1 / 45

High Risk Newborn

High Risk Newborn. Mary L. Dunlap MSN, APRN Fall 10. Preterm Infant. Infant born prior to the completion of the 37 th week Organs immature Lack physical reserves Survivability related to weight / gestational age. Preterm Infant. Respiratory last to mature Surfactant deficiency-RDS

liz
Download Presentation

High Risk Newborn

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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 > 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 > 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 < 12mg/100 ml

  34. Hyperbilirubinemia Pathologic • Develop after first day • Persists beyond 7 days • Bilirubin > 12.9mg/100 term • Bilirubin > 15mg/100 preterm • Increases > 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 infection—late 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)

More Related