07bahigh risk newborn

7/30/2019 07baHigh Risk Newborn

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NEONATAL

DISEASES


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High Risk Newborn?

A newborn, regardless of gestational age or birthweight, who has a greater than average chance ofmorbidity or mortality because of conditions orcircumstances superimposed on the normal

course of events associated with birth and theadjustment to extra uterine existence.

Greater chance of complications because offactors affecting -

Fetal development

Antenatal period of mother Labour and birth.

Complications - unexpected and without warning.


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CLASSIFICATION OFHIGH RISK NEONATES


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Classified according to .

Etiological factors

Special care requirements

Size

Gestational age


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According to etiological factors

Low birth weight (LBW) infant

Infant who requires technologicalsupport

The infant

whose irreversible conditionwill result in an early death.


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According to special care

requirements Those requiring special or assistive

feeding techniques

Thoserequiring respiratory assistance Those with complex congenital

anomalies requiring supportive and

assistive devices.


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According to size

LBW Less than 2500 gm regardless of gest age

MLBW 1501 2500 gm

VLBW -


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According to mortality

Live birth Birth in which the neonate manifests anyheart beat, breathes or displays voluntary movement,regardless of birth weight

Fetal death - Death of fetus after 20 weeks of gestation

and before delivery, with absence of any signs of life afterbirth

Neonatal death Death in the first 27 days of life (Earlyfirst 7 days)

Post natal death Deaths that occur at 28 days to 1 year

Perinatal mortality Total no of fetal and early neonataldeaths per 1000 live births


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ORGANIZATION OF SERVICES

FORHIGH RISK NEONATES


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Level I facility (Minimal care)

Can identify high risk pregnancies & high riskneonates early

Can implement emergency care in the event ofcomplications

80% Newborns require minimal care

Birth wt >2000 gm & Gest age > 37 wks

Care at home, sub center or PHC

Management of normal maternal & newborn care

Care of newborns by mothers under supervision Basic care at birth, providing warmth maintaining

asepsis, promoting breast feeding

Traditional birth attendants can be trained


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Level II facility

Dist hospitals, teaching institutions,

nursing homes

Provides a full range of maternity and

newborn care

Equipped to manage the majority of

maternal & neonatal complications

15 20% neonates

Birth wt 1500 2000 gms, Gest age 32 36 wks

Trained nurses and paediatricians

Equipments For resuscitation, thermoneutral environment,IV infusion, gavage feeding, phototherapy, exch bloodtransfusion

No compromise on adequate space, nursing staff, asepsis,care equipments


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Level III facility

Apex institutions & regional

Perinatal centers

Offers full range of maternal &

newborn services of a level II

facility Has capacity to provide care for

the most complex neonatal complications

Equipped with O2 & suction facilities, servo controlledincubators, vital sign & transcutaneous monitors,ventilators and infusion pumps etc

3 5% neonates

Birth wt


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Transporting High Risk

Newborn Before birth - Intra uterinetransfer

After birth Incubator

transportation after stabilization

( warm, oxygenation/ intubation,

vitals, O2 saturation, IV infusion

as req)

Transport team A

neonatologist, a neonatal nurse,a resp therapist able to

intervene as necessary


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CARE OFHIGH RISK NEWBORN


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Assessment

Apgar- Evaluation of cardiopulmonary &neurologic functions

Constant observation Pulse-oximetry,elect, blood gases

Detailed & ongoing record - of theinfants condition

Systematic assessment Changes in behaviour, activity, SaO2, vital

signs


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Monitoring Physiological Data

TPR - in thermo-neutral environment

Have alarm systems (yet, comparemonitor readings with manual findings)

Accurate I/O records

Blood Glucose, Bilirubin, elect, Ca,

hematocrit, gases (Imp - Record amt ofblood drawn)


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Respiratory support

Positioning & airway maintenance

Suction - SOS

Supplemental O2Assisted ventilation


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Thermoregulation

External warmth Servo-controlled incubator

Radiant warmer

100 watt bulb

Neutral thermal environment


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Hydration

Supplemental parenteral fluids Add calories,

elect & water

Monitor fluid status by

Daily weightsAccurate I/O record

Urine examinations

Watch out for -Hypo/ hyperglycemia


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Nutrition

105 130 cal/kg/day for PT infants

Parenteral route (ELBW, VLBW,critically ill) &/ Enteral route

Prevents jaundice


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On the one hand, intensive care allows preterm infants to survive

On the other hand, the treatment has many adverse consequences


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Oh somebody

Help!


