Management of the Newborn at Risk

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Chapter 24

• Management of the Newborn at Risk

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Asphyxia

• Multiple systems effected
• Predisposing factors
• Nsg goals- oxygenation and warmth
• Initiation of resuscitation
• Check equipment
• Keep parents informed

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Respiratory Distress Syndrome

• Lack of surfactant
• Predisposing factors- prematurity
• Pulmonary vascular resistance increases
• Respiratory acidosis
• Metabolic acidosis
• S/S- cyanosis, tachypnea, flaring, grunting,
  retracting

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Meconium Aspiration

• Plugs alveoli
• Allows air in not out
• Evaluate tracing
• Suction at perineum
• Expect the unexpected

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Persistent Pulmonary Hypertension

• Maintain fetal circulation
• Nursing-Maintain oxygenation, prevent acidosis,
  keep warm
• S/S- tachypnea, cyanosis, grunting, retractions

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Bronchiopulmonary Dysplasia

• Injury to lungs- mechanical ventilation
• Usually premies due to lack of surfactant
• S/S- tachypnea, respiratory distress, poor weight
  gain
• Nursing- wean of O2 ASAP

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Acquired Disorders

• Periventricular Hemorrhage- mostly premies r/t
  trauma
• S/S- low HCT, pallor, seizures, acidosis,
  hypotonia
• NSG- corrective measures, protect head
• NEC-Insult results in decrease blood flow to gut
• NSG-NPO, bowel rest, ABX

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Acquired Disorders-

• GDM- complications R/T glucose control
• Assess- birth injury, RDS, hypoglycemia
• NSG- assess for glucose control
• Birth Trauma- R/t size, presentation or events of
  labor
• Assess for risk factor
• NSG- complete physical and neuro exam

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Newborn Addiction

• Withdrawals.
• FAS have poor prognosis due to CNS damage
• Drug addicted- newborns jittery, high pitched
  cry, poor feeders, disorganized behavior
• Nsg -keep warm, decrease stim., sm feedings

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Jaundice

• Cause- short life of RBCs-lack of intestinal
  bacteria-hydration
• Need albumin to bind
• Can be effected by drugs
• Kernicterus- staining of basal ganglia

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Jaundice

• Cause- short life of RBCs-lack of intestinal
  bacteria-hydration
• Need albumin to bind
• Can be effected by drugs
• Kernicterus- staining of basal ganglia

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Bililights

• Assessment- lighting, palate, oral mucosa
• Bililights helps to convert for excretion
• Nsg- keep eyes covered, diaper, turn
• Assess for dehydration

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Infections

• Congenital-Early-Late
• Premies lack immunity
• S/S- hypothermia, poor feeding, irritable
• Observe for subtle changes in behavior
• NSG- hand washing, skin care, tachypnea
• Do not stress newborn

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Congenital Heart Defects

• Causes- genetic, environmental, drugs
• Cyanotic-flow from right to left
• Acyanotic-left to right- oxygenated blood
• Detect early
• Anticipatory education- parental grief and fears

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Errors in Metabolism

• PKU-Excess pnenylalinine
• Test before discharge
• Maple syrup urine- can be fatal
• Galactosuria-unable to convert glucose
• Hypothyroidism- lack of iodine in maternal diet

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CNS Defects

• Hydrocephalus-overproduction of CSF
• Microcephaly- small brain
• Meningocele- herniation of meninges
• Mylomeningocele- spinal cord and nerve roots
  herniated
• NSG- provide comfort, warmth, prevent infections,
  avoid trauma

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Congenital Anomalies

• Choanal atresia- nasal abnormality
• Unable to breath through nose
• Diaphragmatic hernia- failure of diaphragm to
  close
• Respiratory distress- Assess abdomen and breath
  sounds

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Congenital Anomalies

• Cleft lip and palate- fissure in lip that can
  extend into palate
• Difficulty feeding- need special nipples
• Esophageal atresia- esophagus ends in blind pouch
• Tracheoesophageal fistula- communication between
  esophagus and trachea

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Congenital Anomalies

• Omphalocele-protrusion of bowel- covered by
  peritoneal sac
• Gastrochisis- no sac, exposure causes
  inflammation and edema
• NSG- Protect sac, infection control
• Imperforate anus ends in blind pouch
• NPO- gastric decompression

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Congenital Anomalies

• Hypospadias-opening on underside of penis
• Epispadias-opening on top or side
• Bladder exstrophy- bladder outside abdominal
  wall- surgical reconstruction
• Clubfoot- inversion of feet
• Requires serial casting and ?surgery
• Hip Dysplasia- femoral head displaced from
  acetabulum- special harness