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1、High Risk Newborn,Mary L. Dunlap MSN, APRN,Preterm Infant,Infant born prior to the completion of the 37th week Organs immature Lack physical reserves Survivability related to weight / gestational age,Preterm Infant,Respiratory last to mature Surfactant deficiency-RDS Unstable chest wall-atelectasis
2、Immature respiratory centers-apnea Small passages-obstructions Unable to clear fluid-TTN,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,
3、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,Preterm Infant,Renal System Slow glomerular filtration rate Reduced
4、 ability to concentrate urine Risk: fluid retention, electrolyte imbalance, drug toxicity,Preterm Infant,Immune system Deficiency of IgG Impaired ability to produce antibodies Thin skin- limited protection barrier,Preterm Infant,Central nervous system Long term disability due to injury Difficulty ma
5、intaining temperature Compounded by lack of brown fat,Preterm Infant Nursing Management,Varies with gestational Promote Oxygenation Maintain body temperature nutritional needs,Prevent infections Provide stimulation Pain management,Small for Gestational Age,SGA weight- less than 5lb 8 oz and below th
6、e 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,Small for Gestational Age Characteristics,Decreased breast tissue Scaphoid abdomen (sunken) Wide sutures Thin umbilic
7、al cord,Head larger than body Wasted appearance to extremities Reduced fat stores,Small for Gestational Age Common Problems,Perinatal asphyxia Hypothermia Hypoglycemia Polycythemia Meconium Aspiration,Large for Gestational Age Characteristics,LGA weight- Larger than 9 lbs and above the 90th% Large b
8、ody-plump full face Body size is proportionate Poor motor skills Difficulty in regulating behavioral state (arouse to quiet alert state),Large for Gestational Age Common Problems,Birth Trauma- Hypoglycemia Polcythemia Hyperbilirubinemia,Post term Infant,Gestation 42 weeks Must determine if EDC is tr
9、uly post term After 42 weeks placenta loses ability to nourish the fetus,Post term Infant Characteristics,Newborn emaciated Meconium stained Hair and nails long,Dry peeling skin Creases cover soles Limited vernix and lanugo,Infant of Diabetic Mother,Mother can have pregestational or gestational diab
10、etes Increasing numbers of type 2 Related to increase in morbidity & mortality Congenital abnormalities,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 f
11、etal growth Tight control over glucose levels needed ( less than 1-0mg/dl),Infant of Diabetic Mother Common Problems,Congenital Abnormalities Macrosomia Birth Trauma Perinatal Asphyxia,RDS Hypoglycemia Hyperbilirubinemia Polycythemia,Infant of Diabetic Mother,Infant Characteristics Rosy cheeks Short
12、 neck Wide shoulders Excessive subcutaneous fat Distended abdomen,Infant of Diabetic Mother Nursing 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,Respirato
13、ry Distress Syndrome,RDS caused by lack of surfactant Poor gas exchange & ventilation Seen in preterm newborns Cesarean births without labor Infants of diabetic mothers,Respiratory Distress Syndrome Symptoms,Tachypnea Expiratory grunting Nasal flaring Retractions See-saw respiration Chest x-ray- alv
14、eolar atelectasis (ground glass pattern) & dilated bronchioles ( dark streaks within granular pattern),Respiratory Distress Syndrome Nursing Management,Thermoregulation O2 administration Mechanical ventilation if needed Hold parenteral feedings Monitor VS & O2 sats Provide nutrition ( gavage feeding
15、s),Transient Tachypnea Newborn TTN,Mild respiratory condition Result of delayed absorption of fluid Last about 3 days,Transient Tachypnea Newborn TTN,Symptoms Respiratory rate as high as 100-140 Labored breathing Grunting nasal flaring Retractions Chest x-ray shows lymphatic engorgement ( retained l
16、ung fluid),Transient Tachypnea Newborn Nursing Care,Mainly supportive Monitory VS & O2 Sats Provide supplemental O2,Meconium Aspiration,Fetus inhales meconium into the lungs while in utero Meconium blocks the airway preventing exhalation Meconium irritates the airway making breathing difficult Mecon
17、ium aspiration related to fetal distress during labor.,Meconium Aspiration Symptoms,Cyanosis Rapid breathing Labored breathing Apnea X-ray patches or streaks of meconium & trapped air,Meconium Aspiration Nursing Management,Assess for risk factors prior to delivery Suction at delivery prior to newbor
18、n crying Supplemental O2 Mechanical ventilation Antibiotic therapy,Hyperbilirubinemia,Excess of bilirubin in the blood-elevated bilirubin level 5mg/dl Heme from erythrocytes break down forms unconjugated bilirubin Jaundice Physiologic Pathologic,Hyperbilirubinemia Causes,Drugs/Medical conditions dis
19、rupt conjugation and albumin binding sites Decreased hepatic function Increased erythrocyte production Enzymes in breast milk,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 Unconjug
20、ated bilirubin level 12mg/100 ml,Hyperbilirubinemia Pathologic,Develop after first day Persists beyond 7 days Bilirubin 12.9mg/100 term Bilirubin 15mg/100 preterm Increases 5mg/100ml in 24hrs,Hyperbilirubinemia Nursing Management,Phototherapy Increase feeding to q 2-3 hrs,Phenylketonuria PKU,Inabili
21、ty 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,Phenylketonuria PKU Symptoms,Seizures Irritability Tremors Jerking movements arms & legs Hyperactivity Un
22、usual hand posturing,Phenylketonuria PKU,Diagnosed with PKU screening prior to discharge from hospital,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 ent
23、ering maternal circulation,Hemolytic Disorders,Maternal antibodies of IgG class cross placenta, causing hemolysis of fetal RBCs Fetal anemia Neonatal jaundice Hyperbilirubinemia,Hemolytic Disorders,Rh incompatibility (isoimmunization) Only Rh-positive offspring of Rh-negative mother is at risk If fe
24、tus is Rh positive and mother Rh negative, mother forms antibodies against fetal blood cells,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 acros
25、s placenta to fetus Exchange transfusions required occasionally,Neonatal Infections,Sepsis Bacterial, viral, fungal Patterns Early onset or congenital Nosocomial infectionlate onset,Neonatal Infection,Septicemia Pneumonia Bacterial meningitis Gastroenteritis is sporadic,Neonatal Infections,TORCH infections Toxoplasmosis Gonorrhea Syphilis Varicella-zoster Hepatitis B virus (HBV) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS),