Nursing Care of Premature Infants
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Questions and Answers

What is defined as birth at 20.0-36.6 weeks?

  • Congenital abnormalities
  • Prematurity (correct)
  • Low birth weight
  • Gestational diabetes

    • Which of the following is a common problem associated with premature infants?

  • Respiratory distress (correct)
  • Cerebral palsy
  • Down syndrome
  • Pulmonary embolism

    • What should a nurse ask to ensure understanding of a patient's home care routine?

  • How do you do this at home? (correct)
  • What medications do you take?
  • What is your family history?
  • Who is your primary physician?

    • Which factor is important for assessing lung maturity in newborns?

    <p>L/S ratio</p> Signup and view all the answers

    What is an essential aspect of managing premature infants?

    <p>Supporting breastfeeding and pumping</p> Signup and view all the answers

    What is a potential complication associated with premature infants related to their eye health?

    <p>Retinopathy of Prematurity</p> Signup and view all the answers

    Which of the following is NOT a sign of respiratory distress in an infant?

    <p>Improved appetite</p> Signup and view all the answers

    What is a common symptom of Necrotizing Enterocolitis?

    <p>Temperature instability</p> Signup and view all the answers

    How can nursing interventions help manage oxygen demands in premature infants?

    <p>Provide ambient oxygen as needed</p> Signup and view all the answers

    Which factor is NOT a risk factor for birth trauma?

    <p>Regular prenatal care</p> Signup and view all the answers

    What birth injury is most commonly associated with birth trauma?

    <p>Clavicle fracture</p> Signup and view all the answers

    What is a common nursing action to assess and support respiratory function in premature infants?

    <p>Assess breath sounds and airway patency</p> Signup and view all the answers

    What can decreased surfactant production lead to in premature infants?

    <p>Worsening of hypoxemia and acidosis</p> Signup and view all the answers

    What is one potential outcome of untreated hypoxia in newborns?

    <p>Seizures</p> Signup and view all the answers

    What is one method used to visualize lung conditions in infants suspected of respiratory issues?

    <p>Chest x-ray</p> Signup and view all the answers

    Which of the following statements about human milk is true?

    <p>It reduces the risk of Necrotizing Enterocolitis.</p> Signup and view all the answers

    Which intervention is critical when suctioning the airway of a premature infant?

    <p>Limit suctioning duration</p> Signup and view all the answers

    What is the estimated fatality rate of Necrotizing Enterocolitis?

    <p>10-30%</p> Signup and view all the answers

    Which of the following is not considered a sign of Necrotizing Enterocolitis?

    <p>Rapid growth</p> Signup and view all the answers

    What role does Betamethasone play for premature infants?

    <p>Promotes lung surfactant production</p> Signup and view all the answers

    Which injury can result from forceps-assisted delivery?

    <p>Facial paralysis</p> Signup and view all the answers

    What is the primary goal of hyperbilirubinemia care?

    <p>Preventing bilirubin toxicity</p> Signup and view all the answers

    What should be done to monitor a newborn undergoing phototherapy?

    <p>Monitor temperature regularly</p> Signup and view all the answers

    Which nursing intervention is appropriate for managing jaundice in newborns?

    <p>Educating parents about the risks of jaundice</p> Signup and view all the answers

    What is the significance of maintaining an eye mask during phototherapy?

    <p>To protect the eyes from light exposure</p> Signup and view all the answers

    What happens when the albumin binding sites become saturated in newborns?

    <p>Indirect bilirubin circulates freely</p> Signup and view all the answers

    What is a characteristic of physiologic jaundice in newborns?

    <p>It peaks at 3-5 days after birth.</p> Signup and view all the answers

    Which factor is NOT a risk factor for developing jaundice in newborns?

    <p>High birth weight</p> Signup and view all the answers

    What condition can result if neonatal jaundice is left untreated?

    <p>Kernicterus</p> Signup and view all the answers

    What is the primary cause of jaundice in hemolytic disease of the newborn due to RH incompatibility?

    <p>Excessive bilirubin production</p> Signup and view all the answers

    How does breastfeeding impact the risk of jaundice in newborns?

    <p>It may contribute to delayed or infrequent feedings.</p> Signup and view all the answers

    Which type of jaundice is more common but less severe?

