Ch 8 Health Promotion of the newborn and family Ch 9 Health Problems of the newborn

1. Ch 8 Health Promotion of the newborn and familyCh 9 Health Problems of the newborn • Laura Salisbury RN, MSN/Ed.

2. Chapter 8 Key Points • According to syllabus • Only required to read pg 237-239 • Key Points

3. Key Points • Newborn Discharge criteria • Feeding • Elimination • Circumcision • Color • Newborn Screening • Vital Signs • Activity

4. Key Points • Transition from fetal to independent respiration is the most important physiologic change • Chemical and thermal factors help initiate the neonates respirations. • Newborns large surface area, thin layer of sq fat and unique mechanism for producing heat predispose the infant to excessive heat loss • The infant’s high rate of metabolism is closely correlated with the rate of fluid exchange, which is 7x greater than adults

5. Key Points • APGAR scoring • Physical assessment of the newborn • Physical care for the newborn • Attachment and bonding between infants and parents, but siblings need to be included • DC teaching must include the newborn’s safe transportation home in a federally approved, backward-facing care safety seat

6. Chapter 9 Health problems of the newborn • Birth injuries • Caput succedaneum • Cephalhematoma • Clavicle fracture • Facial nerve damage • Common problems • Candiasis • Neonatal herpes • Birthmarks • Café-au-lait spots, port wine stains, strawberry hemangiomas

7. High Risk Newborns • What makes a baby high risk?? • Classification according to size • LBW, VLBW, AGA, IUGR, LGA • Classification according to gestational age • Preterm, full-term, post-term • Classification according to mortality • Live birth, fetal death, neonatal death

8. Assessment of high risk newborns HRN • Monitoring physiologic data: what is important to watch? • Respiratory support: important to position appropriately • Thermoregulation: • Neutral thermal environment • Humidity • Protection from infection

9. Assessment of high risk newborns HRN • Hydration • IV lines • Umbilical catheters • Nutrition • Minimal enteral feeding • What are HRN’s fed? • Gavage vs. nipple feeding: when is HRN ready for bottle? • Non-nutritive sucking • Feeding resistance • Skin care

10. Assessment of high risk newborns HRN • Med administration • What particular hazards are present with giving meds to HRN? • Developmental • Importance of decreasing environmental stimulation • Kangaroo care • Co-bedding of multiples • What are approach behaviors? Why important?

11. Family Support • Family support • How to facilitate family relationship with HRN • Dealing with anticipatory grief • Dealing with neonatal loss • Discharge planning/home care • Car seat issues

12. Preterm vs. Post-term infants • Preterm infants • Diagnostic evaluation • Differences between preterm/fullterm infants (see pp 272-273) • Posture • Ear • Sole • Genitalia, male/female • Scar sign • Grasp reflex • Heel to ear manuver

13. Respiratory Distress Syndrome • Pathophysiology • Manifestations (pg. 286) • Tachypnea, dyspnea, retractions, crackles, grunting, nasal flaring, cyanosis or pallor • Management • Exogenous surfactant • Ventilation/oxygenation • Prevention: How? • Suctioning: What to remember (see “alert” box p. 288)

14. Respiratory Complications • Bronchopulmonary dysplasia • Retinopathy of prematurity • Apnea of prematurity • Pneumothorax • Meconium aspiration syndrome • Intraventricularhemorrhage

15. Sepsis • Diagnosis/manifestations: What symptoms? (p. 297) • Poor temperature control, pallor, cyanosis, hypotension, edema, bradycardia, tachycardia, irregular HR, dyspnea, retractions, decreased muscle tone, poor feeding, vomitting/diarrhea • Prevention • Management: observe and assess; treat w/antibiotics

16. NEC -- Necrotizing Entercolitis • Necrotizing Entercolitis • What is it? • What are symptoms? • How prevented? • How managed?

17. Infants of Diabetic Mothers IDM • Single most important factor in fetal well being is what? • Problems of IDMs • LGA, low BG • Management of IDMs • Monitor BG levels

18. Drug exposed infant • Manifestations • Neurologic, autonomic, gastrointestinal, miscellaneous • Evaluation • Management and prognosis • Scoring systems (NAS) • What to watch for • Alcohol exposure: • Fetal alcohol syndrome • what is it? • What happens to these kids?

19. Maternal Infections • What is the TORCH complex? • What specific problems are associated with maternal infection/neonatal transmission of: • Rubella • Chlamydia • Cytomegalovirus • Syphilis • Toxoplasmosis • (how is this one prevented?)

20. Congenital Anomalies • Assessment clues (pg. 308) • Major or minor birth defects • Growth & skeletal abnormalities • Vision or hearing problems • Metabolic disorders • Sexual development abnormalities • Skin disorders • Cognitive delays • Behavioral disorders • Difference between chromosomal abnormality, single-gene defect, and multi-factorial inheritance • Teratogens

21. Key points • Birth injuries • High risk neonates • Appropriate developmental care for the preterm infant • Encourage parental bonding with HRN • Preterm infants require special attention to promote respiratory efforts, maintain temp, fluid/ electrolytes, prevent infection and get adequate nutrition • Jaundice is a common problem • Preterm are prone to complications • Maternal conditions increase risks