Newborn High-Risk Factors and Complications

• Care of the High-Risk Newborn to maturity is important to understand
• A nurse should learn how to care for both well children and those with variations in gestational age or wight
• Recognizing these infants and their needs can improve their present and future health

Risk Factors for Illness in Newborns

• Younger or older maternal age can increase risk
• Certain disease conditions, such as diabetes or HIV, can increase risk
• Pregnancy complications, such as placenta previa or abruptio, increase risk
• Unhealthy maternal lifestyles involving drug abuse, alcohol, or smoking can increase risk
• Premature or post-term infants, and those underweight or overweight, are at higher risk
• Predicting high-risk infants allows for specialized healthcare personnel to be present at birth for interventions like resuscitation

Newborn Priorities in First Days

• Initiation and maintenance of respiration is the first priority
• Establishment of extrauterine circulation is very important
• Control of body temperature is crucial
• Adequate nourishment is required
• Waste elimination must be established
• Prevention of infection is a concern
• Establishment of parent-infant relationship is good
• Developmental care/Physiologic stimulation should be maintained

Initiating and Maintaining Respiration

• Most newborn deaths occur within the first 48 hours due to inability to respire correctly.
• Infants who struggle to breathe effectively may experience neurologic dysfunctions (cerebral hypoxia)
• Newborns that fail to establish respiration within the 1st 2 minutes are likely to develop respiratory acidosis because of lactic acid production
• Asphyxia in utero may also lead to respiratory acidosis

Dangers of Delayed Breathing

• Ineffective breathing impacts circulation
• Ductus arteriosus may fail to close from increased pressure on the left side of the heart
• Poor circulation causes the infant to use serum glucose quickly, leading to Hypoglycemia

Factors Predisposing Respiratory Difficulty

• Low birth weight (less than 2,500 grams at birth) increases likelihood of difficulty
• Maternal history of diabetes leads to increased risk
• Premature rupture of membranes can cause issues
• Maternal use of narcotics leads to issue
• Presence of meconium staining is an indicator
• Cord prolapse can lead to issue
• Low apgat score, under 7 at 1 or 5 minutes can cause issue
• Postmaturity increases chance of issues
• SGA can cause issues
• Breech birth often requires intervention
• Multiple birth present greater danger
• Fetal distress is an indicator
• Chest, heart, or respiratory tract anomalies

Resuscitation Defined

• Administration of emergency measures supporting newborn adaptation to extrauterine life.
• Equipments should be setup and tested before birth
• Dry and warm the child with a blanket in a radiant warmer
• Establish and maintain an airway with neck slightly extended
• Suction the mouth, then nose with bulb aspirator
• Tactile stimulation should be used such as crying

Resuscitation Process

• Intubate the child to remove meconium, repeating until return is clear
• Monitor heard rate and respiration
• Expand the lungs using a proper bag
• Oxygen should be at 100% at 40-60cpm, until the newborn's color becomes pink
• Chest compressions should be under 80 bpm until infant's heart rate is over 80 bpm
• Airway should be secured, and appropriate medication administered

Clearing the Airway

• For term newborns, a bulb aspirator should be used to remove mucus and prevent aspiration
• If the infant can't breath then suction the mouth and nose again
• Prevention of Chilling the newborn is important
• Meconium stained babies should not be rubbed on the back to stimulate breathing or get high pressure oxygen
• 02 mask without pressure, intubate baby for deep suctioning

Types of Apnea

• Primary apnea occurs in the first seconds with weak gasps and falling heart rate
• Secondary apnea occurs after 1-2 minutes of apnea
• Resucitation is less effective for secondary apnea cases

Promoting Lung Expansion

• Once an airway is established, newborn's lungs should be expanded.
• Term newborns inflates lungs adequately with the first breath
• Spontaneous respiration but if infant cannot sustain effective respiration, give O2 by mask at of 40-60com
• Mask should cover the nose and mouth for O2 administration to be effective
• It should not cover the eye

Lung Expansion Factors

• Prevent Cooling, with a temp of 32-34*C, humidified 60-80%
• Oxygen levels should not fluctuate
• Do not apply pressure above necessity
• Both lungs should be aerated through auscultation

Drug Therapy

• If respiratory depression is related to maternal use of Meperidine (Demerol) or morphine, narcotic antagonists are given
• Naloxone (narcan) us a narcotic antagonist
• Reverses effects such as respiratory depression
• Given via umbilical vessel or intramuscular (vastus lateralis)

Other Drugs for Resuscitation

• Atropine reduces bronchial secretions, and reduces possible apnea
• Calcium Chloride contractility
• Dopamine increases blood perfusion
• Epinephrine strengths cardiac contractions
• Sodium Bicarbonate relieves respiratory acidosis.
• Surfactants are administered to prevent symptoms of respiratory distress syndrome

Establishment of Extrauterine Circulation

• If respiratory function cannot be initiated and maintained, it leads to lack of cardiac function
• If theres no heart rate or if its less than 80bpm, closed chested massage should be performed
• Holf infant with fingers supporting the back
• Depress sternum with to fingers 1 - 2cm deep and 100 times per minute
• Lung ventilation should be administered 30 times per minute

Fluid and Electrolyte Balance

• Hypoglycemia is decreased blood glucose from the first breaths exertion
• Dehydration leads to insensible water loss
• Rate of fluid administration leads to patent ductus arteriosus
• Radiant warmer requires moisture and increases water loss

Regulating Temperature

• High-risk newborn have difficulty maintaining a normal temperature
• Important to keep in a neutral environment
• Oxygen consumption is increased if in a cold environment
• Cells undergo under anaerobic metabolis leading to lactic acid if theres low 02
• Acidosis can increase possible Kernicterus
• Prevent chilling by wiping
• Cap on head
• Radiant Warmer or skin-to-skin contact

This quiz covers critical aspects of newborn health, including risk factors, respiratory distress, and potential complications like acid-base imbalances and hypoglycemia. It emphasizes the importance of immediate postnatal care and the physiological challenges newborns face.