Postpartum Nursing Care ELO D: Congenital Malformations and Perinatal Injury
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Questions and Answers

What is the primary cause of neural tube defects?

  • Infection during pregnancy
  • Improper formation of cranial sutures
  • Excessive cerebrospinal fluid production
  • Failure of the neural tube closure (correct)

    • How is noncommunicating hydrocephalus characterized?

  • Congenital malformations of the brain
  • Increased production of CSF
  • Obstruction of CSF flow from the ventricles (correct)
  • Inadequate reabsorption of CSF

    • Which symptom is NOT typically associated with hydrocephalus in infants?

  • Enlargement of the head
  • Fused cranial sutures (correct)
  • Shrill and high-pitched cry
  • Poor muscle tone of the extremities

    • What is the classic sign of hydrocephalus in infants?

    <p>Bulging fontanelles</p> Signup and view all the answers

    What does transillumination help diagnose?

    <p>Fluid accumulation in organ cavities</p> Signup and view all the answers

    What is the primary purpose of surgical closure in the treatment of spina bifida?

    <p>To prevent infection and for cosmetic purposes</p> Signup and view all the answers

    Which of the following is a key objective in the nursing care of infants with spina bifida?

    <p>Fostering parent-infant relationships</p> Signup and view all the answers

    What is a common treatment strategy following surgical intervention for spina bifida?

    <p>Habilitation to learn new skills</p> Signup and view all the answers

    In managing a child with suspected hydrocephalus, which of the following assessments is critical for identifying increased intracranial pressure?

    <p>Observing for bulging fontanelles</p> Signup and view all the answers

    When positioning an infant with an open neural tube defect postoperatively, which position is typically recommended?

    <p>Prone with a pad between the legs</p> Signup and view all the answers

    What is the primary purpose of using diuretics such as Acetazolamide and furosemide in the treatment of hydrocephalus?

    <p>To reduce the production of CSF</p> Signup and view all the answers

    What nursing intervention is essential to prevent complications such as pressure sores in an infant with hydrocephalus?

    <p>Changing the position of the infant frequently</p> Signup and view all the answers

    Which of the following symptoms may indicate increased intracranial pressure in infants?

    <p>High-pitched cry and unequal pupil size</p> Signup and view all the answers

    What is the significance of performing echoencephalography, CT scanning, or MRI in infants suspected of having hydrocephalus?

    <p>To visualize enlarged ventricles and identify obstructions</p> Signup and view all the answers

    In cases of spina bifida cystica, which of the following characteristics is most accurate?

    <p>It is associated with a cystic mass containing membranes and CSF</p> Signup and view all the answers

    What is the preferred surgical age for repairing cleft palate to minimize impact on speech development?

    <p>Between 12-18 months</p> Signup and view all the answers

    Which of the following is NOT a common challenge faced by infants with cleft palate?

    <p>Increased appetite due to rapid weight gain</p> Signup and view all the answers

    What is a key intervention in postoperative care for an infant who has undergone a cleft lip repair?

    <p>Preventing sucking to protect the suture line</p> Signup and view all the answers

    What is commonly used to provide nutrition to an infant with cleft lip before surgical repair?

    <p>Syringe with a rubber tip</p> Signup and view all the answers

    Which position should be avoided for a newborn with a neural defect to prevent increasing intracranial pressure?

    <p>Supine with head below heart level</p> Signup and view all the answers

    What is the primary goal of long-term care for an infant with cleft lip/palate repair?

    <p>Promote optimal growth and development</p> Signup and view all the answers

    Which of the following is an appropriate method to prevent injury to the operative site after cleft lip/palate repair?

    <p>Use elbow restraints or a Logan bow</p> Signup and view all the answers

    What is considered a critical nursing intervention for cast care in infants with musculoskeletal malformations?

    <p>Leaving the toes exposed for capillary refill observation</p> Signup and view all the answers

    Which assessment finding would most likely indicate developmental hip dysplasia in an infant?