    <p>Pathologic jaundice due to ABO incompatibility</p> Signup and view all the answers

    What is the necessary condition for pathologic jaundice to be diagnosed?

    <p>It must occur within 24 hours of birth.</p> Signup and view all the answers

    What happens to red blood cells (RBCs) after birth regarding their need in the newborn's body?

    <p>RBC lifespan decreases leading to bilirubin accumulation.</p> Signup and view all the answers

    What is a common withdrawal symptom in newborns exposed to opioids?

    <p>Poor feeding</p> Signup and view all the answers

    Which substance exposure is least likely to be associated with low birth weight?

    <p>Caffeine</p> Signup and view all the answers

    Identifying signs of fetal alcohol syndrome is crucial for which reason?

    <p>It prevents congenital abnormalities</p> Signup and view all the answers

    Which of the following is NOT one of the 6 Ss to calm a baby?

    <p>Sitting</p> Signup and view all the answers

    What condition is indicated by an infant being small for gestational age (SGA)?

    <p>Low birth weight due to substance exposure</p> Signup and view all the answers

    What is the Finnigan scoring tool primarily used for?

    <p>Evaluating neonatal abstinence symptoms</p> Signup and view all the answers

    An infant with a mother who is GBS positive but not treated during labor is at increased risk for which condition?

    <p>Infections</p> Signup and view all the answers

    Which factor is frequently assessed in newborns to identify cognitive, memory, and motor skill problems?

    <p>Withdrawal symptoms from substances</p> Signup and view all the answers

    What is an important supportive action for breastfeeding mothers of premature infants?

    <p>Encouraging breastfeeding over pumping</p> Signup and view all the answers

    Which condition is associated with immature lungs in premature infants?

    <p>Respiratory distress</p> Signup and view all the answers

    Which factor is an indicator of lung maturity in newborns?

    <p>L/S ratio</p> Signup and view all the answers

    What is a common complication of premature infants that affects the gastrointestinal system?

    <p>Necrotizing enterocolitis</p> Signup and view all the answers

    Which question should a nurse prioritize to understand a patient's needs during an assessment?

    <p>How do you manage your symptoms at home?</p> Signup and view all the answers

    What is the primary goal of managing jaundice in newborns?

    <p>To prevent kernicterus</p> Signup and view all the answers

    Which nursing intervention is specifically required during phototherapy for newborns?

    <p>Ensure only a diaper is worn</p> Signup and view all the answers

    What happens when albumin binding sites in a newborn become saturated?

    <p>Unconjugated bilirubin circulates freely</p> Signup and view all the answers

    Which of the following tests is least likely to be utilized in the assessment of jaundice in newborns?

    <p>Hemoglobin electrophoresis</p> Signup and view all the answers

    Which statement about phototherapy for jaundice management is correct?

    <p>Newborns must wear eye protection during the treatment.</p> Signup and view all the answers

    What is the term for the potential risk associated with a post-term infant due to an aging placenta?

    <p>Higher risk of mortality and morbidity</p> Signup and view all the answers

    Which of the following is a characteristic of early onset sepsis in newborns?

    <p>Transmitted during birth process</p> Signup and view all the answers

    Which complication is most commonly related to the aspiration of meconium in newborns?

    <p>Hypoxia</p> Signup and view all the answers

    What is the primary cause of neonatal sepsis and meningitis in the U.S.?

    <p>Group Beta Streptococcus</p> Signup and view all the answers

    How is late onset sepsis in newborns typically acquired?

    <p>Through medical interventions</p> Signup and view all the answers

    Which of the following factors is NOT a concern for post-term infants?

    <p>Increased vernix presence</p> Signup and view all the answers

    Which type of infections presents 7 to 30 days after birth in newborns?

    <p>Late onset sepsis</p> Signup and view all the answers

    What is a common manifestation of neonatal infections due to TORCH pathogens?

    <p>Congenital anomalies</p> Signup and view all the answers

    What sign is commonly associated with infection in newborns?

    <p>Lethargy/irritability</p> Signup and view all the answers

    Which of the following symptoms is most indicative of Neonatal Abstinence Syndrome?

    <p>Irritability</p> Signup and view all the answers

    What is a key action to take when managing an infant experiencing withdrawal?