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http://images.google.co.in/imgres?imgurl=http://www.sunnybrook.ca/files/RESHpreterm_infant.jpg&imgrefurl=http://www.sunnybrook.ca/research/areas/pg/neonatal&h=187&w=249&sz=12&hl=en&start=1&um=1&tbnid=agQUYzV3_2-1fM:&tbnh=83&tbnw=111&prev=/images%3Fq%3Dpreterm%2Binfant%26um%3D1%26hl%3Den%26sa%3DN


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PREPARATION FORDISCHARGE


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Parental education

Return demonstrations Routine child care activities

Care in minor ailments

Hand-outs/ Booklets on child care

Parent rooming-in

Follow up At Well baby clinic

Telephonically


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PRIMARY CAUSES OF NEONATAL DEATHS

IN INDIA

CAUSE OF DEATH NUMBER PROPORTION1) BIRTH ASPHYXIA 517 28.8%2) IMMATURITY3)INFECTIONS4) CONGENITAL

MALFORMATIONS5)MISCLLEANEOUS

408263168444

22.7%14.6%9.3%

24.6%


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Etiology of preterm baby

So many aspects concerning high-risk

neonates are related to the incidence of

prematurity however, the exact cause of

prematurity is not known in most instances.

The incidence of prematurity is lowest in the

middle to high socioeconomic classes, in which

pregnant women are generally in good health,

are well nourished and receive prompt and

comprehensive antenatal care.


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The incidence is highest in the lower

socioeconomic class in which a combination of

deleterious circumstances is present.

Prematurity may be caused by multiple

pregnancies,

Illness of mother (e.g. malnutrition, heart

disease, diabetes mellitus, or infectious

conditions)

Hazards of pregnancy itself, such as

Pregnancy induced hypertension (PIH),


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Placental abnormalities that may result in

premature rupture of the membranes.

Placenta previa (the placenta lies over the

cervix instead of higher in the uterus) and

premature separation of the placenta.


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1) Respiratory distress in newborn babies

Respiratory difficulties constitute the commonest

cause of morbidity in newborn babies.

The clinical diagnosis of respiratory distress in the

newborn is suspected when the respiratory rate is

more than 60 per minute in a quiet resting baby and

there are inspiratory costal recessions or expiratory

grunt.


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Assessment of Severity of RDS

The presence and intensity of cyanosis and its

response to oxygen administration are useful

indicators of gravity of the situation. Apart fromtaking blood pressure, palpation of peripheral

pulsations and color of the baby offers useful

information. The severity of RDS can be

assessed by a simple clinical scoring system .


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Table on Clinical respiratory distress scoring systemScore 0 1 2Respiration

(rate/min)80

Cyanosis None in

room airNo Cyanosis in

40% oxygenRequiring more

than 40% ambient

oxygen

Retractions None Mild Moderate to severeGrunting None Audible with

stethoscope

Audible without

stethoscope

Air entry Good Decreased Barely audible


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Causes :Symptoms complex secondary to a

large number of etiological factors. Newborn

baby has a limited capacity to express

manifestations of a disease process.

Identical responses are seen from a variety of

disorders. Therefore identification of associated

and predisposing conditions is important and

often crucial to make and etiolgic diagnosis of

respiratory distrees in newborn.


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PATHOPHYSIOLOGY OFRESPIRATORY DISTREES

SYNDROME


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Diagnosis of RDS

Septic screening and cultures should be taken

to rule out infection.

