1. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 19 Caring for the Newborn at Risk

2. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Risk Factors for Newborns  Intrauterine development  Intrapartum development  Extrauterine development

3. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley A & P Review  Lung maturity  Circulatory maturity  Neurological maturity

4. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Classification of High-Risk Newborns Gestational Age (GA)  Preterm (born before 37 weeks)  Term (born between 38 and 42 weeks)  Postterm (born after 42 weeks)

5. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Classification of High-Risk Newborns Birth Weight  Low birth weight (LBW) (<2500 g)  Very low birth weight (VLBW) (<1500 g)  Extremely low birth weight (ELBW) (<1000 g)

6. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Intrauterine Growth Restriction (IGUR)  A term used to denote a lack of intrauterine fetal growth that usually results in an SGA newborn

7. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Small-for-Gestational-Age Infants (SGA)  Infants born at any gestational age who have a birth weight that falls below the 10th percentile on the growth charts

8. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Conditions Affecting the SGA Newborn  Hypothermia  Pain  Hypoglycemia  Polycythemia

9. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Large-for-Gestational- Age Infants (LGA)  Infants born who are over the 90th percentile on the growth chart

10. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Conditions Affecting LGA Newborn  Chronic hyperglycemic state  Transient tachypnea of the newborn  Hypoglycemia  Hypocalcemia  Hypomagnesemia  Birth injuries  Brachial plexus injuries  Fractures

11. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley The Premature Newborn  Severe prematurity  23 to 26 weeks  Moderate prematurity  26 to 30 weeks

12. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Physical Assessment of the Premature Newborn  Skin  Head  Chest  Cardiac  Abdomen  Musculoskeletal  Genitalia  Neurological/sensory

13. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Conditions Affecting the Premature Newborn

14. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Respiratory Distress Syndrome (RDS)  Atelectasis with congestion and edema in lung spaces  Lecithin-sphingomyelin (L/S) ratio and phosphatidylglycerol (PG) levels low  Underdeveloped alveoli  Signs and symptoms begin shortly after birth Nursing Care:  Provide oxygenation  Maintain mechanical ventilation  Assist with endotracheal intubation (ET)  Administer syntheic surfactant via ET  Wean ASAP to prevent complications

15. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Apnea of Prematurity  Apnea >15 to 20 seconds accompanied by pallor, hypotonia, cyanosis, and bradycardia Nursing Care:  Monitor cardiorespiratory (C-R) status  Apply continuous pulse oximeter  Watch for A and B spell

16. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Jaundice  Diagnosed in term infants with a serum bilirubin level >12.9 mg/dL and in preterm infants >15mg/dL Nursing Care:  Based on underlying cause  Give phototherapy  Ensure hydration (electrolyte solution) Complications:  Bilirubin encephalopathy  Kernicterus

17. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Retinopathy of Prematurity  Result of immature retinal vasculature followed by hypoxia  Inversely related to gestational age  Risk factors  Diagnosis –– 5 stages Nursing Care:  Fluctuations in concentrations of oxygen must be prevented  Wean off oxygen ASAP  Decrease constant bright lights  Encourage routine examinations

18. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley  Anemia of prematurity  Hemoglobin below 35% and 45% Nursing Care:  Administer recombinant human erythropoieten SC  Sudden Infant Death Syndrome (SIDS)  “Back to Sleep”  Educate parents about prevention

19. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley The Post term Newborn Newborns in utero after the optimal growth time (42 weeks)  Skin is parchment-like  Fingers are long and peeling  Muscle wasting is present

20. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Conditions Affecting the Postterm Newborn Meconium Aspiration Pneumonia — meconium aspirated at birth  Meconium-stained skin, nails, and umbilical cord  Initial respiratory distress  Rales and rhonchi on auscultation Nursing Care:  Give chest physiotherapy (CPT)  Monitor mechanical ventilation  Administer medications

21. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Persistent Pulmonary Hypertension of the Newborn Vascular resistance in pulmonary system  Meconium-stained amniotic fluid  Brief respiratory distress at birth, then resolves and returns about 12 hours later  Centrally cyanotic and tachypenic  Audible murmur Nursing Care:  Extracorporeal membrane oxygenation (ECMO)  See Chapter 19 Nursing Care Plan

22. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Additional Conditions Affecting the High-Risk Newborn  Metabolic conditions  Neurologic conditions  Gastrointestinal conditions  Infections

23. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Metabolic Conditions  Phenylketonuria (PKU)  Phenylalanine-free diet, elimination of protein  Galactosemia  Galactose-free diet  Maple Syrup Urine Disease  Low-protein diet, thiamine supplements

24. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Metabolic Conditions  Homocystinuria  Diet therapy ― high doses vitamin B 6  Methionine and cystine restriction  Biotinidase Deficiency  Pantothenic acid or biotin (types of B vitamins)

25. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Neurological Conditions Intraventricular and Periventricular Hemorrhage [categorized by extent and involvement (grades)] Nursing Care:  Recognize seizures  Administer antiseizure medications  Prevent cerebral damage  Maintain adequate oxygenation  Educate parents

26. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Neurological Conditions  Anencephaly (skull and cerebrum are malformed)  Encephalocele (protrusion of brain through a skull defect)  Microcephaly (smaller than normal head circumference)  Holoprosencephaly (cerebral matter fails to form as two distinct hemispheres)

27. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Gastrointestinal Conditions Cleft Lip and Palate ― has genetic and environmental predispositions Nursing Care:  Provide adequate nutrition  Feed in upright position  Surgery: CL ― 3 months, CP ― before 18 months  Educate and provide emotional support for parents

28. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Gastrointestinal Conditions Necrotizing Enterocolitis  Ischemic episode of the bowel; can produce septicemia Nursing Care:  Ensure that oral feedings are stopped  Discuss possible surgery

29. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Abdominal Wall Defects Gastroschisis and Omphalocele Nursing Care:  Surgery within 2 to 4 hours  Cover abdominal contents with moist gauze and wrap in plastic  Position carefully  Place NG/OG  IVF at 1.5 times normal maintenance  Postoperative care focuses on fluids, electrolyte balance, nutritional support, infection protection, pain management, and keeping parents informed

30. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Infections in the Newborn Herpes Simplex  HSV-1 acquired from people with herpes lesions of the mouth  HSV-2 acquired through a genital infection Nursing Care:  Acyclovir (Avirax)  Ensure proper developmental stimulation Neonatal Sepsis  Systemic infection Nursing Care:  Review diagnostic workup  Give antibiotics for a minimum of 48 hours

31. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Developmental Delay Neonatal Abstinence Syndrome (NAS)  Drug-abusing mother  Irritability Nursing Care:  Laboratory tests done to reveal if drugs are in the newborn’s system  Use neonatal abstinence scoring tool every 3 hours

32. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Care of the High-Risk Newborn  Blood Pressure  Nutritional Care  Developmental Care  Noise  Lighting  Handling  Positioning

33. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Neonatal Intensive Care Unit  Educate parents on what to expect, rules of the unit, and expectations  Create partnership with parents  Encourage touch  Provide discharge planning

34. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Classification of the Neonatal Intensive Care Unit  Level I ― provides well newborn care and stabilization of high-risk newborns  Level II ― provides premature care (give oxygen and intravenous therapy given)  Level III ― provides care to ventilate newborns

35. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Transporting the Preterm Newborn  Transport is done if more technologically advanced care is needed  Transport team comprised of professionals  STABLE program