Chapters 24 – 25 Acquired Conditions and Congenital Abnormalities in the Newborn Flashcards
Exam 3
1
Q
Acquired Disorders Versus Congenital Disorders
Acquired disorders: When do they occur?
A
- typically occur at, or soon after, birth;
2
Q
Acquired Disorders Versus Congenital Disorders
Acquired disorders: What are they composed of? What are the cause of these disorders?
A
problems or conditions experienced by the woman during her pregnancy or at birth ; or possibly no identifiable cause for the disorder
3
Q
Acquired Disorders Versus Congenital Disorders:
Congenital disorders: When do they appear?
A
- present at birth;
4
Q
Acquired Disorders Versus Congenital Disorders:
Congenital disorders: Whey do they occur?
A
usually due to some type of malformation occurring during the antepartal period; typically some problem with inheritance; majority with a complex etiology
5
Q
Preterm Infants: What percent of babies are born before 37 weeks in the US?
A
Approximately 11.6% of babies are born before 37 weeks every year in the United States. (10% as of 2018)
6
Q
Preterm Infants: of the 11.6 percent of babies are born before 37 weeks in the US, how may are born before 34 weeks?
A
Of those babies, 3.4% are born before 34 weeks.
7
Q
Preterm Infants:
Preterm babies face many challenges including:
A
Respiratory distress syndrome (RDS)
Intraventricular hemorrhage (IVH)
8
Q
Preterm Infants:
Risks for prematurity are many and include:
A
Infection
Fetal anomalies
Preeclampsia/eclampsia
9
Q
Preterm Infants: What is a preterm infant?
A
Preterm- < 37 weeks
10
Q
Preterm Infants: What is a LATE preterm infant?
A
Late Preterm -34 -36 6/7
11
Q
Preterm Infants: What is a MODERATE preterm infant?
A
Moderate Preterm -32-33 6/7
12
Q
Preterm Infants: What is an EARLY preterm infant?
A
Early Preterm -<32 weeks
13
Q
Preterm Infants: What is a VERY EARLY preterm infant?
A
Very Preterm - <28weeks
14
Q
Preterm Infants:
Weight distribution: Macrosomic (LGA)
A
Macrosomic (LGA) - >4000 gm
15
Q
Preterm Infants: Term
A
2,500-3999 gm
16
Q
Preterm Infants: Low birthweight (LBW)
A
Low birthweight (LBW)- < 2500 gm
17
Q
Preterm Infants: Very Low birthweight (VLBW)
A
Very Low birthweight (VLBW) - < 1500gm
18
Q
Preterm Infants: Extremely (ELBW)
A
Extremely (ELBW) - < 1000gm
19
Q
What are the two forms of IUGR?
A
Symmetric
Asymmetric
20
Q
Symmetric Intrauterine Growth Restriction (IUGR): What is it?
A
IUGE that is global
The head, torso, and extremities are symmetrically undersized
21
Q
Symmetric Intrauterine Growth Restriction (IUGR): What is it also called?
A
Global growth restriction
22
Q
Symmetric Intrauterine Growth Restriction (IUGR): What does it indicate?
A
Indicates the growth has been slow throughout pregnancy
23
Q
Symmetric Intrauterine Growth Restriction (IUGR): What is it associated with?
A
Associated with a higher incidence of permanent neurological problems
24
Q
Asymmetric Intrauterine Growth Restriction (IUGR): What occurs during it?
A
IUGR in which the head grows normally but the body grows slowly
25
Asymmetric Intrauterine Growth Restriction (IUGR): When does this occur?
Slowed growth of the body typically occurs in the third trimester, after normal growth in the first two
26
Stressors Related to Premature Birth:
Stressors include:
Letting go of the dream of the perfect, healthy infant
Day-to-day “roller-coaster” regarding infant’s health
Disruption of family life
Time spent in the neonatal intensive care unit
Financial strain
Difficult decisions regarding the care of the infant
Feelings of not being able to provide for the infant
27
Complications of Prematurity:
Potential complications for PT include:
Respiratory:
GI:
Cardiovascular:
Neurological:
Retinopathy of prematurity
Sepsis
Longterm complications
28
Complications of Prematurity:
Potential complications for PT include: Respiratory
RDS;respiratory distress;
BPD/CLD; (chronic lung and bronchopulmonary disease)
29
Complications of Prematurity:
Potential complications for PT include: GI
Necrotizing enterocolitis (NEC);
Hyperbilirubinemia;
hypoglycemia;
30
Complications of Prematurity:
Potential complications for PT include: GI
Necrotizing enterocolitis (NEC); What can decrease the incidence of NEC?
studies have shown that human milk can decrease the incidence of necrotizing enterocolitis in this population.
31
Complications of Prematurity
Cardiovascular:
Patent ductus arteriosus (PDA);
32
Complications of Prematurity
Neurological:
Severe Intraventricular hemorrhage (IVH);
Periventricular leukomalacia (PVL)
33
Complications of Prematurity:
Longterm complications:
Increased what? What impairments? Difficulties and problems?
