result from problems or conditions experienced by the woman during her pregnancy or at birth
When do acquired conditions occur?
Soon after or at birth
What maternal conditions could cause acquired disorders?
- maternal diabetes
- maternal infection
- substance abuse
- prolonged ROM/fetal distress
structural, functional, or metabolic abnormalities at birth
What are the most common serious congenital defects?
Neural tube defects
Congenital Disorders often involve a problem with what?
inheritance, structural anomalies, chromosomal disorders, an inborn errors of metabolism
failure to establish adequate, sustained respirations after birth
What is the patho for Neonatal Asphyxia?
insufficient oxygen delivery to meet metabolic needs
Nursing Assessment for Neonatal Asphyxia
risk factors newborn's color work of breathing HR, temp APGAR scores
Nursing Management of Asphyxia
immediate resuscitation continued observation neutral thermal environment BG levels parental support/education
Risk factors for Asphyxia
trauma intrauterine asphyxia sepsis malformation hypovolemic shock medication
self-limiting condition involving mild respiratory distress, retention of lung fluid, or transient pulmonary edema
When does transient tachypnea typically resolve?
w/in 24-72 hours
Nursing Assessment for Transient Tachypnea
- maternal sedation or birth by c/s
- expiratory grunting
- labored breathing; nasal flaring
- mild cyanosis
- RR 100-140
- barrel-shaped chest
- low breath sounds
Nursing Management for Transient Tachypnea
IV fluids or gavage feedings
Neutral thermal environment
Where does an intraventricular hemorrhage usually originate?
The subependymal germinal matrix region of the brain w/ extension into the ventricular system
Respiratory Distress Syndrome results from what?
lung immaturity and lack of alveolar surfactant
What is the most common risk factor for the development of respiratory distress syndrome?
What other risk factors are there for RDS?
C/S male gender previous birth w/ RDS perinatal asphyxia cold stress maternal diabetes
S/S of RDS
expiratory grunting nasal flaring chest wall retractions seesaw respirations generalized cyanosis HR > 150-180 inspiratory crackles tachypnea (RR > 60) silverman-anderson index score > 7
assessment scoring system that can be used to evaluate 5 parameters of work of breathing
What will the chest x-ray reveal for RDS?
ground glass pattern
Nursing Management for RDS
- supportive care; close monitoring
- respiratory modalities
- antibiotics/correction of metabolic acidosis
- fluids and vasopressors; gavage/IV feedings
- cluster care; prone/side-lying position
- parental support
Meconium Aspiration Syndrome
inhalation of particulate meconium w/ amniotic fluid into lungs
Risk Factors for Meconium Aspiration Syndrome
maternal hypertension placental insufficiency preeclampsia fetal hypoxia transient umbilical compression oligohydramnios drug abuse
What would indicate that meconium has been present for some time?
yellowish-green staining of umbilical cord, nails, and skin
S/S of MAS
Barrel-shaped chest prolonged tachypnea increasing respiratory distress intercostal retractions expiratory grunting cyanosis
MAS Nursing Management
Suctioning at birth Adequate tissue perfusion Decrease in oxygen demand and energy Neutral thermal environment Parental support
inflammatory disease of the bowel
What can NEC cause?
ischemic and necrotic injury in the GI tract
What are the 3 pathologic mechanisms for NEC?
Effect of feeding
S/S of NEC
abdominal distention and tenderness bloody stools feeding intolerance/bilious vomiting sepsis lethargy apnea shock
NEC Nursing Management
Maintenance of fluid/nutritional status
Surgery w/ proximal enterostomy
How can you maintain fluid and nutritional status for NEC?
Bowel rest and antibiotic therapy
What happens to infants of diabetic mothers?
high levels of maternal glucose cross placenta stimulating increased fetal insulin production leading to fetal complications
Infants of Diabetic Mothers Characteristics
Full rosy cheeks ruddy skin color short neck buffalo hump massive shoulders distended upper abdomen excessive fat hypoglycemia birth trauma
When would hypomagnesemia be suspected?
when hypocalcemia does NOT respond to calcium
What laboratory tests should be performed for babies of mothers w/ diabetes?
