1. High Risk Neonatal Nursing Care
Developed by D. Ann Currie, RN, MSN

2. High Risk Newborn Nursing Care

3. Fetal/Neonatal Risk Factors for Resuscitation
Nonreassuring fetal heart rate pattern
Difficult birth
Fetal scalp/capillary blood sample-acidosis pH<7.20
Meconium in amniotic fluid
Prematurity
Macrosomia or SGA
Male infant
Significant intrapartum bleeding
Structural lung abnormality or oligohydramnios
Congenital heart disease
Maternal infection
Narcotic use in labor

4. Fetal/Neonatal Risk Factors for Resuscitation (continued)
An infant of a diabetic mother
Arrhythmias
Cardiomyopathy
Fetal anemia

5. Respiratory Distress Syndrome (RDS)
Deficiency or absence of surfactant
Atelectasis
Hypoxemia, hypercarbia, academia
May be due to prematurity or surfactant deficiency

7. RDS: Nursing Care Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
Education and support of family

9. Transient Tachypnea of the Newborn (TTN)
Failure to clear lung fluid, mucus, debris
Exhibit signs of distress shortly after birth
Symptoms
Expiratory grunting and nasal flaring
Subcostal retractions
Slight cyanosis

10. TTN: Nursing Care Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
Support and educate family

11. Meconium Aspiration Syndrome (MAS)
Mechanical obstruction of the airways
Chemical pneumonitis
Vasoconstriction of the pulmonary vessels
Inactivation of natural surfactant

12. MAS: Nursing Care Assess for complications related to MAS
Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration

13. Persistent Pulmonary Hypertension (PPHN
Blood shunted away from lungs
Increased pulmonary vascular resistance (PVR)
Primary
Pulmonary vascular changes before birth resulting in PVR
Secondary
Pulmonary vascular changes after birth resulting in PVR

14. PPHN: Nursing Care Minimize stimulation
Maintain adequate respiratory status
Observe for signs of pneumothorax
Maintain adequate nutritional status
Maintain adequate hydration status
Support and educate family

16. Cold Stress Increase in oxygen requirements
Increase in utilization of glucose
Acids are released in the bloodstream
Surfactant production decrease

18. Cold Stress: Nursing Care
Observe for signs of cold stress
Maintain NTE
Warm baby slowly
Frequent monitoring of skin temperature
Warming IV fluids
Treat accompanying hypoglycemia

19. Hypoglycemia Symptoms
Lethargy or jitteriness
Poor feeding and sucking
Vomiting
Hypothermia and pallor
Hypotonia, tremors
Seizure activity, high pitched cry, exaggerated moro reflex

20. Hypoglycemia: Nursing Care
Routine screening for all at risk infants
Early feedings
D10W infusion

21. Physiologic Hyperbilirubinemia
Appears after first 24 hours of life
Disappears within 14 days
Due to an increase in red cell mass

22. Pathologic Hyperbilirubinemia
Appears within first 24 hours of life
Serum bilirubin concentration rises by more than 0.2 mg/dL per hour
Bilirubin concentrations exceed the 95th percentile
Conjugated bilirubin concentrations are greater than 2 mg/dL
Clinical jaundice persists for more than 2 weeks in a term newborn

23. Causes of Pathologic Hyperbilirubinemia
Hemolytic disease of the newborn
Erythroblastosis fetalis
Hydrops fetalis
ABO incompatibility

24. Treatment of Pathologic Hyperbilirubinemia
Resolving anemia
Removing maternal antibodies and sensitized erythrocytes
Increasing serum albumin levels
Reducing serum bilirubin levels
Minimizing the consequences of hyperbilirubinemia

25. Maternal-Fetal Blood Incompatibility
Rh incompatibility
Rh-negative mother
Rh-positive fetus
ABO incompatibility
O mother
A or B fetus

26. Phototherapy: Nursing Care
Maximize exposure of the skin surface to the light
Periodic assessment of serum bilirubin levels
Protect the newborn’s eyes with patches
Measure irradiance levels with a photometer
Good skin care and reposition infant at least every 2 hours
Maintain an NTE and adequate hydration and nutrition

28. Anemia Hemoglobin of less than 14 mg/dL (term)
Hemoglobin of less than 13 mg/dL (preterm)
Nursing management
Observe for symptoms
Initiate interventions for shock

29. Polycythemia Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit
Monitor for signs of distress
Assist with exchange transfusion

30. Clinical Manifestations of Sepsis
Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit
Monitor for signs of distress
Assist with exchange transfusion
Temperature instability
Feeding intolerance
Hyperbilirubinemia
Tachycardia followed by apnea/bradycardia

31. Clinical Manifestations of Syphilis
Rhinitis
Red rash around the mouth and anus
Irritability
Generalized edema and hepatosplenomegaly
Congenital cataracts
SGA and failure to thrive

32. Syphilis: Nursing Management
Initiate isolation
Administer penicillin
Provide emotional support for the family

33. Gonorrhea Clinical Manifestations Nursing management Conjunctivitis
Corneal ulcerations
Nursing management
Administration of ophthalmic antibiotic ointment
Referral for follow-up

34. Clinical Manifestationfs of Herpes
Small cluster vesicular skin lesions over the entire body
DIC
Pneumonia
Hepatitis
Hepatosplenomegaly
Neurologic abnormalities

35. Herpes: Nursing Management
Careful hand washing and gown and glove isolation
Administration of IV vidarabine or acyclovir
Initiation of follow-up referral
Support and education of parents

36. Chlamydia Clinical Manifestations Nursing management Pneumonia
Conjunctivitis
Nursing management
Administration of ophthalmic antibiotic ointment
Referral for follow-up

37. Needs of Parents of At-risk Infants
Realistically perceiving the infant’s medical condition and needs
Adapting to the infant’s hospital environment
Assuming primary caretaking role
Assuming total responsibility for the infant upon discharge
Possibly coping with the death of the infant if it occurs

38. Facilitating Parental Attachment
Facilitating family visits
Allowing the family to hold and touch the baby
Giving the family a picture of the baby
Liberal visiting hours
Encouraging the family to get involved in the care

40. Cont. to Study other conditions from the Text