1. Normal and The High Risk Newborn Transition to Extra-Uterine Life
Prof. Carole A. Devine RN.MSN.

2. Respiratory System: Initiation of Breathing
Successful Transition:
Pressure Changes in Lungs
S/S of Respiratory Distress
Prevention of Aspiration /Airway Management
Prof. Carole A. Devine RN.MSN.

3. Meconium Aspiration Syndrome
Can Cause Severe Respiratory Distress in Three Ways:
Inflammation
Obstruction
Decreased Surfactant Production
Outcome= Hypoxia and CO2 Retention and Possible Pneumonitis
Prof. Carole A. Devine RN.MSN.

4. Meconium Aspiration Syndrome Cont.
Assessment
Therapeutic Management
Prognosis
Complication
Prof. Carole A. Devine RN.MSN.

5. Immune System/Integumentary System
Prevention of Infection
Safety Issues/Newborn Care
Prof. Carole A. Devine RN.MSN.

6. Prof. Carole A. Devine RN.MSN.
Sepsis Neonatorum
Definition:
Transmission/Etiology
Types:
Early Onset vs Late Onset
S/S
Management
Prof. Carole A. Devine RN.MSN.

7. Prof. Carole A. Devine RN.MSN.
THERMOREGULATION
Necessity of A Neutral Thermal Environment
Too Hot = Must decrease metabolism to cool their body
Too Cool =Must Increase Metabolism to stay warm
This effects the Preterm Baby especially Because:
Has a large surface area per pound of body Wt.
Extended body rather than flexed
Decreased subcutaneous fat
Poor Muscular Development
Limited amt. of brown fat
Prof. Carole A. Devine RN.MSN.

8. Thermoregulation Cont.
Maintain a Neutral Thermal Environment/Prevent Hypothermia
Newborn Care:
Drying Infant after Birth
Cover Head
Use A Heated Radiant Warmer
Kangaroo Care
Breast Feeding !!!!
Prof. Carole A. Devine RN.MSN.

9. Prof. Carole A. Devine RN.MSN.
Endocrine System
Potential Risk for Hypoglycemia
Definition of Hypoglycemia for a Newborn: Glucose < during first 72 hrs. of life in full term infant
Problem/S/S
Newborn Care:
Prof. Carole A. Devine RN.MSN.

10. Cardiovascular /Hematopoietic System
Potential Risk For Hemorrhage/ Cardiovascular Compromise
Newborn care:
Administer Vitamin K (Phytonadione) give
0.5mg -1.0 mg IM in the Vastus Lateralis Muscle at birth
V.S. every 15 min. after birth for one hour, then every ½ hour x 2,then every two hours until stable
Prof. Carole A. Devine RN.MSN.

11. Prof. Carole A. Devine RN.MSN.
Renal /G.I.System
Potential for Inadequate Elimination Patterns
Newborn Care:
Daily Wt.
Nutrition /Fluid and Electrolyte Balance
Premie.Vs Full Term:
Calorie Concentration in formula fed Infants will be different i.e.
Full Term = 20 cal./fl. ounce
Premie. = 24 cal./fl. ounce
Breast Feeding: Advantages
Prof. Carole A. Devine RN.MSN.

12. Prof. Carole A. Devine RN.MSN.
Hepatic System
Bilirubin
Hyperbilirubinemia ( Jaundice):
Definition:
Conjugated vs. Unconjugated:
Unconjugated =Fat soluble=Indirect
Conjugated = H2O soluble=Direct
Etiology/Normal Conjugation of Bilirubin:
S/S
Complications
Prof. Carole A. Devine RN.MSN.

13. Prof. Carole A. Devine RN.MSN.
Types of Jaundice
Physiologic
Onset : occurs on the 2-3rd day of life
Cause:
Bili. Level: <10-12
Tx. Encourage feeding and elimination
Pathologic:
Onset: during first 24 hrs. of life
Cause:
Bili. Level: 13 and> in full term; 15 in Premie
Tx. Phototherapy i.e. (Bili-lights)
Exchange Transfusions
Prof. Carole A. Devine RN.MSN.

14. Prof. Carole A. Devine RN.MSN.
Jaundice (Cont.)
Breast Milk Jaundice:
Onset: Between the 4 -7th day after Birth
Bilirubin Levels Can peak at two weeks up to 15-20
Causes:
Tx. D/C Breast Feeding temporarily for hrs. and place infant in a sunny window
Prof. Carole A. Devine RN.MSN.

