HIGH RISK NEWBORN
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Questions and Answers

Which category includes infants with a birth weight of 2500g-4000g?

  • SGA (Small-for-gestational-age)
  • LGA (Large-for-gestational-age)
  • LBW (Low-birth-weight)
  • AGA (Appropriate-for-gestational-age) (correct)

    • What does SGA (Small-for-gestational-age) indicate?

  • Infants with birth weight above 90th percentile
  • Infants with birth weight below 10th percentile (correct)
  • Infants born after 42 completed weeks of gestation
  • Infants born before 37 completed weeks of gestation

    • What term is used for infants born before 37 completed weeks of gestation?

  • Preterm (correct)
  • Postterm
  • IUGR
  • Term

    • Which group of high-risk infants is associated with macrosomia?

    <p>Post term: macrosomia</p> Signup and view all the answers

    What can meconium aspiration syndrome (MAS) cause during childbirth?

    <p>Mechanical obstruction and chemical pneumonitis</p> Signup and view all the answers

    What are the key characteristics of Persistent Pulmonary Hypertension of the Newborn (PPHN)?

    <p>Pulmonary hypertension and R-to-L shunting</p> Signup and view all the answers

    What can lead to complications such as shoulder dystocia and respiratory distress syndrome in newborns?

    <p>Macrosomia</p> Signup and view all the answers

    What is a contributing factor to impaired pulmonary gas exchange leading to Bronchopulmonary Dysplasia (BPD)?

    <p>Intrauterine growth restriction (IUGR)</p> Signup and view all the answers

    What is crucial in managing Persistent Pulmonary Hypertension of the Newborn (PPHN)?

    <p>Prompt recognition and aggressive intervention</p> Signup and view all the answers

    What is a characteristic of parental support for neonates?

    <p>Encouraging frequent visits and involvement</p> Signup and view all the answers

    What is a potential intervention for severe cases of Meconium Aspiration Syndrome (MAS)?

    <p>ECMO</p> Signup and view all the answers

    What distinguishes pediatric pneumonia in infants from adults?

    <p>Acute abdominal pain</p> Signup and view all the answers

    What is a characteristic of Bronchopulmonary Dysplasia (BPD)?

    <p>Affecting newborns and premature infants</p> Signup and view all the answers

    What may be necessary if a baby is born at 25 weeks?

    <p>Extended parental support</p> Signup and view all the answers

    What can lead to Persistent Pulmonary Hypertension of the Newborn (PPHN)?

    <p>Hindrances in the transition from fetal to neonatal blood flow</p> Signup and view all the answers

    What can minimize risks associated with Meconium Aspiration Syndrome (MAS)?

    <p>Surfactant administration</p> Signup and view all the answers

    What factors influence intrauterine growth and birth weight?

    <p>Heredity, placental insufficiency, and maternal disease</p> Signup and view all the answers

    What is a common complication of preterm birth characterized by lack of surfactant?

    <p>Respiratory Distress Syndrome (RDS)</p> Signup and view all the answers

    What does the cardiovascular assessment of preterm infants involve?

    <p>Checking signs of hypovolemia or shock</p> Signup and view all the answers

    What are preterm newborns susceptible to due to various factors?

    <p>Temperature instability</p> Signup and view all the answers

    What is a common complication of preterm birth responsible for a high percentage of infant deaths?

    <p>Preterm birth</p> Signup and view all the answers

    What does the CNS evaluation of preterm infants include?

    <p>Assessing for injury and monitoring neurologic signs</p> Signup and view all the answers

    What does the renal assessment of preterm infants focus on?

    <p>The immature renal system's inability to excrete waste effectively</p> Signup and view all the answers

    What is a common nutritional issue for preterm infants?

    <p>Imbalanced nutrition and the need for parenteral or gavage feedings</p> Signup and view all the answers

    What is a common complication of preterm birth characterized by bleeding and anemia?

    <p>Bleeding and anemia</p> Signup and view all the answers

    What is a common environmental consideration in nursing care for preterm infants?

    <p>Incubators, ventilatory support, and electronic monitoring</p> Signup and view all the answers

    What is the cause of Respiratory Distress Syndrome (RDS) in preterm infants?