    <p>Limited abduction of the leg on the affected side</p> Signup and view all the answers

    Which treatment is indicated for true clubfoot if conservative methods are ineffective by three months?

    <p>Surgical intervention on tendons and bones</p> Signup and view all the answers

    What is the primary purpose of the Pavlik harness in infants?

    <p>To keep the hips flexed and abducted for socket development</p> Signup and view all the answers

    Which assessment is essential for a patient in a body cast?

    <p>Observing the toes for signs of circulation issues</p> Signup and view all the answers

    What should parents be instructed regarding the care of their child with developmental hip dysplasia?

    <p>Keeping the child’s hips flexed and abducted as advised</p> Signup and view all the answers

    What is a common complication that can arise from prolonged use of a body cast?

    <p>Pressure injuries from lack of movement</p> Signup and view all the answers

    Which sign indicates potential developmental hip dysplasia in a newborn?

    <p>Asymmetrical skinfolds on the thighs</p> Signup and view all the answers

    What is the primary purpose of performing frequent follow-up visits with a newborn in a harness?

    <p>To confirm proper hip placement</p> Signup and view all the answers

    Which of the following best describes the cause of phenylketonuria (PKU)?

    <p>A lack of the enzyme phenylalanine hydrolase</p> Signup and view all the answers

    Which symptom is a classic indicator of an infant having PKU?

    <p>Musty odor of the urine</p> Signup and view all the answers

    What should be avoided in the diet of a child with PKU?

    <p>Natural protein foods</p> Signup and view all the answers

    What is the goal of dietary management for an infant with PKU?

    <p>To maintain phenylalanine levels between 2 – 10 mg/dL</p> Signup and view all the answers

    Why is genetic counseling important for a child with PKU?

    <p>To guide future family planning decisions</p> Signup and view all the answers

    What is the role of the Guthrie blood test in diagnosing PKU?

    <p>It detects phenylalanine levels</p> Signup and view all the answers

    What condition could develop if phenylalanine levels rise above 10 mg/dL in a child with PKU?

    <p>Severe brain damage</p> Signup and view all the answers

    What are some common manifestations seen in infants with metabolic defects like PKU?

    <p>Delayed developmental milestones and failure to thrive</p> Signup and view all the answers

    Which of the following foods is suitable for a child with PKU?

    <p>Specialized low-phenylalanine formulas</p> Signup and view all the answers

    Study Notes

    Neural Tube Defects

    • Most often caused by failure of the neural tube to close at either the cranial or caudal end of the spinal cord
    • Result in hydrocephalus or spina bifida

    Hydrocephalus

    • Characterized by an increase of cerebrospinal fluid (CSF) within the ventricles of the brain
    • Causes pressure changes in the brain and an increase in head size

    Pathophysiology of Hydrocephalus

    • Imbalance between the production and absorption of CSF or improper formation of the ventricles
    • Can be congenital or acquired (tumor, sequela of infections, perinatal hemorrhage)
    • Classified as noncommunicating or communicating:
      • Noncommunicating hydrocephalus results from the obstruction of CSF flow from the ventricles of the brain to the subarachnoid space.
      • Communicating hydrocephalus results when CSF is not obstructed in the ventricles but is inadequately reabsorbed in the subarachnoid space.

    Manifestations of Hydrocephalus

    • Signs and symptoms depend on the time of onset and the severity of the imbalance
    • Classic sign is an increase in head size
    • At birth, the head enlarges rapidly, the fontanelles bulge, and the cranial sutures separate
    • Scalp is shiny, and the veins are dilated
    • The pupils of the eyes may appear to be looking down and the sclera may be seen above the pupils
    • Arnold-Chiari malformation is characterized by a foreshortened occiput suggesting pathology of the fourth ventricle, with the brain stem protruding through the cervical canal
    • Dandy Walker syndrome is characterized by a prominent occiput; the condition usually involves an atresia of the foramen leading CSF out of the brain to the subarachnoid space
    • The infant is often helpless and lethargic with poor muscle tone in the extremities
    • The cry is shrill and high-pitched
    • Irritability, vomiting, anorexia, and convulsions may occur
    • In older children, headaches are a predominant symptom along with cognitive slowing, personality changes, spasticity, and other neurological signs

    Diagnosis of Hydrocephalus

    • Transillumination (inspection of a cavity or organ by passing a light through its walls)
    • Daily head circumference measurements
    • Echoencephalography, computed tomography (CT) scanning, and magnetic resonance imaging (MRI)
    • Ventricular tap or puncture

    Treatment of Hydrocephalus

    • Diuretics (Acetazolamide and furosemide) to reduce CSF production
    • Surgery to bypass or shunt the point of obstruction

    Nursing Care for Hydrocephalus

    • Preoperative nursing care:
      • Most often, surgical correction can be accomplished in utero via fetal surgery or shortly after birth to prevent brain damage caused by increased intracranial pressure
      • Routine preoperative care involves assessment of vital signs, skin preparation, and emotional support of the parents
      • General nursing care includes:
        • Frequent position changes to prevent hypostatic pneumonia and pressure sores. Support the head when changing positions.
        • Use a lamb's wool or sponge rubber pad under the head to prevent skin breakdown.
        • Calm, unhurried feedings in a quiet room. Place infant on their side after feeding to reduce vomiting.
        • Observe fontanelles for size and bulging. Measure and record head circumference.
        • Report signs of increased intracranial pressure (increased BP, decreased P, and signs of infection)
    • Postoperative nursing care:
      • Observe for signs of increased intracranial pressure, infection, and manage pain
      • Bacterial infection is a life-threatening complication. Observe for infection at the operative site, along the shunt line, and in the diaper.
      • Signs of increased intracranial pressure include a high-pitched cry, unequal pupil size, bulging fontanelles, irritability or lethargy, poor feeding, and abnormal vital signs.
      • Positioning of the infant depends on fontanelle status.
      • Assess skin integrity.
      • Record head circumference and abdominal measurements.
      • Record I&O and observe for signs of fluid overload.
      • Provide patient education and support.

    Prognosis of Hydrocephalus

    • Improved with modern medication and surgical techniques to an 80% survival rate when treated early
    • Approximately 1/3 of cases result in normal physical and neurological functions
    • Other survivors may have varying degrees of developmental disabilities

    Spina Bifida

    • A group of central nervous disorders characterized by malformation of the spinal cord, also known as myelodysplasia

    Pathophysiology/Manifestations of Spina Bifida

    • Imperfect closure of the spinal vertebrae
    • Two forms:
      • Occulta (hidden): Small opening with no associated protrusion of structures.
      • Cystica (sac or cyst): Development of a cystic mass in the midline of the opening in the spine.
        • Meningocele contains portions of the membranes and CSF.
        • Meningomyelocele contains membranes, CSF, and spinal cord and is more serious.
        • May be associated with paralysis of the legs and poor control of bowel and bladder functions.
        • Hydrocephalus is a common complication.

    Prevention of Spina Bifida

    • Cause is unknown
    • Use of drugs or poor nutrition may contribute to the development
    • Folic acid supplementation is recommended for women of childbearing age.

    Treatment of Spina Bifida

    • Surgical closure of the spinal vertebrae
    • Multidisciplinary approach required due to potential associated complications (hydrocephalus, orthopedic problems, urinary and bowel difficulties)
    • Habilitation (learning rather than relearning) is the preferred term for treatment following surgery

    Nursing Care for Spina Bifida

    • Main objectives are:
      • Prevention of infection
      • Prevention of injury to the sac
      • Correct positioning
      • Good skin care
      • Adequate nutrition
      • Accurate observations and charting
      • Education of the parents
      • Continued medical supervision
      • Habilitation
    • Immediate care of the sac: Place a moist sterile dressing of saline or an antibiotic solution to prevent drying.
    • Routine observations: Size of the sac, tears or leakage, extremity deformities and movement, head circumference, fontanelles, rectal sphincter control.
    • Positioning: Prone with a pad between the legs and a small roll under the ankles to prevent pressure on the sac and postural deformities.
    • Provide cuddling and sensory stimulation.
    • Postoperative nursing care: Neurological assessment, infection prevention, urological monitoring, and meticulous skin care.
    • Inform parents of the potential for latex allergies and food sensitivities related to those allergies.
    • Provide support and guidance to parents about the disorder.
    • Obtain information and resources from the Spina Bifida Association of America.

