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?

Post term: macrosomia Signup and view all the answers

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

Mechanical obstruction and chemical pneumonitis Signup and view all the answers

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

Pulmonary hypertension and R-to-L shunting Signup and view all the answers

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

Macrosomia Signup and view all the answers

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

Intrauterine growth restriction (IUGR) Signup and view all the answers

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

Prompt recognition and aggressive intervention Signup and view all the answers

What is a characteristic of parental support for neonates?

Encouraging frequent visits and involvement Signup and view all the answers

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

ECMO Signup and view all the answers

What distinguishes pediatric pneumonia in infants from adults?

Acute abdominal pain Signup and view all the answers

What is a characteristic of Bronchopulmonary Dysplasia (BPD)?

Affecting newborns and premature infants Signup and view all the answers

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

Extended parental support Signup and view all the answers

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

Hindrances in the transition from fetal to neonatal blood flow Signup and view all the answers

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

Surfactant administration Signup and view all the answers

What factors influence intrauterine growth and birth weight?

Heredity, placental insufficiency, and maternal disease Signup and view all the answers

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

Respiratory Distress Syndrome (RDS) Signup and view all the answers

What does the cardiovascular assessment of preterm infants involve?

Checking signs of hypovolemia or shock Signup and view all the answers

What are preterm newborns susceptible to due to various factors?

Temperature instability Signup and view all the answers

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

Preterm birth Signup and view all the answers

What does the CNS evaluation of preterm infants include?

Assessing for injury and monitoring neurologic signs Signup and view all the answers

What does the renal assessment of preterm infants focus on?

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

What is a common nutritional issue for preterm infants?

Imbalanced nutrition and the need for parenteral or gavage feedings Signup and view all the answers

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

Bleeding and anemia Signup and view all the answers

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

Incubators, ventilatory support, and electronic monitoring Signup and view all the answers

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

Lack of surfactant 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?

Renal insufficiency Signup and view all the answers

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

Continuous monitoring of oxygen saturation Signup and view all the answers

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

Heart failure Signup and view all the answers

What is a crucial measure for infection prevention in newborns?

Hand hygiene Signup and view all the answers

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

Retinopathy of prematurity Signup and view all the answers

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

Early screening and detection Signup and view all the answers

What can lead to hospital-acquired infections in newborns?

Bacterial transfer during delivery Signup and view all the answers

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

The use of NSAIDs to inhibit prostaglandins Signup and view all the answers

What is a key characteristic of post-term newborns?

Born after 42 weeks of gestation Signup and view all the answers

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

Potential complications and high mortality rates Signup and view all the answers

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

Prompt attention to saturation alarms Signup and view all the answers

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

Apnea Signup and view all the answers

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

Elimination of environmental sources of infectious agents in the nursery Signup and view all the answers

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

Inadequate prenatal care Signup and view all the answers

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

Smoking more than 10 cigarettes a day Signup and view all the answers

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

Poor nutrition Signup and view all the answers

Which factor is considered a biophysical risk for preterm birth?

Uterine anomalies or fibroids Signup and view all the answers

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

Chronic hypertension Signup and view all the answers

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

Preeclampsia Signup and view all the answers

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

Age < 15 years or > 35 years Signup and view all the answers

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

Low socioeconomic status Signup and view all the answers

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

Less than high school education Signup and view all the answers

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

Gestational age Signup and view all the answers

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

Mechanical ventilation Signup and view all the answers

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

Initial tachycardia then bradycardia Signup and view all the answers

What is a normal temperature range for preterm infants?

36.8-37.2°C Signup and view all the answers

Why are preterm infants susceptible to temperature instability?

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

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

Monitoring for residuals during gavage feedings Signup and view all the answers

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

Immature and unable to excrete waste effectively Signup and view all the answers

Why are preterm infants at an increased risk of bleeding?

Immature hematological system and decreased RBC production Signup and view all the answers

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

Diminished immunity Signup and view all the answers

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

Increased risk of apnea and acidosis Signup and view all the answers

Why are preterm infants prone to imbalanced nutrition?

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

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

Tone, symmetry and quality of movements, reflexes, and cranial nerves Signup and view all the answers

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

Incubator or radiant warmer to control temperature Signup and view all the answers

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

Electronic monitoring of respiratory, cardiac, and oxygenation status Signup and view all the answers

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

Parenteral fluids, parenteral nutrition, parenteral meds Signup and view all the answers

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

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

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

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

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

Decreased tracheal cartilage and immature and fragile pulmonary vasculature Signup and view all the answers

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

Nasal flaring, grunting, and tachypnea (> 60 breaths/min) Signup and view all the answers

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

Respiratory Distress Syndrome (RDS) Signup and view all the answers

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

To help with lung development of the baby Signup and view all the answers

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

Apnea (abnormal) Signup and view all the answers

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

Compromised oxygenation Signup and view all the answers

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

Increased risk of infection Signup and view all the answers

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

Premature retinopathy Signup and view all the answers

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

Proper hand hygiene 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?