Nursing Management for Infants w/ Diabetic moms
Prevention of hypoglycemia
Maintenance of fluid/electrolyte balance
How can you help to prevent hypoglycemia?
Oral feedings, neutral thermal environment, and rest periods
Maintenance of Fluid/Electrolyte balance
calcium level monitoring
bilirubin level monitoring
What are the most commonly abused substances during pregnancy?
Fetal Alcohol Syndrome
physical and mental disorders appearing at birth and remaining problematic throughout life
What are other disorders related to alcohol?
Fetal alcohol spectrum disorders
Alcohol related neurodevelopmental disorder
Alcohol related birth defects
Neonatal Abstinence Syndrome
drug dependency acquired in utero manifested by neurologic and physical behaviors
What maternal history should you look for to identify risk factors of substance abuse?
previous unexplained fetal demise/preterm birth lack of prenatal care incarceration toxicology screens History of STI's history of intimate partner violence mental health disorders
Newborn Behaviors w/ substance abuse
Metabolic, vasomotor, and respiratory disturbances
Nursing Management for Infants of Substance-Abusing Moms
comfort promotion; stimuli reduction
prevention of complications
injuries due to forces of labor and birth
Types of Birth Trauma
fractures brachial plexus injuries cranial nerve trauma head trauma cephalhematoma caput succedaneum
Nursing Management for Birth Trauma
Supportive Assessment for resolution or complications Support/Education Realistic appraisal of situation Community referrals
imbalance in rate of bilirubin production and elimination
level > 5 mg/dL
unconjugated hyperbilirubinemia that occurs after the first postnatal day and can last up to 1 week
What are the 2 different types of physiologic jaundice?
Early-onset breast feeding
Late-onset breast feeding
Early-Onset Breastfeeding Jaundice is associated w/ what?
ineffective breastfeeding practices b/c of relative caloric deprivation in the first few days of life
Late-Onset Breastfeeding Jaundice may occur b/c of?
change in milk composition resulting in enhanced enterohepatic circulation
manifested w/in the first 24 hours of life
chronic bilirubin encephalopathy
S/S of Kernicterus
dental enamel hypoplasia
What is the most common condition associated w/ pathologic jaundice?
hemolytic disease of the newborn secondary to incompatibility of blood groups
What are the 2 most frequent blood incompatibility conditions?
Where does neonatal jaundice first become visible?
face and forehead
Nursing Assessment for Hyperbilirubinemia
Signs of Rh incompatibility
Nursing Management for Hyperbilirubinemia
Reduction of bilirubin levels w/ early feedings, phototherapy, exchange transfusions
Education and Support
bacterial, fungal, or viral microorganisms or their toxins in blood or other tissues
Classifications of Neonatal Sepsis
Congenital (intrauterine) Early onset (perinatal period) Late Onset
Nursing Assessment for NNS
elevated C-reactive protein
Nursing Management for NNS
- Antibiotic therapy
- Circulatory, respiratory, nutritional, and developmental support
- Education for prevention/recognition
- Primary disease prevention
- Family education
congenitally interrupted esophagus
abnormal communication b/t trachea and esophagus
Nursing Assessment for EA/TF
copious frothy bubbles of mucus and drooling
coughing, choking, and cyanosis
Preparation of Surgery/Preop Care for EA/TF
- NPO, head elevation, hydration and fluids
- Oxygen and suctioning
- Comfort measures
- Parental education
Postop Care for EA/TF
- TPN and antibiotics
- Oral feeding w/in 1 week
- Parental teaching
umbilical ring defect w/ evisceration of abdominal contents into external peritoneal sac
herniation of abdominal contents through abdominal wall defect w/ NO peritoneal sac