High-Risk Newborns: Nursing Care

Nursing Care of a Family With a High-Risk Newborn

• High-risk newborns have various medical conditions that require a high level of care, and understanding these conditions is critical
• Key terms covered are apnea, apparent life-threatening event, gestational age classifications (AGA, LGA, SGA), and various newborn illnesses and treatments

Key Objectives

• Define terms like small-for-gestational-age (SGA), term, large-for-gestational-age (LGA), preterm, and postterm infants
• Describe common illnesses in high-risk newborns
• Identify National Health Goals related to high-risk newborns
• Instrumental in helping achieve these national objectives
• Analyze the crisis faced by families with newborns experiencing alterations in development or illness
• Provide family-centered care
• Assess high-risk newborns, to determine when safe transition to extrauterine life occurs
• Formulate nursing diagnoses related to the care of high-risk infants
• Identify expected outcomes for both the newborn and the family
• Plan nursing care addressing priorities to stabilize the newborn's body systems
• Implement nursing care, including monitoring body temperature
• Evaluate outcomes for effectiveness of care
• Identify areas needing further research for evidence-based practice
• Integrate knowledge of high-risk newborn needs with the nursing process for quality care

Scenario: The Atkins Family

• Mr. & Mrs. Atkins have a 34-week gestation, 2-lb baby boy who had breathing difficulties at birth
• The healthcare team resuscitated and transported him to the intensive care nursery
• The mother has not visited the nursery and hasn't named the baby, expressing fear of the baby's death
• The father was upset about the baby’s birth and seemingly blames the mother
• This chapter focuses on recognizing and caring for newborns with illnesses or variations in gestational age/weight, emphasizing protecting their present and future health

Identifying High-Risk Newborns

• Screening pregnant women can identify risk factors for newborn illnesses
• Maternal age, diseases (diabetes, HIV), pregnancy complications (placenta previa), unhealthy lifestyle (drug abuse)
• Any infant born dysmature (before term, postterm, or inappropriate weight for gestational age) is at risk
• Thorough parent education is crucial because of potential need for rehospitalization or follow-up
• National Health Goals specifically address preterm birth because of the associated complications
• Reducing low birth weight (LBW)/very low birth weight (VLBW) incidence, increasing VLBW infant care in specialized centers, reducing fetal/infant deaths & SIDS
• Nurses can reduce preterm birth by teaching women about preterm labor symptoms
• Planning for resuscitation and developmental care are also key interventions
• More research is needed to improve infant positioning, prevent intraventricular hemorrhage, and enhance parent-infant interaction in neonatal units

Nursing Process Overview for the High-Risk Newborn

• All newborns are assessed at birth for congenital anomalies and gestational age
• This assessment is done by the nurse to guard against heat loss.
• High-risk infant assessment includes cardiac, apnea, and blood pressure monitoring
• Observation is still critical along with comments from the team
• Nursing diagnoses should focus on nine priority areas
• Ineffective airway clearance, ineffective cardiovascular tissue perfusion, risk for deficient fluid volume, ineffective thermoregulation, risk for imbalanced nutrition, risk for infection, risk for impaired parenting, deficient diversional activity etc
• Outcome identification/planning must consider the newborn's potential and be individualized

Continued Care Considerations

• Care should consider developmental and physiological needs
• Consistent caregivers help conserve the baby’s energy and provide a thermoneutral environment
• Minimizing painful procedures will ensure comfort and balance
• Involving parents in care, such as bathing or feeding, helps personalize the child and start the bonding progression
• Long-term follow-up is essential for identifying and addressing lasting problems from birth status, like subtle neurological injury
• Expected outcomes: patent airway, tolerating procedures, appropriate growth/development, stable body temperature
• Parental involvement (visits/calls) and positive coping are essential

Newborn Priorities in the First Days of Life

• Eight priority needs for all newborns in the first few days:
• Initiate & maintain respiration
• Establish extrauterine circulation
• Control body temperature
• Adequate nourishment
• Waste elimination
• Prevent infection
• Develop infant-parent relationship
• Provide appropriate stimulation for best development
• These needs are the priority for high-risk newborns, but are difficult to fulfill because of immaturity/illness
• A failure to transition from intrauterine life may be seen during labor, at birth, or during assessment for Apgar scores

Initiating and Maintaining Respirations

• The prognosis relies on how the first moments of life are handled
• Deaths in the first 48 hours come from an inability to breathe
• Infants who survive poor respiratory effort may experience neurological difficulties because of hypoxia
• Most infants are born with respiratory acidosis
• Rapidly corrected after breathing, however
• If breathing doesn't begin, acidosis will increase along with pH and bicarbonate buffer system failure
• Defense mechanisms are too small of a change to reverse, and intervention must begin immediately
• Infants who experience asphyxia should already be experiencing acidosis when born
• Predisposing factors to respiratory difficulties are: low birth rate, mother disease (diabetes) etc

Resuscitation Procedures

• Follows an organized process: (a) establish/maintain airway, (b) expand lungs, (c) initiate/maintain effective ventilation
• Resuscitation should also include cardiac massage
• For a well-term newborn, bulb syringe suction is adequate to help establish a clear airway
• If a newborn does not draw a first breath spontaneously, suction the mouth/nose using a bulb syringe and rub back

Severe intervention

• IF amniotic fluid stained, do not stimulate until trachea is suctioned
• Catheter is passed over tongue while placing padding to raise shoulders for neutral position
• If still not breathing use immediate laryngoscopy to open tube
• Can use positive pressure bag with 100% oxygen to assist at 40-60 Breaths
• A halted period of respirations = primary apnea
• Gasping respirations however the baby cannot maintain this effort = Secondary Apnea
• Because it is difficult to distinguish between the two periods, use intervention at all times

