NCM 109 - UNIT 3: The Newborn at Risk Quiz

Ophthalmia Neonatorum

• Eye infection occurring at birth or during the first month of life
• Most common causative agents: Neisseria gonorrhoeae and Chlamydia trachomatis
• These agents are contracted through vaginal secretions
• N. gonorrhoeae causes a more serious form, leading to corneal ulceration and destruction if left untreated
• Resulting in opacity of the cornea and severe vision impairment
• Prophylactic instillation of erythromycin ointment into the eyes of newborns prevents both gonococcal and chlamydial conjunctivitis

Therapeutic Management

• Treatment depends on the organism cultured from the exudate
• If gonococci, erythromycin is used
• Sterile saline solution lavage is used to clear discharge from the eyes
• Ophthalmic solution is used to treat the mother of the infant if she has gonorrhea or chlamydia
• Sexual contacts of the mother should be treated to prevent the spread of disease
• With early diagnosis and treatment, prognosis for normal eyesight is good

Post-term Infant

• Born after the 41st week of pregnancy
• Infants who stay in utero past week 41 are at special risk due to placenta dysfunction
• Characteristics: dry, cracked skin, absence of vernix, meconium staining, and fingernails that have grown beyond the fingertips
• Demonstrate alertness like a 2-week-old baby
• May have difficulty establishing respiration if meconium stained
• Polycythemia may develop due to decreased oxygenation in the final weeks
• Hypoglycemia may develop due to low subcutaneous fat levels
• Prone to hypothermia

Preterm Infant

• Born before the end of week 37 of gestation
• Occurs in approximately 11% of live births worldwide
• At least 50% of neonatal deaths are preterm
• Most preterm births need intensive care
• Prone to hypoglycemia, intracranial hemorrhage, and respiratory distress syndrome
• Late preterm: born between 34 and 37 weeks
• Early preterm: born between 24 and 34 weeks

Neonatal Assessment

• Inspection for sole creases
• Skull firmness
• Ear cartilage
• Neurologic development
• LMP of the mother

Contrast between Small for Gestational Age and Preterm Infants

• Common factors associated with preterm birth: low socioeconomic level, poor nutritional status, smoking, and alcohol use
• Multiple pregnancy, lack of prenatal care, previous early birth, race, and age of mother
• Abnormalities of the mother's reproductive system, infections, and pregnancy complications
• Iatrogenic issues: early induction of labor and elective caesarian section

ABO Incompatibility

• In most instances, the maternal blood is O and the fetal blood type is either A or B
• Hemolysis can become a problem with a first pregnancy
• Assessment: indirect Coombs test, detecting antibodies on the fetal erythrocytes in cord blood
• Enlargement of the liver and spleen, edema, severe anemia leading to heart failure, and hydrops fetalis
• Progressive jaundice usually occurring within the first 24 hours of life

Therapeutic Management of ABO Incompatibility

• Early breastfeeding
• Phototherapy
• Exchange transfusion
• Blood transfusion
• Erythropoietin therapy

Twin to Twin Transfusion

• Phenomenon that occurs if twins are monozygotic and abnormal arteriovenous shunts occur
• Directing more blood to one twin than the other

Sudden Infant Death Syndrome (SIDS)

• Sudden unexplained death in infancy
• Tends to occur at a higher rate in infants of adolescent mothers, infants of closely spaced pregnancies, and underweight and preterm infants
• Contributing factors: sleeping prone, viral respiratory or botulism infection, exposure to secondary smoke, pulmonary edema, brainstem abnormalities, and neurotransmitter deficiencies
• Autopsy reveals: petechiae in the lungs and mild inflammation and congestion in the respiratory tract
• Recommendations: put newborn to sleep on their back, use firm sleep surface, breastfeeding, room sharing without bed sharing, routine immunization, using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs.