Complications of Preterm & Post-term Newborns

Question 1

These infants are born before 37 completed weeks of pregnancy.

Answer 1

Preterm infants

Question 2

Usual birthweight of preterm infants

Answer 2

Less than 2,500 grams (5.8 lbs)

Question 3

Causes of Prematurity

Answer 3

1. Low socio-economic level
2. Lack of prenatal care
3. Multiple pregnancy
4. Closely spaced pregnancy
5. Maternal age
6. Order of birth
7. Abnormalities on the mother’s reproductive system (ex.cerivical insufficiency)
8. Obstetric Complications - PROM or premature separation of placenta
9. Infections
10. Cigarette Smoking
11. Previous early delivery
12. Early induction of labor
13. Gestational Hypertension
14. History of preterm birth
15. PPROM, Placenta Previa, Placental abruption

Question 4

Potential Complications of Preterm NBs

Answer 4

1. Anemia of Prematurity
2. Kernicterus
3. Hydrocephalus
4. Persistent Patent Ductus Arteriosus

Question 5

What is the cause of AOP in preterm NBs?

Answer 5

Due to low RBC production since the bone marrow does not increase its production until the end of 32 weeks AOG
- Latrogenic cause (caused by medical examination or treatment) : frequent extraction of blood sample for monitoring or evaluation

Question 6

Management of AOP

Answer 6

• Iron supplements
• Blood transfusion

Question 7

It is a rare preventable brain damage caused by the build up of too much bilirubin in their blood caused by an immature liver (cannot eliminate too much bilirubin)

Answer 7

Kernicterus

Question 8

What is the normal indirect bilirubin in newborns within the first 24 hours of birth.

Answer 8

Under 5.2 mg/dL

Question 9

At what level of indirect bilirubin does jaundice happen?

Answer 9

greater than 7mg/dL

Question 10

At what level does indirect bilirubin rises for kernicterus to happen?

Answer 10

greater than 20 mg/dL

Question 11

At what level of indirect bilirubin is treatment usually considered?

Answer 11

10-12 mg/dL

Question 12

Is treatment with a special type of light (Bili lights)
- treats neonatal jaundice through a process called photo-oxidation

Answer 12

Phototherapy

Question 13

A process that adds oxygen to the bilirubin so it dissolves easily in water.

Answer 13

Photo-oxidation

Question 14

Nursing Responsibility for Phototherapy.

Answer 14

Ensure to place proper eye shield & cover genitals (with diaper) while on phototherapy
- Infant’s clothes should be removed

Question 15

Another cause for increased bilirubin in the newborn

Answer 15

Cephalohematoma

Question 16

Is a collection of blood under the periosteum of the baby’s skull.

Answer 16

Cephalohematoma

Question 17

Why are babies born with cephalohmatoma at an elevated risk for jaundice?

Answer 17

Blood accumulated in cephalohematoma can cause the RBCs to destruct which eventually increases levels of bilirubin in the baby’s blood stream.
- Elevated bilirubin levels = trigger jaundice

Question 18

Signs & Symptoms of Jaundice

Answer 18

• Yellow discoloration of the skin, mucous membranes & scleara
• Light-colored stool
• Lethargy / excessive sleepiness
• Poor feeding

Question 19

Kernicterus Signs & Symptoms

Answer 19

• Sleepiness / lethargic
• High-pitched crying
• Poor / decreased feeding / appetite
• Inconsolable crying / Irritability
• Floppy or limp body
• Missing reflexes (Startle reflex absent)
• Arching of the head & heels back
• Lack of wet or dirty diapers
• Fever

Question 20

What causes hydrocephalus

Answer 20

Intracentricular Hemorrhage

Question 21

Chambers in the brain that hold the CSF. It cushions the brain & circulates nutrients, remove wastes from the brain.

Answer 21

Ventricles

Question 22

How is Intraventricular Hemorrhage diagnosed?

Answer 22

Cranial UTZ
- done after few days of life & again at different intervals to determine if bleeding has occured

Question 23

If IVH is detected, a grade of 1-2 (mild) indicates?

Answer 23

May not cause any problem to the NB - good prognosis

Question 24

If IVH is detected, a grade of 3 indicates?

Answer 24

Bleeding causes enlarged ventricles, may require treatment

Question 25

If IVH is detected, a grade of 4 indicates?

Answer 25

Bleeding in the ventricles may cause development of **hydrocephalus** if bleeding persists

Question 26

A condition in which there is excessive CSF in and around the brain.

Answer 26

Hydrocephalus

Question 26

Causes of Hydrocephalus

Answer 26

- Blockage of the CSF flow inside of the brain (IVH, PVH or tumor) - Congenital causes - Infection - Overproduction of CSF

Question 27

Signs of Hydrocephalus

Answer 27

- Increased head circumference - Prominent scalp veins - Increased intracranial pressure - Bulging eyes & inability of the baby to look upward with the head facing forward - Lethargy & Irritability - Separated suture lines - Enlarged fontanelles - Bossing of forehead

Question 28

Treatment Procedures for hydrocephalus

Answer 28

- Lumbar Puncture - Ventriculoperitoneal shunt

Question 29

This treatment procedure involves inserting a needle into the space between two lumbar vertebrae to remove a sample of CSF for diagnostic & therapeutic procedure.

