Newborn at Risk

Question 1

list tx for hypoglycemia in infants (4)

Answer 1

Feed the baby (preferred!)
Glucose gel
Dextrose IV
Monitor until stable

Question 2

list ways to provide comfort care to babies that have Neonatal abstinence syndrome (11)

Answer 2

• whenever possible, involve mom
• skin to skin w mom
• breastfeeding unless polysubstance abuse
• swaddling
• holding
• swinging
• rocking
• decreased stimuli
• volunteer “cuddlers”
• pacifiers/non-nutriative sucking
• cream to prevent diaper rash

Question 3

what is given to babies for neonatal abstinence syndrome (NAS)?

Answer 3

morphine, methadone, and suboxone

Question 4

when is breastfeeding encouraged & discouraged for NAS?

Answer 4

Encouraged if on methadone or suboxone but discouraged if on harder drugs

Question 5

What does caffeine citrate do/used for?

Answer 5

Prevents episodes of apnea in preterm infants

long term treatment using cardiorespiratory monitor for apnea of prematurity (AOP)

Question 6

What does surfactant do?

Answer 6

decreases airway resistance for preterm infants

Question 7

when is surfactant administered and how?

Answer 7

administered in respiratory distress syndrome via ET tube

can also be administered via CPAP but usually child is intubated

Question 8

what is vancomycin?

Answer 8

broad spectrum abx used to tx sepsis

Question 9

what can vancomycin cause?

Answer 9

ototoxicity & nephrotoxicity

Question 10

what must be monitored when a baby is taking vancomycin? (4)

Answer 10

• peaks & troughs
• BUN/Creatinine
• Hearing screens

Question 11

why would prophylaxis therapy be used?

Answer 11

to keep from acquiring respiratory infections or ventilator acquired infection (i.e. pseudomonas)

Question 12

What methods of oxygenation are used in respiratory distress syndrome?

Answer 12

nasal cannula, mask, CPAP ( can help open airways; not for prolonged periods)

Question 13

Why do we wean newborns with bronchopulmonary dysplasia off of O2 as soon as possible?

Answer 13

it is an invasive method of prevention

Question 14

retinopathy of prematurity is most common in who?

Answer 14

infants born < 31 weeks or < 1250 g

Question 15

what can retinopathy of prematurity cause?

Answer 15

retinal detachment & blindness

Question 16

when can retinopathy of prematurity be detected?

Answer 16

at their eye exam 4-9 weeks post birth

Question 17

what may cause retinopathy of prematurity?

Answer 17

unstable oxygenation

Question 18

how should supplemental oxygen be administered in infants with retinopathy of prematurity?

Answer 18

Titrate oxygen down w/o desatting

Question 19

what can prevent retinopathy of prematurity?

Answer 19

Prevent erratic O2 levels during delivery, maintaining at a constant level of O2 delivery

Question 20

retinopathy of prematurity may require what?

Answer 20

surgical intervention to repair sight

Question 21

list signs and sx of necrotizing enterocolitis (5)

Answer 21

• Lack of bowel movements
• Abdominal distention
• Increase in abdominal circumference of 1 to 2 cm since last feed
• Irritability
• Lethargy

*If you note poor color or poor tone or any abnormality suspect NEC

Question 22

necrotizing enterocolitis can lead to ________ _________

Answer 22

respiratory difficulties

Question 23

how is necrotizing enterocolitis diagnosed?

Answer 23

X-ray will show free air in the abdominal cavity and distended loops of bowel

Question 24

to prevent necrotizing enterocolitis, how should infants less than 32 weeks be fed?

Answer 24

with humans milk, either mom’s or donors

Question 25

to prevent necrotizing enterocolitis, what should be measured?

Answer 25

abdominal circumference should be measured and recorded

Question 26

to prevent necrotizing enterocolitis, what should be done before every feeding?

Answer 26

auscultate bowel sounds and observe for abdominal distention

Question 27

to prevent necrotizing enterocolitis, what should be done before any gastric tube feeding?

Answer 27

check for aspirates of undigested formula or breast milk

Question 28

to prevent necrotizing enterocolitis, what should you record and monitor regarding bowel movements?

Answer 28

amount, consistency & frequency

Question 29

list the tx measures for necrotizing enterocolitis (4)

Answer 29

Stop all feeds (gut rest) TPN Place replogle tube for venting Surgical resection of bowel; possible ostomy

Question 30

what is bronchopulmonary dysplasia (BPD)?

Answer 30

Chronic condition in which the newborn becomes oxygen dependent past 36 weeks of gestation

Question 31

what causes bronchopulmonary dysplasia (BPD)?

Answer 31

extreme prematurity & damage from vents causing airway remodeling

Question 32

what is the main S&S of bronchopulmonary dysplasia (BPD)?

Answer 32

inability to wean off O2 completely

Question 33

How can we prevent bronchopulmonary dysplasia (BPD)?

Answer 33

Wean newborns from O2 as soon as possible Prevent erratic O2 levels during delivery, maintaining at a constant level of O2 delivery **this also prevents retinopathy of prematurity!**

Question 34

what are the long-term consequences of bronchopulmonary dysplasia (BPD)? (5)

Answer 34

- Poor feeding - Delayed growth (bc of poor feeding) - Susceptibility to infection - Right-sided heart failure - Susceptibility to other lung disease, i.e. asthma, frequent resp infections (RSV)

Question 35

list the tx methods for bronchopulmonary dysplasia (BPD) (3)

Answer 35

Antibiotics Bronchodilators Continued oxygenation support, trach may be necessary