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OB Ch. 27

Infants w/ Gestational Age Probs

QuestionAnswer
What is late preterm or near term infant 34-36 1/2 wks
LBW wt? VLBW? ELBW? AGA? SGA? LGA? preterm? full? post? live birth? fetal death? neonatal death? LBW:2500g, VLBW:1500g, ELBW:1000g(2.2lbs) AGA: 10-90th, SGA:<10th, LGA: >90th pre:<37, full:38-42, post: >42 fetal death: after 20wks, neonatal death: first 27 days
preterm infants are susceptible to? necrotizing enterocolitis, growth failure, brochopulmonary dysplasia, intraventricular/peri hemorrhage, retinopathy
What three things are part of high risk infant classification birth wt, gestational age, patho probs
What fx of infant renal system are immature? adequately excrete metabolites/drugs, concentrate urine, maintain acid-base, fluid, electrolyte balance Assess I/O and specific gravity
Three options for O2 therapy for infant O2 hood, nasal cannula, CPAP(most preferred for positive pressure)
Physical/emotional abuse is more common in which type of infant? preterm birth
At what gestational age do infants need surfactant? <32wks
what are additional therapies for resp distress Inhaled nitric oxide, extracorporeal membrane exygenation
With nutrition, what is a major complication in feeding preterm infants aspiration bc gag and swallow reflex is not formed
what is gavage feeding? feed thru nasogastric or orogastric tube. Record hourly amts.
tube feeding must be assessed how often? before each feeding
what is gastronomy feeding thru stomach
when bathing preterm <32 wks, what should you bathe with? warm sterile water for 1st week
what adhesives do you use for preterm? semipermiable transparent adhesive dsg to secure lines, pectin barriers
what is polyethylene body bag is used when after birth to xfer to neonatal unit for <30wks
at what decibel lvl can hurt infant's hearing? constant 90db or frequent exposure of 110db
how long should sleep cycles go for complete sleep cycle to finish? 50min.
what is containment/facilitated tucking/blanket swaddling mean? infant limbs held flexed and close to body during turning or other position changes or heel stick
what nonpharmacological method acts as analgesic? kangaroo care, skin to skin contact, helps maintain higher O2 sat
what are examples of approach behaviors of infant? avoidance? approach: tongue ext, hand clasp, hand to mouth mvmts, sucking, looking, cooing avoid: flushed, dusky, pale, gray skin, tachypnea, gasping, sighing, tremors, startles, twitches, hiccups, grunting, spit up, yawning, coughing, arm/leg extensions
what are 4 central themes for NICU staff to use when caring for families? 1.nurture parents 2.provide accurate/consistent info 3.clarify NICU policies 4.help parents connect with infant
what main criteria allow infant to go home? physiologically stable, receive adequate nutrition, gain wt daily
NICU infants will die how much more than non NICU infants in 1st year. What must parents know before discharge? Twice as likely CPR
Resp Distress Syndrome RDS is caused by lack of sufactant Tx: O2, exogenous surfactant
Normal ABGs for neonates pH: 7.35-7.45 PaO2: 60-80mmHg PaCO2: 35-45mmHg HCO3(bicarb): 22-26mEq/L Base excess: (-4) to (+4) O2 sat: 92%-94%
What does the ductus arteriosus connect? What occurs when fails to close? left pulmonary aa and dorsal aorta PDA occurs
what is most common heurologic injury in neonates? peri/intraventricular Hemorrhage in brain. Elevate HOB. Watch for pneumothorax
What is necrotizing Enterocolitis acute inflammatory disease of GI mucosa from perforation. Preterms at most risk. Ileus forms. Tx: control infection
High arterial O2 saturations in ELBW/VLBW has been linked to what complication? Retinopathy
Mechanical ventilation can lead to what complication Bronchopulmonary Dysplasia(chronic lung disease) in infants <1000g or born <28wks. Listen for crackles, wheezing Tx: O2 therapy, nutrition, fluid restriction, meds. Key to preventing is prevent preterm births
What two problems come wtih post term infants? Meconium aspiration syndrome and Persistent pulmonary HTN of newborn- baby does not change away from fetal O2 exchange like supposed to
Explain fetal blood flow from placenta to brain O2 rich blood leaves placenta by umbilical v, thru ductus venosus, enter inf vena cava, empty in rt atrium, x foramen ovale to lft atrium(bypass lungs), leave thru aorta to heart adn brain.
Fetal blood flow from brain back to mom Blood from brain to sup vena cava, to rt atrium, to rt ventricle, exit pulmonary art.
Where does the ductus arteriosus take blood connect main pulmonary art and aorta leaving right side of fetal heart shunting to systemic system away from lungs. (right-to-left shunting)
Blood flow after birth ductus arterosus and foramen ovale close allowing all CO to go to lungs
Common problems taht affect SGA perinatal ssphyxia - prolonged hypoxia hypoglycemia- decr stores, Tx: IV dextrose, oral feedings hyperglycemia heat loss- decr brown fat, decr gycogen stores
Problems for LGA babies morbidity birth trauma asphyxia congenital anomalies
IDM's(infants of Diabetic Mothers)have macrosomia, what's this? excessive fetal growth due to incr insulin(growth hormone). Round, cherry red face, fat
In IDM's, mother's blood is more acidic than baby's, this causes what to happen ketoacidosis and little CO2 or O2 exchange occurs with placenta.
what is single most important factor influencing fetal well being? Mother's glycemic status. Keep 100-120. Anomalies occur b4 8th wk
Birth traumas include cephalhematoma, Erb Palsy(rt arm), dystocia, phrenic nerve paralysis, brachial plexus paralysis, fracture clavical/humerus
Hypoglycemic most common in SGA and macrosomia, what r s/s jitteriness, apnea, tachypnea, cyanosis, seizures. Glucose needs to be above 50
Created by: palmerag