Answer 29

Lumbar Puncture

Question 30

This treatment procedure involves draining the excess CSF directly from the ventricles of the brain to the peritoneum to relieve pressure in the brain

Answer 30

Ventriculoperitoneal shunt

Question 31

Occurs when the hole or the Patent DA fails to close after birth

Answer 31

Persistent Patent Ductus Arteriosus

Question 32

Why is there a Patent DA in a fetus?

Answer 32

In utero, fetal blood does not need to go to the lungs for oxygenation - DA allows the **bypass the lungs**

Question 33

Why is a persistent patent DA a problem in newborn?

Answer 33

If the DA does not close, then **extra blood will go into the lungs** & the l**ungs have to work harder to handle the extra volume of blood** in the lungs - interfere with breathing & feeding, heart failure

Question 34

Failure of the DA to close shortly after birth up to how many months is termed persisten patent ductus arteriosus?

Answer 34

3 months

Question 35

Symptoms of Large PDA

Answer 35

- Cyanosis - Fatigue - Full, bounding pulses - Heart palpitations - Shortness of breath ( reduced fxn & fluid build-up in the lungs) | Requires surgery - Close DA by stitches or clips

Question 36

Medication for PDA

Answer 36

Indomethacin IV

Question 37

This stimulates the muscles inside the PDA to tighten / constrict to close the connection between the aorta & pulmonary artery.

Answer 37

Indomethacin IV

Question 38

Surgical interventions for PDA

Answer 38

- Using **sutures or metal clips** - Occlusion device via **cardiac catheterization**

Question 39

Nursing Care Management for Preterm Newborns

Answer 39

1. Provide Respiratory Ventilation 2. Monitor vital sigs; O2 sat & presence of abnormal heart sounds 3. Provide adequate fluids, electrolytes & nutrition 4. Maintain a neutral thermal environment - **KMC** 5. Prevent infection 6. Promote parent-child bonding

Question 40

Why must IV infusions administered carefully?

Answer 40

To prevent rapid change in BP which may cause capillary rupture (IVH /PVH)

Question 41

Refers to infants born after 42 completed weeks of pregnancy

Answer 41

Post-term infants

Question 42

What causes post term pregnancy?

Answer 42

- Inaccurate dating based on the LMP - **most common cause**

Question 43

Why are post term infants considered at risk?

Answer 43

Because the placenta functions effectively for only 40 weeks.

Question 44

A fetus who remains in utero with a failing placenta develops?

Answer 44

**Post term syndrome** - weight gain in the uterus after due date has stopped

Question 45

# True or False Post term newborn shows characteristics of an SGA infant

Answer 45

True

Question 46

Assessment findings of a post-term newborn

Answer 46

1. **Dry, cracked, peeling, leather-like skin** to the loss of the protective effect of vernix caseosa 2. Malnourished / wasted appearance / weight loss 3. **Advanced maturity** - open eyed & alert baby 4. Overgrown curved nails 5. Visible creases on palms & sole 6. Hypoglycemia 7. Polycythemia 8. Little / No Vernix Caseosa 9. Meconium-aspiration 10. Meconium-stained amniotic fluid, skin, cord & nails.

Question 47

Why does a post term newborn develop hypoglycemia?

Answer 47

Due to low glycogen levels which were used for nourishment during the last weeks of intrauterine life.

Question 48

Is the first stool passed by a newborn soon after birth, but in some case it is passed while in utero. This can happen when babies are "under stress" due to a decrease in blood & oxygen supply.

Answer 48

Meconium

Question 49

Why do these adverse consequences happen in a post term pregnancy?

Answer 49

- Due to placental senescence / insufficiency / aging - Decreased placental oxygenation secondary to placental aging

Question 50

Management options for post term pregnancy

Answer 50

- Labor induction - Expectant management with fetal surveillance - amniotic fluid volume assessment

Question 51

This management option is a more popular option and can be down w/ complications

Answer 51

Labor induction

Question 52

What bishop score is ideal for labor induction?

Answer 52

Greater than or equal to 8

Question 53

Nursing Care Management of Post term newborns

Answer 53

1. Manage meconium aspiration syndrome 2. Obtain serial blood glucose measurements 3. Provide early feeding to prevent hypoglycemia 4. Maintain skin integrity

Question 54

How to manage meconium aspiration syndrome

Answer 54

1. **Suction immediately** and thoroughly mouth & nares before infant's first breath to prevent aspiration of meconium that is already in the airway. 2. **Perform CPT** with suctioning to remove excess meconium & secretions. 3. **Provide supplemental oxygen** & respiratory support as needed