Reliance should be placed on radiological

examination of chest to exclude life threateningmalformations.

Availability of facilities to monitor the status of

arterial gases and acid base parameters is

essential to assess the severity and prognosis

of the disease process.


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MANAGEMENT - Improve ventilation in order to

enhance oxygenation

correct acidosis

provide thermoneutral environmentThe goal of therapy is to maintain arterial pH

between. 7.35-7.45mm Hg.


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cardiorespiratory monitoring

oxygen therapy ventilation are required to

improve the outcome.

a vital sign monitor and pulse oximeter for

continuous display of vital signs and arterial

oxygen saturation.


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Rectal or skin temperature hourly until stable

and then 4 hourly Respiratory rate hourly or continuously

Severity of retractions and grunting

Status of peripheral pulses, capillary filling and

blood pressure. Color

Apneic episodes

Activity, responsiveness and cry

Urine output


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INTRAVENOUS INFUSION

Required is guided by the weight use of

phototherapy and radiant warmers. Sodium

bicarbonate 7.5 percent solution half diluted with

distilled water.

In seriously ill infants, umbilical arterial catheter

should be inserted to obtain samples for acid

base parameters and blood gases.


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Antibiotics -

Ampicillin is the drug of choice.


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Surfactant

Surfactant therapy Most important

Clinical advance in neonatal intensive care

Useful both for prevention and treatment of

RDS.Improves oxygenation by resolving atelectasis

and improving lung compliance.

Surfactant of human bovine (survanta, infasurf)

or porcine (Curosurf) origin and two synthetic

(Exosurf, DPPC / PG or ALEC) preparations are

available.


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Prognosis :

It depends upon the nature of underlyingcondition causing RDS associated complications

and quality of neonatal care. Outcome is

extremely poor in HMD with a case fatality rate

of 50 percent when adequate ventilator facilitiesare not available.


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Respiratory system disorders

The common condition in this group include

Meconium aspiration

Hyaline membrane disease

massive pulmonary hemorrhage pneumothorax and congenital malformations.

The respiratory distress of pulomary origin is

characterized by tachypnea, marked intercostalretractions and expiratory grunt. Cyanosis is

usually mild except in later stages of hyaline

membrane disease and certain malformations.


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Meconium aspiration syndrome

Meconium stained amniotic fluid occurs in 5 to10 per cent of births. It generally occurs in term

or post term newborns who are immature or

small for gestational age.


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Nursing Management

Removed suctioning the oropharynx.

Endotracheal tube insertion .

Resuscitation at birth may be indicated

Sodium bicarbonate may be given to correct

cyanosis and acidosis.


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Outcome

If treatment is not instituted promptly, meconiumaspiration results in a significant number of

neonatal deaths. The death rate of meconium

stained infants is twice that of nonstained infants.

The outcome for neonates who have aspiratedmeconium depends on the extent of central

nervous system injury from anoxia both before

and after birth.


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ATELECTASIS

Introduction-The lungs are collapsed in fetal life, and the

fetus receives oxygen through the maternal

circulation. After birth, with the infant's first

breath, the lungs normally expand to a variabledegree. It may be several days before full

expansion occurs. Atelectasis-imperfect

expansion or collapse of lung tissue that carries

air is found to a greater or lesser degree in

almost all infants dying soon after delievery


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Pathophysiology

This condition may be either primary orsecondary. In primary atelectasis the alveoli fail

to expand initially. This is common in premature

infants because of the immaturity of the

diaphragm . It may also be due to oversedation of the

mother before delivery. A mucus or meconium

plug may cause atelectasis.


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All infants are acidotic to some degree at birth,

but in normal neonates the acidosis generally

corrects itself within the first 60 minutes of life.

In neonates whose lungs do not expandnormally, the acidosis becomes more , possibly

with pH values of below 7.0


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Assessment

The major signs of primary atelectasis are

poor respiratory effort

poor air exchange, persistent cyanosis.