    Cleft Lip

    • Characterized by a fissure or an opening of the upper lip
    • Resulting from the failure of the maxillary and median nasal processes to unite during embryonic development, usually between the 7th or 8th weeks of gestation
    • Seems to be caused by an autosomal dominant hereditary predisposition
    • More frequent in boys and may occur on one or both sides of the lip
    • Common congenital anomaly, occurring in about 1 in 600 births
    • Occurs more often in Asian Americans and Native Americans

    Treatment of Cleft Lip

    • Initial treatment is surgical repair (cheiloplasty)
    • Repair is completed before age 6 months when weight gain is stabilized and the infant is free from infections
    • Surgery improves the infant's sucking ability and appearance

    Nursing Care for Cleft Lip

    • Preoperative:
      • Complete physical exam and routine bloodwork
      • Photographs may be taken.
      • Report any oral, respiratory, or systemic infections.
      • Arm restraints may be ordered.
      • Feeding via syringe with a rubber tip or a long nipple with a large hole.
    • Postoperative:
      • Prevent sucking and crying to reduce tension on the suture line.
      • Careful positioning to prevent injury to the operative site (never on the abdomen).
      • Elbow restraints and Logan bow to immobilize the upper lip.
      • Provide emotional support.
      • Provide appropriate pain relief and sedation.
      • Feedings by dropper until the wound is completely healed.

    Cleft Palate

    • Failure of the hard palate to fuse at the midline during the 7th to 12th weeks of gestation.
    • Separation forms a passageway between the nasopharynx and the nose
    • Complicates feeding
    • Leads to infections of the respiratory tract and middle ear
    • Cleft palate may not be readily apparent at birth
    • Feeding is a problem because the cleft prevents negative pressure from being formed in the mouth, which is necessary for successful sucking
    • Speech may be affected later in life

    Treatment of Cleft Palate

    • Goal of therapy is union of the cleft, improved feeding, improved speech, improved dental development, and nurturing a positive self-image
    • Surgery is preferred between 12-18 months of age
    • Requires multidisciplinary teamwork: surgeon, pediatrician, pediatric dentist, orthodontist, nurse, psychologist, speech therapist, and social worker
    • Psychosocial adjustment of the family is crucial to the infant's self-image.

    Postoperative Nursing Care for Cleft Palate

    • Nutrition: Fluids offered by cup and soft diet. Hot foods and liquids are avoided. No sucking on straws.

    Postoperative Nursing Care for Cleft Lip/Palate Repair

    • Preventing injury to the operative site:
      • Consult with physician about feeding methods like sucking to minimize stress and crying
      • Use comfort measures to reduce crying
    • Positioning:
      • Use elbow restraints to prevent the child from placing fingers or other objects in the mouth
      • Use Logan bow position to maintain proper positioning
      • Avoid abdominal positioning
    • Prevention of infection:
      • Gently cleanse sutures
      • Use antiseptic mouthwash
    • Emotional care:
      • Provide cuddling and other means to express love and comfort
    • Pain relief:
      • Provide pain relief or sedation as needed for the infant

