N113 - Care of High-Risk Newborn
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| Premature | Infant born before completion of 37 weeks.
Major problem of preterm newborn is immaturity of all systems.
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| Characteristics of preterm infant | Small & scrawny-minimal subq fat, large head, skin-bright pink, abundant fine lanugo hair, soft & pliable ear cartilage
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| Male preterm | Undescended testes, few scrotal rugae
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| Female preterm | Labia minora is under-developed, labia minora & clitoris are prominent.
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| Preterm reflexes | Sucking is absent or weak, swallowing, gag & cough reflexes are absent or weak.
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| Respiratory alteration in preterm | Lungs not fully mature, lack of sufficient surfactant, increased respiratory distress syndrome.
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| Thermoregulation in preterm | Heat loss is major problem - prone to cold stress. Little subq fat, thinner more permeable skin
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| Clinical problems of preterm newborn | Apnea, Patent ductus arteriosis, RDS, intraventricular hemorrhage, hypoglycemia, necrotising enterocolitis, anemia, hyperbilirubinemai, infection
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| Post-mature newborn | Born after 42 weeks
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| Post-mature associated factors | 5 or more pregnancies, history of prolonged pregnancies
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| Post-mature infant characteristics | Absence of lanugo, little vernix, abundant scalp hair, long fingernails, cracked skin, wasted physical appearance (aging of placenta), depletion of subq fat
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| Large for gestational age (LGA) | Best known condition associated with LGA is maternal diabetes.
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| LGA complications | Birth trauma, increased chance of c-section & induction, hypoglycemia, polycthemia - increased # of RBC's
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| Small for gestational age (SGA) | Newborns at or below the 10th percentile, may be preterm or postterm, IUGR - intrauterine growth restriction
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| Maternal factors contributing to IUGR | Maternal factors - smoking, lack of prenatal care, age extremes (under 16 over 40)
Maternal disease - heart disease, substance abuse, PIH
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| Environmental factors contributing to IUGR | High altitude, exposure to x-rays, excessive exercise, work related exposure to toxins
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| Placental factors contributing to IUGR | Small placenta, infarcted area, abnormal cord intersections, placenta previa
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| Fetal factors contributing to IUGR | Congenital infections, malformations, chromosomal syndromes
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| Complications of SGA newborn | Prenatal asphyxia, aspiration syndrome, heat loss, hypoclycemia, polycythemia
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| Prenatal asphyxia - SGA | Chronic hypoxia in utero
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| Aspiration syndrome - SGA | In utero - fetus can gasp during birth aspirating amniotic fluid into lower airways
Hypoxia can lead to relaxation of anal sphincter & passage of meconium
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| Heat loss - SGA | Diminished subcutaneous fat, depletion of brown fat in utero, large surface area
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| Hypoglycemia - SGA | Inadequate supplies of enzymes to activate gluconeogenesis, increase in metabolic rate in response to heat loss, infant will have routine one touch
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| Polycythemia - SGA | Increased # of RBC's - considered a physiologic response to hypoxic stress, produce more RBC's to carry O2, causes an increase in bilirubin
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| Nursing care for high risk newborn | #1-Support respiratory function, thermoregulation, protect from infection, hydration, nutrition
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| Respiratory distress syndrome (RDS) | Also known as Hyaline membrane disease. Result of absence or deficiency in the production of surfactant.
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| RDS manifestation | Scattered atelectasis, overinflation of some areas, grunting, cyanosis on room air, tachypnea, nasal flaring
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| RDS management | Ventilator support, surfactant replacement therapy, in severe RDS - partial liquid ventilation
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| RDS complications | Too much O2 can damage retina
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