Neonatal Health Problems PDF

# Common problems of high risk neonates ## Prematurity ### Definition of premature newborn: The premature newborn is a baby born before completion of 37 weeks of gestation. The cause of pre-maturity is unknown. ### Predisposing Factors of Premature Newborn: - Mothers' age less than 17 years or ov...

# Common problems of high risk neonates ## Prematurity ### Definition of premature newborn: The premature newborn is a baby born before completion of 37 weeks of gestation. The cause of pre-maturity is unknown. ### Predisposing Factors of Premature Newborn: - Mothers' age less than 17 years or over 35 years. - Toxemia of pregnancy. - Multiple births; - Ante-partum hemorrhage. - Premature rupture of membrane. - Chronic maternal malnutrition. - Cardiac disease and hypertension of the mother. - Maternal diabetes mellitus. - Acute or chronic infection. - Inadequate antenatal care. - Abnormality of the pelvis. - Exposure to radiation during pregnancy. - Fetal abnormality\. ## Characteristics of Premature Newborn: Identification of these characteristics provides valuable clues to the gestational age and hence to the physiologic capabilities of newborns. - Premature newborn is small in size with large head in proportion to the whole body. - Hair is fine and fuzzy on the head. - Subcutaneous tissue is deficient. - Skin is thin, wrinkled, red, and smooth and clearly visible blood vessels. - Excessive lanugo and no or/ little vernix caseosa. - Eyes are prominent and the ear cartilage is soft and easily folded. - Thorax is less firm. - Breast tissue is minimal (less than 10 mm in diameter), nipple flat and barely seen. - Abdomen is protruded. - Extremities and muscles are thin and small. - Small genitalia, as male newborn have few scrotal rugae and testes are un-desecnded. Female newborn has separated libia majora and libia minora are protruding. - Soles and palms have minimal creases. - Short and soft finger nails and toenails. - Premature newborn is inactive and has a weak cry with extremities extended. ## Physiological Reasons for Premature Newborn Maladaptation: Pre-maturity accounts for the largest number of admission to an N1CU. The pre-mature newborn is at risk because of immaturity of organ system and lack of reserves ### 1-Respiratory function: There is a numerous deficits in the respiratory system: - Decreased number of alveoli. - Deficient surfactant levels. - Smaller lumen in the respiratory system. - Greater collapsibility of respiratory passages. - Immature and friable capillaries in the lungs. ### 2-Cardiovascular function: The nurse must be prepared to intervene if symptoms of hypovolemia, or shock, are present as indicated by decreased blood pressure, slow capillary refill and continued respiratory distress. ### 3-Central nervous system function: The premature newborn CNS is susceptible to injury from various sources: - Birth trauma with damage to immature structures. - Bleeding from fragile capillaries. - Impaired coagulation process, including prolonged prothrombin time. ### 4-Renal function: The premature newborn immature renal function is unable: - Adequately excrete metabolites. - To concentrate the urine. - To maintain the balance in acid-base, fluids, or electrolytes. ### 5-Hematologic status: The premature hematologic problems raised as a result of the following factors: - Increased capillary friability. - Increased tendency to bleed. - Slowed production of red blood cells (because of rapid decrease in erthyropoiesis after birth). - Loss of blood from frequent laboratory tests. - Decreased red blood cell survival related to relatively larger size of the RBC and increased permeability to sodium and potassium. ## Therapeutic Management: Newborns who do require resuscitation are transferred immediately to the NICU in a heated incubator where they are weighed. Intravenous lines, 02 therapy, and other therapeutic interventions are initiated as needed. Subsequent care is determined by the status of newborn. ## Nursing Consideration: The nursing care, like the therapeutic management is individualized for each newborn (see nursing care of high -risk newborn). # Postmaturity ## Defination of post-term newborn Post-term newborns are those born after 42 weeks of gestation, calculated from the mother's last menstrual period. ## Etiology: Causes: unknown. ## Incidence: nearly by 12% of all pregnancies extend beyond 42 weeks of gestation. 1. Placenta develops completely by 5th month of gestation and achieves peak function by 36 week's gestation. Placental growth continues then at a slow rate, with a decrease noted after 42 week's gestation, which may lead to post maturity. 2. Delay placental maturation due to maternal systemic diseases, uterine anomalies, placenta abnormalities, and fetal factors (e.g. multiple gestation), which alter placental function. 3. Placental dysfunction results in compromised blood supply to the fetus. ## The fetus is at risk for: - a-Nutritional deficiency. - b-Hypoxia. - c-Asphyxia. ## The fetus may show evidence of growth retardation. ## Nursing Management: ### 1-Assessment: 1. Assessment of the maternal history. 2. Assess gestational age. 3. Physical examination to identify post-mature characteristics: - Pale, dry, cracked, wrinkled skin. - Skin maceration, especially skin in folds. - Loose skin, especially around the thigh and buttocks, giving them the appearance of having recently lost weight. - Long nails. - Absent lanugo hair. - Abundant hair (scalp hair). - Hardness of skull. - Decrease or absence of vernix caseosa. - Long, thin arms and legs, decreased subcutaneous tissue. - Meconium -stained nails, skin, vernix, and umbilical cord. - Appearance of hypoglycemia: Assess raised problems such as meconium aspiration, hypoglycemia, and hypocalcaemia. ### 2-Nursing Diagnosis: Altered growth and development related to placental insufficiency as evidence by post-maturity syndrome. - High risk for respiratory distress; hypoglycemia, hypocalcaemia. - High risk for impaired 'skin integrity related to altered nutritional state (post-maturity syndrome). ### 3-Implementation: - Provide care individually according to each newborn's needs. - Observe signs and symptoms of respiratory distress. - Take temperature. - Monitor serum glucose. - Observe signs and symptoms of hypoglycemia because of limited glycogen stores. - Monitor serum calcium.