High-Risk Newborns & Care

High-Risk Newborns

• High-risk newborns have a greater chance of morbidity or mortality

• The risk is due to conditions beyond birth and extrauterine life adjustments

• Screening during pregnancy is essential to identify at-risk newborns

• Basic nursing actions for high-risk newborns:

  • Detect early
  • Keep newborns warm
  • Provide immediate supportive care
  • Report/refer promptly

• Maintaining dryness is crucial in newborns to prevent hypothermia

• Newborns need to burn energy to produce body heat

• Glycogen is stored energy

• Glucagon is the hormone produced by the liver that converts glycogen into glucose

• Brown fat is an another energy source

• Avoid exposing the baby to cold stress, preserve these energy sources

Danger Signs of Newborn Distress

• Difficult respirations or tachypnea is dangerous

• Difficulty breathing means not feeding the baby due to risk of aspiration

• Normal respiration: 30-60

• Lethargy and failure to suck means don't feed the baby

• Cyanosis means lack of oxygen

• Excessive mucus/drooling may mean Tracheoesophageal fistula

• Don't feed the baby if the upper issue is suspected

• Sac or dimpling at the lower back may suggest spina bifida

• Absent or sluggish Moro reflex mean neurologic impairment (brain damage)

• Moro reflex is being startled suddenly

• Bile-stained vomitus is not normal, and may indicate a blockage

• Ganglion cells stimulate peristalsis

• Bile stained vomit may indicate

• Jaundice and icteric sclera in the 1st 24 hours not normal

• Meconium staining of skin and nails suggest fetal distress

• Not passing meconium in 1-2 days with abdominal distention is not normal

• Imperforate anus (no anal opening) is not normal

• Check the rectal temp at birth isn't best way, check passageway of stool in 1st 24 hours is best way

Classification of High-Risk Newborns

• Low birth weight (LBW): less than 2500 g (5.5 lbs)
• Very low birth weight (VLBW): between 1,000-1,500 g (3.3 lbs)
• Extremely low birth weight (ELBW): between 500-1000 g (2.2 lbs)
• Appropriate for gestational age (AGA): between the 10th and 90th percentile (2,500 to 4,000g or 5.5 - 8.75 lbs)
• Small for date (SFD) or small for gestational age (SGA): Below the 10th percentile
• Intrauterine growth restriction (IUGR): Fail to grow at the expected rate at the utero
• Large for gestational age (LGA): Above the 90th percentile (4kg and above)
• Preterm (premature): Completion of the 37 weeks gestation
• Full-term: Beginning of 38 weeks and the completion of 42 weeks
• Post term (postmature): After 42 weeks of gestation
• Late-preterm: Between 34 weeks and 36 weeks of gestation

Definitions Related to Newborn Mortality

• Live birth: Manifests any heartbeat, breaths or voluntary movement
• Fetal death: Death of the fetus after 20 weeks of gestation and before delivery
• Neonatal death: Occurs during the first 27 days of life
  • Early neonatal death: During the first week
  • Late neonatal death: Between 7th and 27th days
• Perinatal mortality: Total number of fetal and early neonatal deaths per 1000 live births
• Postnatal death: Occurs at 28 days to 1 year after birth

Initial Newborn Assessment

• Initial APGAR scoring should performed

• Cardiovascular assessment (heart rate, rhythm, sounds, infant color, blood pressure, peripheral pulses)

• Thorough, systematic physical assessment should preformed

• General assessment (weight, length, circumferences, body shape size, body posture, ease of breathing, presence or location of edema, anomalies and distress)

• Respiratory (shape of chest, signs of resp distress, respi rate, the regularity of their breathing, auscultate for breath sounds and saturation)

• : Gastrointestinal assessment (abdominal distention, character and amount of residuals, stools, auscultate for bowel sounds)

• Genitourinary: Check genitalia, urinary output Skin: Discoloration, redness, irritation, blister and texture

• Nuero Musculoskeletal: Movements, level of activity, positions and reflexes. : The skin should also be assessed in addition of temurature.

Newborn Head Injuries

• Head is the biggest part that's commonly injured at birth
• Caput Succedaneum
  • Edema of the scalp
  • Cone head appearance
  • Cause: pushing when the cervix is not yet fully dilated
  • Charasteristics: Bilateral and self-resolving in 3-5 days.
  • Crosses suture lines
• Cephalhematoma
  • Blood clot between the periosteum and the frontal bones of the skull
  • Cause: pressure from bony pelvis or blades of forceps
  • Characteristics: Unilateral, self-resolving in 1-2 weeks
  • Does not cross suture line
• Intracranial Hemorrhage
  • Cause: Forceps delivery (masyadong madiin), precipitate labor, premature birth
  • Sign: Irregularrespirations.
    • High pitched shrill dry
    • Tense, bulging anterior fontanel (it will close 12-18 mos. and then posterior fontanel 2-3 months) increase BP, headache
    • Projectile vomiting (malakas)
    • Lethargy
    • Tremors -Absent moro reflex – best index of CNS integrity (brain damage)
  • Nursing care:
    • Avoid Trendelenburg position, instead elevate head of bed (tataas ung intracranial pressure)