    Clubfoot

    • Pathophysiology:
      • A congenital deformity characterized by a foot that is twisted inward or outward
      • Incidence of 1 in 1000 births
      • Mild cases can be fixed with manipulative exercises
      • True clubfoot cannot be fixed with simple exercises
      • Most common type is talipes equinovarus where the feet are turned inward and the child walks on the toes and outer border of the feet
      • Generally affects both feet
    • Treatment:
      • Treatment should begin as early as possible to avoid abnormal bone and muscle development
      • Conservative treatment involves splinting or casting the foot in the correct position, performed during infancy
      • Passive stretching exercises are recommended
      • Surgery may be necessary if conservative methods are ineffective by 3 months of age
    • Nursing Care:
      • Cast Care:
        • Plaster casts dry from the inside out over 24-48 hours, they should be left uncovered and protected from pressures
        • The leg and foot may be elevated on pillows to reduce swelling
        • Moving the leg with a cast requires using the palms of the hands, not fingers, to avoid damaging the skin
        • Synthetic casts are lighter, dry faster and are water-resistant
        • Toes are left exposed for observation of capillary refill and signs of poor circulation
        • If circulation is poor, the cast can be split to relieve pressure or removed and reapplied
        • The cast may need to be removed and reapplied as the infant grows
        • If surgery is performed, monitor for bleeding and vital signs
      • Educate parents about orthopedic devices, cast care, exercise, hygiene, and treatment goals
      • Provide support for financial burdens associated with treatment

    Developmental Hip Dysplasia

    • Pathophysiology:
      • The head of the femur is partly or completely displaced due to a shallow hip socket
      • Heredity and environmental factors play a role
      • Hip malformation, joint laxity, breech position, and maternal hormones contribute
      • Seven times more common in girls than boys
      • Early detection and treatment are crucial before ossification occurs
      • High risk in cultures where newborns are wrapped snuggly with hips adducted and extended
    • Manifestations:
      • Often discovered during periodic health examinations in the first or second month of life
      • Limited abduction of the leg on the affected side
      • Asymmetry of skin folds and shortening of the femur are early signs of dislocation
      • Ortolani’s sign: a "clicking" sound as the femoral head is felt to slip back into the acetabulum
      • Barlow’s test: feeling the dislocation as the femur leaves the acetabulum when adducting and extending the hips while stabilizing the pelvis
      • Radiographic studies confirm the diagnosis
    • Treatment:
      • Treatment begins immediately upon detection of the dislocation
      • Hips are maintained in constant flexion and abduction for 4-8 weeks to keep the femur within the socket
      • Pavlik harness is used for long-term immobilization for severe dislocation or when dislocation is detected later
      • Spica cast can maintain position, the length of time varies and the cast usually needs to be changed every 6 weeks
      • Surgery may be required in infants older than 18 months who don't respond to treatment
    • Nursing Care:
      • Carefully observe infants during baths for signs of hip dysplasia, such as variations in buttock size, leg length, kicking with one leg only, and asymmetric skin folds
      • Note gait and posture in older children
      • Guide parents on the care and application of the Pavlik Harness
      • Neurovascular assessments need to be completed on infants in a body spica cast
      • Provide firm, plastic-covered pillows for support
      • Overhead bar and trapeze can benefit older children
      • Slightly elevate the head of the bed to help urine and feces drain away from the body
      • Frequent changes of position are essential
      • Allow older children to be involved in turning processes for a sense of control
      • Position older children on their abdomen during mealtime to ease swallowing
      • Provide toys that can be used while prone
      • Leave articles and toys within reach to promote independence
      • Frequent adjustments in home and clinical care are necessary due to rapid growth and development
      • Include the child in everyday family and play activities to encourage normal development

    Phenylketonuria (PKU)