The respiration are irregular, rapid, and

shallow


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Cyanosis may be persistent or intermittent; it

decreases if the infant cries or is given oxygen.

(Congenital heart disease may also cause

cyanosis after birth, but this cyanosis increases

with crying and is relieved with oxygen

administration


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The Apgar score is low.

The signs of secondary atelectasis are usually

those of the underlying respiratory problem.

When there is an obstruction causing the

atelectasis, the infant may have respiratory

distress, cyanosis rapid deep breathing with

retractions, and grunting.


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Nursing Management

Early recognition

Clothing

Positioned so that the arms do not press orrest on the chest wall.

Positioning the infant in a semi-Fowler position

Suctioning and posturaLdrainage Humidity


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Outcome and prevention-the outcome for an

infant or child with atelectasis depends on the

cause of the condition. Prevention of premature

labor, hyaline memberane disease, fetal and

neonatal anoxia and pneumonia as well as the

aspiration of foreign bodies by young children

would eliminate most causes of atelectasis.


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Pathogenesis

The lack of surfactant due to immaturity of

lungs appears to be the basic abnormality.

Deficiency of surfactant due to immaturity of lungs or itspoor regeneration by damaged Type II alveolar cells.

HMD appear to be due to hypoperfusion of the lungsleading to epithelial necrosis 'and transudation of plasma.


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The lecithin / Sphingomyelin (L/S) Ratio

amniotic fluid can be easily determined.

A L/S ratio of 2 or more adequate lung maturityLess than 1.5 is often associated with hyaline

membrane disease.

Clinical triad of tachypnea, expiratory grunt andinspiratory retractions in a prematurely born

asphyxiated infant.

untreated diabetic mothers, severe Rh-

isoimmunization and those born by emergency

cesarean section are prone to develop HMD


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3 Grunting during expiration.

4) Serial gastric aspirate shake tests assess thestatus of pulmonary maturity .


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5) MassivePulmonary Hemorrhage

About to 10 percent of neonatal autopsies show

evidences of massive pulmonary hemorrhage.

Pathogenesis poorly understood

Intrauterine growth retardation

severe hemolytic disease of the newborn Twin gestation

Congenital heart disease, sepsis, cold injury;

perinatal distress factors.

Born to a diabetic mother


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It is characterized by

Sudden apneic attacksDyspnea associated with frothy blood welling

through the nose and the oral cavity.

Maintaining a clear airway, administration of freshblood transfusion and fresh frozen plasma are

recommended.


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7)Transient Tachypnea of the Newborn

(TTNB)

Common among term babies born by cesarean

section or precipitate delivery.Other risk factors include delayed cord clamping

Macrosomia, male sex, excessive maternal

sedation. It is also called as "wet lung syndrome"

or type II RDS.


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Oxygen should be administered to maintain

SaO2between 90% to 95%.

Oral feeds can be started when respiratory rate

is less than 60/min.


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Recurrent apnea-

Intermittent cyanosis associated with repeatedprotracted apneic episodes is generally known

as recurrent neonatal apnea or apneic spells.

Apnea is defined as cessation of respiration for>20 seconds or cessation of respiration of any

duration accompanied by bradycardia and/or

cyanosis.

Important cause of mortality and brain damage

in immature babies


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C P di i f t R i d


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Causes :Predisposing factors : Raised

environmental temperature, vigorous suction and

sudden flexion of neck are common triggeringfactors.

Immaturity

Pulmonary conditions

Cardiac malformations Neurological disorders

Congenital anomalies

Metabolic causes

Infection Anemia


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Assessment of the infant

Duration of apnea and its frequency presence or

absence of cyanosis and bradycardia should be

recorded.

The signs of raised intracraminal pressure e.g high pitched

cry, reflexes diminished general activity, poor feeding etc.


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Investigations :

Methemoglobin spot test . A drop of babys(patient) blood is placed on filter paper next to

the one from a normal baby (control) and

allowed to dry. In methemoglobinemia the blood

spot will appear brown rather than the red .

