Care of the High-Risk Newborn

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    Chapter 18
* Born before the beginning of the 38th week
* Low Birth Weight (LBW)
* Very Low Birth Weight (VLBW)
* Extremely Low Birth Weight (ELBW)

* Advances in technology
* Infant mortality and morbidity increase as gestational age
* Ethical questions?
* Causes?
* Prevention

*Problems with Skin    *Problems with Infection
Fragile, permeable,   Maternal infection
 easily damaged skin   Inadequate passive
Chemicals              immunity
Tape                  Immature immune
Equipment              response
Bathing               Hospital exposure
* Problems with Pain
Painful procedures
Effects of pain on preterm infants
Assessment tools
Nursing Interventions
Comfort measures
Pharmacologic measures    *
* Inadequate nutrient stores and digestive capacity
* Require approximately 105-130kcal/kg/day
* Require more protein, iron, calcium, and phosphorous
* Inadequate absorption of nutrients in gastrointestinal tract
* Smaller stomach capacity

* Respiratory Distress Syndrome (RDS)

* Bronchopulmonary Dysplasia (BPD)

* Periventricular-Intraventricular

* Hemorrhage (PIVH)

* Retinopathy of Prematurity (ROP)
* Necrotizing Enterocolitis (NEC)

* Post-term Infants

* Small for Gestational Age (SGA)

* Large for Gestational Age (LGA)

* Cleft lip and palate
* Esophageal
* Omphalocele/gastroschisis
* Diaphragmatic hernia
* Neural tube defects
* Congenital hydrocephalus

* Ventricular septal defect(VSD)
* Patent ductus arteriosus(PDA)
* Coarctation of the aorta
* Tetralogy of Fallot
* Transposition of the great arteries

* Cyanosis  with crying   * Tachypnea
* Pallor                   * Dyspnea
* Murmurs                  * Choking spells
* tachycardia              * Poor intake
                           * diaphoresis

*Asphyxia: lack of O2 and increase of CO2 in the
*Transient tachypnea of the newborn(TTN):
 retained lung fluid
*Meconium aspiration syndrome(MAS): aspiration
 of meconium stained fluid.
*Persistent pulmonary hypertension of the
 newborn(PPHN): the vascular resistance of the
 lungs does not decrease after birth and normal
 changes to neonatal circulation are impaired.

* Infection is a major cause of death during the neonatal
* Vertical transmission; before or during birth
* Horizontal transmission; after birth by contact with
 hospital staff, contaminated equipment, family

* Sepsis; systemic, bacteria in the bloodstream
* Most common organisms GBS & E.Coli
* Early vs late onset
* CBC with differential, blood cultures & C-reactive
* Broad spectrum antibiotic therapy
* Temp. instability       * muscle tone
* Tachypnea               * hypoglycemia
* RDS                     * Jitteriness
* Cyanosis/pallor         * Irritability
* oral intake            * Bulging fontanel

*Appears in the first 24 hours
*Kernicterus: acute bilirubin encephalopathy
*Hemolytic disease caused by RH
 incompatibility, antibodies attach to fetal
 RBC’s and destroy them
*ABO incompatibility
*Prevention of kernicterus
*Phototherapy; bilirubin in the skin absorbs
 light & changes to water-soluble
 photoisomers excreted in urine and bile

*Occurs in 10-15% births; 5% develop MAS
*Occurs most often in post-term infants who
 have AFI and are prone to cord compression
*Occurs in infants who have suffered
 intrauterine asphyxia
*Results in obstruction, pneumonitis,& air
*Amnioinfusion, mechanical suction on

*Neonatal abstinence syndrome(NAS )
*Prenatal opiate exposure sufficient enough to
 cause withdrawl signs after birth
*Codeine, tranquilizers, & sedatives
*SGA, preterm, RDS, jaundice, SIDS
*Special care to cope with drug withdrawl
*Care focuses on rest, feeding, & parental
*Genetic disorder that causes CNS damage
 from toxic levels of the amino acid
 phenylalanine in the blood
*Liver enzyme deficiency preventing normal
 conversion of phenylalanine
*In the USA, all newborns are screened after
 12 hours of age
*Requires special diet throughout life

*Exstrophy of the