    <p>Swaddle the infant</p> Signup and view all the answers

    What aspect of care is crucial for a newborn that presents with signs of infection?

    <p>Astute assessment of history for risk factors</p> Signup and view all the answers

    Which of the following is an appropriate nursing intervention for infants exhibiting increased work of breathing?

    <p>Monitor vital signs closely</p> Signup and view all the answers

    What is one of the risks associated with maternal HIV during breastfeeding?

    <p>Transmission of HIV to the infant</p> Signup and view all the answers

    Which symptoms are indicative of a newborn's increased work of breathing?

    <p>Apnea and tachycardia</p> Signup and view all the answers

    What is essential for the care of an infant experiencing withdrawal symptoms?

    <p>Regular scoring of withdrawal signs</p> Signup and view all the answers

    What is the most serious form of spina bifida?

    <p>Myelomeningocele</p> Signup and view all the answers

    What can lead to increased bilirubin production in neonates?

    <p>Hemolytic disease (ABO incompatibility)</p> Signup and view all the answers

    Which condition is linked to decreased bilirubin clearance in newborns?

    <p>Prematurity</p> Signup and view all the answers

    Which factor is a potential complication resulting from bilirubin accumulation?

    <p>Kernicterus</p> Signup and view all the answers

    What should be included in the management of jaundice due to breastfeeding?

    <p>Assessing feeding frequency</p> Signup and view all the answers

    What role does bilirubin play in the body following red blood cell breakdown?

    <p>It serves as a waste product to be eliminated</p> Signup and view all the answers

    What complication arises due to polycythemia in newborns?

    <p>Increased red blood cell count</p> Signup and view all the answers

    What is a common impact of using tools like Betamethasone in premature infants?

    <p>Enhanced lung maturity</p> Signup and view all the answers

    What maternal substance exposure is most commonly associated with congenital abnormalities in newborns?

    <p>Alcohol</p> Signup and view all the answers

    Which withdrawal symptom is characteristic of a newborn exposed to opioids?

    <p>Hypertonia</p> Signup and view all the answers

    What is a significant risk for infants born to mothers who smoked during pregnancy?

    <p>Increased risk of Sudden Infant Death Syndrome (SIDS)</p> Signup and view all the answers

    Which condition is a baby likely to face if a mother is GBS positive and did not receive treatment during labor?

    <p>Sepsis</p> Signup and view all the answers

    What is the primary purpose of the Finnigan scoring tool?

    <p>To monitor neonatal abstinence syndrome</p> Signup and view all the answers

    Which of these substances is NOT typically linked to preterm birth?

    <p>Caffeine</p> Signup and view all the answers

    What is a common consequence of fetal alcohol syndrome on newborns?

    <p>Motor skill deficits</p> Signup and view all the answers

    Study Notes

    Nursing Tip of the Day

    • Trust your gut and advocate for your patient
    • Ask patients how they perform tasks at home
    • Ask patients for the most important information needed about them

    Newborn Complications

    Preterm Birth Rate

    • North Carolina's 2023 preterm birth rate was 10.7%, same as 2022
    • Black birthing people have a preterm birth rate 1.4 times higher than other racial groups

    Infant Mortality Rate

    • North Carolina's infant mortality rate decreased in the past decade
    • In 2022, 825 babies died before their first birthday
    • Infant mortality rate among Black babies is 1.7 times higher than the state rate

    Prematurity

    • Birth between 20.0 and 36.6 weeks is considered premature
    • Common problems include: respiratory distress, retinopathy of prematurity, patent ductus arteriosus, intraventricular hemorrhage, and necrotizing enterocolitis

    Management

    • Lung maturity (L/S ratio) is evaluated
    • Betamethasone (corticosteroids) may be administered
    • Respiratory support like thermoregulation, labs, and medications are part of the treatment
    • Parenteral nutrition and UAC/UVC are also part of the treatments
    • Support breastfeeding and encourage kangaroo care
    • Prevent infections

    Respiratory Conditions

    • Transient tachypnea of the newborn (TTN): Mild respiratory distress after birth usually resolving in hours to 3 days
    • Respiratory distress syndrome (RDS): Deficient surfactant and underdeveloped alveoli requiring surfactant and NICU care

