High-Risk Pregnancy: Risks and Factors

High-Risk Pregnancy Definition

• A pregnancy that poses a greater risk to the mother or fetus.

Risk Factors for High-Risk Pregnancy

• Existing conditions like high blood pressure, diabetes, or HIV can elevate pregnancy risk.
• A history of prior pregnancy complications.
• High Body Mass Index (BMI).
• Advanced maternal age (AMA) or being under 18.
• Multigestation pregnancies.
• Disparities in healthcare access impact pregnancy outcomes.
  • Nurses should address barriers through advocacy with organizations like AWHONN and legislators.

Illegal Substances and Pregnancy/Delivery

• The most frequently missed diagnosis involves illegal substance use due to fear of losing custody, affecting prenatal care.
• Alcohol consumption during pregnancy can result in abnormalities in brain and neuron development.
  • It is also associated with low birth weight, prematurity, fetal alcohol syndrome, and mental retardation (the #1 cause).
• Cocaine use can cause cardiac events maternal death and placental abruption.
  • It can result in PROM.
  • Fetal effects stem from the drug's vasoconstrictive and neuroexcitation properties.
• Opioid use can cause withdrawal symptoms in neonates (NAS) and stillbirth.
• Smoking or tobacco use can decrease fertility.
  • It is associated with increased risks of miscarriage and stillbirth.
  • It can also cause placenta previa, IUGR, and long-term cognitive function impairment and increased risk of brain damage.

Multigestation

• Refers to pregnancies with more than one fetus.
• Associated with a higher risk of all complications.
• There is a fivefold risk increase of stillbirth and a sevenfold risk increase of neonatal death.
• Monochorionic placentas (one chorion) pose a risk for Twin-Twin Transfusion Syndrome (TTTS)
• Dichorionic placentas involve two chorions.
• Monozygotic twins originate from one zygote that divides in the early weeks.
  • These twins are identical and of the same gender.
  • Can be dichorionic/diamniotic, monochorionic/diamniotic, or monochorionic/monoamniotic (high risk which can lead to cord entanglement).
  • 70% of twins are monochorionic/diamniotic, and 1% are mono/mono.
• Dizygotic twins come from two eggs fertilized, and can be the same or different genders.
  • Dizygotic twins are always dichorionic/diamniotic.

Maternal Complications and High-Risk Pregnancy

• HTN/Pre-E, GDM, Hemorrhage like abruptions or previa, C/S, PTL, and Cord Prolapse are high risk for Maternal Complications

Fetal Complications and High-Risk Pregnancy

• Mortality, LBW, and TTTS are high risk for Fetal Complications

Hyperemesis Gravidarum

• Uncontrolled vomiting caused by rising hormone levels (hCG, progesterone/estrogen).
• Dehydration may require medical management like IV fluids, anti-nausea medications, gut rest, and vitamin B6.
• Dextrose may be needed for vitamin correction due to ketosis (thiamine).
• Can lead to ketosis, electrolyte/acid-base imbalance, and weight loss.

Intrahepatic Cholestasis of Pregnancy

• Reversible liver disease that can be hormonally influenced.
• Characterized by generalized itching, particularly on palms and soles.
  • It caused by a defect in excreting bile salts, leading to their deposit in the skin.
  • Ursodeoxycholic acid (UDCA) can be used to treat the itching and decrease bile salts.
• Poses a risk of IUFD, PTD, and meconium aspiration.

Diabetes Types

• Type 1 involves insulin deficiency, requiring insulin management.
• Type 2 involves insulin resistance and can be managed.
• Pregestational diabetes includes either type 1 or 2.
• Gestational diabetes starts during pregnancy and is marked by glucose intolerance.

Placental Insulin Antagonists

• They help spare glucose for the fetus.
• Examples include hPL, progesterone, and hCG, somatotropin

Diagnosing Diabetes

• Diagnosing Gestational Diabetes occurs between 24 and 28 weeks.
• The first step involves a non-fasting glucose test.
  • A test is considered "failed" if glucose levels are greater than 135-140 mg/dl.
• If a second test is needed, a 3-hour fasting test is performed (considered "failed" if 2 values exceed)
  • Fasting glucose > 95 mg/dl, 1-hour glucose > 180 mg/dl, 2-hour glucose > 155 mg/dl, 3-hour glucose > 140 mg/dl.

Symptoms of Diabetes

• Polyuria (frequent urination), Polydipsia (excessive thirst), Weight loss (unintended), Polyphagia (excessive hunger), and UTI/yeast infections

Risk Factors for Developing GDM

• Fetal macrosomia, family history, obesity, physical inactivity, PCOS, and HTN.
• In 50% of cases, risk factors are not identified.

Maternal Risks for Diabetes

• Hypoglycemia, DKA, Preeclampsia, C-section, Development of diabetes after birth, Hydramnios, increased susceptibility to infection, and loss of vision

Fetal Risks related to Diabetes

• Macrosomia (birth weight greater than 90th percentile), IUGR, Hypoglycemia, Hyperbilirubinemia, Shoulder dystocia, and Respiratory distress.

Controlling GDM

• The Glycosylated hemoglobin A1C level should be less than or equal to 6%.
  • A1C levels between 5 and 6 correlate with a 2-3% increase in fetal malformation.
  • Levels near 10% is associated with a 20-25% increase in fetal anomaly.
• Blood Sugar/Glycemic control is essential (euglycemia) with diet and exercise or insulin.
• 70% of Latin American women can develop type 2 after pregnancy.

Hypertension in Pregnancy

• There can be BP trends for each trimester of pregnancy.
• Chronic Hypertension is defined as a BP above 140/90 before conception.
  • It is present or observable before 20 weeks gestation.
  • There is none or stable proteinuria,

Chronic Hypertension with Superimposed Preeclampsia

• Pregnant women with high blood pressure before 20 weeks and new or increased proteinuria.

Gestational Hypertension

• Pregnant women with high blood pressure that occurs after 20 weeks with no proteinuria present.

Pre-Eclampsia definition

• Pregnant women with high blood pressure after 20 weeks and proteinuria in urine.
• It is a hypertensive and multisystem disorder than can affect the brain, liver, kidneys, and vascular system.

Pre-Eclampsia Pathophysiology

• Spinal arteries of the uterus do not increase to promote increased perfusion to the placenta.
• Vascular remodeling does not occur, leading to decreased perfusion and hypoxia.
• There is an imbalance of vasodilator hormones (prostacyclin) and vasoconstrictor hormones (thromboxane).

Pre-Eclampsia Characteristics

• Decreased organ perfusion and vasodilation.
• Intravascular coagulation
• Increased permeability and capillary leakage.

Clinical Manifestations and Diagnosis of Pre-Eclampsia

• BP is 140/90 on twice four hours apart or 160/110 a few minutes apart.
• Proteinuria - 300 mg/24 hour urine collection or protein/creatinine =0.3. Dipstick reading of 2+ is only an option if other ways can't be followed
• In absence of proteinuria. can lead to:
  • Thrombocytopenia - platelets less than 100,000
  • Renal insufficiency - serum creatinine more than 1.1 or doubling
  • Impaired liver function - twice normal of liver transaminases
  • Pulmonary edema (from left ventricular failure) - leg swelling
  • Cerebral or visual symptoms (headache)
  • Epigastric pain

Two Stages of Pre-Eclampsia

• Placental abnormalities like poor placental perfusion
• Maternal manifestations and onset of symptoms(high BP)

Risk Factors for Pre-Eclampsia

• Nulliparity, maternal age, high BMI, multiple gestation, family history, HTN, kidney disease, SLE, and diabetes

Risks for Women with Pre-Eclampsia

• Cerebral edema, hemorrhage, or stroke, DIC, pulmonary edema, CHF, abruptio placenta, seizure (eclampsia), and HELLP syndrome.
• HELLP syndrome can lead to hemolysis, elevated liver enzymes, and low platelet count
  • It is associated with severe preeclampsia, and patients will show symptoms like nausea, vomiting, malaise, and epigastric pain.
• There is a 20% increase in mortality for women with pre-eclampsia.

Risks for fetus with Pre-Eclampsia

• IUGR, oligohydramnios, placental abruption, PTD, and fetal death.
• There is fetal intolerance to labor and stillbirth.
• Metabolic related diseases later in life - obesity, T2D, HTN

Nursing Assessments Signaling Worsening Pre-Eclampsia

• Increasing edema, scotomata, blurred vision, decreasing urinary output, epigastric pain, vomiting, bleeding gums, persistent or severe headache, neurologic hyperactivity, pulmonary edema, and cyanosis

Fetal Nursing Assessment

• Use BPP, fetal movement assessment, oligohydramnios observations, and elevated S/D ratio (+3,+4)

Treatment of Pre-Eclampsia

• Early detection and delivery is the only cure.
• Treat the symptoms by maintaining Bedrest, regular diet, monitoring BP and proteinuria, and hospitalization.
  • Avoid Nervous System stimulation and create quiet environment.
  • Therapeutic goal - keep diastolic BP between 90 and 100
  • Medications include corticosteroids (fetal lung maturity) hydralazine (anti-hypertensive), labetalol (anti-hypertensive), and oral nifedipine.

Magnesium Sulfate

• It is a CNS depressant and seizure prophylaxis that is also a smooth muscle relaxant.
  • It is safe to use for fetus.
• Toxicity symptoms include decreased reflexes (patellar) - clonus, respiratory depression (less than 14), oliguria (low urine output), shortness of breath, and hypotension.
  • The level becomes toxic when it's over 9 mg/dl
  • Antidote = calcium gluconate
• Expected Symptoms: Nausea, flushing, diaphoresis, blurred vision, lethargy, and decreased reflexes,

Eclampsia

• Eclampsia involves the occurrence of seizure or coma
  • Can be multi focal, focal or generalized.
• It involves severe manifestations of preeclampsia
• Affects cerebral vasospasm, hemorrhage, ischemia, and edema
  • Preceded by cerebral irritation (headache, blurred vision, and photophobia)

Eclampsia Care During a Seizure

• Stay with patient and call for help to notify physician.
• Provide patient safety by assessing airway and breathing
  • Lower head of bed, turn head to one side
  • Anticipate suctioning to decrease risk of aspiration, which can be the leading cause.
• Prevent maternal injury by keeping side rails up, and padded if possible
• Record time, length, and type of seizure

Eclampsia Care After Seizure

• Rapidly assess maternal and fetal status
• Assess airway - aspiration if needed
• Administer supplemental oxygen and ensure IV access
  • Administer magnesium sulfate per orders and provide a quiet environment.

HELLP Syndrome

• HELLP syndrome occurs up to 48 hours postpartum
• Characteristics include hemolysis, elevated liver enzymes, and low platelet count
• Associated with severe preeclampsia
• Symptoms include nausea, vomiting, malaise, and epigastric pain

HELLP Assessment

• Right upper quadrant pain and generalized malaise in up to 90% of cases and unexplained bruising and bleeding.
• Changes in liver function and platelets should always be monitored

HELLP Cure and Risks

• Cure: delivery only
• Risks for women: abruptio placenta, renal failure, liver hematoma and possible rupture, death
• Risks for fetus: preterm birth, death

Placenta Previa

• Placental implantation occurs in the lower uterine segment over or near the cervical os.

Placenta Previa Risks

• Endometrial scarring like previous placenta previa, prior C section, abortion involving suction curettage, multiparity or short pregnancy interval.
• Impeded endometrial vascularization such as AMA, diabetes, hypertension, smoking, cocaine, uterine anomalies.
• Infertility like those who are non-white, low socioeconomic status, short inter pregnancy interval
• Increased placental mass, large placenta, and multiple gestation.

