Infants w/ Gestational Age Probs
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| What is late preterm or near term infant | 34-36 1/2 wks
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| 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
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| preterm infants are susceptible to? | necrotizing enterocolitis, growth failure, brochopulmonary dysplasia, intraventricular/peri hemorrhage, retinopathy
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| What three things are part of high risk infant classification | birth wt, gestational age, patho probs
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| 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
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| Three options for O2 therapy for infant | O2 hood, nasal cannula, CPAP(most preferred for positive pressure)
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| Physical/emotional abuse is more common in which type of infant? | preterm birth
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| At what gestational age do infants need surfactant? | <32wks
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| what are additional therapies for resp distress | Inhaled nitric oxide, extracorporeal membrane exygenation
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| With nutrition, what is a major complication in feeding preterm infants | aspiration bc gag and swallow reflex is not formed
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| what is gavage feeding? | feed thru nasogastric or orogastric tube. Record hourly amts.
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| tube feeding must be assessed how often? | before each feeding
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| what is gastronomy feeding | thru stomach
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| when bathing preterm <32 wks, what should you bathe with? | warm sterile water for 1st week
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| what adhesives do you use for preterm? | semipermiable transparent adhesive dsg to secure lines, pectin barriers
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| what is polyethylene body bag is used when | after birth to xfer to neonatal unit for <30wks
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| at what decibel lvl can hurt infant's hearing? | constant 90db or frequent exposure of 110db
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| how long should sleep cycles go for complete sleep cycle to finish? | 50min.
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| 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
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| what nonpharmacological method acts as analgesic? | kangaroo care, skin to skin contact, helps maintain higher O2 sat
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| 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
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| 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
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| what main criteria allow infant to go home? | physiologically stable, receive adequate nutrition, gain wt daily
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| NICU infants will die how much more than non NICU infants in 1st year. What must parents know before discharge? | Twice as likely
CPR
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| Resp Distress Syndrome RDS is caused by | lack of sufactant
Tx: O2, exogenous surfactant
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| 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%
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| What does the ductus arteriosus connect? What occurs when fails to close? | left pulmonary aa and dorsal aorta
PDA occurs
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| what is most common heurologic injury in neonates? | peri/intraventricular Hemorrhage in brain. Elevate HOB. Watch for pneumothorax
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| What is necrotizing Enterocolitis | acute inflammatory disease of GI mucosa from perforation. Preterms at most risk. Ileus forms.
Tx: control infection
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| High arterial O2 saturations in ELBW/VLBW has been linked to what complication? | Retinopathy
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| 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
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| 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
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| 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.
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| Fetal blood flow from brain back to mom | Blood from brain to sup vena cava, to rt atrium, to rt ventricle, exit pulmonary art.
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| 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)
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| Blood flow after birth | ductus arterosus and foramen ovale close allowing all CO to go to lungs
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| 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
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| Problems for LGA babies | morbidity
birth trauma
asphyxia
congenital anomalies
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| 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
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| 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.
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| what is single most important factor influencing fetal well being? | Mother's glycemic status. Keep 100-120. Anomalies occur b4 8th wk
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| Birth traumas include | cephalhematoma, Erb Palsy(rt arm), dystocia, phrenic nerve paralysis, brachial plexus paralysis, fracture clavical/humerus
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| Hypoglycemic most common in SGA and macrosomia, what r s/s | jitteriness, apnea, tachypnea, cyanosis, seizures. Glucose needs to be above 50
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