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Maternal/Child > Lecture 10.1 - At Risk Newborn > Flashcards

Lecture 10.1 - At Risk Newborn Flashcards

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1
Q

What are the three classifications of at risk NBs?

A

Birth weight, GA, common pathophysiological problems

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2
Q

What is considered a low birth weight?

A

< 2500 g

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3
Q

What is considered a very low birth weight?

A

< 1500 g

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4
Q

What is considered an extremely low birth weight?

A

< 1000 g

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5
Q

What is considered a preterm infant? What percent of births are preterm?

A

An infant born before 37 completed weeks of gestation, regardless of birth weight

8%

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6
Q

What is considered a late preterm GA? What percent of preterm infants are LPT?

A

between 34 to 36+6 weeks
–> 70% of preterm infants

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7
Q

What are some causes for indicated preterm birth?

A

Placenta previa/abruption
Pre-eclampsia
Poor fetal growth / IUGR
DM
Atypical / abnormal testing

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8
Q

What are some risks for spontaneous preterm births?

A

Hx
Multifetal gestation
Genital tract infection
Periodontal disease
Pow pre-pregnancy wt
Low SES
Lack of access to PNC
High stress
Smoking/substance use

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9
Q

What is the leading cause of neonatal and infant mortality?

A

Immaturity

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10
Q

What is the impact of neonatal complications on the family?

A

Loss of control + separation in NICU/special care causes interruption in attachment development

Greif over loss of healthy NB

Separation from rest of family/children

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11
Q

Late preterm babies are at increased risk for what complications?

A

Resp distress
Thermal instability
Hypoglycemia
Jaundice
Feeding problems
Neurodevelopmental issues
Infection

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12
Q

Preterm infants are at increased risk of having an ineffective breathing pattern/resp distress. Why is this?

A

Decreased number of functioning alveoli
Decreased surfactant - increased surface tension
Immature & fragile pulmonary vasculature
Decreased tracheal cartilage

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13
Q

What kind of monitoring should be done for a preterm newborn’s respiration?

A

VS, perfusion
Continuous SpO2
Obtain & monitor blood gas

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14
Q

Why can be done to manage periods of apnea in a preterm newborn?

A

Oxygen
Stimulation for wakefulness
Caffeine if necessary

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15
Q

What respiratory interventions are done for preterm infants?

A

Respond to apneic episodes/desats/brady

Oxygen:
- suction prn
- titration of O2

Surfactant replacement therapy

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16
Q

What are some complications of oxygen therapy that is too high?

A

Retinopathy

Intraventricular hemorrhage

Bronchopulmonary dysplasia

Not from slides:
Can impact hemodynamics of infants with congenital heart malformations

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17
Q

What is the O2 saturation goal for neonates?

A

93-95%

90-95% for ELBW

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18
Q

What factors increase the risk of ineffective thermoregulation for preterm infants?

A

Immature CNS control

Increased heat loss and inability to produce heat d/t less brown fat

Absent or decreased subcutaneous fat

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19
Q

What are some signs of ineffective thermoregulation?

A

Body temperature below 36.5°C

Cool, mottled, pale skin

Tachypnea, apnea, resp distress

Irritability, restless, agitated

Hypoglycemia

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20
Q

What is a neutral thermal environment?

A

Environment that maintains body temperature so that no energy is needed to do so.

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21
Q

What interventions can be done to maintain body temperature of infant?

Study These Flashcards
A

Radiant warmer, isolette

Skin-to-skin, cap

Warmed, humidified O2

22
Q

What monitoring or precautions might be done for an infant who is not thermoregulating?

Study These Flashcards
A

A continuous temperature probe might be used

Use caution when weaning to a cot

23
Q

What factors predispose a newborn to infection?

Study These Flashcards
A

Immature immune system
Invasive procedures

24
Q

What are some signs of infection in an infant?