Maternal Risks for Placenta Previa

• HEMORRHAGE
• P= painless bleeding
• R= red in color, relaxed uterus
• E episodic bleeds
• V visible
• I intercourse
• A= abnormal fetal lie

Fetal Risks for Placenta Previa

• PREMATURITY
• IUGR, decreased uteroplacental blood flow, prematurity, blood loss/hypoxia/anoxia/death/anemia related to maternal blood loss.

Placenta Previa Assessment

• Presentation begins in the third trimester
  • The first episode is usually slight
• Ultrasound confirms placental location
• Vaginal exam is contraindicated
• If there is active bleeding, make sure to secure large bore IV access. Measure intake and output. Weigh pads, CBC, oxygen, and anticipate possible emergent C section

Monitor with Placenta Previa

• Maternal signs and pulse ox, perform continuous EFM to asses for preterm labor, NST, BPP, and Amniocentesis for lung maturity
• Patient must have C/S delivery and should not contract

Placental Abruption

• Premature separation of a normally implanted placenta
  • Bleeding may be external or concealed.
  • Severity depends on degree of separation
• Mild abruption: 15% separates with concealed hemorrhage
• Moderate abruption: less than 50% separates with apparent hemorrhage
• Severe abruption: more than 50 separates with concealed hemorrhage

Placental Abruption Risk Factors

• Hypertension is the most consistent cause
• Seizures, blunt trauma, short umbilical cord, previous history of abruption, multi gestation, PROM, smoking or cocaine use.

Placental Abruption Maternal Risks

• Hemorrhage, need for transfusion, hysterectomy, DIC, renal failure, and death

Placental Abruption Fetal Risks

• LBW, PTD, asphyxia, stillbirth, and perinatal death.

Placental Abruption Assessment

• Set an onset of intense, sharp, rigid uterus abdominal/uterine pain with/without bleeding.
• Follow up with assessment of Uterine irritability, Tachysystole, Increase resting tone of uterus, Dark or port wine stain amniotic fluid, Fetal heart rate patterns - indicative of compromise, Maternal tachycardia

Placental Abruption Management

• Assess fundal height, consider abdominal girth measurements, assess for increasing pain and tenderness, measure intake and output, weigh pads, provide, continuous CFM, provide oxygen, anticipate and prepare for emergency delivery, observe for DIC, administer blood products.
• Hypovolemic shock: hypotension; oliguria; thready pulse; shallow or irregular respirations; pallor; cold, clammy skin; and anxiety
• Kleihauer–Betke test in maternal blood may be positive and indicate the presence of fetal RBC

Placenta Accreta Spectrum

• characterizations: Placenta becomes inseparable from the uterine wall
• it grows in too deeply does not affect fetus.
• It is hemorrhage post-delivery, hypovolemic shock, hysterectomy, HIGH morbidity.
• Has greatest risk factor being a previous C-section.
• Nursing Actions: Make birth plan regarding timing of birth, hysterectomy, and treatment and also want to maintain IV access

Abortion

• Spontaneous or elective termination of pregnancy before the 20th week.
• Induced abortion: procedure done to end pregnancy
• Elective abortion: termination of pregnancy at request of women, not for health reasons
• Therapeutic abortion: termination of pregnancy for serious maternal or fetal issues
• Spontaneous abortion: natural termination before week 20 for unknown reasons
  • Medication: Combination of mifepristone or misoprostol is preferred therapy
  • Surgical intervention: (suction-curettage or vacuum)
• Disproportionate care: for adolescents, people of color, rural areas, low incomes, and incarcerated people

Ectopic Pregnancy

• Fertilized egg attempts to implant somewhere besides endometrial lining.
• Most common site is in the fallopian tubes (95%)
• Can rupture and cause life-threatening bleeding and it is the leading cause of maternal death within first trimester.
• Assessment includes:
  • Pelvic or abdominal pain, abnormal vaginal bleeding, shoulder pain, weakness, dizziness, and fainting with unstable vital signs
  • Non-surgical Treatment: (if early & stable) give Methotrexate, otherwise surgical intervention