    • Pathophysiology:
      • Faulty metabolism of phenylalanine, an amino acid found in protein foods
      • Phenylalanine hydrolase enzyme converts phenylalanine into tyrosine, but it's missing in classic PKU
      • Transmitted by an autosomal recessive gene
      • Phenylalanine builds up in the bloodstream when the infant is fed breast milk or formula
      • Phenylpyruvic acid appears in the urine in early life
      • PKU occurs more commonly in blonde and blue-eyed children
    • Manifestations:
      • Severe retardation is evident in infancy
      • Infant appears normal at birth but shows delayed development by 4-6 months
      • Failure to thrive
      • Skin conditions like eczema
      • Peculiar musty odor
      • Personality disorders
      • Seizures
    • Diagnosis:
      • Guthrie blood test is the most reliable test, performed on blood obtained by a heel stick
      • The test should be performed 48-72 hours after birth, after protein ingestion
      • Quantitative elevations of phenylalanine in the blood confirm the diagnosis
    • Treatment:
      • Close dietary management is essential
        • Formulas: Lofenalac, Phenex-1, Phenyl-Free, and Phenex-2
        • Breastfeeding: Partial breastfeeding with Lofenalac supplementation
        • Solid foods: Introduction of solid foods low in phenylalanine at the same time as children without PKU
      • A dietitian can provide guidance and support in maintaining the diet regimen
      • Children with PKU must avoid aspartame
      • Flavoring substitutes can increase compliance
      • Frequent evaluation of blood phenylalanine levels is crucial
        • The goal is to maintain phenylalanine levels between 2-10 mg/dL
        • Levels below 2 mg/dL can result in growth retardation
        • Levels above 10 mg/dL can cause brain damage
      • Genetic counseling is important for family planning
        • Women with PKU need to follow a low-phenylalanine diet before conception
      • Sapropterin dihydrochloride (Kuvan) is the first drug available to treat this disorder

    Maple Syrup Urine Disease

    • Pathophysiology:
      • Caused by a defect in the metabolism of branched-chain amino acids (leucine, isoleucine, and valine)
      • Results in severe serum elevations of these amino acids
      • Leads to acidosis, cerebral degeneration, and death within 2 weeks if untreated
    • Manifestations:
      • The infant appears healthy at birth but develops feeding difficulties
      • Loss of Moro reflex, irregular respirations, and convulsions
      • Urine, sweat, and earwax have a sweet or maple syrup odor (ketoacidosis)
      • Urine contains high levels of leucine, isoleucine, and valine
    • Diagnosis:
      • Confirmed by blood and urine tests
    • Treatment:
      • Early detection in the newborn period is critical
      • Treatment involves removing these amino acids and their metabolites from the body through hydration and peritoneal dialysis
      • Lifelong diet low in leucine, isoleucine, and valine
      • Special formulas are available
      • Exacerbations can be life-threatening and are related to abnormal leucine levels and infections

    Galactosemia

    • Pathophysiology:
      • The body is unable to use the carbohydrates galactose and lactose.
    • Manifestations:
      • Galactosemia affects the liver, kidneys, brain, and eyes.
      • Symptoms typically appear within a few days to weeks after birth
      • Vomiting, diarrhea, failure to gain weight
      • Jaundice, lethargy, and seizures
      • Cataracts and liver damage
    • Diagnosis:
      • A blood test can detect the presence of galactose in the blood
      • A urine test can detect the presence of galactose in the urine
    • Treatment:
      • Remove galactose from the diet
      • Avoid lactose-containing foods, such as milk, cheese, and yogurt
      • Soy-based formula is a suitable alternative for infants
      • Long-term treatment is necessary for prevention of complications

    Galactosemia

    • A disorder where an enzyme is defective or missing.
    • Causes a disturbance in a normal chemical reaction.
    • Results in an increase of galactose in the blood and urine.
    • Can result in:
      • Cirrhosis of the liver
      • Cataracts
      • Intellectual impairment
    • If left untreated.
    • Symptoms start abruptly and worsen gradually.
    • Early warning signs are lethargy, vomiting, hypotonia, diarrhea, and failure to thrive.
    • Jaundice may be present.
    • Can be confirmed with blood and urine tests, including galactosemia, galactosuria, and evidence of reduced enzyme activity in red blood cells.
    • Screening tests are available.
    • Treatment is to avoid milk and lactose containing products in the diet.
      • This includes the nursing mother discontinuing breastfeeding.
      • Lactose-free formulas and soy protein based formulas are often substituted.