    RDS: Signs/Symptoms

    • Tachypnea ( >60/min)
    • Retractions: intercostal, subcostal, substernal
    • Nasal flaring
    • Audible expiratory grunting
    • Decreased breath sounds
    • Crackles on auscultation
    • Skin gray to dusky; pallor
    • Lethargy
    • Tachycardia ( >160 bpm)
    • Hypoxemia

    Nursing: Respiratory assessment & support

    • Minimize oxygen demands as ordered to prevent hypoxemia
    • Assess breath sounds
    • Assess endotracheal tube placement
    • Suction airway as needed

    Retinopathy of Prematurity

    • Abnormal blood vessel growth that causes retina scarring.
    • Risk increases with less gestational age and lower birth weight.
    • Risks include less than 31 weeks of gestation, oxygen exposure, hypoxia, infections, and multiple gestation.

    Necrotizing Enterocolitis

    • Inflammation and necrosis of the bowel
    • Causes include altered intestinal blood flow, impaired gastrointestinal defense, and inflammatory responses
    • Fatal in 10-30 percent of cases
    • Symptoms include abnormal vital signs, abdominal distension, abdominal discoloration, feeding intolerance

    Birth Trauma

    • Common types include clavicle fracture (most common), humerus fracture, brachial plexus injury, facial injury (forceps-related injury), and facial paralysis.

    Risk Factors for Birth Trauma

    • Cephalopelvic disproportion
    • Maternal age (under 16 or over 35)
    • Primigravida
    • Preterm/post-term labor
    • Prolonged/precipitous labor
    • Oligohydramnios
    • Vacuum extraction/forceps-assisted delivery

    Key Nursing Assessments for Injuries

    • Head (swelling, bruising, molding): Does swelling cross a suture line?
    • Caput succedaneum
    • Cephalohematoma
    • Conjunctival Hemorrhage
    • Bruising, erythema, petechiae, abrasions, lacerations
    • Movement of extremities/reflexes
    • Symmetry of facial movements
    • Crepitus
    • Alertness/cry

    Different types of hemorrhage

    • Cephalohematoma: swelling that does not cross suture lines, jaundice can result. Could suggest skull fracture
    • Subgaleal Hemorrhage: extended to the neck, bleeding continues for days, elevated heart rate, decreased blood pressure, respiratory distress, diminished tone

    Outcomes for infants with injury

    • Protection from further injury
    • Comfort
    • Adequate perfusion to affected limb
    • Ability to feed
    • Maintenance of blood volume
    • Elimination of bilirubin from hemolysis

    Myelomeningocele

    • Most serious form of spina bifida
    • Requires surgical repair
    • Congenital anomalies

    Jaundice (Hyperbilirubinemia)

    • Increased bilirubin in the blood
    • Increased bilirubin production: hemolytic disease (ABO incompatibility), polycythemia, bleeding
    • Decreased bilirubin clearance: prematurity, breastfeeding issues, metabolic problems

    Jaundice (Hyperbilirubinemia) cont.

    • Physiologic jaundice (immature liver, breastfeeding): Increased unconjugated bilirubin, peaks at 3-5 days
    • Pathologic jaundice (ABO/RH incompatibility, infections): Present within 24 hours, persists beyond 10 days, can cause kernicterus if left untreated

    Newborn Jaundice

    • Red blood cells carry oxygen through fetal circulation
    • When babies breathe, they do not need all red blood cells
    • Red blood cells die faster, and create bilirubin, which causes jaundice if builds up in body.

    Risk Factors for Jaundice

    • Maternal factors: Asian, Native American, Greek descent, ABO incompatibility, RH incompatibility, breastfeeding, diabetes
    • Neonatal factors: Delayed cord clamping, delayed or infrequent feedings, excessive weight loss, bruising, prematurity, infections, cold stress

    Hemolytic Disease of Newborn

    • Rh incompatibility (less common and more severe): Rh-positive fathers and Rh-negative mothers
    • Invading Rh-positive blood cells cause production of Rh antibodies
    • Rh antibodies attack the Rh-positive baby's blood cells

