Common Conditions

Question 1

Respiratory Distress Syndrome (RDS)

Answer 1

a common and serious condition in preterm newborns, caused by surfactant deficiency. It’s a leading cause of respiratory failure in neonates, especially those born before 34 weeks gestation. Without enough surfactant, the alveoli collapse, gas exchange is impaired, and the baby struggles to breathe—this is RDS.

Question 2

Necrotizing Enterocolitis (NEC)

Answer 2

a life-threatening gastrointestinal disease that primarily affects premature or medically fragile neonates. It involves inflammation and necrosis of the intestinal mucosa, which can lead to perforation, sepsis, and death if not promptly managed.

Question 3

Hyperbilirubinemia

Answer 3

Jaundice
excess bilirubin in the blood, leading to jaundice—a yellowing of the skin, sclera, and mucous membranes. It’s common, affecting over 50% of term and 80% of preterm newborns to some degree due to immature liver.

If bilirubin gets too high, it can cross the blood-brain barrier and cause kernicterus, a form of permanent brain damage.

Question 4

Sepsis

Answer 4

a life-threatening condition caused by infection in the bloodstream of a newborn. It can progress rapidly and lead to shock, organ failure, and death if not recognized and treated promptly.

Question 5

Intraventricular Hemorrhage (IVH)

Answer 5

bleeding into the brain’s ventricular system, where cerebrospinal fluid (CSF) is produced and circulates. It primarily affects premature infants, especially those born before 32 weeks gestation or weighing <1500 grams.

Question 6

Hypoglycemia

Answer 6

Newborns—especially in the first hours after birth—transition from getting glucose through the placenta to using their own stores. Some babies struggle with that transition.

Question 7

Patent Ductus Arteriosus (PDA)

Answer 7

a condition where a normal fetal blood vessel—the ductus arteriosus—fails to close after birth.

In fetal circulation, the ductus arteriosus is a vital connection between the pulmonary artery and the aorta. It allows blood to bypass the non-functioning fetal lungs and circulate oxygenated blood from the placenta to the rest of the body.

Normally, it closes within the first 24–72 hours after birth due to:
-Increased oxygen in the blood
-Decreased prostaglandin levels

Question 8

Hypoxic- Ischemic Encephalopathy (HIE)

Question 9

Who is at risk for PDA

Answer 9

• Prematurity (most common)
• Low birth weight
• Maternal rubella infection
• High altitude birth
• Genetic conditions (e.g. trisomy 21)

Question 10

Signs and Symptoms of PDA

Answer 10

-Murmur: Continuous “machine-like” murmur (best heard at left upper sternal border)
- Tachypnea, respiratory distress
- Poor feeding, failure to thrive
- Bounding pulses, wide pulse pressure
- Crackles, hepatomegaly (signs of CHF)

Question 11

Nursing Considerations for PDA

Answer 11

• Monitor for signs of CHF and respiratory distress
• Support feeding and growth
• Administer medications and monitor for side effects (renal, GI)
• Prepare families for possible procedures or transfer to NICU

Question 12

Surfactant

Answer 12

Surfactant is a substance produced by type II alveolar cells that reduces surface tension in the lungs, preventing alveolar collapse during exhalation. Production begins around 24 weeks gestation and surges after 32–34 weeks.

Question 13

Risk Factors for RDS

Answer 13

Prematurity (esp. <34 weeks)
Male sex
Cesarean birth without labor
Infant of diabetic mother (IDM)
Perinatal asphyxia
Multiple gestation
Cold stress or hypothermia

Question 14

Clinical Presentation for RDS

Answer 14

Typically within first few hours of life
Tachypnea >60 breaths/min
Grunting (expiratory effort to keep alveoli open)
Nasal flaring
Retractions (intercostal, subcostal)
Cyanosis
Decreased breath sounds
Hypoxemia, respiratory acidosis

Question 15

Treatment for RDS

Answer 15

1. Respiratory Support ( CPAP, mechanical ventilation and O2 therapy)
2. Surfactant Replacement therapy
3. supportive Care ( thermoregulation, fluid and electrolyte replacement)

Question 16

Nursing Considerations for RDS

Answer 16

• Assess for respiratory distress signs
• Administer surfactant or assist with intubation setup
• Monitor ABGs and oxygen saturation
• Educate and support family, especially if NICU admission is needed

Question 17

Risk Factors for necrotizing enterocolitis

Answer 17

Prematurity (<32 weeks)!!!!!!
Very low birth weight (<1500 g)
Enteral feeding, especially formula
Rapid feed advancement
Asphyxia or hypoxia
Sepsis
Patent ductus arteriosus (PDA)
Blood transfusions

Question 18

Signs and symptoms of Necrotizing Enterocolitis

Answer 18

GI symptoms:
Abdominal distension
Feeding intolerance (residuals, vomiting)
Bloody stools
Tenderness or discoloration of abdomen
Decreased bowel sounds

Systemic signs:
Temperature instability
Lethargy
Apnea/bradycardia
Hypotension
Poor perfusion/shock

Question 19

Nursing Considerations for NEC

Answer 19

• Watch for subtle early signs (feeding changes, abdominal girth, behavior changes)
• Stop feeds and notify provider for concerning signs
• Measure abdominal girth and assess bowel sounds regularly
• Manage IV fluids, antibiotics, and TPN
• Support families

Question 20

Management of Jaundice

Answer 20

Phototherapy ( first line treatment )
Converts bilirubin into a water-soluble form that can be excreted.
Nursing care:
- Eye protection
- Frequent feeds to promote excretion (through stool)
- Monitor temp, hydration, I/Os, and bilirubin levels

Question 21

Common causes of Sepsis for Newborns EARLY onset

Answer 21

during first 72 hours
acquired vertically from the mother during labor/delivery
GBS
E.coli
Listeria
K. enterobacter

Question 22

Common causes of Sepsis for Newborns LATE onset

Answer 22

Acquired horizontally from the environment, caregivers, or invasive devices
- Coagulase-negative Staph (CoNS)
-Staph aureus
- Gram-negatives (E. coli, Klebsiella, Pseudomonas)
- Fungal infections (especially Candida in preemies)

Question 23

symptoms of shock in newborns

Answer 23

General/Systemic:
Temperature instability (fever OR hypothermia)
Lethargy, irritability, poor tone
Poor feeding or suck
Apnea, bradycardia
Pallor, mottling, or cyanosis

Respiratory:
Grunting, flaring, retracting
Tachypnea or apnea
Desaturation episodes

GI:
Abdominal distension
Feeding intolerance
Vomiting, bloody stools

Neurologic:
Hypotonia, seizures, high-pitched cry

Question 24

Why does IVH happen

Answer 24

Preterm infants have fragile blood vessels in the germinal matrix (a highly vascular brain region near the ventricles). These vessels can rupture easily due to:

-Hypoxia
-Fluctuations in cerebral blood flow
-Mechanical ventilation
-Handling or stress

After rupture, blood may enter the ventricles, causing potential blockage of CSF flow (→ hydrocephalus) and brain injury

Question 26

Risk Factors of IVH

Answer 26

Prematurity (<32 weeks) Very low birth weight Birth asphyxia Mechanical ventilation Hypotension or rapid fluid volume shifts Pneumothorax Coagulopathy Chorioamnionitis (maternal infection)

Question 27

Signs of IVH

Answer 27

Subtle signs: Decreased tone or activity Apnea or bradycardia Full or bulging fontanelle Pallor, hypotension Poor perfusion or feeding Severe signs (Grades III–IV): Seizures Coma Shrill cry Sunset eyes (late sign of hydrocephalus)