    <p>Lack of surfactant</p> Signup and view all the answers

    What is a common complication of preterm birth characterized by an immature renal system's inability to excrete waste effectively?

    <p>Renal insufficiency</p> Signup and view all the answers

    What is a key consideration in the care of infants receiving assisted ventilation?

    <p>Continuous monitoring of oxygen saturation</p> Signup and view all the answers

    What is a potential complication of Patent Ductus Arteriosus (PDA) in newborns?

    <p>Heart failure</p> Signup and view all the answers

    What is a crucial measure for infection prevention in newborns?

    <p>Hand hygiene</p> Signup and view all the answers

    What is a potential consequence of elevated oxygen tension in newborns?

    <p>Retinopathy of prematurity</p> Signup and view all the answers

    What is a key consideration in the collaborative management for retinopathy of prematurity?

    <p>Early screening and detection</p> Signup and view all the answers

    What can lead to hospital-acquired infections in newborns?

    <p>Bacterial transfer during delivery</p> Signup and view all the answers

    What is a potential intervention for the prevention of Patent Ductus Arteriosus (PDA) in newborns?

    <p>The use of NSAIDs to inhibit prostaglandins</p> Signup and view all the answers

    What is a key characteristic of post-term newborns?

    <p>Born after 42 weeks of gestation</p> Signup and view all the answers

    What is a potential consequence of post-term infants not having their increased oxygen demands met?

    <p>Potential complications and high mortality rates</p> Signup and view all the answers

    What is a key consideration in the management of retinopathy of prematurity?

    <p>Prompt attention to saturation alarms</p> Signup and view all the answers

    What is a potential adverse effect of surfactant replacement therapy in premature infants?

    <p>Apnea</p> Signup and view all the answers

    What is a key measure in the prevention of hospital-acquired infections in newborns?

    <p>Elimination of environmental sources of infectious agents in the nursery</p> Signup and view all the answers

    Which of the following is a behavioural-psychosocial risk factor for newborns?

    <p>Inadequate prenatal care</p> Signup and view all the answers

    What is a potential risk factor for newborns related to maternal habits?

    <p>Smoking more than 10 cigarettes a day</p> Signup and view all the answers

    Which of the following is a potential risk factor for newborns related to maternal nutrition?

    <p>Poor nutrition</p> Signup and view all the answers

    Which factor is considered a biophysical risk for preterm birth?

    <p>Uterine anomalies or fibroids</p> Signup and view all the answers

    What maternal condition is listed as a potential risk factor for preterm birth?

    <p>Chronic hypertension</p> Signup and view all the answers

    What pregnancy complication is considered a current pregnancy risk for preterm birth?

    <p>Preeclampsia</p> Signup and view all the answers

    Which age group is considered a demographic risk factor for preterm birth?

    <p>Age &lt; 15 years or &gt; 35 years</p> Signup and view all the answers

    Which of the following is a socioeconomic risk factor for preterm birth?

    <p>Low socioeconomic status</p> Signup and view all the answers

    Which educational level is associated with an increased risk of preterm birth?

    <p>Less than high school education</p> Signup and view all the answers

    What is a key factor influencing the chances of survival for preterm infants?

    <p>Gestational age</p> Signup and view all the answers

    What is the last resort for respiratory support in preterm infants with severe hypoxemia or severe hypercapnia?

    <p>Mechanical ventilation</p> Signup and view all the answers

    What is a sign of hypovolemia or shock in preterm infants?

    <p>Initial tachycardia then bradycardia</p> Signup and view all the answers

    What is a normal temperature range for preterm infants?

    <p>36.8-37.2°C</p> Signup and view all the answers

    Why are preterm infants susceptible to temperature instability?

    <p>Large surface area in relation to weight and minimal subcutaneous fat</p> Signup and view all the answers

    What is a key consideration in the nutritional care of preterm infants?

    <p>Monitoring for residuals during gavage feedings</p> Signup and view all the answers

    What is a characteristic of the renal system in preterm infants?

    <p>Immature and unable to excrete waste effectively</p> Signup and view all the answers

    Why are preterm infants at an increased risk of bleeding?

    <p>Immature hematological system and decreased RBC production</p> Signup and view all the answers

    What is a key consideration in infection prevention for preterm infants?

    <p>Diminished immunity</p> Signup and view all the answers

    What is a potential consequence of rapidly changing the temperature of preterm infants?

