High Risk Newborn: 2013Student

8/14/2019 High Risk Newborn: 2013Student

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Gastro-intestinal

Difficulty with digestion & absorptionPoor gag reflex, incompetent cardiac sphincterSmall stomach capacity

Requires a high concentration of whey to casinratio in formulaDeficiency of Ca & phosphorousIncreased BMR & O2 requirements r/t fatiguefrom suckingFeeding intolerance & NEC r/t blood flow tointestines


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Nutritional & FluidManagement

High caloric need (110-130kcal/kg/day)Need for supplemental vitaminsNeed Vitamin E - r/t diet high in fatswhich they needNutritional intake adequate ifgaining 20-30 gms/dayInitial weight loss 10-15%


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Nursing Care - Nutrition

120 cal/kg/dayBefore feeding Measure abdominal girth

Auscultate for bowel soundsWatch for signs of feeding intolerance + Guiac stools Lactose in stools Vomiting & diarrhea Abdominal distention Weight loss or plateau


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Nursing Care - Nutrition

Signs of readiness for oral feeding Strong gag Non-nutritive sucking Rooting 34 wk gestation or greater & 1500 grams Gaining 20-30 grams/day


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Nursing CareNutrition Bottle Fed

Soft, smaller nipple

Semi sitting position

Burp Q -1 oz

Feeding last no longer than 15-20 min


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Nursing CareNutrition - Breast Feeding

Put to breast when Suck & swallow developed Consistent weight gain Control body temp outside isolette

Football hold

May take 45 min (sleep and restperiods)Pump and gavage until able to nurse


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Nursing CareNutrition - Gavage

Adjunct to nipple feeding

Nasogastric or orogastric route Gavage Gastronomy feeding


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Complications

Apnea of prematurity 20sec or > or , 20 sec + cyanosis & bradycardPDA pulmonary arteriole musculature & hypoxeRDS surfactant

GMH-IVH - Hemorrhage Germinal matrix lines brain ventricles & is high

susceptible to hypoxia


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Complications

Anemia Rapid rate of growth Shorter RBC life Excessive blood sampling iron stores

HypocalcemiaNEC Necrotizing Enterocolitis


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Long Term Outcomes

Retinopathy of prematurity (ROP)Bronchopulmonary Dysplasia (BPD) r/tdamage to alveoli from CPAP therapy &

high O2 concentrationsSpeech defectsNeurological deficits

Auditory defects


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Nursing CareInfection Prevention

Strict hand washing

Maintain asepsis

Change position regularly

Sheepskin Avoid chemical skin preps/tape


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Post-term

> 42 weeks gestationPost-maturity syndrome

Dont tolerate prolonged pregnancy

Placenta degenerates Poor oxygenation Poor nutrition Poor waste removal


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Characteristics

Loose, dry peeling skinMeconium stainingLong fingernails

Alert facesLook old & worried


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Postmaturity Complications

Hypoglycemia Nutritional deprivationMeconium aspiration

hypoxiaPolycythemia

R/t hypoxiaSeizure activity

R/t hypoxiaCold stress sub Q fatCongenital anomalies


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Meconium Staining

Occurs in 10-15% of all live birthsPredominantly in Term, SGA, or Post-term infants

Cause may be in u tero h yp oxia Almost never observed in infants lessthan 34 weeks gestation


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Aspiration Syndromes

Fetal stress or distress ordevelopmentalProcess: Gasping of fluid, blood, meconium etc.

into lung with breathing Rapid distal migration with first breaths

Prevention Delay first breath

Intubate and suction

d


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Aspiration Signs andSymptoms

Barrel chest TachypneaGrunting, retractions,Pallor, cyanosisCO2 retention, acidosisRales, decreased breath soundsStained nails, cord & skin


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Substance Abuse

Alcohol Fetal alcohol syndrome (FAS) Fetal alcohol effects (FAEs)

HeroinMethadoneMarijuana

Cocaine


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Fetal Alcohol Spectrum Disorder

Leading cause of mental retardationSGA/IUGRLife long affecting learning, behavior,relationshipsSpeech/hearing/languageEating, sleeping


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Triad for Diagnosis

Facial abnormalitiesGrowth deficitsCNS abnormalities or Neuro-behavioral disabilities


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FAS 1 st Week 1 st Month

SleeplessnessInconsolable crying

Abnormal reflexes

HyperactivityJitterinessExcessive mouthing behaviors

Hyperactive rootingIncreased non nutritive sucking


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Long Term Complications

Failure to thrive ability to block out repetitive stimuli

Severe mental retardation or normalImpulsivityCognitive impairmentSpeech/language abnormalities


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Cocaine

Greatest impact on perinatal morbidityIncrease risk for: Spontaneous abortion/stillbirth STDs, HIV Abruptio placenta Prematurity

LBW - low birth weight


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Heroin and Methadone

Results in IUGR, prematurity , stillbirths, butno documented congenital anomalies

Methadone - better infant outcomes then

heroin such as: fewer infections, larger birthweight Withdrawal symptoms may be more severein methadone exposed infants.

Long-term - increased risk for SIDS X 10-15


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Risks to Infants with NAS

Intrauterine asphyxia maternal withdrawal fetal withdrawal

hyperactivity increased O2

consumption asphyxiaIntrauterine infection r/t addicts lifestyle

Alterations in body weight


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Observe for Withdrawal S & S

Most common Poor weight gain

diarrhea, vomiting

Tremors Seizures SIDS Irritable


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Nursing Care

Temperature regulationMonitor P & R q 15 m till stableSmall, frequent feedings

IV prn hydrationMedication-PhenobarbitalPosition on R side aids in digestionWeight Q8H during withdrawal

Swaddle with hands near mouthGentle vertical rockingQuiet, dimly lit area


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Nursing Care

Quiet dimly lit environmentExtra time & patience with fdgMonitor VS

Observe for seizuresObserve for RDSMom can breastfeed

alcohol will intoxicate newborn inhibits letdown

Support parents & reinforce + parentingskills


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Substance Abuse

Other substancesNicoteneCaffeine


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Critical thinking

Assessments on SGA, LGA,Pre/PosttermWhat causes them?

What are their major problems? System by system

Which are the priorities?

How do you solve them?Developmental delays.Parental involvement and care.


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Example

The mother admits to alcoholWhat will the baby look like?How will the baby act?

What problems is the baby likely tohave?How will you respond to them?

What are your interventions? Feeding, diapering, sleeping, stimulation,pt education, medications, collarboration

What does the mother need to know?


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Next Week

Exam 350 questions

All multiple choice

All on the high risk and complicationsof pregnancy, birth and newbornUse the critical thinking topics to helpfocus your preparationRoom 25612:30 Review at 1:45

Documents

High Risk Newborn: 2013Student