G l H dli h ld b d d


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General measure-Handling should be reduced

to the bare minimum and infant should be

nursed without a pillow.

Infant should preferably be nursed in a prone

position or kept in a supine position with slight

extension of neck.

Stimulation,Warmth, Oxygen..

Feeding- Infusion of 10 percent glucose

solution till the apneic attacks are controlled


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INFECTIONS-

Infections occur frequently in the neonate,causing illness and possibly death. Reasons : (1)

the variety of organisms potentially present in

the uterus , in the cervix and vagina during

delivery, and in the environment of the hospitaland community

(2) immature host resistance that causes the

neonate to be overcome by these organisms

(3) Difficulty in treating some infections because lack of

specific therapeutic agent


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PATHOPHYSIOLOGY

1) The agents that can cause infection in

neonates include bacteria, viruses, protozoa,

fungi, and Chlamydia and Mycoplasma

organisms.

2) Transplacentally from a mother who has the

infection (congenital infection) or during

delivery from colonies of organisms .


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5)The smaller the neonate, the less resistance

there is to infection. This is especially true in

premature infants, who are more susceptible to

generalized sepsis, meningitis, and urinary tract

infections than are full-term neonates.

The use of therapeutic procedures after birth(such as resuscitation, particularly if an

endotracheal tube is used) and the use of an

umbilical catheter or other invasive procedures

increase the risk of infection.

NURSING MANAGEMENT


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NURSING MANAGEMENT

Since organisms can be carried to neonates on

the hands or under the nails or jewelry ofcaregivers, no one with a skin or other infection

should enter the nursery or the rooms occupied

by mothers.

A mother who becomes infected should be

isolated and, if there is any question of

contamination, her neonate should be isolated

from other infants in the nursery.When an outbreak of illness occurs, certain

measures must be taken to prevent its spread.


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Cultures are done on all infected infants as

well as on those who may be incubating thedisease or may be asymptomatic carriers.

ISOLATION

ANTIBIOTIC THERAPY side effects


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MATERNAL TRANSMISSION OF INFECTION

TO THE NEONATE

Treat the young infant for local infections

There are three types of local infections in a

young infant that a mother or caretaker can treatat home: an umbilicus that is red or draining pus

skin pustules, and thrush. Follow the instructions

in the TREAT THE YOUNG INFANT AND

COUNSEL THE MOTHER section of theYOUNG INFANTchart.


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Twice each day, the mother cleans the infected

area and then applies gentian violet.

Teach the mother how to treat the infection and

check her understanding.

If the mother will treat thrush, give her a bottle of

hal f -st rength (0.25%) gentian violet. If the

mother will treat skin pustules or umbilical

infection, give her a bottle of full strength (0.5%)gentian violet.


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Adequate feeding: Hydration should be

maintained and hypoglycemia prevented byearly feeding when jaundice is anticipated or

already existent

Treatment of sepsis and hepatitis: Whensepsis is suspected, appropriate antibiotics

should be administered after collection of blood

sample for culture. Vitamin K should be used

with caution.


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Phenobarbitone: Phenobarbitone in a single

dose of 10 mg/kg intramuscular or 5 mg/kg/day

in 2 divided doses orally for 3 days is indicated in

cases of cord serum bilirubin level of > 2.5 mg/dl.

Clofibrate:Clofibrate is a more potent enhancer

than Phenobarbital. In one study, it caused a

100% increase in hepatic bilirubin clearance

within one week.


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EXCHANGE BLOOD TRANSFUSION

Early indications for exchange blood transfusion in infants with Rh-

hemolytic disease of the newborn1. Cord hemoglobin of 10 g/dl or less.2. Cord bilirubin of 5 mg/dl or more.3. Unconjugated serum bilirubin of 10 mg/dl within 24 hours or 15

mg/dl within 48 hours or rate of rise of > 0.5 mg/dl per hour.