Increased hospitalizations in childhood
Impairments of learning and memory
Behavioral problems such as attention deficit hyperactivity disorder
Cerebral palsy
Sensory difficulties (such as vision and hearing)
34
Neonatal Asphyxia
Failure to establish adequate, sustained respirations after birth
Oxygen demands are not being met.
35
Neonatal Asphyxia
Pathophysiology:
insufficient oxygen delivery to meet metabolic demands
36
Neonatal Asphyxia:
Nursing assessment
risk factors,
newborn’s color,
work of breathing,
heart rate,
temperature,
Apgar scores
37
Neonatal Asphyxia:
Nursing management:
Immediate resuscitation,
Continued observation,
Neutral thermal environment,
Blood glucose levels,
Parental support and education
38
Preterm Infants: What are they at high risk for?
Preterm infants are at high risk for hypothermia
39
Preterm Infants:
Preterm infants are at high risk for hypothermia because:
They do not have an accumulation of body fat,
Don’t have muscle tone to maintain a flexed posture,
And the temperature center in the brain is immature.
40
Preterm Infants:
What is the treatment of mild hypothermia?
Treatment of mild hypothermia is gradual rewarming.
41
Preterm Infants:
Treatment of mild hypothermia is gradual rewarming.
How is this accomplished?
Rewarming is often accomplished by radiant warmer and/or warming mattress.
42
Preterm Infants: Thermoregulation
Nursing considerations to avoid temperature instability include:
What should be maintained?
Maintaining a warm delivery room.
43
Preterm Infants: Thermoregulation
Nursing considerations to avoid temperature instability include:
What should be done immediately after birth?
Drying the infant immediately after birth.
44
Preterm Infants: Thermoregulation
Nursing considerations to avoid temperature instability include:
What should be done with blankets?
Replacing wet blankets with dry ones.
45
Preterm Infants: Thermoregulation
Nursing considerations to avoid temperature instability include:
How should assessments be performed?
Performing assessments and interventions on skin-to-skin with the mother or under a prewarmed radiant heater.
46
Preterm Infants: Thermoregulation
What occurs with hypothermia? What happens to metabolic rate?
Cold stress occurs with hypothermia when blood vessels constrict to conserve heat. The metabolic rate increases as does oxygen consumption.
47
Preterm Infants: Thermoregulation
What can prolonged cold stress lead to?
Prolonged cold stress can lead to respiratory distress, acidosis, hypoglycemia, and reopening or failure to close of the ductus arteriosus.
48
Preterm Infants: Respiratory Considerations
Factors that contribute to respiratory issues for preterm infants include:
Production of what is affected? How?
Surfactant (responsible for alveoli expansion and facilitating gas exchange) production is decreased.
Airway lumens are small.
Premature infants lack a gag reflex.
49
Preterm Infants: Respiratory Considerations
What is common in preterm infants? When is it significant?
Apnea is common in preterm infants and significant if breathing stops for more than 20 seconds or is associated with either a heart rate less than 100 ( text 70 - 80) bpm or oxygen saturation below 88% (text 80% to 85%).
50
Preterm Infants: Respiratory Considerations:
Continuous monitoring how is indicated?
Continuous monitoring of preterm infants by pulse oximetry and cardiac monitor is indicated.
51
Preterm Infants: Respiratory Considerations
How can occasional apnea be treated?
Occasional apnea may be treated with tactile stimulation.
52
Preterm Infants: Respiratory Considerations
What may frequent apnea require?
Frequent apnea may require CPAP.
53
NICU Equipment
Respiratory Equipment includes:
Nasal cannula
Continuous positive airway pressure (CPAP)
Mechanical Ventilation
54
NICU Equipment
Respiratory Equipment: What is Nasal Cannula used for?
Nasal cannula – infant has spontaneous respirations, needs additional oxygen support
55
NICU Equipment
Respiratory Equipment: What is Continuous positive airway pressure (CPAP) used for?
Continuous positive airway pressure (CPAP) - for infants unable to obtain adequate oxygenation by nasal canula alone.
56
NICU Equipment
Respiratory Equipment: What is Mechanical Ventilation used for?
Mechanical Ventilation - An endotracheal tube (ET) is placed by intubation through the infant’s mouth. The ET tube is then attached to a ventilator.
57
NICU Equipment
What is Nasogastric tubes (NGT)/orogastric (OGT) used for?
Nasogastric tubes ( NGT)/orogastric (OGT) are used for feeding and for gastric suction.
58
NICU Equipment
Where are Umbilical artery/venous catheters placed?
Umbilical artery/venous catheters are placed into the umbilical cord stump
59
NICU Equipment
What are Umbilical artery (UAC) used for? How long is it left in place?
UAC- used to monitor arterial blood glasses.
It is rarely left in place more than 1 week.
60
NICU Equipment
What are Umbilical venous (UVC) used for? How long is it left in place?