    Down Syndrome

    • One of the most common chromosomal abnormalities.
    • Occurs in around 1 in 700 births in the US.
    • Most common cause of genetic intellectual disability.
    • There are three phenotypes of Down Syndrome:
      • Trisomy 21- 95% of cases
      • Mosaicism
      • Translocation
    • Screening begins in the first trimester with an ultrasound and nuchal translucency assessment.
    • Second trimester quad test that involves testing blood for levels of AFP, UE, inhibin-A, and hCG.
    • Pregnant-associated plasma protein A (PAPP-A) can also indicate a risk for Down syndrome.
    • Diagnosed by clinical manifestations.
    • Clinical signs are present at birth, which include:
      • Close set, upward slanting eyes
      • Small head
      • Round face
      • Flat nose
      • Protruding tongue
      • Short and thick neck
      • Simian crease
      • Short and thick hands
      • Little finger curved and doesn’t extend past the distal joint
      • Wide space between the first and second toes
      • Underdeveloped muscles and loose joints
      • Physical growth may be slower than normal.
      • The child is often intellectually limited and has been found to have IQ’s in the borderline to low-average range.
      • Congenital heart deformities are associated.
      • Resistance to infection is poor, and they are prone to respiratory and ear infections.
      • There are often speech and hearing problems.
      • Lifespan has increased but they are at a higher risk for acute leukemia and Alzheimer’s disease.

    Hemolytic Disease of the Newborn (Erythroblastosis Fetalis)

    • A disorder that becomes apparent during fetal life or soon after birth.
    • Occurs when an Rh-negative mother and an Rh-positive father produce an Rh-positive fetus.
    • Mother’s body creates antibodies that destroy fetal blood cells, leading to anemia in the fetus and newborn.
    • Early detection and prophylactic treatment with Rh immune globulin (RhoGAM) has made it rare today.
    • Extensive maternal health history is gathered, including previous Rh sensitizations.
    • Indirect Coombs’ test is used to detect the presence of Rh-positive antigens.
    • Amniocentesis is done to confirm the diagnosis.
    • The fetal RH status can be determined noninvasively with free DNA in maternal plasma.
    • Prevention is accomplished by using RhoGAM at 28 weeks of gestation and within 72 hours of delivery.
    • Also administered after spontaneous or therapeutic abortion, amniocentesis, and after bleeding during pregnancy.
    • A direct Coombs’ test is done on cord blood at delivery.
    • Symptoms include:
      • Anemia
      • Jaundice
      • Excessive immature RBCs
      • Enlarged liver and spleen
      • Extensive edema
    • Bilirubin toxicity can lead to kernicterus.
    • Treatment can be done before or after birth and includes:
      • In utero intravascular transfusion of packed RBCs
      • Exchange transfusion
      • Phototherapy
      • Intravenous immunoglobulin (IVIG)
    • Nursing care for phototherapy includes:
      • Protecting the infant’s eyes from the lights.
      • Protecting gonads from heat damage.
      • Observing for maculopapular rash.
      • Observing for jaundice and bronze baby syndrome
      • Monitoring for pressure areas.
      • Maintaining adequate fluid volume.
      • Monitoring the infant’s temperature.
      • Observing for neurological deficit, such as twitching or lethargy.
      • Providing feedings and assisting with breastfeeding.
      • Providing reassurance and education to parents.

    Nursing Care for a Newborn with Hemolytic Disease

    • Monitor newborn's body temperature to provide a neutral thermal environment
    • Check laboratory values and report any abnormal levels or spread of jaundice discoloration.
    • Provide information to the newborn's parents about his condition and treatment interventions

    Intracranial Hemorrhage

    • Most common type of birth injury, can occur due to trauma or anoxia
    • Occurs more often in preterm infants with fragile blood vessels
    • Can also occur during precipitate delivery, prolonged labor, or when the newborn's head is large compared to the mother's pelvis
    • Location of hemorrhage can be subdural, subarachnoid, or intraventricular

    Manifestations of Intracranial Hemorrhage

    • Signs can occur suddenly or gradually depending on severity
    • Poor muscle tone
    • Lethargy
    • Poor sucking reflex
    • Respiratory distress
    • Cyanosis
    • Twitching
    • Forceful vomiting
    • High-pitched, shrill cry
    • Convulsions
    • Opisthotonos posturing
    • Tense, bulging fontanelle
    • Pupil dilation or inequality