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Infection Maternal

infection

Clinical

manifestation

Laboratory

Diagnosis

Nursing

intervention and

management

Prevention

Cytomegalic

inclusion disease

(salivary gland

virus) causative

agent

Cytomegalvirus

Time ofTransmission

Transplacental

throughout

pregnancy

and during

delivery

Fetal damage

most severe if

infection occurs

in ist trimester

Half of

childbearing

women have

no

immunologic

response tothis virus

mother

asymptomati

c this

disease is

most

common

cause of

intrauterine

infection

Premature

delivery

lethargy

jaundice

hemolytic

anemiathrombocytop

enia

pneumonitis

hepatospleno

megaly

Isolate virus

from

nasopharyn

x blood and

urine

\elevatedIgM in

neonate

No specific treatment

available

transfusions for

anemia antimicrobial

agents for concurrentbacterial infections

None

experiment

al live CMV

vaccines

are beingevaluated


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Infection Maternal

infection

Clinical

manifestation

Laboratory

Diagnosis

Nursing

intervention and

management

Prevention

Coxsackie

Causative agent

Coxsackievirus

Time of

transmission

Transplacental

during delivery orin the neonatal

period

Nonspecific

illness in

mother

Condition

common but

clinical

manifestations

relatively rare

Elevation of

temperaturerespiratory

and

gastrointestina

l symptoms

lethargy and

feeding

difficulties

petechiae

apneic period

cyanosis

jaundice,.

Viral

antibody

studies on

acute and

convalescen

t sera

examinationof feces

collected for

virus

isolation

Supportive care

isolation of affected

neonate

No effective antiviral

chemotherapy

Gamma

globlin is

not

effective in

prevention

prevent

crossinfection

and

epidemics

in nursery

with

isolation

technique

Infection Maternal

infection

Clinical

manifestation

Laboratory

Diagnosis

Nursing

intervention and

Prevention


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management

Herpes simples

(HSV I) causes

common cold

sore or fever

blister

HSV II causes

cervicitis and

vaginits

Sexually

transmittedCausative Agent

Herpesvirus

hominis \Time of

transmission

Transplacental or

transmniotic at

delivery

Maternal

herpetic

vulovagintis

usually

evident

(HSV II)

Mild with few

skin lesions

(vesicles) or

severe

systemic

disease

hypothermia

or fever

anemia

hepatitisjaundice

hepatomegaly

thrombocytop

enia

Isolation of

virus from

lesions

serologic

tests show

rise in level

of

neutralizing

antibody

duringconvalescen

ce

Supportive treatment

of dehydration

Less risk if

delivered

by

cesarean

section.

active

gential

herpes

lesions

Acyclovir atreatment

should be

given

during

pregnancy

only if the

potential

benefit

justifies the

potential

risk to the

fetus

Infection Maternal

infection

Clinical

manifestati

Laborator

y

Nursing

intervention and

Preventio

n


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infection manifestati

on

y

Diagnosis

intervention and

management

n

Infectious

hepatitis

Causative

agent

Infections with

hepatitis B can

be identified

Time oftransmission

Any time

during

gestation or

delivery or

duringneonatal

period from

cracked

nipples or

breast milk

Mother

may be

asymptom

atic or

have

active or

chronic

infection

Prematurity

may be

asymptomati

c of have

jaundice

hepatosplen

omegaly

hemolyticanemia

Liver

function

test

indictes

obstructive

type of

jaundice

No effective

antiviral

chemotherapeutic

agent medical

isolation with

emphasis on

handwashing use

of gloves whenhandling infant

drawing blood or

caring for

excretions

Hepatitis

B immune

gamma

globulin or

standard

immune

serum

globulinshould be

given to

neonates

of mother

having

clinicalhepatitis

B near

time of

delivery

Infection Maternal

infection

Clinical

manifestation

Laboratory

Diagnosis

Nursing

intervention and

Prevention


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management

Ophthalmitis

(ophthalmia

neonatorum)1. Gonococcal

Causative Agent

Neisseria

gonorrhoeae

time of

transmission

during delivery

2. Chalmydial

Causative Agent

: Chlamydia

trachomatis time

of transmission

during delivery

Infection of

cervix and

vaginaInfection of

cervix and

vagina :

otherwise

asymptomati

c

Most

common

cause of

ophthalmitis

in neonates

Conjuctivitis

Mild to severe

conjunctivitis :purulent

discharge

from one or

both eyes

swollen lids

pseudomembr

anes possibly

distinctive

syndrome of

pneumonia

(tachypnea

cough

vomitingcyanosis)