UVC- used for fluid, medication administration, blood administration, in place x 1 week
61
NICU Equipment:
What is
Peripherally inserted central line (PICC) used for?
Peripherally inserted central line (PICC) is used when intermediate-term intravenous (IV) access is required.
62
What are Acquired Conditions of the Newborn? (There are 10)
Transient tachypnea of the newborn (TTN)
Respiratory Distress Syndrome (RDS)
Meconium aspiration (MAS)
Persistent pulmonary hypertension of the newborn (PPHN)-
Bronchopulmonary dysplasia-(BPD)
Retinopathy of prematurity (ROP)
Peri-/intraventricular hemorrhage (PVH/IVH)
Necrotizing Enterocolitis (NEC)
Neonatal Encepatholopathy (NE/HIE)
Hyperbilirubinemia
63
Acquired Conditions of the Newborn:
Transient tachypnea of the newborn (TTN):
What is it? What does it have to do with lung fluid? When is resolution of the issue?
TTN is mild respiratory distress;
lung fluid removed slowly or incompletely;
resolution by 72 hours of age;
64
Acquired Conditions of the Newborn:
Transient tachypnea of the newborn (TTN):
What is part of the assessment?
Assessment:
Maternal sedation or birth by cesarean;
tachypnea,
expiratory grunting,
retractions,
labored breathing, nasal flaring,
and mild cyanosis;
slightly decreased breath sounds
65
Acquired Conditions of the Newborn:
Transient tachypnea of the newborn (TTN):
What is part of the nursing management?
Nursing management:
Oxygenation;
IVF/gavage feeds;
thermoregulation
66
Acquired Conditions of the Newborn:
Respiratory Distress Syndrome:
What is RDS due to?
RDS is Due To:
Lung immaturity and lack of alveolar surfactant;
problem of prematurity
67
Acquired Conditions of the Newborn:
Respiratory Distress Syndrome:
What is in nursing assessment? (include signs and symptoms)
Nursing Assessment:
Risk factors: PT;
S/S:Expiratory grunting, nasal flaring, chest wall retractions, see-saw respirations, generalized cyanosis; heart rate >160 to 180; fine inspiratory crackles, tachypnea (rates >60)
68
Acquired Conditions of the Newborn:
Respiratory Distress Syndrome:
What is Nursing Management:
Nursing Management:
Respiratory modalities: ventilation (CPAP, PEEP);
exogenous surfactant;
oxygen therapy;
69
Acquired Conditions of the Newborn:
Meconium aspiration (MAS)
What is it?
MAS is the inhalation of particulate meconium with amniotic fluid into lungs;
secondary to hypoxic stress
70
Acquired Conditions of the Newborn:
Meconium aspiration (MAS)
What is in nursing assessment? (include signs and symptoms)
Nursing assessment:
Risk factors (hypoxic episodes);
S/S: Staining of amniotic fluid, nails, skin, or umbilical cord; Barrel-shaped chest; prolonged tachypnea, increasing respiratory distress; intercostal retractions, end-expiratory grunting, cyanosis
71
Acquired Conditions of the Newborn:
Meconium aspiration (MAS)
Nursing Management:
Nursing Management:
Suctioning at birth-no longer routinely done;
Adequate tissue perfusion;
Decrease in oxygen demand and energy expenditure;
Neutral thermal environment;
Parental support and education
72
Acquired Conditions of the Newborn
Persistent pulmonary hypertension of the newborn (PPHN)- What is it and what does it cause?
PPHN- persistent increased pulmonary vascular resistance (PVR) that causes left to right shunting and hypoxia, underdeveloped or abnormal pulmonary vascular, or lung disease.
73
Acquired Conditions of the Newborn
Persistent pulmonary hypertension of the newborn (PPHN)- What are symptoms?
Symptoms include: Respiratory distress within 24 hours of birth: Cyanosis; Prominent apical impulses; Systolic murmur
74
Acquired Conditions of the Newborn
Persistent pulmonary hypertension of the newborn (PPHN)- What are Nursing Management?
Nursing Management:
Immediate resuscitation;
Monitoring of oxygenation and perfusion, BP;
oxygen therapy;
Respiratory support;
Medications;
Clustering of care;
Parental support and education
75
Acquired Conditions of the Newborn
Bronchopulmonary dysplasia-(BPD): What it is also known as and what is needed?
BPD -AKA chronic lung disease (CLD) - need continued oxygen after initial 28 days of life or >36 weeks GA
76
Acquired Conditions of the Newborn:
Bronchopulmonary dysplasia-(BPD): What are possible causes?
Possible causes: surfactant deficiency, pulmonary edema, lung immaturity, barotrauma from mechanical ventilation, fluid overload
77
Acquired Conditions of the Newborn:
Bronchopulmonary dysplasia-(BPD): What are signs and symptoms?
