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High Risk Newborn

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High Risk Newborn Mary L. Dunlap MSN, APRN Fall 10 Hyperbilirubinemia Pathologic Develop after first day Persists beyond 7 days Bilirubin 12.9mg/100 term Bilirubin ... – PowerPoint PPT presentation

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Title: High Risk Newborn


1
High Risk Newborn
  • Mary L. Dunlap MSN, APRN
  • Fall 10

2
Preterm Infant
  • Infant born prior to the completion of the 37th
    week
  • Organs immature
  • Lack physical reserves
  • Survivability related to weight / gestational age

3
Preterm Infant
  • Respiratory last to mature
  • Surfactant deficiency-RDS
  • Unstable chest wall-atelectasis
  • Immature respiratory centers-apnea
  • Small passages-obstructions
  • Unable to clear fluid-TTN

4
Preterm Infant
  • Cardiovascular
  • Difficulty transitioning from fetal to neonatal
    circulatory pattern
  • Congenital anomalies due to continued fetal
    circulation
  • Fragile blood vessels (brain)
  • Impaired regulation of B/P

5
Preterm Infant
  • Gastrointestinal
  • Lack neuromuscular coordination suck-
    swallow-breath
  • Hypoxia shunts blood from the gut- ischemia and
    intestinal wall damage
  • Risk for malnutrition -wt. loss
  • Small stomach-compromised metabolic function

6
Preterm Infant
  • Renal System
  • Slow glomerular filtration rate
  • Reduced ability to concentrate urine
  • Risk fluid retention, electrolyte imbalance,
    drug toxicity

7
Preterm Infant
  • Immune system
  • Deficiency of IgG
  • Impaired ability to produce antibodies
  • Thin skin- limited protection barrier

8
Preterm Infant
  • Central nervous system
  • Long term disability due to injury
  • Difficulty maintaining temperature
  • Compounded by lack of brown fat

9
Preterm Infant Nursing Management
  • Varies with gestational Promote Oxygenation
  • Maintain body temperature
  • nutritional needs
  • Prevent infections
  • Provide stimulation
  • Pain management

10
Small for Gestational Age
  • SGA weight- less than 5lb 8 oz and below the
    10th at term
  • IUGR- High risk growth does not meet the norm
    and is pathologic
  • Symmetric IUGR- poor growth rate of head, abdomen
    and long bone
  • Asymmetry IUGR- head long bones spared

11
Small for Gestational Age Characteristics
  • Decreased breast tissue
  • Scaphoid abdomen (sunken)
  • Wide sutures
  • Thin umbilical cord
  • Head larger than body
  • Wasted appearance to extremities
  • Reduced fat stores

12
Small for Gestational AgeCommon Problems
  • Perinatal asphyxia
  • Hypothermia
  • Hypoglycemia
  • Polycythemia
  • Meconium Aspiration

13
Large for Gestational Age Characteristics
  • LGA weight- Larger than 9 lbs and above the 90th
  • Large body-plump full face
  • Body size is proportionate
  • Poor motor skills
  • Difficulty in regulating behavioral state (arouse
    to quiet alert state)

14
Large for Gestational AgeCommon Problems
  • Birth Trauma-
  • Hypoglycemia
  • Polcythemia
  • Hyperbilirubinemia

15
Post term Infant
  • Gestation gt 42 weeks
  • Must determine if EDC is truly post term
  • After 42 weeks placenta loses ability to nourish
    the fetus

16
Post term Infant Characteristics
  • Newborn emaciated
  • Meconium stained
  • Hair and nails long
  • Dry peeling skin
  • Creases cover soles
  • Limited vernix and lanugo

17
Infant of Diabetic Mother
  • Mother can have pregestational or gestational
    diabetes
  • Increasing numbers of type 2
  • Related to increase in morbidity mortality
  • Congenital abnormalities

18
Infant of Diabetic Mother
  • Congenital abnormalities- during first trimester
    due to fluctuations in BS and ketoacidosis
  • Macrosomia- develops last trimester due to
    maternal hyperglycemia- excessive fetal growth
  • Tight control over glucose levels needed ( less
    than 1-0mg/dl)

19
Infant of Diabetic MotherCommon Problems
  • Congenital Abnormalities
  • Macrosomia
  • Birth Trauma
  • Perinatal Asphyxia
  • RDS
  • Hypoglycemia
  • Hyperbilirubinemia
  • Polycythemia

20
Infant of Diabetic Mother
  • Infant Characteristics
  • Rosy cheeks
  • Short neck
  • Wide shoulders
  • Excessive subcutaneous fat
  • Distended abdomen

21
Infant of Diabetic MotherNursing Management
  • Monitor glucose level q. 3 to 4 hrs. level no
    above 40 mg/dl
  • Until stable monitor q. 3-4 hrs
  • Feed q. 2-3 hrs
  • IV glucose
  • Monitor serum bilirubin levels
  • Maintain thermal environment

22
Respiratory Distress Syndrome
  • RDS caused by lack of surfactant
  • Poor gas exchange ventilation
  • Seen in preterm newborns
  • Cesarean births without labor
  • Infants of diabetic mothers

