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High Risk Newborn Lecture

High Risk Newborn Lecture. Preterm Infant. Born before 38 weeks gestation Immaturity of all systems. Physical assessment. Gestational age <37 weeks Resp. irregular Bowel sounds diminished Temp below 97.8 Hypoglycemia Poor suck and swallow Poor flexion. Psychosocial Assessment.

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High Risk Newborn Lecture

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  1. High Risk Newborn Lecture

  2. Preterm Infant • Born before 38 weeks gestation • Immaturity of all systems

  3. Physical assessment • Gestational age <37 weeks • Resp. irregular • Bowel sounds diminished • Temp below 97.8 • Hypoglycemia • Poor suck and swallow • Poor flexion

  4. Psychosocial Assessment • Parents shock & disbelief • Fear holding baby • Grieve for “perfect” baby • Financial concerns • Fear for Baby’s life

  5. Goals • safe effective environment • Maintain resp & nutrition & temp • Promote interaction with parents • Education of parents in care

  6. Implementations • Antibiotics • Fluids & electrolytes (bicarb & Ca) • Oxygen, Chest therapy • Coordinate labs & tests • Monitor Temp, apical P, Resp • Handle carefully, reposition • Tactile stimulation for apnea, suction prn

  7. Implementations Con’t. • Avoid exposure to infection • Gavage feed q 2-3 hr, Premie formula • freeze breast milk • psychological support, share info, reinforce positives • share caretaking responsibilities with parents • allow to ventilate feelings

  8. Nutrition of the Preterm Infant • Initially needs 80-100 ml/Kg/day may need more fluid if lower birth weight • Requires 120-150 cal/Kg/day oral intake for growth • Supplemental multivitamins, Vit E, folic acid and calcium • Desired weight gain 20-30 g/day • Desired initial weight loss only 1-2% per day

  9. Risk of Intraventricular Hemorrhage • Hypoxia • Inc. BP, Inc. head pressure • (do not place in Trendlenberg position) • Chest percussion • Assess: fontanels for increase in size • seizures, apnea, bradycardia, drop in Hct

  10. Preterm Case Study • Baby Girl Petite

  11. Small for Gestational Age • Definition= below 10th percentile on growth chart • Problems: Congenital problems • fetal distress • hypoglycemia • polycythemia • infection • aspiration of Meconium

  12. SGA

  13. Nursing Care for SGA • Maintain airway & temperature • Sx resp distress • Monitor glucose level, sx hypoglycemia • Provide NTZ, minimize heat loss • Provide Feedings, touch, support, teaching • Evaluate Hct, sx sepsis,

  14. Case Study Small for Gestational Age • Baby Boy Slim

  15. Large for Gestational Age • Defined- Above the 90th percentile on growth chart • Problems: Birth trauma • Infant of Diabetic Mother • Hypoglycemia • Respiratory Distress Syndrome (RDS) • Hypotension • Sepsis

  16. Nursing Care of LGA • Maintain Resp. Observe for sx sepsis (& prevent) • Monitor Temp, minimize heat loss • Sx hypoglycemia, monitor Glucose levels • Initiate early feedings • Provide touch & cuddling • Support parents & teach

  17. Postterm Infant • Description: born after 42 weeks gestation • Problems: Hypoglycemia • meconium aspiration (MAS) • polycythemia • seizure activity • cold stress

  18. Physical Characteristics of Postterm • wide-eyed & alert (irritable) • Skin- no lanugo, dry, cracked, parchment-like • Fingernails long, over ends • Scalp hair profuse • Body long and thin (fat & muscle wasting) • Meconium staining of nails & umbilical cord

  19. Case Study for Postterm Infant • Baby Girl Green

  20. Cold Stress in Infants • Excessive heat loss • Use of compensatory mechanism • inc. respirations • non-shiver themogenisis • Preterm and SGA at risk