Tachypnea
Poor weight gain
Tachycardia
Sternal retractions
Nasal flaring
Bronchospasm (abnormal breath sounds - crackles, wheezing)
Abnormal blood gas results (hypoxia)
78
Acquired Conditions of the Newborn:
Bronchopulmonary dysplasia-(BPD): What is therapeutic management?
Continuous ventilatory and oxygen support
79
Acquired Conditions of the Newborn:
Retinopathy of prematurity (ROP): What is it?
ROP- is abnormal vascular growth of the blood vessels of the retina in infants born prematurely.
80
Acquired Conditions of the Newborn:
Retinopathy of prematurity (ROP):
ROP- is abnormal vascular growth of the blood vessels of the retina in infants born prematurely. What does it cause?
This causes scarring that pulls on the retina leading to distortion and detachment.
Leading cause of blindness in children in US: DT to LBW; PTB; and excess oxygen after birth.
81
Acquired Conditions of the Newborn:
Retinopathy of prematurity (ROP):
When is treatment required? What does treatment include?
Treatment is only required for severe disease and includes laser photocoagulation and/or anti-vascular endothelial growth factor monoclonal antibodies.
82
Acquired Conditions of the Newborn:
Retinopathy of prematurity (ROP):
What is nursing management?
Administer oxygen therapy cautiously- ensure lowest concentration and shortest duration
Assist with scheduling opthalmic exam
Protect newborn's eyes from light after exam
Provide parents support by giving them information and providing detail about the conditions and follow-up examinations
83
Acquired Conditions of the Newborn:
Peri-/intraventricular hemorrhage (PVH/IVH): What is it? When is it most common? How is it graded?
What It Is: Bleeding in the brain due to fragility of cerebral vessels; most common in the first 72 hours after birth; grades I to IV
84
Acquired Conditions of the Newborn:
Peri-/intraventricular hemorrhage (PVH/IVH): Nursing Assessment
Possibly no symptoms
RIsk factors- very PT
Unexplained drop in hematocrit
pallor
Poor perfusion
seizures
Lethargy
Weak suck
high pitched cry
hypotonia
cranial ultrasonography (Grades bleeds 1-4)
85
Acquired Conditions of the Newborn:
Peri-/intraventricular hemorrhage (PVH/IVH): Nursing Management
Nursing Management:
Prevention ( midline position of head at birth for very preterm x 72 hrs);
Correction of anemia, acidosis, hypotension;
maintain flexed contained positioning;
Daily head circumferences;
Clustering of care;
limit stimulation;
Parental support for possible long-term sequelae
86
Acquired Conditions of the Newborn:
Necrotizing Enterocolitis (NEC): What is it?
NEC is ischemic necrosis of the intestines and is a gastrointestinal emergency.
87
Acquired Conditions of the Newborn
Necrotizing Enterocolitis (NEC): How do most infants initially appear?
Most infants with NEC initially appear healthy.
88
Acquired Conditions of the Newborn
Necrotizing Enterocolitis (NEC):
What is the first sign of this?
The first sign of a problem is typically feeding intolerance.
89
Acquired Conditions of the Newborn
Necrotizing Enterocolitis (NEC): What are signs and symptoms?
Other S/S include:
poor feeding;
Abdominal distension;
Vomiting;
Respiratory failure;
Hypotension;
Temperature instability;
lethargy;
apnea;
blood in stools
90
Acquired Conditions of the Newborn
Necrotizing Enterocolitis (NEC): Nursing Assessment/Management:
Monitor infants closely for s/s above; Keep NPO; administer antibiotics; prepare for surgery
91
Acquired Conditions of the Newborn
Necrotizing Enterocolitis (NEC): What is treatment?
Treatment includes antibiotics,
laboratory monitoring (CBC, electrolytes, BUN, creatinine, and acid base studies),
radiographic monitoring every 6 to 12 hours (monitors progression),
and bowel resection,
which may result in malabsorption.
92
Acquired Conditions of the Newborn
Neonatal Encepatholopathy (NE/HIE): What is it?
Brain injury causing seizures or a reduced level of consciousness.
93
Acquired Conditions of the Newborn
Neonatal Encepatholopathy (NE/HIE): What is it thought to be caused by?
It is thought to be caused by perinatal asphyxia. AKA: Hypoxic Ischemic Encephalopathy (HIE)
94
Acquired Conditions of the Newborn:
Neonatal Encepatholopathy (NE/HIE)
What are other symptoms?
Other symptoms include: diminished reflexes and muscle tone, difficulty maintaining respiratory function, low Apgars, a weak cry, and feeding difficulties.
95
Acquired Conditions of the Newborn:
Neonatal Encepatholopathy (NE/HIE): What is the treatment? When does it begin?
Therapeutic hypothermia (body cooling)- neuroprotective therapy. Begun within 6 hours of birth and lasts for 72 hours for infants of at least 36 weeks of gestation.
96
Acquired Conditions of the Newborn
Hyperbilirubinemia: What is it?
Greater than normal bilirubin levels.
What is bilirubin?
