Newborn Complications Study Guide

• The text provides study notes on newborn complications, including hypoglycemia, hypocalcemia, neonatal sepsis, newborn abstinence syndrome (NAS), fetal alcohol syndrome (FAS), hyperbilirubinemia, and hemolytic disease of the newborn (HDN), including neonatal loss/death.

Hypoglycemia

• Reduced serum glucose in newborns which may occur as early as 2-3 hours or as late as 48 hours after birth
• While there is no universal definition of hypoglycemia, normal value is considered between 45 to 50 mg/100 mL
• Clinically significant when blood glucose is less than 35 mg/dL or plasma glucose less than 40 mg/dL
• Risk Factors:*
• Intrauterine growth retardation/IUGR (SGA)
• Newborns of diabetic mothers
• Hemolytic disease
• Birth trauma
• Hypothermia
• Sepsis
• Hypoxia and asphyxia
• Developmental defects
• Lack of oral intake/prolonged NPO
• Assessment Findings:*
• Tremors and jitteriness
• Lethargy
• Poor feeding
• Hypotonia
• High-pitched cry
• Tachypnea, tachycardia
• Temperature instability
• Pallor, cyanosis
• Hyper irritability
• Apnea and convulsions: serious and may indicate neuroglycopenia
• Nursing Implementation:*
• Early detection: Dextrostix screening using capillary blood via heel-prick done at birth and 30 minutes after for six times, then every hour for three times, and every 2 hours for six times
• Oral glucose stat can be administered if hypoglycemia is identified
• IV glucose can be administered as ordered (10% or 25%), taking care not to run too fast to prevent hyperglycemia, which is defined as blood glucose above 125 mg/100 mL
• Interventions should include keeping the newborn warm and reducing environmental stimuli to prevent seizures

Hypocalcemia

• Decreased serum calcium below 7 to 7.5 mg/100 mL.
• Risk Factors:*
• Hypoglycemia
• Asphyxia
• Low APGAR score
• Lack of intake
• Prematurity
• Newborns of diabetics
• Birth trauma
• Treatment of acidosis with bicarbonate
• Assessment Findings:*
• Neuromuscular irritability: tetany - chief sign
• Jitteriness
• Muscular twitching and carpopedal spasm; generalized seizures; manifest tetany
• Lethargy
• Poor feeding
• High-pitched cry
• Increased apneic episodes
• Diagnosis:*
• Confirmed by a low serum calcium level on laboratory testing
• Treatment:*
• Oral calcium can be given if the infant can suck and swallow
• Intravenous calcium can be given as a 10% solution of calcium gluconate if it is not possible for oral liquids to be taken safely
• Administer sodium phenobarbital, in addition to calcium gluconate, to halt the seizures
• Nursing Implementation:*
• Administer ordered calcium orally or intravenously
• Monitor the rate of IV flow to prevent hypercalcemia
• Maintain serum calcium at above 8 mg/100 mL
• Implement measures for prevention and management of seizures
• Vitamin D administration to facilitate the absorption of calcium and phosphorus from the gastrointestinal tract

Neonatal Sepsis

• Generalized infection in the newborn leading to a clinical syndrome of systemic illness accompanied by bacteremia
• Risk Factors:*
• Prematurity and prolonged period between rupture of membranes and delivery, fever, chorioamnionitis
• Dystocia
• Maternal infection
• SGA
• Resuscitation
• Aspiration of mucus, meconium, and vaginal secretions
• Iatrogenic-infected personnel/equipment
• Assessment Findings:*
• Generalized signs and symptoms
• Lethargy
• Poor respiratory effort, apnea, cyanosis, persistent hypoglycemia
• Jaundice or pallor
• Decreased or increased temperature
• Diagnosis:*
• Culture of body secretions or blood to confirm if there is no focus of infection
• Nursing Implementation:*
• Isolate the newborn (first nursing action), and observe strict asepsis in handling the newborn
• Provide oxygen and respiratory support and administer the ordered antibiotics stat
• Keep the newborn warm, maintain nutrition and hydration, adn meet the newborn's emotional needs

Newborn Abstinence Syndrome (NAS)