Surfactant replacement therapy Signup and view all the answers

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

Premature retinopathy Signup and view all the answers

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

Elevated O2 tension and subsequent vasoconstriction Signup and view all the answers

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

Using supplemental O2 judiciously and monitoring O2 levels carefully 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?

Circumferential cryotherapy and laser photocoagulation Signup and view all the answers

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

It provides oxygen and prostaglandins to facilitate closure Signup and view all the answers

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

Decreased oxygen supply or increased sensitivity to prostaglandins Signup and view all the answers

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

Inhibit prostaglandins to prevent PDA Signup and view all the answers

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

Decreases due to vasoconstriction Signup and view all the answers

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

Causes heart overload, failure, and worsens respiratory failure Signup and view all the answers

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

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

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

O2 increases and prostaglandins decrease to facilitate closure Signup and view all the answers

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

May contribute to the development of PDA Signup and view all the answers

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

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

What is the pathophysiological mechanism of PV-IVH?

Venous congestion leading to periventricular hemorrhagic necrosis Signup and view all the answers

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

Communicating hydrocephalus Signup and view all the answers

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

Hypotonia, apnea, and altered level of consciousness Signup and view all the answers

What is a potential sign of Catastrophic Deterioration in newborns?

Seizures Signup and view all the answers

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

Preserve brain cells Signup and view all the answers

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

Impaired coagulation process Signup and view all the answers

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

Noise reduction Signup and view all the answers

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

Increased intracranial pressure Signup and view all the answers

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

Tone and symmetry 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?

Avoid rapid infusion of fluids Signup and view all the answers

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

Impaired pulmonary gas exchange Signup and view all the answers

What is a common symptom of necrotizing enterocolitis in newborns?

Absent bowel sounds and distension Signup and view all the answers

Which diagnostic tests are commonly used to assess necrotizing enterocolitis?

Blood cultures and CT scan Signup and view all the answers

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

Stop all feeds immediately, start on IV fluid Signup and view all the answers

What is the pathophysiological mechanism of necrotizing enterocolitis?

Bacterial colonization leading to ischemic necrosis of intestinal mucosa Signup and view all the answers

What is a potential complication of necrotizing enterocolitis in newborns?

Short gut syndrome Signup and view all the answers

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

Imbalanced nutrition due to gastrointestinal immaturity Signup and view all the answers

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

Identifying the cause through CT and laboratory tests Signup and view all the answers

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

Unstable temperatures and altered vitals Signup and view all the answers

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

Hand hygiene and appropriate use of PPE Signup and view all the answers

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

During delivery Signup and view all the answers

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

Performing labs, cultures, and administering antibiotics Signup and view all the answers

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

Environmental sources of infectious agents Signup and view all the answers

What is a potential consequence of post maturity in newborns?

Meconium staining of fingernails Signup and view all the answers

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

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

What is a common characteristic of post-term newborns?

Placental insufficiency Signup and view all the answers

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

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

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

Surfactant administration to minimize risks Signup and view all the answers

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

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

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

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

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

Meconium staining of the amniotic fluid Signup and view all the answers

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

Mechanical obstruction leading to MAS Signup and view all the answers

What is a potential consequence of meconium aspiration?

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

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

Surfactant administration Signup and view all the answers

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

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

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

Persistent Pulmonary Hypertension of Newborn (PPHN) Signup and view all the answers

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

Placenta → IVC → RA → foramen ovale → LA → LV Signup and view all the answers

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

Extracorporeal Membrane Oxygenation (ECMO) Signup and view all the answers

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

Increased hypoxia and pulmonary vasoconstriction Signup and view all the answers

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

Limited development of high airway pressure Signup and view all the answers

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

Improving survival in some infants for impaired ventilation Signup and view all the answers

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

Maturation of pulmonary circulation Signup and view all the answers

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

Risk of meconium aspiration Signup and view all the answers

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

Polycythemia 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?

Transient tachypnea of newborns Signup and view all the answers

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

Hypoglycemia Signup and view all the answers

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

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

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

Visiting the NICU often, naming the infant, and bringing personal items Signup and view all the answers

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

Consistent and frequent information and assessment of their understanding Signup and view all the answers

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

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

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

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

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

Encourage parents to bring other siblings to visit the preterm infant Signup and view all the answers

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

Consistent and frequent information regarding the infant's condition Signup and view all the answers

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

Reinforce parent involvement and praise care endeavors 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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