Newborns at Risk: Conditions Present at Birth

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Newborns at Risk Conditions Present at Birth

• LLD Chapter 28

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Classification of Newborn

• Use birth weight and gestational age to determine
  maturity, morbidity and mortality.
• Preterm less than completion of 37 weeks
• Term- end of 37 week to 41 6/7
• Post term later than 42 week
• Late preterm 34-37 weeks

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At Risk Newborns

• Review risk factors
• Ability to tolerate stress of labor not
  predictable
• Weight/ gestation age used for criteria

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Neonatal Mortality Chart

• Mortality risk of death within 28 days
• AGA 80 percentile
• SGA lower 10
• LGA upper 10
• Graph identifies potential problems
• Goals- decrease stress, observation, labs,
  conserve energy, sleep, attach, family involvement

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SGA

• IUGR vs SGA
• Caused by vasoconstriction
• At risk - polycythemia and hypoglycemia
• Symmetrical- first half of second
  trimester-decrease head circumference
• Asymmetrical occurs in third tri-BPD nl
• Asymmetrical catch up
• Symmetrical poor prognosis

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Complications R/T SGA

• Asphyxia- chronic hypoxia
• Aspiration syndrome-Hypothermia
• Hypoglycemia-Polycythemia
• Bad outcomes R/T
• Congenital malformations-Infections-Growth
  problems-Cognitive deficits

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Nursing Care

• Identify early
• Asymmetrical little fat, thin, dry, alert, wide
  eyed
• Maintain blood sugar
• Keep warm
• Need follow up to evaluate growth

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LGA

• Upper 10
• Macrosomic poor motor skills difficult to arouse,
  poor feeders
• Complications- trauma, C/S
• Assess-hypoglycemia and polycythemia
• Help to arouse for feeding

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Diabetic Infant

• Brain is not large
• Hypocalcemia-r/t hypoparathyroism
• Hyperbilirubinemia
• Trauma
• Polycythemia
• RDS
• Congenital birth defects

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Diabetic Infant

• Heel stick first four hours then q 4 hrs
• Maintain at 40mg/dl if not IV tx
• Big is not mature
• At risk for RDS and anomalies
• Evaluate for polycythemia
• Teach parents

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Post maturity Syndrome

• Assess for accurate EDD
• Can use up reserves
• Placental insufficiency
• Asphyxia and hypoglycemia
• Assess for polycythemia, meconium aspiration,
  cold stress
• Wide eyedhypoxia, look old

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Premature Newborn

• Very high incidence
• All systems are immature
• Assess for RDS
• Heat loss
• Risk for aspiration-less than 34 wks no gag
  reflex (1500 grams)
• Risk for infection
• No mylenization

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Prematurity

• Cluster care
• Do not over stimulate
• Best to use breast milk with gavage feedings
• Can breastfeed if have suck swallow and gag
  reflex
• Initiate skin to skin contact
• Evaluate parental care

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Common Complications

• Apnea
• PDA-- failure to close
• Intraventricular hemorrhage- germinal matrix can
  rupture from hypoxia
• Anemia

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Long term Consequences

• R/T degree of prematurity
• ROP
• Bronchiopulmonary dysplasia
• Speech
• Neuro/ hearing
• Assess from EDD not birth date

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Nursing

• Prevent infections- good handwashing
• 2-3 minute scrub
• Skin care
• Attachment -give picture- assess involvement
• Decrease stimuli in NICU

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Discharge of Premie

• Evaluate parents response to cues
• Provide discharge teaching
• Referral to community agencies
• Review vaccine schedule

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Congenital anomalies

• Find one look for another
• FASD -fetal alcohol spectrum disorder-umbrella
  term for exposure
• Syndrome can be multifactorial
• Often have failure to thrive
• May be microcephalic
• Not consolable

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Drug Dependency

• Increase in prescription drug dependency
• Usually have problems but advance fetal lung
  maturity
• Poor feeders not consolable
• Difficult to withdraw from methadone

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Drug Dependency

• Need medical management for withdrawal
• Ask question regarding drug use
• Do not be judgmental
• Parents need to understand newborns behavior

21
Tobacco Dependency

• Increases infertility
• Increase carbon monoxide to fetus
• Likely to have LBW
• Can interfere with CNS development
• Should quit smoking

22
HIV

• 90 of exposure during perinatal and neonatal
  period
• Crosses placenta or through breast milk
• Antivirals decrease rate to 2
• Inappropriate to test with ELISA for 18 months
• Use DNA PCR test within 48 hrs

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HIV

• Use standard precautions
• Use gloves to change diapers
• Linens visibly soiled use bleach
• Diaper changing area 110 bleach
• Alert to s/s of infection
• No documented cases of contracting HV from
  newborn
• IF positive give antivirals

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Congenital Heart Defects

• At risk if have infection, used steroid, alcohol,
  lithium, and anticonvulsants
• Assess for cyanosis, murmur, CHF

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Inborn Errors of Metabolism

• Newborn Screening
• PKU- Phenylanine converted to tyrosine
• Accumulation of phenylpyruvic acid and
  phenylacetic acid
• Newborn must eat
• Galactosemia- cannot convert galactose and
  lactose to glucose

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Inborn Errors of Metabolism

• PKU- more likely to be blond
• Must limit phenylalanine
• If pregnant stay on low PKU diet