Gestational Trophoblastic Disease - Hydatidiform Mole

• Molar pregnancy.
• Characteristics are as follows: -Abnormal trophoblast growth which causes chorionic villi to form grape like cysts, nonviable pregnancy cells do not contain a fetus and can cause cancer
• Increased incidence in women with low protein intake, women over 35, asian women, and women who experience prior miscarriage or have undergone ovulation simulation (clomid)
• 20% become malignant.
• Signs and symptoms: rapid, growing uterus, vaginal bleeding, nausea, vomiting, and hypertension
• Abnormally high hCG levels no fetal heartbeat

RH Factor Complications

• RH blood group present on surface of RBCS.
• If RH is - for mother and + for baby antibody-antigen response is activated the mother is considered sensitized and antibodies are produced
• Maternal alloimmunization/isoimmunization: a woman's immune system is sensitized to foreign erythrocyte surface antigens, stimulating the production of immunoglobulin G (IgG) antibodies.
• Sensitized women: small amounts of fetal blood cross placenta leading to risk of hemolysis
• Primary intervention: indirect coomb test, monitoring pregnancy, and early birth Intrauterine transfusion of fetus + Correct anemia Exchange transfusion of newborn
• Management of RH incompatibility goals prevent sensitization, treat isoimmune disease in newborn, Rhogam prophylactically at 28 weeks
• RH - mother with negative titer and RH + fetus give 300 mcg of Rhogam IM within 72 hours of birth

ABO Incompatibilities

• Most common with mother being O- and infant having A or B.
• Check with cord blood test
• Maternal serum antibodies cross placenta which can cause hemolysis of fetal RBC, mild anemia, and hyperbilirubinemia (jaundice) and is not treated antepartal.

Herpes Simplex Virus

• 1 in 6 people between the ages of 14 and 49 infected.
  • Spontaneous abortion
  • Preterm labor
  • Intrauterine growth restriction
  • Neonatal infection
• Varied with route of birth and presence of lesions.
• C section needed if outbreak during labor occurs.
• Should test mother early in pregnancy and start Antiviral therapy after 36 weeks which includes Acyclovir, famciclovir, and valacyclovir

Group B Streptococcus (GBS)

• Lower GI and urogenital tract infected
• Fetal neonatal risks includes Unexpected intrapartum stillbirth.
• Follow Clinical therapy guidelines

Polyhydramnios

• Excessive amniotic fluid usually over 2000 ml.
• Associated with fetal GI anomalies and maternal diabetes
• Treatment: watch and do nothing unless becomes short of breath and in pain and proceed with an amniocentesis

Oligohydramnios

• Scanty amniotic fluid usually less than 500 ml.
• Etiology is otherwise unknown which poses risks for fetal adhesions and fetal malformations
• Treatment: amnioinfusion

Disseminated Intravascular Coagulation

• proteins that control clotting become overactive and blood clots excessively

Cardiac Disease

• Results in increased demand for cardiac output throughout pregnancy as demand to the heart may increase by as much as 50% which may exacerbate any underlying conditions
• Some signs that indicate cardiac decompensation include progressive/generalized edema, crackles at base of lungs, rapid, weak irregular pulse(100 bpm+), difficulty catching breath, cough, and increased fatigue
• Nursing Care for cardiac patients EKG and FHR monitoring, anticoagulants to decrease risk of thrombotic clot (Warfarin → heparin), O2 and pulse ox, pain management and decreased heart rate, antibiotics for endocarditis, optimize placental perfusion/reduce oxygen needs,operative vaginal birth common

