Developed by D. Ann Currie, RN, MSN

High Risk Newborn Nursing Care

Fetal/Neonatal Risk Factors for Resuscitation Nonreassuring fetal heart rate patternDifficult birth Fetal scalp/capillary blood sample-acidosis pH<7.20Meconium in amniotic fluidPrematurityMacrosomia or SGAMale infant Significant intrapartum bleedingStructural lung abnormality or oligohydramniosCongenital heart diseaseMaternal infectionNarcotic use in labor

Fetal/Neonatal Risk Factors for Resuscitation (continued) An infant of a diabetic motherArrhythmiasCardiomyopathyFetal anemia

Respiratory Distress Syndrome (RDS)

Deficiency or absence of surfactantAtelectasisHypoxemia, hypercarbia, academiaMay be due to prematurity or surfactant

deficiency

RDS: Nursing Care Maintain adequate respiratory statusMaintain adequate nutritional statusMaintain adequate hydrationEducation and support of family

Transient Tachypnea of the Newborn (TTN)

Failure to clear lung fluid, mucus, debrisExhibit signs of distress shortly after birthSymptoms

Expiratory grunting and nasal flaringSubcostal retractionsSlight cyanosis

TTN: Nursing Care Maintain adequate respiratory statusMaintain adequate nutritional statusMaintain adequate hydrationSupport and educate family

Meconium Aspiration Syndrome (MAS)

Mechanical obstruction of the airwaysChemical pneumonitisVasoconstriction of the pulmonary vesselsInactivation of natural surfactant

MAS: Nursing Care Assess for complications related to MASMaintain adequate respiratory statusMaintain adequate nutritional statusMaintain adequate hydration

Persistent Pulmonary Hypertension (PPHN

Blood shunted away from lungsIncreased pulmonary vascular resistance

(PVR)Primary

Pulmonary vascular changes before birth resulting in PVR

SecondaryPulmonary vascular changes after birth

resulting in PVR

PPHN: Nursing Care Minimize stimulationMaintain adequate respiratory statusObserve for signs of pneumothoraxMaintain adequate nutritional statusMaintain adequate hydration statusSupport and educate family

Cold Stress Increase in oxygen requirementsIncrease in utilization of glucoseAcids are released in the bloodstreamSurfactant production decrease

Cold Stress: Nursing Care Observe for signs of cold stressMaintain NTEWarm baby slowlyFrequent monitoring of skin temperatureWarming IV fluidsTreat accompanying hypoglycemia

Hypoglycemia Symptoms Lethargy or jitterinessPoor feeding and suckingVomitingHypothermia and pallorHypotonia, tremorsSeizure activity, high pitched cry,

exaggerated moro reflex

Hypoglycemia: Nursing Care

Routine screening for all at risk infantsEarly feedingsD10W infusion

Physiologic Hyperbilirubinemia

Appears after first 24 hours of lifeDisappears within 14 daysDue to an increase in red cell mass

Pathologic Hyperbilirubinemia Appears within first 24 hours of lifeSerum bilirubin concentration rises by more

than 0.2 mg/dL per hourBilirubin concentrations exceed the 95th

percentileConjugated bilirubin concentrations are

greater than 2 mg/dL Clinical jaundice persists for more than 2

weeks in a term newborn

Causes of Pathologic Hyperbilirubinemia

Hemolytic disease of the newbornErythroblastosis fetalisHydrops fetalisABO incompatibility

Treatment of Pathologic Hyperbilirubinemia

Resolving anemiaRemoving maternal antibodies and sensitized

erythrocytesIncreasing serum albumin levelsReducing serum bilirubin levelsMinimizing the consequences of

hyperbilirubinemia

Maternal-Fetal Blood Incompatibility

Rh incompatibilityRh-negative motherRh-positive fetus

ABO incompatibilityO motherA or B fetus

Phototherapy: Nursing Care Maximize exposure of the skin surface to the

lightPeriodic assessment of serum bilirubin levelsProtect the newborn’s eyes with patchesMeasure irradiance levels with a photometerGood skin care and reposition infant at least

every 2 hoursMaintain an NTE and adequate hydration and

nutrition

AnemiaHemoglobin of less than 14 mg/dL (term)Hemoglobin of less than 13 mg/dL (preterm)Nursing management

Observe for symptomsInitiate interventions for shock

Polycythemia Increase in blood volume and hematocritNursing management:

Assessment of hematocritMonitor for signs of distressAssist with exchange transfusion

Clinical Manifestations of SepsisIncrease in blood volume and hematocritNursing management:

Assessment of hematocritMonitor for signs of distressAssist with exchange transfusion

Temperature instabilityFeeding intoleranceHyperbilirubinemiaTachycardia followed by apnea/bradycardia

Clinical Manifestations of Syphilis RhinitisRed rash around the mouth and anusIrritabilityGeneralized edema and hepatosplenomegalyCongenital cataractsSGA and failure to thrive

Syphilis: Nursing Management

Initiate isolation Administer penicillinProvide emotional support for the family

Gonorrhea Clinical Manifestations

ConjunctivitisCorneal ulcerations

Nursing managementAdministration of ophthalmic antibiotic

ointmentReferral for follow-up

Clinical Manifestationfs of Herpes Small cluster vesicular skin lesions over the

entire bodyDICPneumoniaHepatitisHepatosplenomegalyNeurologic abnormalities

Herpes: Nursing Management

Careful hand washing and gown and glove isolation

Administration of IV vidarabine or acyclovirInitiation of follow-up referralSupport and education of parents

ChlamydiaClinical Manifestations

PneumoniaConjunctivitis

Nursing managementAdministration of ophthalmic antibiotic

ointmentReferral for follow-up

Needs of Parents of At-risk Infants

Realistically perceiving the infant’s medical condition and needs

Adapting to the infant’s hospital environmentAssuming primary caretaking roleAssuming total responsibility for the infant

upon dischargePossibly coping with the death of the infant if

it occurs

Facilitating Parental Attachment

Facilitating family visitsAllowing the family to hold and touch the

babyGiving the family a picture of the babyLiberal visiting hoursEncouraging the family to get involved in the

care

Cont. to Study other conditions from the Text