15. Gestational Age Assessment
Indicators of Maturity in the Newborn
Dubowitz and Ballard Scales are used to Determine
Categories: SGA (small for Gestational Age) IUGR (Intrauterine Growth Restriction) VS
LGA (Large for Gestational Age)
(Macrosomia)
Prof. Carole A. Devine RN.MSN.

16. Small for Gestational Age Neonates (SGA)
Definition/Appearance:
Etiology:
Diagnosis:
Risk Factors/Common Cause:
Nursing Management:
Developmental Outcome:
Prof. Carole A. Devine RN.MSN.

17. Large For Gestational Age Neonate (LGA)
Definition/Appearance:
Etiology:
Diagnosis:
Risk Factors/Common Cause:
Nursing Management:
Developmental Outcome:
Prof. Carole A. Devine RN.MSN.

18. The Premature (Preterm) Infant
Criteria/Definition:
Wt. <2500G ( 5 1/2 lbs ) at Birth
Infant born between the 20th week and <end of 37th week Gestation
General Appearance:
Small and underdeveloped
Head is large
General Appearance cont:
Ruddy skin-little subcutaneous fat
Veins are readily noticeable
Extensive lanugo with little vernix
Little or no creases on sole of foot
Prof. Carole A. Devine RN.MSN.

19. Collaborative Problems of the Preterm Infant
Respiratory Distress Syndrome (RDS)
Definition/Etiology Underdevelopment of lungs
Chief feature= fibrous membrane formed by exudate of infant’s blood that forms lining of respiratory tract (prevents exchange of CO2 and O2)
Problem: decrease production of Surfactant
L/S ratio is low (Lecithin/Sphingomyelin)
Management
Prevention
Prof. Carole A. Devine RN.MSN.

20. Collaborative Problems Cont.
Broncopulmonary Dysplasia (BPD)
Etiology/Incidence
S/S
Management
Prof. Carole A. Devine RN.MSN.

21. Peri/Intraventricular Hemorrhage (PVH)(IVH)
Etiology
Incidence:
S/S
Diagnosis
Management
Prof. Carole A. Devine RN.MSN.

22. Necrotizing Entercolitis
Etiology/Incidence
S/S
Diagnosis
Management
Prof. Carole A. Devine RN.MSN.

23. Retinopathy of Prematurity (ROP)
Definition/Etiology:
S/S:
Management: Prevention:
L/T. Consequences
Prof. Carole A. Devine RN.MSN.

24. Prof. Carole A. Devine RN.MSN.
Post Term Infant
Definition: Gestational age > than 42 weeks
Factors assoc. with Post Term:
Aging Placenta
Oligohydramnios
CPD (Cephalopelvic Disproportion)
MAS
Factors Cont.
Hypoglycemia
Polycythemia
Thermoregulation
Appearance
Therapeutic Management
Prof. Carole A. Devine RN.MSN.

25. Infant of a Diabetic Mother
Appearance:
Etiology:
Complications:
Management:
Prof. Carole A. Devine RN.MSN.

26. Prenatal Drug Exposure
Risk Factors:
Effect on Fetus/Newborn:
Neonatal Abstinence Syndrome
Management/Nursing Care
Alcohol
Heroin
Cocaine
PCP
Marijuana
Caffeine
Nicotine
Prof. Carole A. Devine RN.MSN.

27. Torch Infections That Effect The Fetus/Newborn
S/S; Nursing Dx.; Management (see handout)
T=Toxoplasmosis
O=Other:
Gonorrhea
Syphilis
Varicella
Hepatitis B Virus
HIV
R= Rubella
C=Cytomegalovirus (CMV)
H=Herpes Simplex Virus (HSV)
Prof. Carole A. Devine RN.MSN.

28. Parenting Issues with a High Risk Newborn
NSG.DX. High Risk for Altered Parenting R/T Impaired Parent/Infant Bonding
Promote Bonding
Emotional support
Fetal Demise
Nursing Responsibilities
Care of Infant
Care of Family
Prof. Carole A. Devine RN.MSN.

29. THE END Of THE STORY ! ! For Now……
Prof. Carole A. Devine RN.MSN.