  21. COLD STRESS

  22. COLD STRESS

  23. Signs & Symptoms of Cold Stress • Inc. Resp (sx Non Shiver Thermogenesis) • Dec. Skin temp • Dec. peripheral profusion • Dec. Blood Glucose (using to generate heat)

  24. Nursing Care for Cold Stress • Warm slowly (too rapid may cause apnea) • check skin temp q 15 min. • maintain Neutral Thermal Environment • Monitor BGK for hypoglycemia • Give feeding or glucose (IV) to inc. Blood Glucose

  25. Necrotizing Enterocolitis • Complication of Premie • r/t dec. blood flow to GI tract • 2 º to hypoxia or shock

  26. Signs & Symptoms • Dec. bowel sounds or none • Inc. abd. Girth • Bowel loops • No meconium or OB + stool • Temp instability • Inc. apnea, bradycardia • Inc. in feeding residuals

  27. Treatment • GI rest (NPO) • Antibiotics • Surgery • TPN • NG or gavage feedings • advance to bottle feedings

  28. Case Study Necrotizing Enterocolitis • Tiny Tim

  29. Infant of a Diabetic Mother • Risk of Hypoglycemia • Blood Glucose < 40 mg/dl • R/T overstimulated fetal insulin production

  30. Assessment • Predisposing Factors for Hypoglycemia • Preterm or premature birth • Large for Gestational age • Maternal diabetes • Hypertension • Infant stress

  31. Signs and Symptoms • Jitteriness, twitching, seizures • Poor-feeding, weak sucking reflex • Irregular respiration cyanosis, respiratory distress • Edema (bloated appearance) • Weak, high-pitched cry • Poor muscle tone • Low blood sugar & low serum calcium levels

  32. Case Study- Infant of Diabetic Mother • Larry Large

  33. Goals • Environment will be safe without signs of hypoglycemia • Parents will ask questions re care of infant & signs and symptoms • Parents will be able to demonstrate proper infant care.

  34. Implementation • Assess parental awareness & understanding • Assess feelings of guilt • Assess vital signs, BGK, serum Ca & seizures • Administer 10% glucose IV as ordered • Facilitate early full feedings • Prevent infection

  35. Hyperbilirubinemia • Elevated bilirubin level r/t : • Physiologic Jaundice: 3-5 days > 12 mg/dl • Prematurity: liver not able to metabolize bili • ABO, Rh incompatibilities: Mother “O” Baby A,B, AB mom’s antibodies cross placenta O A,B,AB

  36. Hyperbilirubinemia • Elevated bilirubin level r/t : • Breast Milk: reduced excretion of bilirubin • Extravascular hemolysis: bruises, cephalohematoma, petechiae • Others: polycythemia, drugs, hypoglycemia, hypoxia

  37. Assessment • biliflash above indication line

  38. Assessment Con’t • serum bili 8-12 mg/dl at 1-2 days and > 12 mg/dl 3-5 days • palpable spleen, enlarged liver • poor feeding, edema • vomiting, fever, dark urine

  39. Kernicterus • Diminished Moro reflex • Poor sucking • Difficult feeding • High pitched cry • Setting sun eyes • Irritability or Seizures • Opisthotonos • muscle spasms • back arching)

  40. Baby with Jaundice

  41. Baby Under Bili Lights

  42. Goals • Pt will have bili level less than 12 mg/dl, no signs of jaundice • Parents will state they feel supported, counseled, educated • Parents will demo correct care measures for infant with jaundice

  43. Implementations • Phototherapy: Bili Light or Blanket • Undress • Shield eyes (remove for feeding) & genitals • Monitor temp q 2hr • Fluids q2 hr to avoid dehydration • Change position q 2 hr • Weigh q12 hr, I &O, assess hydration

  44. Implementations Con’t • Observe stools & urine for darkening • Observe for tanning (bronze baby syndrome) • Plexiglas shield between infant & light • Record number of lights used and hours • Monitor bili levels Q 6-8 hr

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