97
Acquired Conditions of the Newborn
Hyperbilirubinemia: What are the two types of jaundices that occur?
Physiologic jaundice
Pathological jaundice
98
Acquired Conditions of the Newborn
Hyperbilirubinemia: When does physiologic jaundice occur?
Occurs 3-5 days after birth,
Is common in newborns
99
Acquired Conditions of the Newborn
Hyperbilirubinemia: When does pathological jaundice occur?
occurs within 24 hours of birth
ABO incompatibility
Rh hemolysis
100
Acquired Conditions of the Newborn
Hyperbilirubinemia: What kind of implications can occur with pathological jaundice?
Can have serious implication for the newborn such as cerebral palsy or hearing loss
101
Slide 14- Strep B
102
Infant Feeding:
What is a problem for preterm infants with feeding?
Preterm infants - often too immature to coordinate sucking, swallowing, and breathing (<34 weeks).
103
Infant Feeding:
What is a common problem with enteral feeding? What must be done instead?
Infants - unable to obtain sufficient nutrition by enteral feeding(NGT/OGT, PO), may have parenteral feeding ( IVF, TPN).
104
Infant Feeding:
What is the benefits of parenteral nutrition?
Parenteral nutrition may improve neurodevelopmental outcomes and growth while reducing the risk of NEC.
105
TPN for a Premature Neonate:
How may it be administered?
May be administered through a central venous catheter or a peripheral venous catheter (PIV); central line preferred.
106
TPN for a Premature Neonate:
What is TPN?
Total parenteral nutrition (TPN) is a vesicant that can cause tissue damage with infiltration.
107
TPN for a Premature Neonate:
How much ingredients in TPN?
No more than D12.5% Dextrose in a PIV
108
TPN for a Premature Neonate:
What may TPN cause in a neonate?
May cause hyperglycemia in the neonate.
109
TPN for a Premature Neonate:
What is TPN used in combination with?
Often used in combination with oral feedings of breast milk.
110
TPN for a Premature Neonate:
What is TPN often given with? What does this do?
Often given with intralipids to support growth
111
NGT/OGT Feeds:
How long do enteral feedings last?
Enteral tube feedings may be continuous or every 2 to 3 hours.
112
NGT/OGT Feeds:
What is checked? What is it an indirect measure of? How often is it used?
Checking for gastric residual volume - done as an indirect measurement of bowel motility. (No longer a routine practice)
113
NGT/OGT Feeds:
What may improve tolerance of NGT/OGT feedings?
Delayed feedings or decreased feeding volume may improve tolerance.
114
Neonatal Pain:
What happens if neonatal pain is not treated adequately?
Not treating neonatal pain adequately can have long-term effects on how the neonate responds to pain throughout his or her life.
115
Neonatal Pain: How is pain assessed?
Pain Assessed using pain tools that measure physiologic and behavioral signs
NIPS, PIPP, N-PASS, CRIES
116
Neonatal Pain: How many painful procedures do infants in the NICU experience in a day?
Infants admitted to the NICU experience an average of 5 to 15 painful procedures every day.
117
Neonatal Pain: How should pain be treated?
Pain should be treated preemptively when possible.
118
Neonatal Pain:
Pain management for neonates include:
Breastfeeding
Nonnutritive sucking (pacifier)
Skin-to-skin contact
Oral sucrose 24%
Topical anesthesia
Acetaminophen or opioid analgesics
Nerve block with lidocaine
119
Hyperbilirubinemia in the Newborn:
Where does bilirubin come from?
Bilirubin comes from the breakdown of hemoglobin from red blood cells.
120
Hyperbilirubinemia in the Newborn:
Step 1: Where does bilirubin bind? Then what happens?
Bilirubin binds to albumin and is transported to the liver where it is detached from the bilirubin and conjugated.
121
Hyperbilirubinemia in the Newborn:
Step 2: What happens to conjugated bilirubin?
Conjugated bilirubin is excreted in bile into the digestive tract; because it is conjugated, it cannot be reabsorbed by the intestine.
122
Hyperbilirubinemia in the Newborn:
Step 2: bilirubin and newborn sterile intestine?
Because the newborn intestinal system is initially sterile, conjugated bilirubin can be unconjugated and reabsorbed through the intestinal epithelium and deposited back into the circulatory system.
123
Hyperbilirubinemia in the Newborn:
What is Hyperbilirubinemia known as in infants?
The result is hyperbilirubinemia. Hyperbilirubinemia is common in newborns and is known as physiological jaundice.
124
Hyperbilirubinemia in the Newborn
What are serious implications of hyperbilirubinemia?
However, in some cases, hyperbilirubinemia is pathological and can have serious implications for the newborn such as cerebral palsy or hearing loss.
125
Physiological Jaundice:
Causes of physiological jaundice include:
Breastmilk jaundice starts 3 to 5 days after birth and peaks in 2 weeks.