• Condition affecting newborns exposed to addictive substances through the placenta during pregnancy
• Causes:*
• Addictive substances received by the mother such as opioids, stimulants, antidepressants, depressants, and nicotine
• Onset:*
• Symptoms typically onset between 1 and 3 days after birth
• Symptoms can vary based on the drug used, timing of use, and the baby's gestational age
• Assessment Findings:*
• Withdrawal signs include coarse flapping tremors, restlessness, sleepiness, irritability, hyperactivity, hypertonicity
• Symptoms such as fever and sweating, vomiting and/or diarrhea, high-pitched cry, and feeding difficulties may be observed
• NAS is diagnosed through the assessment of maternal history and diagnostic tools, such as the Finnegan Neonatal Abstinence Scoring Tool (FNAST)
• Management/Intervention:*
• Depends on the infant's age, symptoms, general health, and severity, and may include pharmacological and non-pharmacological interventions
• Prognosis:*
• Long-term effects are unknown and may include hyperactivity, temper tantrums, brief attention span, and abnormal psychomotor development

Fetal Alcohol Syndrome (FAS)

• Collection of physical and behavioral problems seen in children of women who drink heavily during pregnancy
• Risk Factor:*
• Alcohol drinking during pregnancy
• Assessment Findings:*
• Physical defects include growth retardation, microcephaly, facial malformations, joint malformations, organ malformations, and eye anomalies
• Mental/neurologic defects include mental retardation and seizure disorders
• Behavioral problems include attention difficulties, learning difficulties, and hyperactivity
• Treatment:*
• Consists of prevention and management
• Prognosis:*
• Physical defects such as low birth weight may improve over time, but CNS damage is permanent

Hyperbilirubinemia

• Description relates to excessive levels of serum bilirubin greater than 12-13 mg/100 mL.
• Risk Factors:*
• Prematurity
• Sepsis/infection
• Exposure to drugs in utero or excessive vitamin K
• Isoimmunization
• Polycythemia
• Hypothermia
• Breastfeeding due to pregnanediol which affects liver enzyme
• Assessment Findings:*
• Pathologic jaundice, occurs in the first 24 hours, lasting more than a week, with dangerous levels at which kernicterus may occur
• Dangerous levels at which kernicterus may set in: Full term: 20 mg/100 mL or above, Preterm: 15 mg/100 or above
• Irritability, lethargy
• Polycythemia, tachycardia, red hands/feet, distress, High-pitched cry, increasing serum bilirubin
• Treatment:*
• Phototherapy which converts bilirubin for excretion
• Exchange transfusion
• Effects of exchange transfusion:*
• Lowers serum bilirubin and corrects hyperbilirubinemia
• Elevates hemoglobin, corrects anemia
• Reduces/prevents congestive heart failure

Hemolytic Disease of the Newborn (HDN)

• A blood disorder with severe hemolytic reaction resulting in the breakdown of red blood cells and the production of immature red blood cells, termed erythroblastosis
• Description:*
• Severe hemolytic reaction is characterized by severe anemia, severe hyperbilirubinemia, severe hypoxia, cardiac decompensation, edema, hydrothorax, ascites and death
• Characteristic features:*
• Hemolytic Anemia and Hyperbilirubinemia
• Types:*
• Rh incompatibility and ABO incompatibility
• Pathophysiology:*
• Blood incompatibility (Rh-negative mother with Rh-positive fetus) results in fetal antigens entering maternal circulation and forming antibodies that affect subsequent pregnancies
• Diagnosis:*
• Prenatal detection and Indirect Coombs tests
• Amniocentesis
• Treatment:*
• RhoGAM to prevent or suppress sensitization in susceptible Rh-negative women carrying Rh-positive fetuses

Neonatal Loss/Death

• Neonatal loss is part of perinatal loss, which includes losses in the prenatal, intranatal, and postnatal periods
• Causes of most neonatal deaths are preterm birth, intrapartum-related complications, infections, and birth defects
• Prevention:*
• Quality antenatal care, skilled care at birth, postnatal care for mother and baby, and care of small and sick newborns
• Supporting the family and Grief:*
• Recognize and accept the initial grief responses of disbelief, shock, and confusion, and encourage verbalization
• Identify, support, and respect important cultural and spiritual practices