23
Respiratory Distress SyndromeSymptoms
  • Tachypnea
  • Expiratory grunting
  • Nasal flaring
  • Retractions
  • See-saw respiration
  • Chest x-ray- alveolar atelectasis (ground glass
    pattern) dilated bronchioles ( dark streaks
    within granular pattern)

24
Respiratory Distress SyndromeNursing Management
  • Thermoregulation
  • O2 administration
  • Mechanical ventilation if needed
  • Hold parenteral feedings
  • Monitor VS O2 sats
  • Provide nutrition ( gavage feedings)

25
Transient TachypneaNewborn TTN
  • Mild respiratory condition
  • Result of delayed absorption of fluid
  • Last about 3 days

26
Transient TachypneaNewborn TTN
  • Symptoms
  • Respiratory rate as high as 100-140
  • Labored breathing
  • Grunting nasal flaring
  • Retractions
  • Chest x-ray shows lymphatic engorgement (
    retained lung fluid)

27
Transient Tachypnea Newborn Nursing Care
  • Mainly supportive
  • Monitory VS O2 Sats
  • Provide supplemental O2

28
Meconium Aspiration
  • Fetus inhales meconium into the lungs while in
    utero
  • Meconium blocks the airway preventing exhalation
  • Meconium irritates the airway making breathing
    difficult
  • Meconium aspiration related to fetal distress
    during labor.

29
Meconium Aspiration Symptoms
  • Cyanosis
  • Rapid breathing
  • Labored breathing
  • Apnea
  • X-ray patches or streaks of meconium trapped
    air

30
Meconium Aspiration Nursing Management
  • Assess for risk factors prior to delivery
  • Suction at delivery prior to newborn crying
  • Supplemental O2
  • Mechanical ventilation
  • Antibiotic therapy

31
Hyperbilirubinemia
  • Excess of bilirubin in the blood-elevated
    bilirubin level gt 5mg/dl
  • Heme from erythrocytes break down forms
    unconjugated bilirubin
  • Jaundice
  • Physiologic
  • Pathologic

32
Hyperbilirubinemia Causes
  • Drugs/Medical conditions disrupt conjugation and
    albumin binding sites
  • Decreased hepatic function
  • Increased erythrocyte production
  • Enzymes in breast milk

33
Hyperbilirubinemia Physiologic
  • Develops in 3-4 days after term birth
  • Develops3-5 days after preterm birth
  • Term birth resolves 7 days
  • Preterm birth resolves 9-10 days
  • Unconjugated bilirubin level lt 12mg/100 ml

34
Hyperbilirubinemia Pathologic
  • Develop after first day
  • Persists beyond 7 days
  • Bilirubin gt 12.9mg/100 term
  • Bilirubin gt 15mg/100 preterm
  • Increases gt 5mg/100ml in 24hrs

35
Hyperbilirubinemia Nursing Management
  • Phototherapy
  • Increase feeding to q 2-3 hrs

36
Phenylketonuria PKU
  • Inability to metabolize phenylalanine- amino acid
    found in protein
  • Affect brain and CNS development
  • Interferes with the production of melanin,
    epinephrine thyroxine
  • Both parents must pass the gene on

37
Phenylketonuria PKU Symptoms
  • Seizures
  • Irritability
  • Tremors
  • Jerking movements arms legs
  • Hyperactivity
  • Unusual hand posturing

38
Phenylketonuria PKU
  • Diagnosed with PKU screening prior to discharge
    from hospital

39
Hemolytic Disorders
  • Hemolytic disease occurs when blood groups of
    mother and newborn are different
  • Antibodies are present or formed in response to
    antigen from fetal blood crossing placenta and
    entering maternal circulation

40
Hemolytic Disorders
  • Maternal antibodies of IgG class cross placenta,
    causing hemolysis of fetal RBCs
  • Fetal anemia
  • Neonatal jaundice
  • Hyperbilirubinemia

41
Hemolytic Disorders
  • Rh incompatibility (isoimmunization)
  • Only Rh-positive offspring of Rh-negative mother
    is at risk
  • If fetus is Rh positive and mother Rh negative,
    mother forms antibodies against fetal blood cells

42
Hemolytic Disorders
  • ABO incompatibility
  • Occurs if fetal blood type is A, B, or AB, and
    maternal type is O
  • Incompatibility arises because naturally
    occurring anti-A and anti-B antibodies are
    transferred across placenta to fetus
  • Exchange transfusions required occasionally

43
Neonatal Infections
  • Sepsis
  • Bacterial, viral, fungal
  • Patterns
  • Early onset or congenital
  • Nosocomial infectionlate onset

44
Neonatal Infection
  • Septicemia
  • Pneumonia
  • Bacterial meningitis
  • Gastroenteritis is sporadic

45
Neonatal Infections
  • TORCH infections
  • Toxoplasmosis
  • Gonorrhea
  • Syphilis
  • Varicella-zoster
  • Hepatitis B virus (HBV)
  • Human immunodeficiency virus (HIV) and acquired
    immunodeficiency syndrome (AIDS)
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