Breastfeeding failure jaundice is due to decreased intake and slow passage of stool and bilirubin via the digestive system. Slow passage increases exposure time to deconjugating enzymes and provides more time for the reuptake of deconjugated bilirubin into circulation.
126
Physiological Jaundice:
Although physiological jaundice is expected, there is an increased risk of infants developing what?
Although physiological jaundice is expected, there is an increased risk of infants developing pathological jaundice.
127
Physiological Jaundice:
How should the nurse prevent complications?
To prevent complications, the nurse should carefully assess infant feeding and ensure frequent feedings.
128
Jaundice: Assessments
How often should nurses assess all infants for jaundice?
The nurse should assess all infants after birth for jaundice by visual inspection every 8 to 12 hours.
129
Jaundice: Assessments
What are specific things the nurse should look out for?
Watch carefully infants with cephalohematomas, bleeding/bruising; polycythemia
130
Jaundice: Assessments
What do many institutions now screen for?
Many institutions now universally screen infants by transcutaneous bilirubin (TCB) measurements.
131
Jaundice: Assessments
Many institutions now universally screen infants by transcutaneous bilirubin (TCB) measurements.
How are results confirmed?
Results are often confirmed by total serum bilirubin (TSB) measurements.
132
Jaundice: Assessments
Infants who are jaundiced prior to 24 hours of age are at higher risk for what?
Infants who are jaundiced prior to 24 hours of age are at higher risk for severe hyperbilirubinemia, often due to ABO or Rh(D) incompatibility.
133
Jaundice: Assessments
Galactosemia
Galactosemia (a disorder in the metabolism of the simple sugar galactose from an enzyme deficiency or liver impairment)
134
Jaundice: Assessments
Preterm infants are at higher risk of what kind of jaundice?
Preterm infants are at higher risk for pathologic jaundice.
135
Jaundice: Assessments
When are infants screened and treated?
Infants born below 35 weeks of gestation are often screened and treated based on weight and gestational age at birth but protocols may vary by institution.
136
Slide 22
137
Signs and Symptoms (aka Kernicterus)
Lethargy
Fever
Irritability
Jitteriness
Hypotonia
Poor feeding
Apnea
Seizures
High pitched cry
138
Hyperbilirubinemia Treatments
What is the goal of treating hyperbilirubineamia?
The goal of treating hyperbilirubinemia is to avoid kernicterus.
139
Hyperbilirubinemia Treatments
What are treatments?
Phototherapy
Exchange transfusion
140
Hyperbilirubinemia Treatments
Phototherapy
exposes the infant’s skin to a particular wavelength of light.
Converts the bilirubin - lumirubin (more soluble) does not need to be conjugated in the liver and can be excreted directly into the bile.
141
Hyperbilirubinemia Treatments
Exchange transfusion
Exchange transfusion - For high levels, removes bilirubin from the circulation by replacement of blood volume.
142
Hyperbilirubinemia Treatments
What should nurses monitor?
Nurses should monitor the infant’s temperature, serum bilirubin, hydration status, and exposure time during phototherapy.
143
Hyperbilirubinemia Treatments
Nursing Care:
Keep eyes covered
Skin exposed as much as possible
Keep under lights as long as possible
Monitor intake and output
Monitor temperature
Provide education to parents
144
Newborn Infections:
Preterm infants are at high risk of what (having to do with infections)?
When does IGg transfer occur?
Preterm infants are at high risk for sepsis. IGg transfer occurs after 32 weeks.
145
Newborn Infections:
What is neonatal sepsis caused by?
Neonatal sepsis: bacterial (GBS; E.coli), fungal (candida), or viral (TORCH) microorganisms or their toxins in blood or other tissues
146
Newborn Infections
Classification
Congenital (intrauterine)
Early onset (perinatal period)
Late onset
Nursing assessment: risk factors;
nonspecific symptoms; elevated C-reactive protein, positive cultures
147
Newborn Infections:
How is sepsis treated?
Sepsis is treated with antibiotics
148
Newborn Infections:
Nursing Management
Antibiotic therapy ( broad spectrum until rule out sepsis)
Circulatory, respiratory, nutritional, and developmental support
Education for prevention and early recognition
Primary disease prevention
Family education
149
Preterm Infants: Immune System Considerations
What are late signs of sepsis?
Lethargy
Irritability
Bradycardia
Hypotension
Pallor
150
Preterm Infants: Immune System Considerations
Other than antibiotics, what may infants require for sepsis treatment?
Antibiotics are the primary treatment for sepsis.
Some infants over 34 weeks gestation may require ECMO.
151
Preterm Infants: Immune System Considerations:
What are measures taken to minimize infections?
Supportive care measures and careful hand hygiene are effective in minimizing infections associated to care.
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Other Sources of Neonatal Infections
Congenital syphilis
Gonorrhea neonatorum
Chlamydia
Herpes
Toxoplasmosis
Hep B
HIV
Congenital cytomegaly virus
Congenital rubella syndrome
Neonatal varicella
Candidiasis
Zika
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Other Sources of Neonatal Infections
Congenital syphilis: How is it transmitted? What can it cause?
is transmitted vertically from mother to fetus and can result in stillbirth, prematurity, or hydrops fetalis.