Gram stain

and culture

(ThayerMartin

medium of

purulent

exudates

from eye

Culture or

Giemsa

stain of

conjuctival

scraping

bacterial

cultures

negative

Strict isolation use of

arm restraints to

prevent rubbing ofeye (s)

An eye shield may

be used for

protection over

unaffected eye

intravenous or

intramuscular

aqueous penicillin G

Warm saline

irrigations of eye

instillation of

penicillin G

tetracycline orchlorampheniocol

eye drops

Conjunctivitis :

tetracycline or

sulfonamides.

Prevention

treatment

of maternaldisease

instillation

after birth

of 1%

solution of

silver

nitrate or

erythromyci

n or

tetracycline

ophthalmic

ointment

Infection Maternal

infection

Clinical

manifestati

Laborator

y

Nursing

intervention and

Preventio

n


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infection manifestati

on

y

Diagnosis

intervention and

management

n

Rubella

(German

measles )

Causative

agent

Rubella virus

Time of

transmission

Transplacental

:first trimester

If mother

contracts

rubella in 1st

months ofgestation

incidence of

malformation is

30 to 505

Mild

usually.

Mother

may have

encephaliti

s

Low birth

weight

Anemia,

rash,

thrombocyto

penic

purpura,

jaundice,

hepatitis,

hepatosplen

omegaly,

osteitis,

myocarditis,

pneumonia,chronic

meningoenc

ephalitis,

Viremia

isolate

virus from

nasophary

nx, urine,

Strict isolation for

as long as virus is

present in urine or

pharynx; this may

continued for

many months

Active

immunizat

ion should

be done if

women

are not

immune

prior to

but not

during

gestation

Susceptibl

e

pregnantwomen

should

avoid

contact

Infection Maternal Clinical Laboratory Nursing Prevention


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Infection Maternal

infection

Clinical

manifestation

Laboratory

Diagnosis

Nursing

intervention and

management

Prevention

Rubeola

(measles)

causative agent :

Measles virus

time of

transmission :

tansplacental : 1st

trimester or any

time during

gestation

Mild usually Low birth

weight

Congenital or

neonatal

measles; skin

lesions like

those of

mother ,

diarrhea

Isolation of

virus from

blood, urine,

nasopharyn

x

Antibody

titer

Supportive care Vaccination

before

pregnancy

Use of live

measles

vaccine is

not

recommend

ed during

pregnancy


101/108

Infection Maternal

infection

Clinical

manifestation

Laboratory

Diagnosis

Nursing intervention and

management

Prevention


102/108

Thrush (oral

monillasis

Causative Agent:

Candida albicans(fungus) Time of

Transmission:

During birth from

a contaminated

birth canal: after

delivery from

contact with

infected infants

and contaminated

supplies or

caregivers May

occur when

antibiotic therapychanges oral flora

Vaginal

monillasisWhite plaques

(resembling

milk curds)

over tongue,lips, gingival

and buccal

mucous

membranes.

