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Flashcards in Newborn Complications Deck (35)
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1

SGA causes

Small Gestational Age

causes:
-maternal factors/disease/smoking
-environmental, placental and fetal factors

2

Complications of SGA & IUGR

-fetal hypoxia, asphyxia
-aspiration syndrome
-hypothermia
-hypoglycemia
-polycythemia
-hyperbilirubinemia

3

Care for SGA is aimed...

at promoting growth (feeding and NTE) and caring for complications

4

IUGR

intrauterine growth restriction

-advanced gestation
-extremes of maternal age
-lack of prenatal care
-low socioeconomic status

5

IUGR associated with...

-hypoglycemia (very common)
-congenital malformations
-intrauterine infections

future:
-growth difficulties
-cognitive delays

6

Differentiating SGA and IUGR

-not synonymous

SGA NB is constitutionally small but otherwise normal

IUGR is a fetus with delayed growth late in gestation. May not have a reduction in birth weight significant enough to be classified as SGA

7

Prognosis for SGA

-symmetric SGA most likely stay small

8

Prognosis for IUGR

-often catch up by 2nd year

-greater risk for impaired school performance, behavior problems, and poor fine motor control

-as adults, IUGR infants are at a greater risk for obesity, type 2 DM and cardiovascular dz

9

Post-maturity syndrome

cause: unknown, more common in certain ethnicities (Australian, Greek and Italian)

complications:
-higher risk for morbidity
-hypoglycemia and cold stress
-meconium aspiration
-polycythemia
-seizure activity
-congenital anomalies

10

Post-term infant

Assessment:
-dry, cracking skin
-no vernex/lanugo
-scalp hair profuse
-body long, thin

nursing care:
-most adapt well
-monitor blood glucose frequently
-assess respiratory status (risk - meconium aspiration)
-neutral thermal environment - provide warmth

11

Pre-term infant

-less than 37 weeks gestation

-12 percent of all US births, 17 percent of all AA

-common in single mothers and adolescents

-rise in multiple births from IVF

-main problem is the variable immaturity of all body systems. Function is dependent on length of gestation

12

Thermoregulation

-glycogen and brown fat not available
-lose heat from blood vessels close to skin
-high ratio of body surface area to body weight
-extended position increases body surface area
-decreased vasoconstriction ability of superficial blood vessels

13

Nursing Care of the Preemie

-maintain respiratory function
-cluster care to promote rest
-maintain neutral environment
-balance fluids and electrolytes
-prevent infection
-provide adequate nutrition - breast milk is best and may fortified and given as slow continuous feed via pump. Donor milk if needed
-promote parent-infant attachment

14

Respiratory Distress Syndrome

-inadequate surfactant production
-pulmonary blood vessels aren't fully developed
-decreased pulmonary vascular resistance
-left-to-right shunting through ductus arteriosus
-increased blood flow back to lungs
-surfactant required for alveolar stability
-instability causes atelectasis
-atelectasis causes hypoxemia and acidosis

15

Nursing care for the infant with RDS

-before birth (prevent preterm birth, admin glucocorticoids)

-after birth (surfactant replacement therapy, assess for signs of distress, cluster care)

-monitoring blood gases and pulse oximetry

-respiratory support includes nasal cannula, CPAP or intubation with ventilator

16

Feeding infants

-bottle feeding/breast feeding
-requires suck-swallow-breathing patterns

-gavage feeding for infants
-with poor suck-swallow-breathing patterns
-on ventilators
-who tire easily
-losing weight
-supplementation with fortifiers common

17

Pre-term infant short term complications

-apnea of prematurity
-hypoglycemia
-patent ductus arteriosus
-respiratory distress syndrome
-intraventricular hemorrhage
-hyperbilirubinemia
-necrotizing enterocolitis
-sepsis

18

Long term complications of the Preemie

-higher rate of SIDS
-retinopathy of prematurity
-broncho-pulmonary dysplasia
-speech defects
-neurologic defects
-auditory defects
-abuse and neglect

19

Asphyxia

-neonatal emergency can lead to hypoxia and possible brain damage or death if not correctly managed

20

newborn asphyxia

defined as a failure to start regular respiration within a minute of birth

21

perinatal asphyxia

leads to multi-organ system dysfunction

22

CV

alterations in blood volume, redistribution of cardiac output and a syndrome of transient myocardial dysfunction

23

Management of Asphyxia

-adequate ventilation

-perfusion and BP management

-fluid management

-avoid extreme glucoses

-avoid hyperthermia

-tx of seizures

-hypothermia therapy followed by slow and controlled rewarming for infants with mod to severe HIE

24

Meconium Aspiration Syndrome Nursing Care


-tracheal suctioning
-umbilical arterial line
-umbilical venous catheter
-high levels of O2
-exogenous surfactant
-prophylactic antibiotics

25

Meconium in the lungs...

-mechanical airway obstruction
-chemical pneumonitis
-vasoconstriction of pulmonary vessels
-inactivation of surfactant

26

Meconium assessment

-apnea
-pallor
-bradycardia
-barrel chest
-distress yellow-green skin
-nail discoloration

27

The key to meconium...

prevention
-suction oropharynx and naspharynx before first breath. May need to intubate to aggressively suction

-if aspiration is significant, will need ECMO

28

Pulmonary HTN

-Failure of the normal circulatory transition that occurs after birth

-Breathing and increase PO2 is altered so that the normal mechanisms for transition are altered

-Marked pulmonary hypertension that causes hypoxemia secondary to right to left shunting of blood

29

Symptoms of Pulmonary HTN

-tachypnea, respiratory distress
-loud, single second heart sound (S2)
-harsh systolic murmur (secondary to tricuspid regurgitation)
-cyanosis
-poor cardiac function and perfusion, hypotension

30

Management of Pulmonary HTN

-continuous monitoring of oxygenation, blood pressure, and perfusion

-maintaining a normal body temp

-correction of electrolytes/glucose abnormalities and metabolic acidosis

-nutritional support

-minimal stimulation/handling of the newborn

-minimal use of invasive procedures