    Treatment of Intracranial Hemorrhage

    • Place infant in incubator for temperature control, administer oxygen, and continuous observation
    • Administer vitamin K to control bleeding
    • Administer phenobarbital for twitching or convulsions
    • Prophylactic antibiotics and vitamins may be used

    Nursing Care for Intracranial Hemorrhage

    • Handle infant gently and elevate head to decrease intracranial pressure
    • Feed carefully as the sucking reflex may be affected and infant vomits easily
    • Monitor for signs of increased intracranial pressure: perform neurochecks, monitor vital signs, measure head circumference, palpate fontanelles
    • Observe and document the character of convulsions to help determine the location of the bleeding
    • Assist the healthcare provider with procedures such as lumbar puncture and aspiration of subdural hemorrhage

    Transient Tachypnea of the Newborn (TTN)

    • Usually occurs after cesarean section birth or rapid vaginal delivery
    • Thought to be caused by slow absorption of lung fluid after birth

    Manifestations of TTN

    • Characterized by tachypnea, chest retractions, grunting, and mild cyanosis
    • Resolves within 3 days

    Treatment for TTN

    • Supportive care
    • Providing warmth
    • Energy conservation
    • Supplemental oxygen

    Meconium Aspiration Syndrome (MAS)

    • Occurs when fetus or newborn aspirates meconium-stained amniotic fluid into the lungs
    • Can occur during prolonged labor or if the infant takes their first breath before the nose and mouth are suctioned

    Manifestations of MAS

    • Respiratory distress, including nasal flaring, retractions, cyanosis, grunting, rales, and rhonchi

    Treatment for MAS

    • Supportive care
    • Providing warmth
    • Energy conservation
    • Supplemental oxygen
    • Intubation and mechanical ventilation may be necessary

    Neonatal Abstinence Syndrome (NAS)

    • Occurs when a fetus is exposed to drugs such as opiates, amphetamines, tranquilizers, or multiple illicit drugs while in utero
    • The infant born to an addicted mother is physiologically dependent and experiences withdrawal symptoms after birth

    Manifestations of NAS

    • Body tremors and hyperirritability
    • Wakefulness, diarrhea, poor feeding, sneezing, and yawning

    Treatment of NAS

    • Provide a quiet environment
    • Swaddling
    • Reduce external stimuli
    • Close observation for seizures

    Infant of a Diabetic Mother

    • Diabetes in the mother can present various problems for the newborn
    • Effects depend on the duration and control of the mother's condition
    • Well-controlled diabetes leads to minimal adverse effects
    • Poorly controlled diabetes can lead to serious complications
    • High glucose levels are transferred to the fetus, leading to hyperglycemia, hyperinsulinism, and macrosomia.
    • Infant may be large for gestational age (LGA)

    Manifestations of Infant of a Diabetic Mother

    • Infant may experience birth injuries due to size
    • Hypoglycemia after birth due to loss of maternal glucose and overproduction of insulin
    • Round, puffy face due to increased subcutaneous fat
    • May have developmental deficits, respiratory distress syndrome (RDS), or congenital anomalies
    • Infants with poorly controlled diabetes in the mother may be small for gestational age due to poor placental perfusion, and experience hypoglycemia, hypocalcemia, and hyperbilirubinemia

    Nursing Care of Infant of a Diabetic Mother

    • Close monitoring of vital signs
    • Early feeding and frequent assessment of blood glucose levels for the first 2 days of life
    • Observe for irritability, tremors, and respiratory distress

    Nursing Care for Infants with Congenital Anomalies and Perinatal Injuries

    • Emphasize the importance of addressing individual needs based on specific conditions
    • Provide emotional support to the infant and parents
    • Encourage family involvement in care
    • Educate families on the importance of early intervention and long-term follow-up

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    Test your knowledge on neural tube defects and hydrocephalus with this quiz. Topics include causes, symptoms, diagnosis, and nursing care for affected infants. Enhance your understanding of these critical conditions in pediatric care.

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