Intubation

• Should be performed by trained/skilled professional
• Wide variation of size of infants so knowledge/profession help is needed
• Sizes depend on baby birth level
• Gentle Care is Crucial to preterm babies

Drug Interactions

• Naloxone: pure narcotic antagonist / Pregnancy risk category: B
• Nursing implications, depth / character and be ready for more dose if needed
• Assess the respirator status while making sure the patent Airway is clear

Ventilation Maintenance

• The focus of ventilation is to allow changes to the cardiovascular level
• Careful observation must be done to be sure the respiration is maintained
• Tachypnea can be the first sign of obstruction then you undress the babies chest wall
• Position the mattress 15 Degrees and make sure to suction to remove obstruction
• Provide transcutaneous ( oxygen and pulse)
• If no heart sounds is heard use closed chest massage
• Continue use to maintain transcutaneous oxygen
• Hypoclycemia happens because the baby has expended too much energy
• Rate of of fluid must be constantly monitored for high fluid intake
• Dehydration, is too less then you want more fluid
• Monitor babies weight, make sure to use neutral thermal and not to cold
• Too cold call for increased levels of oxygen , however w/o oxygen hypoxia can save oxygen for important process
• In Anaerobic glycolysis, the supply will pour into the stream making an unfertile process

Hypothermia Interventions

• Wipe and dry the baby
• Cover babies head with a cap
• Place under a pre warmed radiant warmer + Incubator
• radiant heaters work better to heat source

Additional Aspects of Newborn Care

• Monitor radiant to maintain the babies temperature
• After use the correct incubator until ready to do with out.
• Ensure skin to skin/ kangaroos care is maintained so that baby makes strides to complete.

Nutrition and Digestion

• Babies under asphixia get intravenous fluids
• check and get rid of necrotizing from too much oxygen in bowel
• 37 weeks can start to feed by gavage / check if okay
• Feed pre term babies where immunity offers the best
• Make sure stored and named for babies correctly when supplied with information
• signs to check for is motion ,hunger, fatigue
• reveal hunger by same signs as term also non nutritive, may help develop the sucking

Waste Elimination

• May be delayed because of blood pressure might now be adequate
• Immature, stool later because meconium not reached the end

Avoiding Infection

• By limiting , infection will greatly limit development , especially during first days.
• Be extra cautious to not transmit infections from other patients

Parent Bonding

• Check the babies so that bond between them and guardians remain open

Devolpmental Needs

To keep the pain from being as great as people want keep high light of development and provide all possible comfort to family

Altered Gestational Age and Birth Weight Categorization

• Infants are evaluated soon after birth for weight and gestational age, which helps determine immediate healthcare needs due to growth charts/gestational timing

• Term infants

  • Born from the beginning of week 38 to the end of week 42

• Preterm Infants

  • Borne before the 37th week of pregnancy, regardless of birth weight

Classifications Based on Weight/Gestational Age

Appropriate for Gestational Age (AGA) If between 10th 90th Small for Gestational age (SGA) If Below the 88th percentile Large for Gestational age (LGA) Above the 90th Low For weight (LBW) Under 2500 All infants of these classes require different help to meet the ever changing term. Each category carries a set of factors

Small for Gestation Age (SGA) Infant

• birth weights below 10th percentile for age
• may be bored with Pterham or term
• Experiencing Interuterine growth restriction
  • small due to nutrition and lack of access due to poor access for mothers.
• Placental Abnormality/ damage
  • prevent proper nutrinets
• Infections from mothers can cut short access and supply

Assessing SGA Infants

• when fundal height does not correctly alighn
• Ultrasound
  • low size Biophysical examination from test Poor placential function can happen / birth method in case Appearance. Avarage low weight /length/ head . skull May have poor skin turgor and large heads that looks small/ dull losterless hair . Dry umbilical

Laboratory findings

• high bloodstudies level at birth
• hypoglycemic : must be kept glucose fed and sustained with sugar.

LGA Infanct

• High 90th, Deceptively healthy with bad gesture age
• May have developed Immature

###Eitology

Infants with LGA have gone through with an overproduction of growth in eutero . Diabetes and obesity of the the mother can lead to complications by

Acessment Unusually size found at an eutero dating Non-Stresstest Immaturity due to reflexives Bruising injuries from clavicle or Erb-Duchenne Can have cardiovascular dysfunction

Hyperbiliruinema results from too many cells being used Check heat rate To maintain hypoglycemia : more care is needed

Nursing Diagnosis of SGA Infants

• Ineffective breathing: Maintain Respiratory at rate
• Ineffiective Thermo regularaton: Lack sub. Fat means control the temp in neutral zone
• Risk of Parentinh: To understand Childs need Because they require Adequate stimulation

Premature Infants

• Accounted for 80-90 mortality of the first year
• can be cut down only corrected and prevented .
• Lga characteristics- Weight , lung capacity , strong ossibility.
• Assessment- detailed history may show something.
• B. Hemolytic, Group B Streptococcal Infection* The major cause of infection in newborns
• Beterial is natural
• Is in uterus

B.hemolytic

• If coloned the respitaton rate and lungs can be found. If the infection is high check glucosee and keep the body at bay. High levels

This can help. Make sure their is an open line , monitor B This can also be seen if one of you sides was seen to get it.

• Always keep one and a all ready, to stop Sids of of your baby and keep her in a good environment
• Always take note

These can be made out to do damage and harm with it. You must do your all to keep it from becoming an issue , do everything to make sure that you and your child, stay safe and secure from the first few