Study These Flashcards
A

Literally every single system might have changes + might look shocky or poorly perfused

Temperature instability - mostly hypothermia

25
Why are premature babies at an increased risk of NEC?
Immature digestive system + flora Immature immune system
26
What factors put preterm infants at risk of imbalanced nutrition/less than requirements?
GI immaturity - adsorption Decreased stomach capacity Limited nutritional stores Associated illness factors Poor suck/swallow/breathe coordination Resp distress
27
What are some signs of inadequate nutrition in a NB?
Inadequate weight gain Feeding intolerance
28
PO feeding is always preferred for a NB is there is an adequate suck/swallow/feed/breathe reflex, and GI function and energy levels are good. What are some challenges to PO feeding?
Weak, uncoordinated, poorly developed reflexes. Easily fatigues Need to gain weight and have a small margin of weight loss Issues with hypothermia can compound the problem
29
What are Gavage feedings?
Intermittent bolus/continuous feeding through NG/OG tube. Amount increases gradually and then eventual switch to PO. Requires assessment if gastric residuals are > 50% of feed.
30
When would TPN be considered for a NB?
If they are too physiologically immature or seriously ill for enteral feeding
31
What are benefits of non-nutritive sucking?
Practice for premies + source of comfort
32
When an infant is hypoglycemic what other assessments should be performed?
Assess for physiological stress Inadequate intake Increased metabolic demands d/t illness or decreased glycogen supply Inadequate gluconeogenesis
33
How long should we assess BGLs on a preterm infant?
for the first 36 hours if stable and feeding is established
34
What is the BGL goal for a NB?
>/= 2.6 mmol/L
35
What are some benefits of Kangaroo Care in the NICU?
Stable VS + oxygenation + thermoregulation Improved sleep/wake cycles Reduced pain Facilitates BFing, increased weight gain attachment, and parental confidence
36
Which infants are more likely to have respiratory distress syndrome?
Preterm To mothers with DM1 --> Increased insulin can inhibit surfactant production By CS --> Stress of birth releases glucocorticoids which increases surfactant production
37
What care is given to neonates with RDS?
Establish oxygenation & ventilation Supportive care --> Maintain neutral thermoregulation, perfusion, hydration Surfactant replacement therapy Antenatal betamethasone
38
What are some S/S of PDA?
Systolic murmur, active precordium, bounding pulses Inspiratory crackles (pulmonary edema) TachyTachy
39
How is PDA diagnosed?
X-ray, blood gases, echocardiography
40
Why are CS babies more likely to have RDS?
Less mechanical stimulation to clear amniotic fluid from lungs Less release of endogenous glucocorticoids to increase surfactant productive
41
What is a post-term baby?
Born after 42 weeks regardless of birth weight
42
What risks are post-term infants at risk of?
Placental insufficiency Increased O2 demands --> hypoxia Meconium staining Persistent pulmonary HTN of the newborn (PPHN)
43
What is PPHN?
Persistent pulmonary hypertension of the newborn is caused by persistent feta circulation d/t airways not opening well with meconium aspiration/resp distress --> Critically ill with increasing hypoxia, pulmonary vasoconstriction, oxygenation failure
44
What is considered small for gestational age?
Birth weight that falls below the standard 10th percentile of sex-specific birth weight for GA --> Not always pathological
45
What are symmetrical and asymmetrical IUGR?
Symmetrical --> Starts in first trimester (infection, teratogens, chromosomal abnormalities) --> All measurements below 10th percentile Asymmetrical --> Later onset due to maternal or placental factors --> Head circ + length are above 10th percentile
46
What is considered LGA?
> 90th percentile for age and sex
47
What are some risks for SGA infants?
Perinatal asphyxia Hypo/Hyperglycemia + insulin resistance leading to growth delay Temp instability Often tolerate feeds but run out of energy quickly Developmental delay that may persist into school age
48
What risks of LGA infants predisposed to?
Birth injury, asphyxia, shoulder dystocia, hypoglycemia
49
What injuries are common in infants who experienced shoulder dystocia
Brachial plexus injury Clavicle injury
50
What is a top priority for babies that are SGA or LGA?
Breastfeeding within first hour
51
How can we foster a nurturing environment in a NICU?
Quiet ambient sound - maximum decibel level of 45 dB Clustering care Covering isolettes with blankets for facilitate sleep/wake cycles
52
What can improve oxygenation in persistent pulmonary hypertension of the newborn?
Inhaled nitric oxide causes pulmonary vasodilation and reduces vascular resistance

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