Nerve Injuries

• Facial nerve injury (Bells Palsy) 7th cranial nerve injury -Cause: Unknown. Maybe Viral or autoimmune, Forceps del. -Signs: Complete paralysis of one side of the face. -Loss of expression of the affected side -Inability to close eyelids - Forceps mark on the face
  • Nursing care: -Early detection Administer drugs – corticosteroid to decrease edema and analgesic -Care of the affected eye – artificial tears, eye patch during sleep -Complete recovery in 3-5 weeks in most cases.
• Brachial nerve paralysis/ upper arm paralysis. ERB Duchenne Paralysis -Most common neurologic injury in newborns -Causes:LGA – difficulty in rotating and delivering the shoulders = injury to the brachial plexus (Plexus – terminal ng pain impulses)
• Cephalopelvic disproportion
• Cephalopelvic disproportion
• Forceps delivery injury
• Vacuum extraction injury
• Head-first delivery
• Head-first delivery Signs: •Decreasemuscle tone on the affected side (stimulate grasp reflex) •Negative arm recoil (Waiter’s sign} hindi bumabalik ung kamay, parang may bitbit parin na tray Decrease muscle tone •Asymmetry in arm movement (isa lang gumagalaw) •Incomplete tonic neck reflex (if the head is right, the right hand is extended, and left is flex. If the head is left, then the left hand is extended, and right hand is flex.) In supine position, one arm is extended
• Prognosis: resolves in 2 weeks -Nursing care:
• Place arm then at leg pillow
• Provide arms support when holding • Arm exercises (range of motion) Educate parent on arm support and exercises

Resuscitation and Management

• Most deaths post birth occur due to failures in respiration

• Promptness is important to prevent residual neurological morbidities as a result of cerebral hypoxia

• Respiratory acidosis from birth is rapidly corrected by the spontaneous onset of respirations

• Immediate actions: airway, lung expansion, drug therapy, ventilation maintenance

• Respiratory assistance, chest compressions, temperature control via radiant heat sources, incubators, and skin to skin

• Intake and Nourishment

• Intravenous fluids to prevent sucking exhuastion or help necrotizing enterocolitis

• Preterm, Breast milk for the immune protection Establishment of Waste Elimination Carefully document any voidings that occur during resuscitation because this is proof that hypotension is improving, and the kidneys are being perfused.

• Infants who are in severe asphyxia Preterm infants should be fed breast milk if at all possible, because of the immune protection this offers.

Prevention of infection

-Infection, like chilling, has the detrimental effect of increasing metabolic oxygen demands as well as stressing an immature immune system, thus lowering defense mechanism protection. -Personnel with infections avoid contact with the new born.

Care of the parents

• It is helpful if all women who are diagnosed as having a highrisk pregnancy are offered a tour of a neonatal intensive care unit (NICU) during pregnancy
• Viewing the baby can help reassure them the baby was a perfect newborn in every other way except lung function or whatever the infant's specific fatal disorder.

Development care

High-risk newborns need special care to ensure the amount of pain they experience during procedures is limited to the least amount possible and that they also receive adequate stimulation for growth.

Small for Gestational Age Infant

• Birth weight is below the 10th percentile on an intrauterine growth curve for that age.
• May be born preterm, term or post term ###Small Liver Symptoms Below average weight,length,and head circumference Small Liver Poor skin Turgor Large head with small body Widely separated skull suture
• Dull and Lusterless her
• Sunken Abdomen
• Umbilical cord may appear dry and yellow-stained
• Better developed Neurologic responses
• Sole creases and ear cartridges

Large for Gestational Age Infant

 Also termed as macrocosmia

• Birth weight is above the 9 the percentile on an interuterine growth chart for that gestational

Assessment for LGA

-Appears heathy at birth but a Gestional examination reveals immature development.

• Extensive bruising and birth injury (vaginal birth) Cardiovascular Dystfunction

• Assess Eyes for Evidence of unresponsive pupils

• Vomiting bulging fontanelles and high pitched suggestive. Increased Inter Cranial pressure

Premature/Preterm Infant

• Born after 20 weeks and before 37 week

Etiology Common Factos associated with prematurity

• Low Scioeconomic leval Poor Nutritional status Lack of prenatal Care Multiple Pregnancy Previous Early birth
• Cigarette smokin Closely spaced

Assessment

• Immature ear cartilage fell foward Physical oppearrance; Head;dis proportionatly large

Respiratory System

Poorly developed longs an respuratory muscle Decreased surge ctant

Poor thermal control Hypothalmus ten regulating center of the body

Immune System

Developed

Potential

Animia pre maturity Periventricular Nagka karon ng bleeding into tissues

Maintain respirtation atless then 60mins

Retrolental fibroplaisa Neonatalsepsi

Hyperbilivremia Nutrtional problems

Care of Mother and Child at risk

• Maintain hight Vit C

Q.6 for support patient support Enchurize verbalazation or concerns and safety

Post Mature/ Post term infant

    After more than 42 Weeks

• problems because of ageing placenta At birth is that like to have difficulty establishing , especiallys

Post Mature Managment

• Same with Preterm more delgado under developed. Also Known has Hydro membrane.

Assess

Assessment findings: Drh almost leather like skin

J.A.K.E.

Respiratory Distress Syndrome

Serious cause by immaturity inability to produce Naka kamatay

What oxygen level is the baby?

Assessment ARDS

Atelestasis copsove para san balloon buboses and a ruption Biglang pupotok surfrant para hinding meg rupture

Assesment Major Sighns

• Tuchypnoa or namal

• Flexing

• chest

• pneo Apnea Cyanosis Respirotations

• Diagnostic test

• Lessurfangant copsovo

Reperotary severity Score

• Grade high

Nursing Intervations .Q Suctioning

• Oxygen support J.A. K.

Me onium

Theespeating and and then hewborn trencher and a time of birth

• Fetal distress increase intestinalis perstaticis relaxic Forus on precious

Management

• Succoning oxygen
• Seals Bacteria Intection the blow stream baby 1 Early one that septus

Lab Result

Lacks of or that the red blood

Hyperbiliremia

S&S OF Hy

Refessity of abnormal blood JAKE