Neonatal Assessment

• Preparing for Assessment: review record and determine what places newborn at risk
  • Risks include: inadequate prenatal care, substance use, maternal age, chronic maternal illness, how did birth go, medications, APGAR, etc.
• Gather equipment, ensure neutral thermal environment, and inform parents to watch
• General survey: Before physical assessment - best when neonate is quiet + Respiratory patterns, heart sounds, color of skin, level of alertness, muscle tone
• Posture normal: Extremities should be flexed with symmetrical movements. Deviation from normal being limp or floppy - related to prematurity, medications, birth injuries etc.
• Normal Head circumference: 32 - 36 cm. Deviation from normal: Microcephaly - below 10th %, macrocephaly - above 90th%
• Normal Chest Circumference: 30.5 33 cm or 2 - 3 cm less than head
• Normal Length: 46 to 52 cm; Deviation from normal : Below 10th examined for IUGR or prematurity
• Normal Weight: Weigh 25004000g, 5.5 to 9.0 lbs; Deviation from normal : Above 90th% - diabetic mother, below 10th% - IUGR, prematurity
• Normal Temperature: Is 97.7 - 99.0 F axillary + Deviation from normal : Hypothermia or hyperthermia
• Normal Respirations: 30 - 60 breaths/min, unlabored, no more than 15 sec pauses + Deviation from normal : apnea more than 20 sec, less than 30 medication
• Normal Pulse: Is 110-160 bpm, up to 180 when crying
• Normal Blood pressure: Is 50/30-75/45
• Normal Pulse Ox: over 95%
• Normal Head Characteristics:
  • Molding Present
  • Fontanels open, intact, soft
  • Anterior fontanel diamond shaped - closes 18 mo
  • Posterior fontanel triangle shaped - closes 2 mo - 4 mo
  • Overriding sutures
• Deviation from normal head:
  • Firm, bulging fontanels not due to crying and depressed fontanelle + Bruising or laceration + Caput succedaneum (lumps from bleeding or pressure)

Newborn Eyes

• Normal: equal and symmetrical in size, able to follow objects, edema normal, sclera is white, pupils reactive to light, red light and blink reflex present, no tears
• Deviation: unequal, pupil, reactions, blue sclera - osteogenesis imperfecta
• Normal Ears: top of pinna aligned with the eye, no deformities, responding to sounds; absent startle reflex
• Normal Nose: flattened or bruised, small amount of mucus, breathing through nose; Large amounts of drainage, flat, nasal bridge, absent startle reflex
• Normal Mouth: is lips, gums, tongue, palate, and mucous membranes are pink, moist and intact, reflexes are positive, dry lips, or Epstein's pearls; Deviation for abnormal mouth Cyanotic membranes, dry, mucous membranes, teeth, or cleft lip
• Normal Neck: Short with skin folds, positive tonic reflex; Deviation: webbing or thick skin folds, or absent reflex
• Thorax Normal: Cylindrical, Breast may be engorged with secretion. Deviation: Nasal flaring, Intercostal, substernal or xiphoid retractions, Expiratory grunting or sighing, Seesaw respirations, Tachypnea, Murmur, absence of femoral pulses, and heart defects
• Abdomen Normal: round, symmetrical
• Rectum Normal: Stool within 24 hours, anus intact
• Genitourinary (female) Normal: Labia majora covers minora and clitoris, may be edematous
• Genitourinary (male) Normal: is Testes descended, rugae present, brick dust urine normal,
  • Deviation is Hypospadias and Epispadias + Cryptorchidism + Hydrocele
• Musculoskeletal Normal: is arms and legs symmetrical, 10 fingers and toes, no clicks at joints, range of motion, equal gluteal folds, spine should feel straight Deviation: Polydactyly - syndactyly - unequal gluteal folds, or Decreased range of motion
• Integumentary:Normal: is pink, warm, mild acrocyanosis, or Milia on nose and chin; Deviation: Central cyanosis
• Neurological: Normal: Flexed position, rapid recoil of extremities, positive reflexes
• REFLEXES! The MORO or STARTLE, Tonic Neck, Rooting, Sucking, Palmar and Plantar Grasp, Babinski, and Stepping or Dancing

Gestational Age Assessment

• New Ballard Score- estimates age, predicts problems, and establishes plan of care
• Assessments are done on abnormal births for inadequate prenatal care, preterm or postterm, large or small babies, diabetic mothers or NICU babies
  • Follow Physical Maturity which includes Skin and Lanugo etc.
  • Observe Neuromuscular system which includes Posture, Square window, Arm recoil , Popliteal angle , and Scarf sign - more the elbow crosses, more preterm
• Observe for few things examples: ABC’s , baby is a RDS , baby is MAS , and the baby has SEPSIS or Glucose or Temperature instability
• Behavioral states and Periods of activity are both key
• REPORT THE DANGER SIGNS to any provider which include Tachypnea and seizures Lethargy
• Evaluate with APGAR Signs