    <p>Increased risk of apnea and acidosis</p> Signup and view all the answers

    Why are preterm infants prone to imbalanced nutrition?

    <p>Immature digestive capacity and weak or absent suck, swallow, and gag reflexes</p> Signup and view all the answers

    What should be assessed in preterm infants to evaluate CNS function?

    <p>Tone, symmetry and quality of movements, reflexes, and cranial nerves</p> Signup and view all the answers

    What is a key component of the environment for preterm infants?

    <p>Incubator or radiant warmer to control temperature</p> Signup and view all the answers

    Which monitoring is essential for preterm infants in the neonatal environment?

    <p>Electronic monitoring of respiratory, cardiac, and oxygenation status</p> Signup and view all the answers

    What may be instituted for preterm infants in terms of intravenous support?

    <p>Parenteral fluids, parenteral nutrition, parenteral meds</p> Signup and view all the answers

    What is the pathophysiological mechanism of Respiratory Distress Syndrome (RDS) in preterm infants?

    <p>Deficient surfactant levels leading to progressive atelectasis and loss of functional residual capacity</p> Signup and view all the answers

    What are the potential signs and symptoms of severe Respiratory Distress Syndrome (RDS) in preterm infants?

    <p>Shock-like state from diminished cardiac inflow and low BP</p> Signup and view all the answers

    What are the potential risks associated with Respiratory Distress Syndrome (RDS) in preterm infants?

    <p>Decreased tracheal cartilage and immature and fragile pulmonary vasculature</p> Signup and view all the answers

    What are the potential signs and symptoms of Respiratory Distress Syndrome (RDS) in preterm infants?

    <p>Nasal flaring, grunting, and tachypnea (&gt; 60 breaths/min)</p> Signup and view all the answers

    What is the primary diagnosis indicated by 'Dx:  Ineffective breathing pattern r/t pulmonary immaturity'?

    <p>Respiratory Distress Syndrome (RDS)</p> Signup and view all the answers

    What is the purpose of administering betamethasone to the mother of a preterm infant?

    <p>To help with lung development of the baby</p> Signup and view all the answers

    What is the potential adverse effect of surfactant replacement therapy in premature infants?

    <p>Apnea (abnormal)</p> Signup and view all the answers

    What is a potential complication of Patent Ductus Arteriosus (PDA) in newborns?

    <p>Compromised oxygenation</p> Signup and view all the answers

    What is the potential consequence of rapidly changing the temperature of preterm infants?

    <p>Increased risk of infection</p> Signup and view all the answers

    What is the potential risk associated with hyper-oxygenation in preterm infants?

    <p>Premature retinopathy</p> Signup and view all the answers

    What is a key measure in the prevention of hospital-acquired infections in preterm infants?

    <p>Proper hand hygiene</p> Signup and view all the answers

    What is a potential intervention for the prevention of complications related to ductus arteriosus and foramen ovale in preterm infants?

    <p>Surfactant replacement therapy</p> Signup and view all the answers

    What is a potential adverse effect of providing excessive oxygen to preterm infants?

    <p>Premature retinopathy</p> Signup and view all the answers

    What can lead to retinal revascularization, capillary hemorrhages, and/or retinal detachment in preterm infants?

    <p>Elevated O2 tension and subsequent vasoconstriction</p> Signup and view all the answers

    What is a key measure in the prevention of wide fluctuations in O2 blood levels for preterm infants?

    <p>Using supplemental O2 judiciously and monitoring O2 levels carefully</p> Signup and view all the answers

    Which treatment option is used for retinopathy of prematurity to prevent complications such as capillary hemorrhages and retinal detachment?

    <p>Circumferential cryotherapy and laser photocoagulation</p> Signup and view all the answers

    What is the role of placental blood in the closure of ductus arteriosus?

    <p>It provides oxygen and prostaglandins to facilitate closure</p> Signup and view all the answers

    What can cause Patent Ductus Arteriosus (PDA) in newborns?

    <p>Decreased oxygen supply or increased sensitivity to prostaglandins</p> Signup and view all the answers

    What is the purpose of NSAIDs in the prevention of PDA?