    ABO Incompatibility

    • More common, less severe
    • If a mother with blood type O has an infant with a different blood type, the mother's anti-A or anti-B antibodies pass through placenta attacking the infant's red blood cells

    Management of Jaundice

    • Tests: Transcutaneous, Serum bilirubin, Coombs (DAT)
    • Interventions: Review for risk factors, assessments, testing per protocol, help with feedings, implement phototherapy, education
    • Phototherapy: Continuous treatment, maintain eye mask, only diaper, no lotions, and monitor newborn temperature. Frequent feedings

    Kernicterus

    • Acute bilirubin encephalopathy
    • Irreversible chronic bilirubin toxicity
    • Hyperbilirubinemia care prevents this

    Infant of a Mother with Diabetes

    • High maternal glucose leads to delayed surfactant production and high fetal insulin/glucose
    • The baby secretes large amounts of insulin, acts as a growth hormone
    • Excess stores of glycogen, protein, and adipose tissue lead to macrosomia

    Newborn with Hypoglycemia

    • Signs: Jittery, tachypneic, apneic, flushed, cyanotic
    • Prevention: Frequent feedings (q2H), parent education
    • Nursing interventions: Feed and reassess, administer glucose gel, monitor for seizure activity

    Post Term Infant

    • 42 weeks gestation

    • Higher risk of mortality and morbidity
    • Complications include an aging placenta and meconium aspiration, hypoxia

    Infections in the Newborn

    • Early-onset sepsis: Presents within 24-72 hours, transmitted prenatally/during birth
    • TORCH infections: Toxoplasmosis, other (hep B, syphilis, varicella-zoster, parvovirus, HIV), Rubella, CMV, Herpes
    • Late-onset sepsis: Presents in the first 7-30 days, transmitted during birth
    • Hand hygiene crucial/preventing acquired infections

    Neonatal Infection

    • Signs: fever, hypothermia, jaundice, increased work of breathing, apnea, tachycardia, hypotension, decreased perfusion, lethargy/irritability, vomiting diarrhea, abdominal distension, petechiae, and rashes
    • Importance of prevention: Assess maternal and newborn history for risk factors, astute assessment of newborn, obtain cultures, give antibiotics/antivirals.

    Neonatal Abstinence Syndrome (NAS)

    • Can manifest between 7-10 days old
    • Signs: irritability, diarrhea, temperature instability, yawning, tremor, increased muscle tone/reflexes, skin breakdown, vomiting
    • Care: Assessment of withdrawal signs (scoring), minimize stimulation, cluster care, swaddling, provide for rest while feeding, assess feedings, monitor VS, daily weights, assess materal/newborn interactions, educate mother

    Newborns Exposed to Substances

    • Alcohol, Tobacco, Caffeine, Opioids, Amphetamines, Heroin, Marijuana, Cocaine, resulting in congenital abnormalities, preterm, SGA, abruption, pPROM, increased risk of SIDS, NAS, low birth weight, placental abruption, decreased blood flow, preterm/IUGR/LBW, ADD, social interaction problems

    EAT-SLEEP-CONSOLE

    • Tool to assess feeding, sleep and consolability issues
    • 8-12 feeds per day with effective latch
    • Sleep for 1+ hour at a time.

    Neonatal Abstinence Scoring

    • Finnigan scoring tool – common tool used in assessing infants
    • High-pitched cries, sleeps <1+ hrs. after feeds, hyperactive Moro, increased muscle tone, excoriation, fever, frequent yawning, sweating, nasal stuffiness, sneezing, tachypnea, vomiting, poor feeding

    Case Study - Newborn Concerns

    • Concern for possible GBS, type I diabetes, maternal fever and untreated GBS during labor
    • Concern for jaundice (yellow skin with blanching) and potential underlying condition/infection (possible sepsis due to untreated GBS)

    Newborn Assessment

    • Findings that require further assesment: Vernix caseosa, Caput Succedaneum, Yellow Hue to skin, Intercostal Retractions, Blood sugar 39, Respirations 65, Erythema toxicum

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    Newborn Complications PDF

    Description

    This quiz assesses your knowledge of nursing care specific to premature infants. It covers key aspects such as complications, management strategies, and assessments needed for the health of these vulnerable patients. Test your understanding of essential nursing practices related to premature infants.

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