High Risk Newborn

Question 1

Preterm (Premature) Newborn

Answer 1

• Respiratory Problems:
• Cardiac Problems
• Thermoregulation
• GI alterations: smaller gi/ difficulties sucking/swallowing
• Renal: immature/ can’t compensate for acid-base balance issues/ can’t concentrate urine/ unable to excrete drugs
• Behavioral states: altered wake and sleep pattern
• Management of nutrition & Fluid Requirements
• Long term problems: apnea, congenital heart defects, preterm infants: Bronchopulmonary dysplasia (BPD)/ retinopathy of prematurity (ROP)

Question 2

Assessment of Respiratory Distress

Answer 2

• Skin color
• Respiratory System
  — Rate
  — Labored respirations
  — Auscultation of chest
  — Cardiovascular System: urinary output (1-2 ml/kg/ hr)
  — Hypothermia
  — Muscle tone

Question 3

Bronchopulmonary Dysplasia (BPD)

Answer 3

• Bronchopulmonary Dysplasia (BPD)
• Chronic lung disease
• Infant requires oxygen 28 days after birth and inability to be weaned
• Caused by preterm, mechanical ventilation, high levels of O2, PDA (patent ductus arterioles) and lung infection
• decrease alveoli in lungs/ thick alveoli sac; non compliant
• treatment: caffeine; stimulate respiratory response in brain/ diaphragm

Question 4

Meconium Aspiration Syndrome

Answer 4

• Meconium in the amniotic fluid indicates a potential hypoxic insult
• Triggers chemical pneumonitis which can lead to a bacterial pneumonia, prevents O2 intake/ CO2 release
• Severity of symptoms depends on extent of aspiration
• green amniotic fluid

Question 5

Meconium Aspiration Syndrome
Treatment

Answer 5

• Intrauterine saline flushes
• Initial suctioning
• Resuscitation; based on Apgar score
• Ventilation
• Surfactant replacement therapy
• Med: Curosef- synthetic surfactant given through endotracheal tube
• Stimulate lung growth
• Nitric oxide: vasodilator

Question 6

Intraventricular Hemorrhage (IVH)

Answer 6

• Bleeding in and around ventricles
• 30% of preterms weighing less than 1500gm (3lb 5oz)
• Caused by fluctuation in BP, mechanical ventilation, asphyxia

Question 7

Intraventricular Hemorrhage (IVH)
Nursing intervention

Answer 7

• Avoid crying, overstimulation
• Neuro check
• Measure head circumference; enlarged= hemorrhage

Question 8

Retinopathy of Prematurity (ROP)

Answer 8

• High levels of O2 injure blood vessels in eye which leads to abnormally developed vessels which lead to blindness
• Preterm, LBW (low birth weight)
• Laser Surgery

Question 9

Necrotizing Enterocolitis (NEC)

Answer 9

• Inflammation & death of intestinal mucosa Preterm Feeding to early or quickly
• Treatment
  — Antibiotics, NPO, suction, TPN, surgery, abdominal girths

Question 10

Newborns with Infection
Signs & Symptoms

Answer 10

• Subtle behavioral changes
• Temperature instability
• Feeding intolerance
• Hyperbilirubinemia
• Initially Tachycardia, spells of apnea or bradycardia (later)

Question 11

Transient Tachypnea of the Newborn (TTN)-

Answer 11

• Occurs in babies who are term
• Little or no difficulty breathing at birth
• Shortly after, expiratory grunting, tachypnea, nasal flaring, cyanosis.
• Due to maternal oversedation, bleeding, prolapsed cord, breech, maternal diabetes or c-section.
• Resolves on its own 24-48 hours
• Treatment: treat symptoms/ o2 if needed

Question 12

Infant of Diabetic Mother: Complications

Answer 12

• LGA Birth Trauma
• Hypoglycemia
• Hypocalcemia
• Hyperbilirubinemia
• Polycythemia
• RDS
• Congenital Birth Defects

Question 13

Infant HYPOGLYCEMIA

Answer 13

• Intervention when glucose 40mg/dl / or when symptomatic
• Most common metabolic disorder of IDM, SGA and LGA
• Screened within 1st 30 minutes to 2 hours of birth
• Treatment: formula/ Dextrose IV

Question 14

NAS s/s

Answer 14

• high pitched/ cat like cry
• Irritable
• Seizures
• Sleep deprivation/ fragmentation
• Tachypnea
• Hypertension
• Tachycardia
• *Diarrhea
• Excessive weight loss
• Vomiting
• *Sneezing
• Excessive sucking
• Poor or excessive feeding
• Yawning
• Hyperthermia
• Hypertonia
• Tremors

Question 15

NAS Treatment

Answer 15

find out what the substance is:
- Opiod: methadone
- Stimulant (cocaine): let it pass out of body
- Cluster care
- Keep lights low
- Social case worker