    <p>Inhibit prostaglandins to prevent PDA</p> Signup and view all the answers

    What happens to the pulmonary blood flow when pulmonary arteries do not receive enough oxygen?

    <p>Decreases due to vasoconstriction</p> Signup and view all the answers

    What is the effect of a persistently open ductus arteriosus in a newborn in respiratory distress?

    <p>Causes heart overload, failure, and worsens respiratory failure</p> Signup and view all the answers

    What is the significance of Qp:Qs ratio in the context of PDA?

    <p>It measures pulmonary to systemic flow rate and indicates the level of shunting</p> Signup and view all the answers

    What is the role of O2 and prostaglandins in the closure of ductus arteriosus after birth?

    <p>O2 increases and prostaglandins decrease to facilitate closure</p> Signup and view all the answers

    What is the potential effect of maternal rubella on the development of PDA in newborns?

    <p>May contribute to the development of PDA</p> Signup and view all the answers

    Which infants are most at risk for PV-IVH (PERIVENTRICULAR-INTRAVENTRICULAR HEMORRHAGE)?

    <p>Infants ≤ 32 weeks gestation or under and those weighing less than 1500g/1.5kg</p> Signup and view all the answers

    What is the pathophysiological mechanism of PV-IVH?

    <p>Venous congestion leading to periventricular hemorrhagic necrosis</p> Signup and view all the answers

    What can decreased absorption of CSF due to dysfunction of arachnoid villi result in?

    <p>Communicating hydrocephalus</p> Signup and view all the answers

    What are the manifestations of PV-IVH in preterm infants due to decreased blood flow to the brain?

    <p>Hypotonia, apnea, and altered level of consciousness</p> Signup and view all the answers

    What is a potential sign of Catastrophic Deterioration in newborns?

    <p>Seizures</p> Signup and view all the answers

    What is a key goal of collaborative management for newborns with Catastrophic Deterioration?

    <p>Preserve brain cells</p> Signup and view all the answers

    What is a potential risk associated with Catastrophic Deterioration in newborns?

    <p>Impaired coagulation process</p> Signup and view all the answers

    What is a recommended measure to reduce environmental stress for newborns with Catastrophic Deterioration?

    <p>Noise reduction</p> Signup and view all the answers

    What is a potential consequence of rapidly changing the temperature of preterm infants with Catastrophic Deterioration?

    <p>Increased intracranial pressure</p> Signup and view all the answers

    What should be assessed in preterm infants to evaluate CNS function in the context of Catastrophic Deterioration?

    <p>Tone and symmetry</p> Signup and view all the answers

    What is a key measure to prevent wide fluctuations in O2 blood levels for preterm infants with Catastrophic Deterioration?

    <p>Avoid rapid infusion of fluids</p> Signup and view all the answers

    What is a potential adverse effect of providing excessive oxygen to preterm infants with Catastrophic Deterioration?

    <p>Impaired pulmonary gas exchange</p> Signup and view all the answers

    What is a common symptom of necrotizing enterocolitis in newborns?

    <p>Absent bowel sounds and distension</p> Signup and view all the answers

    Which diagnostic tests are commonly used to assess necrotizing enterocolitis?

    <p>Blood cultures and CT scan</p> Signup and view all the answers

    What is a key component of collaborative management for necrotizing enterocolitis?

    <p>Stop all feeds immediately, start on IV fluid</p> Signup and view all the answers

    What is the pathophysiological mechanism of necrotizing enterocolitis?

    <p>Bacterial colonization leading to ischemic necrosis of intestinal mucosa</p> Signup and view all the answers

    What is a potential complication of necrotizing enterocolitis in newborns?

    <p>Short gut syndrome</p> Signup and view all the answers

    What nutritional issue is commonly observed in infants with necrotizing enterocolitis?

    <p>Imbalanced nutrition due to gastrointestinal immaturity</p> Signup and view all the answers

    What is a potential intervention for the prevention of complications related to necrotizing enterocolitis?

    <p>Identifying the cause through CT and laboratory tests</p> Signup and view all the answers

    What is a key symptom of sepsis in the context of necrotizing enterocolitis?

    <p>Unstable temperatures and altered vitals</p> Signup and view all the answers

    What is a key measure in the prevention of neonatal sepsis?