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Other Sources of Neonatal Infections
Congenital syphilis: How do symptoms vary and how is syphilis identified? What is treatment?
Symptoms of congenital syphilis vary widely and is identified with a blood test or an evaluation of cerebrospinal fluid.
Treatment is with penicillin G.
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Other Sources of Neonatal Infections
Gonorrhea neonatorum: What is it and how is it treated?
(newborn conjunctivitis) was once a leading cause of blindness and is now routinely treated with an antibiotic eye ointment at the time of birth.
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Other Sources of Neonatal Infections
Chlamydia: What can it cause? How is it transmitted? How is it treated?
Chlamydia can cause conjunctivitis or pneumonia. Often transmitted through a vaginal birth but may pass the membranes or the placenta. Treated with oral antibiotics.
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Other Sources of Neonatal Infections"
When is herpes most common? What may it cause? What is treatment?
Herpes is most common when vaginally delivered by a mother experiencing a herpes outbreak. May cause sepsis. Treatment is antiviral medication therapy for 14 to 21 days.
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Other Sources of Neonatal Infections:
Toxoplasmosis: What is it caused by?
Is caused by a common protozoan parasite found in cat feces, contaminated soil and undercooked meat
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Other Sources of Neonatal Infections
Toxoplasmosis: What may it cause? How is it diagnosed?
Toxoplasmosis may cause anemia, seizure activity, calcifications in the brain, thrombocytopenia, or jaundice. Diagnosed with blood test or CSF evaluation.
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Other Sources of Neonatal Infections
Hep B: How are infants of mothers with Hep B treated?
Infants born to Hepatitis B positive mothers are treated with HBsAG after birth and receive the first does of the hepatitis B vaccine within 12 hours to reduce transmission by 95%.
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Other Sources of Neonatal Infections
When does transmission of HIV occur between mother and child?
Two thirds of mother-to-child transmission of human immunodeficiency virus (HIV) occurs during the intrapartum period.
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Other Sources of Neonatal Infections
HIV: How to reduce the risk of transmitting HIV during delivery?
Women who are taking antiretroviral therapy (ART) are at low risk for transmitting the virus during delivery.
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Other Sources of Neonatal Infections
HIV: When is treatment on infants started?
Prophylactic treatment of infants with ART is begun 6 to 12 hours after delivery.
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Other Sources of Neonatal Infections
HIV: What is contraindicated?
Breastfeeding is contraindicated for HIV-positive mothers.
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Other Sources of Neonatal Infections:
What is the leading caused of nonhereditary hearing loss and other long term neurodevelopmental disabilities?
Congenital cytomegalovirus is a leading cause of nonhereditary hearing loss and other long-term neurodevelopmental disabilities.
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Other Sources of Neonatal Infections:
What is treatment for Congenital cytomegalovirus ?
Treatment includes IV antiviral medications.
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Other Sources of Neonatal Infections
Congenital rubella syndrome: Where is it rare?
What are symptoms?
Congenital rubella syndrome is rare in countries with high immunization rates.
Symptoms include hearing loss, cataracts, and jaundice.
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Other Sources of Neonatal Infections
Neonatal varicella: When does it occur? How is it treated?
Neonatal varicella is dangerous if the infection occurs within the first 5 days of life. Treated with acyclovir as soon as possible.
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Other Sources of Neonatal Infections
Candidiasis- fungal infection: How is it diagnosed? How is it treated?
Candidiasis- fungal infection.
Diagnosed by blood culture
Treated with antifungals and by removing any medical hardware such as IV lines or urinary catheters immediately
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Other Sources of Neonatal Infections
Zika: How is it transmitted?
What is associated with it?
What is treatment?
Zika is transmitted sexually or by mosquito bite and transmitted prenatally to a fetus.
Associated with microcephaly, craniofacial disproportion, and hearing loss.
There is no specific treatment.
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Preterm Infants: Cardiovascular Considerations
Patent ductus arteriosus (PDA).
What do most infants have? By when does this occur? What about preterm infants?
Mostly all infants born at term have complete closure ( constriction due to increased oxygen) by 72 hours after birth; preterm infants may have delayed closure.
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Preterm Infants: Cardiovascular Considerations
What are infants with PDA at higher risk for?
Infants with PDA are at higher risk for necrotizing enterocolitis and intraventricular hemorrhage
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Preterm Infants: Cardiovascular Considerations
What do signs and symptoms of PDA depend on?
Depend on the degree of the PDA
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Preterm Infants: Cardiovascular Considerations
What are signs and symptoms of PDA ?
Depend on the degree of the PDA and include (can occur at 2-3 days old)
Systolic murmur (ULSB)
Ventricular dilation
Cyanosis
Bounding pulses (widened pulse pressures)
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Preterm Infants: Cardiovascular Considerations
Preterm infants are prone to hypotension and hypoperfusion of tissues- What is treatment?
