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Newborns at Risk

Newborns at Risk. Chapter 27. Newborns at Risk. Premie, LGA, SGA Risk for mortality and morbidity Nsg care-decrease physiological stress Assess for subtle changes Decrease stress, provide stimulation, promote bonding. Maternal and Fetal Risk Factors.

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Newborns at Risk

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  1. Newborns at Risk Chapter 27

  2. Newborns at Risk • Premie, LGA, SGA • Risk for mortality and morbidity • Nsg care-decrease physiological stress • Assess for subtle changes • Decrease stress, provide stimulation, promote bonding

  3. Maternal and Fetal Risk Factors • Maternal- DM, PIH, vascular, drugs, alcohol • Environmental factors • Fetal factors- infections, anomalies • Need to identify early • Symmetrical vs. asymmetrical IUGR

  4. Small for Gestational Age • Depletion of brown fat • Hypoglycemia- due to heat loss • Hypocalcemia-result of asphyxia • Poor outcomes of newborns with gestation of less than 37 weeks • Long term consequences

  5. LGA • Need correct dating • Complications include CPD, breech, shoulder, birth trauma • Jaundice, polycythemia, poor glucose control, meconium

  6. Complications of Gestational Diabetes • Insulin acts as growth hormone • Complications- hypoglycemia, polycythemia, hypocalcemia, hyperbilirubinemia • RDS due to inhibition of surfactant • Nsg- promote glucose control and stabilization

  7. Post Term Newborn • Check dates • At risk for trauma and poor placental perfusion • Complications similar to SGA

  8. Premature Newborn • High incidence in US • Problems with transition • Respiratory distress • All system effected by prematurity • Maintenance or respiratory function #1 • Keep warm

  9. Alteration in Physiology • Gastrointestinal- poor suck- energy expenditure • Unable to tolerate proteins- kidneys immature • Unable to absorb fats- pancreas immature • Lack of mineral deposits • Wgt gain 20-30/gms/day, will loose 15%

  10. Renal • Poor perfusion • Cannot concentrate urine, • Slow to metabolize drugs • Early feeding prevent complications

  11. Complications • Apnea- common if less than 37 weeks • PDA- hypoxemia, revert to fetal circulation • RDS- decrease surfactant • Intraventricular hemorrhage due to trauma and hypoxemia • Anemia

  12. Long Term Outcomes • Retinopathy- high dose 02 damages retina • Bronchiopulmonary dyspalsia • Do poorly in school • Assess from EDC, not birth date

  13. Nursing • Maintenance of respiratory function • Give 02 • Keep warm • Intake and output • Feedings- assess for gag reflex • Prevent infection

  14. Newborn Addiction • Withdrawals. • FAS have poor prognosis due to CNS damage • Drug addicted- newborns jittery, high pitched cry, poor feeders, disorganized behavior • Nsg -keep warm, decrease stim., sm feedings

  15. HIV • May take 15 months to r/o HIV • Universal precautions • Wash hands -immunocompromised • Wash diapers with bleach • Encourage bonding

  16. Congenital Heart Defects • Causes- genetic, environmental, drugs • Cyanotic-flow from right to left • Acyanotic-left to right- oxygenated blood • Detect early • Anticipatory education- parental grief and fears

  17. Errors in Metabolism • PKU-Excess pnenylalinine • Test before discharge • Maple syrup urine- can be fatal • Galactosuria-unable to convert glucose • Hypothyroidism- lack of iodine in maternal diet

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