetal blood crossing placenta and entering maternal circulation
Most common
Rh incompatibility
ABO incompatibility

40. Hemolytic Disorders
Maternal antibodies of IgG class cross placenta, causing hemolysis of fetal RBCs
Fetal anemia
Neonatal jaundice
Hyperbilirubinemia

41. Hemolytic Disorders Rh incompatibility (isoimmunization)
Only Rh-positive offspring of Rh-negative mother is at risk
If fetus is Rh positive and mother Rh negative, mother forms antibodies against fetal blood cells

42. Hemolytic Disorders ABO incompatibility
Occurs if fetal blood type is A, B, or AB, and maternal type is O
Incompatibility arises because naturally occurring anti-A and anti-B antibodies are transferred across placenta to fetus
Exchange transfusions required occasionally

43. Neonatal Infections Sepsis Bacterial, viral, fungal Patterns
Early onset or congenital
Nosocomial infection—late onset

44. Neonatal Infection Septicemia Pneumonia Bacterial meningitis
Gastroenteritis is sporadic

45. Neonatal Infections TORCH infections Toxoplasmosis Gonorrhea Syphilis
Varicella-zoster
Hepatitis B virus (HBV)
Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)