High Risk Newborn

The Preterm Newborn

Delivery prior to 37 weeks’ gestation

Factors– Multiple gestation – PROM – incompetent cervix– Maternal disease

Preterm Newborn Complications

Patent ductus arteriosus (PDA) Apnea Respiratory Distress Syndrome Intraventricular hemorrhage (IVH) Retinopathies of prematurity (ROP) Auditory, speech & neurologic defects

Postdates Newborn

Born after 42 weeks

Postdates are prone to:– Hypoglycemia– Meconium aspiration– Polycythemia– Congenital anomalies– Seizures– Cold Stress

Nursing management for postdates

Serial Glucose Testing

O2 therapy

Thermoregulation techniques

Lab work

Large for Gestational Age (LGA)

Infants >90th percentile for weight at birth

Factors– Maternal diabetes – parental obesity – male infants, – multiparous – Genetics– Erythroblastosis fetalis

Large for Gestational Age (LGA)

Complications– Difficult delivery, birth trauma, hypoglycemia,

polycythemia high risk for cesarean births due to CPD and breech

Nursing implications– Assess for birth injury– Vital signs– Monitor for hypoglycemia– Educate the family

Small for Gestational Age (SGA)

At or below the 10th percentile

Contributing factors:– Genetics– Malnutrition– Vascular changes in PIH/DM– Maternal factors– Environmental factors– Placental factors– Fetal factors

SGA Complications

Perinatal asphyxia Aspiration Syndrome Hypothermia Hypoglycemia Polycythemia

Hypothermia (Cold Stress)

Excessive heat loss that requires a newborn to use compensator mechanisms to maintain core body temperatures

Who is at risk?– Preterm and SGA newborns

Signs and Symptoms– Decreased temperature– Increased respiration– S/S of hypoglycemia

Hypoglycemia

Blood glucose is less than 40 mg/dL Signs & Symptoms

– Lethargy/jitteriness– Poor feeding– Vomiting– Pallor– Apnea– Tremors– High pitched cry– Exaggerated moro reflex

Nursing Interventions for Hypoglycemia

Check blood glucose levels:– Q1H x 4hrs then Q4H x 24 hrs– If high risk infant- 2,4,6,12,24,48hrs– Early feeds– IV D10W based on body weight

Sepsis in the Newborn

Immature immune system and lack of factors for phagocytosis put neonates at risk for infection

Signs & Symptoms

Pallor/dusky looking Lethargy Temperature fluctuations - hypothermia Decreased intake - vomiting, poor feeding Hyperbilirubinemia

Treatment

Preventative treatment includes:– Strict hand washing– Reverse isolation– Individual equipment– Limited visitors– Turning, ROM

Labwork - cultures, WBC– Spinal tap– Double antibiotic therapy (amp &

gent)

Jaundice

Yellow pigment deposited in lipid tissue.

Two types:

– Physiologic jaundice

– Pathologic jaundice

Types of Jaundice

Physiologic Jaundice– Seen in second or third day of life– Treated with phototherapy

Pathologic Jaundice– Seen in first 24 hrs. Level above 12 mg/dL– May require exchange transfusion &/or

phototherapy

Care of the Neonate

Phototherapy Exposure to high intensity light decreases the serum

bilirubin levels in the skin.

High volume feeds. Increase fluids Cover newborn eyes, genital area Monitor I & O Provide stimulation Hydration status Skin care Safety - burns

RDS Respiratory Distress

known as hyaline membrane disease.

Caused by the absence of surfactant which prevents alveolar collapse on expiration.

Respiratory Distress

Early symptoms include:– Hypothermia– Nasal flaring– Expiratory grunting– Sternal and/or

subcostal retractions– Tachypnea(>60

respirations)

Worsening symptoms include:– See saw breathing– Decreased urinary

output– Pallor/ ashy grayish

color– Periods of apnea(>15

secs)– Bradycardia

Managing RDS

Surfactant replacement and/or steroid therapy

Oxygen administration and monitoring

Ventilator management – (CPAP,HFOV)

Prevent hypothermia, hypoglycemia, stress during care of infant - minimal touch therapy

Drug/Alcohol abused infants

Common Complications Respiratory Distress Jaundice Congenital abnormalities Growth retardation Behavioral abnormalities Withdrawal

Metabolic Conditions

Hereditary disorders - increased metabolites toxic to the newborn– PKU - phenylketonuria – Galactosemia– Hypothyroidism– Others

MST - Done in first 72 hrs of birth