Immediate needs of newborns at birth

• Care of newborn at delivery
• Provide warmth
• Clear airway with rapid assessment of breathing and tone
• Stimulate breathing
• Assess heart rate and provide effective ventilations/ compressions if needed

Respiratory Adaptation in Newborn

• Stimulation of breathing occurs by Mechanical, Chemical, Sensory
• Needs Surfactant for alveolar stability
• Assess Lung maturity and make sure the L/S ratio is fine

Cardiorespiratory Adaptations in Newborn

• Blood flow increases to lungs - Oxygenation occurs
• High pulmonary vascular resistance is related:
  • Oxygenation of fetus occurs in placenta
• Major physiologic changes to get Neonatal circulation
• Systemic vascular resistance increases and pulmonary pressure drops to cause Closure of fetal shunts

Cardiac Adaptations

• Foramen ovale - the opening between right atriums that closes within the first 2 hours
• Ductus arteriosus - opening between pulmonary artery and aorta that closes within the first 15 hours
• Ductus venosus - connects umbilical vein to inferior vena cava (IVC). Closes with umbilical cord clamping Hematopoietic adaptations
• Blood volume 80-90 ml/kg of body weight and Increased erythropoietin secreted in fetus
• Due to 50% saturation of fetal blood and also the Production decreases after birth also normal when Leukocytosis is a normal finding and the
• Recommendations:
  • Considerations for heat loss mechanisms, Convection - air currents, Conduction and Radiation all help babies why they lose hear
• Establish Thermal Balance with skin to skin and making sure all the items the baby is using are sterile

Cold Stress

Excessive heat loss that results in compensation methods .Can lead to

• Hypoglycemia

• Hypoxia

• Metabolic acidosis

• Decreased surfactant production

• Respiratory distress, bilirubin/jaundice, poor feeding/weight loss, apnea, neonatal death Risk Factors for cold stress related to: Prematurity, SGA, etc

• Assess what the baby is feeling with Symptoms such as Temperature below 97.7, cool skin, pale or mottled skin, acrocyanosis

• Follow the Nursing actions and care Dry neonate thoroughly immediately after birth, Remove wet blankets, Place stocking cap on head, Provide skin to skin

• Review Metabolic - blood sugar adaptations which involves neonates with Hypoglycemia

• Perform SCREENINGS for neonates by checking CDs and PKU and also Hearing

• Follow the Hepatic System Adaptations and check Liver functions

Newborns

• Newborns in General: Involve RBC is the first place you are in your life after taking your life
• Follow the Breastfeeding techniques and ways
• Prepare of Formulating food
• Follow Education with the formula, bathing, and clothes

High-Risk Infant

• Defined
  • Newborn, regardless of gestational age or birth weight, that has greater than average chance of morbidity (illness) or mortality (death) because of conditions present at birth or the stress of birth itself
• IUGR
  • Deviation and reduction in expected fetal growth pattern in which multiple adverse conditions may cause
  • Associated Fetal, Maternal, Placental factors
• Preterm Neonates:
  • Defined as Extremely to Very Premature baby
• Birth Weight can say a lot due to if its at such low weights for baby
• Risk Factors for pre term birth are very big.

Preterm Baby Medication

• Steroids to help accelerate lung growth/maturity of baby
• Monitoring cardiorespiratory status Perinatal nutrition -ERO (Red Blood Cell) to decrease.
• Also follow Respiratory Distress syndrome in preterm infants and Thermoregulation in preterm infants is something important GI issues in preterm infants - Neurological issues in preterm infants
• Look up to if baby become a case of Post Term Neonates which will follow Hypoglycemia because of low sugar.
• Assess if baby has Jaundice and check Intervention, and Levels