1. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. NEWBORN CARE CHAPTER 54 Part 3

2. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. PROBLEMS OF THE NEWBORN Hyperbilirubinemia Respiratory distress Cleft lip/palate Hydrocephalus Spina bifida Down Syndrome Talipes equinovarus

3. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. PROBLEMS OF THE NEWBORN Hyperbilirubinemia – an excess of bilirubin in the blood, JAUNDICE Physiologic jaundice-appears after 24 hours Pathologic jaundice-appears in the first 24 hours May lead to kernicterus (deposits of bilirubin causing yellow staining on the brain) Phototherapy is the MOST COMMON treatment for jaundice. Infant may experience frequent, green, loose stools as the bilirubin is excreted. Exchange transfusion Blood type O, Rh-negative blood, 5-10ml removed from infant and replaced with this type blood. SLOW PROCESS. Complications of hypervolemia, hypovolemia, infection, cardiac arrhythmias, and air emoblism may occur. Rarely necessary due to widespread use of RhoGAM to prevent Rh incompatibility.

4. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. PROBLEMS OF THE NEWBORN Respiratory Distress RDS (Respiratory distress syndrome) Preterm infants Surfactant deficiency Caused by alterations in surfactant quantity, composition, function, or production. Hypoxia, respiratory acidosis, metabolic acidosis TTN (Transient tachypnea of the newborn) AGA and near-term infants Intrauterine or intrapartum asphyxia had occurred Newborn’s failure to clear the airway of lung fluid and mucus or aspiration of amniotic fluid No repiratory difficulties at birth, but develops shortly after Flaring nares, expiratory grunting, tachypnea by 6 hours, resp 100-140, cyanosis, pallor or mottling of skin, retractions

5. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. PROBLEMS OF THE NEWBORN Cleft lip/Palate –Immediate concern is problem of feeding infant Hold the infant in an upright sitting position while feeding. Special nipples and feeding devices depending on extent. Burp frequently. Side lying when sleeping. Hydrocephalus Excess cerebrospinal fluid in the cerebral ventricles, causes the infant’s head to be enlarged. Head circumference daily, check fontanelles for flat or bulging, change infant’s position frequently Infant cannot usually move the head.

6. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. PROBLEMS OF THE NEWBORN Spina Bifida 3 types spina bifida occulta-failure of the vertebral arch to close. Dimple on back which may have a tuft of hair in it. No care is required meningocele Saclike protrusion along the vertebral column filled with cerebrospinal fluid and meninges Surgery is required to repair the defect, no long term effects. mymeningocele Saclike protrusion along the vertebral column filled with spinal fluid, meninges, nerve roots, and spinal cord. Paralysis at some level after surgical repair Protrusions must be kept covered with sterile saline dressings, and the infant handled carefully when changing position from side to side. Sac must be kept from contamination for stool or urine. Fontanelles checked for bulging and head circumference measured each shift to assess for hydrocephalus.

7. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. PROBLEMS OF THE NEWBORN Downs Syndrome Chromosomal abnormality (Trisomy 21) Talipes Equinovarus Clubfoot, foot and ankle are twisted inward and cannot be moved to a midline position May be casted before going home

8. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. INFANT OF A DIABETIC MOTHER Hypoglycemia-within hours after birth Blood glucose Q1H first 4-6 hrs then Q4H x 24H IV glucose if not >45mg/dl after feedings. Monitor for and prevent COLD STRESS. S/S jitteriness/tremors, diaphoresis, poor muscle tone, low termperature, and rapid respirations. Respiratory distress-less mature lungs Hyperbilirubinemia-immature liver and increased extracellular fluid may be cause seen 48-72 hours after birth Birth trauma-Large size contributes to trauma during birth process Congenital birth defects-may include patent ductus arteriosis, ventricular septal defect, transposition of the great vessels, small left colon syndrome, and sacral agenesis.

9. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. INFANT OF AN HIV POSITIVE MOTHER Transmission may occur through placenta, maternal blood, secretions during birth, through breast milk. At birth, infant typically has no symptoms. All infants of HIV positive mothers should be presumed to be HIV positive. Breastfeeding is not recommended.

10. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. INFANT OF A SUBSTANCE-ABUSING MOTHER When umbilical cord is cut, the newborn experiences withdrawal. May develop symptoms 24-48hr after birth or to 4-5 days of age. Complications: withdrawal, respiratory distress, jaundice, behavior problems, congenital anomalies, growth retardation. Infants of alcohol dependent mothers may have fetal alcohol syndrome (FAS). May see S/S of hyperactivity, persistent high-pitched cry, tremors, seizures, tachypnea, disorganized sucking and swallowing, vomiting diarrhea, stuffy nose, yawning.

11. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. PHENYLKETONURIA (PKU) Inborn error of metabolism. Infant cannot digest amino acid phenylalanine. Test at least 24 hours after initial breast or formula feeding. Infant with PKU needs diet low in phenylalanine or severe mental retardation may occur.

12. Copyright 2005 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license.