Treatment includes volume expanders: NS or blood products (fresh frozen plasma).
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Preterm Infants: Cardiovascular Considerations
PDA: What are preterm infants prone to with this issue?
Preterm infants are prone to hypotension and hypoperfusion of tissues.
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Preterm Infants: Cardiovascular Considerations
Preterm infants are prone to hypotension and hypoperfusion of tissues- What is NOT recommended? Why?
Albumin- not recommended, increases jaundice
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Preterm Infants: Cardiovascular Considerations
Preterm infants are prone to hypotension and hypoperfusion of tissues- What is treatment if volume expansion is not enough?
Inotropic agents (dopamine, dobutamine, or epinephrine) given if volume expansion is not enough.
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Preterm Infants: Cardiovascular Considerations
Preterm infants are prone to hypotension and hypoperfusion of tissues- What is treatment?
Treatment: ibuprofen or indomethacin ( renal complications).
Infants who do not respond to medications may need surgery.
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Preterm Infants: Neurological Considerations
Intraventricular hemorrhage (IVH) is bleeding into the lateral ventricles of the brain and is one of the most common and dangerous causes of brain injury.
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Preterm Infants: Neurological Considerations
Risks for developing IVH include:
Birth prior to 29 weeks gestation
Breech birth
Intrapartum asphyxia
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Preterm Infants: Neurological Considerations
What are signs and symptoms of IVH? How is it diagnosed?
Signs and symptoms are varied. Often diagnosed with routine ultrasonography.
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Preterm Infants: Neurological Considerations
What happens if IVH is very severe?
The more severe the IVH, the increased risk for complications.
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Preterm Infants: Neurological Considerations
What is treatment of IVH?
Treatment includes supportive care such as avoiding hyper- or hypotension, providing adequate oxygen and nutrition, and treat seizures to avoid alterations in cerebral blood flow.
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Maternal Substance Abuse: Neonatal Abstinence Syndrome: What is it?
Neonatal abstinence syndrome (NAS) - term used to describe withdrawal symptoms that occur as a result of in utero exposure to opioids.
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Maternal Substance Abuse: Neonatal Abstinence Syndrome
What may mimic NAS symptoms?
Other substances (such as, alcohol, nicotine, benzodiazepines, and antipsychotics) may cause symptoms that mimic NAS symptoms.
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Maternal Substance Abuse: Neonatal Abstinence Syndrome
What is the goal of treatment of NAS?
The goal of treatment is to reduce NAS symptoms.
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Maternal Substance Abuse: Neonatal Abstinence Syndrome
How are infants treated?
The goal of treatment is to reduce NAS symptoms.
Infants are treated according to NAS scales or Eat, Sleep, Console (ESC) method – maximize non-pharmacologic methods, increase family involvement & prn use of morphine
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Maternal Substance Abuse: Neonatal Abstinence Syndrome
How is treatment? (Having to do with opioids)
Infants are given opioids for symptoms and then weaned from them after they are stable for 24 hours.
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Maternal Substance Abuse: Neonatal Abstinence Syndrome
What does discharge planning include?
Discharge planning includes an evaluation of the home environment and maternal substance abuse treatment.
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Maternal Substance Abuse: Fetal Alcohol Spectrum Disorder
Prenatal alcohol exposure can result in:
Prenatal alcohol exposure can result in fetal alcohol spectrum disorder (FASD), which expresses as a wide range of physical, mental, and cognitive issues.
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Maternal Substance Abuse: Fetal Alcohol Spectrum Disorder:
What is the safe amount of alcohol in pregnancy?
There is no recognized safe amount of alcohol in pregnancy.
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Maternal Substance Abuse: Fetal Alcohol Spectrum Disorder
What is alcohol considered?
Alcohol is a central nervous system teratogen.
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Maternal Substance Abuse: Fetal Alcohol Spectrum Disorder
What are care considerations for people with FASD?
Care considerations for people with FASD include an interprofessional approach with social work, occupational therapy, physical therapy, and speech therapy, as well as nursing, medicine, and psychology as indicated.
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Congenital Anomalies: Orofacial Cleft
What is it?
An orofacial cleft is a cleft lip with or without a cleft palate or a cleft palate without a cleft lip.
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Congenital Anomalies: Orofacial Cleft
What is it caused by?
An orofacial cleft may be caused by a genetic syndrome, maternal exposure to certain teratogens, smoking, diabetes, or obesity.
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Congenital Anomalies: Orofacial Cleft
When are repairs done? (lips and palate)
Orofacial cleft lip repairs are usually performed at 3 months, cleft palates at 6 months of age.
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Congenital Anomalies: Orofacial Cleft
Infants with orofacial clefts may not be able to what?
What is needed?
Infants with orofacial clefts may not be able to feed without assist because they cannot create suction to extract milk. A special bottle and nipple, (e.g. Haberman) may be used.