    <p>Hand hygiene and appropriate use of PPE</p> Signup and view all the answers

    When does the transfer of bacteria from mother to baby during delivery pose a risk for neonatal sepsis?

    <p>During delivery</p> Signup and view all the answers

    What is a key component of collaborative management for neonates with suspected sepsis?

    <p>Performing labs, cultures, and administering antibiotics</p> Signup and view all the answers

    What is a potential source of infection that should be eliminated in the nursery to prevent neonatal sepsis?

    <p>Environmental sources of infectious agents</p> Signup and view all the answers

    What is a potential consequence of post maturity in newborns?

    <p>Meconium staining of fingernails</p> Signup and view all the answers

    What is a significant difference in perinatal mortality between post-term and term infants?

    <p>Oxygen demands are not met in post-term infants</p> Signup and view all the answers

    What is a common characteristic of post-term newborns?

    <p>Placental insufficiency</p> Signup and view all the answers

    What is the pathophysiological mechanism of Meconium Aspiration Syndrome (MAS)?

    <p>Intrauterine stress leading to passage of meconium into amniotic fluid, followed by aspiration into the tracheobronchial tree and mechanical obstruction</p> Signup and view all the answers

    What is a key intervention for managing Meconium Aspiration Syndrome (MAS)?

    <p>Surfactant administration to minimize risks</p> Signup and view all the answers

    What is the recommended approach for airway clearance in a newborn with Meconium Aspiration Syndrome (MAS)?

    <p>Digital intubation followed by suctioning out meconium and oxygenation using an ambu-bag</p> Signup and view all the answers

    What can lead to persistent pulmonary hypertension in the context of Meconium Aspiration Syndrome (MAS)?

    <p>Aspiration of meconium causing chemical pneumonitis and alveolar over-distention</p> Signup and view all the answers

    What can lead to Meconium Aspiration Syndrome (MAS) during childbirth?

    <p>Meconium staining of the amniotic fluid</p> Signup and view all the answers

    What may result from the migration of meconium into the terminal airways?

    <p>Mechanical obstruction leading to MAS</p> Signup and view all the answers

    What is a potential consequence of meconium aspiration?

    <p>Chemical pneumonitis and/or persistent pulmonary hypertension</p> Signup and view all the answers

    What intervention minimizes risks associated with Meconium Aspiration Syndrome (MAS)?

    <p>Surfactant administration</p> Signup and view all the answers

    What is a potential management approach for severe cases of Meconium Aspiration Syndrome (MAS)?

    <p>Infant may need ECMO (oxygenate blood outside body) if other interventions are failing</p> Signup and view all the answers

    Which condition is characterized by tachycardia and cyanosis that progress to severe respiratory compromise with acidosis?

    <p>Persistent Pulmonary Hypertension of Newborn (PPHN)</p> Signup and view all the answers

    What is the path of fetal blood flow in the context of R to L shunting?

    <p>Placenta → IVC → RA → foramen ovale → LA → LV</p> Signup and view all the answers

    What intervention has improved survival in some infants with impaired ventilation?

    <p>Extracorporeal Membrane Oxygenation (ECMO)</p> Signup and view all the answers

    What is the consequence of any process hindering the transition from fetal to neonatal blood flow?

    <p>Increased hypoxia and pulmonary vasoconstriction</p> Signup and view all the answers

    What is a characteristic of high-frequency ventilation used in newborns?

    <p>Limited development of high airway pressure</p> Signup and view all the answers

    What is the role of ECMO in the management of PPHN?

    <p>Improving survival in some infants for impaired ventilation</p> Signup and view all the answers

    What does the closure of foramen ovale and ductus arteriosus after birth lead to?

    <p>Maturation of pulmonary circulation</p> Signup and view all the answers

    What is a potential consequence of post-maturity in newborns?

    <p>Risk of meconium aspiration</p> Signup and view all the answers

    What is a potential consequence of increased O2 demands due to macrosomia in newborns?

    <p>Polycythemia</p> Signup and view all the answers

    What is a complication related to the release of epinephrine and glucocorticoids during delivery that may be delayed in macrosomic newborns?

    <p>Transient tachypnea of newborns</p> Signup and view all the answers

    What is a potential consequence of maternal diabetes in newborns with macrosomia?