When removed,

they leave a

bright red.,

bleeding base

Anorexia may

be due to

discomfort

from lesions

Esophagogastritis or

pneumonitis

may develop

Direct

microscopic

examination

and culture ofscraping from

oral cavity

Nystain solution or 1%

aqueous gentian violet

applied slowly and

gently to individuallesions several times

each day. placed prone

so that saliva will drain

from the mouth and the

infant will not swallow

the remainder of the

drug. If gentaian violet

stains the clothing or

bed lines, the stains

can be removed with

sodium bicarbonate

paste

Treatment of

maternal

infectionThoroughhandwashin

g and

cleanliness

of supplies

Inspect

mouth of

infants

receiving

antibiotic

theraphy


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Infection Maternal

infection

Clinical

manifestation

Laboratory

Diagnosis

Nursing

intervention and

management

Prevention

ToxoplasmosisCausative Agent:Toxoplasma gondilTime of

Transmission:In utero: 1st

trimester, but anytime during

pregnancy. Since

the organism

crosses the

placenta during an

acute infectio, only

1 infant/family can

acquire this disease

Transmitted

to mother by

ingestion of

infected raw

meat or

unwashed

raw fruits orvegetables

raised at soil

level, or by

handling of

cat feces

Maternal

infection

many times is

asympomatic

Premature

delivery

Some neonates

may not be

infected; other

may have

anemia,jaundice,

hepatosplenome

galy,

encephalitis,

convulsions,

chorioretinitis

Higher titer

of dye test

antibody, but

no

complement-

fixing

antibodyAbnormal

cerebrospinal

fluid

containing

parasites

Combination of

sulfadiazine and

pyrimethamine

(Daraprim). (Frequent

leukocyte counts must

be done because both

drugs causeleucopenia)

Supportive care

Maternal

antibody

titer done

before

pregnancyPrevent

maternalexposure;

Hands

should be

washed after

handing raw

meat, and

fruits and

vegetables

should be

washed

carefully


104/108

INFECTION SOURCE

OF

Clinical

Manifestation

Nursing

Intervention

Outcome Prevention


105/108

Infection/La

boratory

Diagnosis

s and

Managemen

t

Impetigocontagiosa.

Causative Agent:

Streptococcus,

Staphylococcus

Direct contactwith

contaminated

hands of

caregivers or

with

contaminated

supplies

Laboratory:

Culture

lesions

Invasion ofsuperficial

layers of skin

: at first

erythematous

macules; later,

vesicles

When vesicles

break, they

leave superficial

moist areas

Amber-colored

crusts form

when exudates

driesHighly

contagious

Crusts areremoved

carefully after

softening with

1:20 Burrows

solution

compressesApplication of

Neo-Polycin,

Neosporin

ointmentIf infection is

extensive, a

systemic

antibiotic

(penicillin) is

administered

orally or

parentrally

Heals without scarringunless lesions become

secondarily infected

Can be spread to self

and other through

contact

Skincleanliness

Prevention of

contact with

infected

lesions

INFECTION SOURCE OF

Infection/Lab

Clinical

Manifestations

Nursing

Intervention

Outcome Prevention


106/108

oratory

Diagnosis

and

Management

Omphalities

Causative Agent:Escherichia coli,

Staphylococci,

Other pyogenic

organisms

Inadequate

care ofumbilicus;

contamination

with soiled

diaper or with

hands of

caregivers

Laboratory;

Culture

umbilical

stump

Redness,

moisture orpurulent

discharge, and

induration of

card stump

Foul odor cord

stump Possible

septicemia

Careful

cleansing ofthe umbilicus

with antiseptic

solution, such

as alcohol or

triple dye

Local

application

and systemic

use of broad-

specturm

antibiotic

If abscess

forms,incision and

drainage may

become

necessary

Good with early

recognition andadequate treatment

Assessment

and cleaningof umbilicus

until healed


107/108

BIBLIOGRAPHY-Dorothy R Marlow. Barbara A. Redding.Textbook of

Peadiatric Nursing .6th Edition. New Delhi, Saurabh

publications; 2006.Page no- 450-630.

Basvanthappa BT.Textbook of Pediatric Child HealthNursing.1st Edition.New delhi . Ahuja Publications

House;2008.Page no-114-122.

Singh Meherban.Textbook of Care of Newborn.6th Edition.

NewDelhi.Sagar Publications;2002.Page no-261-390


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07bahigh risk newborn

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