    <p>Hypoglycemia</p> Signup and view all the answers

    What is a recommended way to prepare parents of a neonate in NICU?

    <p>Explain what the neonate will look like and the function of NICU equipment</p> Signup and view all the answers

    What is an encouraged practice for parents with infants in NICU?

    <p>Visiting the NICU often, naming the infant, and bringing personal items</p> Signup and view all the answers

    What should be provided to parents regarding the infant's condition in NICU?

    <p>Consistent and frequent information and assessment of their understanding</p> Signup and view all the answers

    What should parents be encouraged to do regarding their preterm infant in NICU?

    <p>Visit the NICU often, name the infant, touch, hold, or caress the infant</p> Signup and view all the answers

    What should parents be prepared for by healthcare staff regarding the preterm infant in NICU?

    <p>Explain what the neonate will look like and what the NICU equipment will look like and its function</p> Signup and view all the answers

    What should healthcare staff do to support parents of a preterm infant in NICU?

    <p>Encourage parents to bring other siblings to visit the preterm infant</p> Signup and view all the answers

    What should healthcare staff provide to parents regarding the preterm infant's condition in NICU?

    <p>Consistent and frequent information regarding the infant's condition</p> Signup and view all the answers

    What should healthcare staff do to increase parental self-confidence in caring for the preterm infant?

    <p>Reinforce parent involvement and praise care endeavors</p> Signup and view all the answers

    Study Notes

    High-Risk Infants: Care and Complications

    • Factors influencing intrauterine growth and birth weight: heredity, placental insufficiency, and maternal disease
    • Preterm newborns have immature organ systems and lack physiological reserve for extrauterine life
    • Preterm birth responsible for approximately 60-80% of infant deaths
    • Respiratory function assessment includes difficulties transitioning to extrauterine life and use of O2 therapy
    • Cardiovascular assessment involves checking signs of hypovolemia or shock
    • Preterm infants are susceptible to temperature instability due to various factors
    • CNS evaluation includes assessing for injury and monitoring neurologic signs
    • Nutritional assessment involves addressing imbalanced nutrition and the need for parenteral or gavage feedings
    • Renal assessment focuses on the immature renal system's inability to excrete waste effectively
    • Preterm infants are at an increased risk of bleeding and anemia
    • Diminished immunity in preterm infants leads to a high risk for infection
    • Nursing care for preterm infants includes physical care and environmental considerations, such as incubators, ventilatory support, and electronic monitoring
    • Respiratory Distress Syndrome (RDS) is a common complication of preterm birth, characterized by lack of surfactant, resulting in progressive atelectasis and VQ mismatch.

    Care of High-Risk Newborns: Key Points

    • Assisted ventilation for premature infants involves electronic monitoring of respiratory, cardiac, and oxygenation status
    • Surfactant replacement therapy can prevent complications such as ductus arteriosus and foramen ovale, and potential adverse effects include apnea, bradycardia, and pulmonary hemorrhage
    • Care for infants receiving assisted ventilation includes continuous monitoring of oxygen saturation, avoidance of hyper-oxygenation, and immediate attention to alarms and discomfort
    • Retinopathy of prematurity can result from elevated oxygen tension, leading to capillary hemorrhages, retinal detachment, and scar tissue formation
    • Collaborative management for retinopathy of prematurity involves early screening and detection, judicious use of supplemental oxygen, and prompt attention to saturation alarms
    • Patent ductus arteriosus (PDA) is a condition where the ductus arteriosus fails to close shortly after birth, leading to potential complications such as heart failure and hypoperfusion of the lungs
    • Prevention of PDA involves the use of NSAIDs to inhibit prostaglandins and providing oxygen to stimulate closure of the ductus
    • Hospital-acquired infections in newborns can result from bacterial transfer during delivery and underdeveloped immune systems
    • Infection prevention measures for newborns include hand hygiene, appropriate PPE, and elimination of environmental sources of infectious agents in the nursery
    • Collaborative management for infections includes conducting labs and cultures, administering prophylactic antibiotics, and providing IV fluids and thermal stability
    • Post-term newborns, born after 42 weeks of gestation, may experience perinatal mortality due to placental insufficiency and may present with meconium staining and absent vernix
    • Post-term infants are at risk of not having their increased oxygen demands met, leading to potential complications and high mortality rates

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