Newborn Complications PDF

Nursing Tip of the Day Always trust your gut and advocate for your patient Ask your patient, “how do you do this at home” Ask your patient, “what is the most important thing I need to know about you today”  NEWBORN COMPLICATIONS  Prematurity Birth at 20.0-36.6 weeks...

Nursing Tip of the Day Always trust your gut and advocate for your patient Ask your patient, “how do you do this at home” Ask your patient, “what is the most important thing I need to know about you today”  NEWBORN COMPLICATIONS  Prematurity Birth at 20.0-36.6 weeks Common Problems Respiratory distress Retinopathy of prematurity Patent ductus arteriosus Intraventricular Hemorrhage Necrotizing enterocolitis Newyork.cbslocal.com Review assessment findings on Pg 549-550 abortion - < 20 wks = sport, Management Support breastfeeding (pumping) Lung maturity (L/S ratio) - encourage mom , highly encourage ! Formula more rough - how immature are there lungs? > - amniocentesis Kangaroo Care Betamethasone (corticosteroids) - skin to skin - pre-maturity 60/min) (30 - 60) Lethargy; hypotonic - floppy baby Retractions: Tachycardia (> 160 chest Intercostal bpm) - sucking-in subcostal Hypoxemia substernal see-saw patterns Diagnosed by Chest x-ray Nasal flaring working harder - to breathe Audible expiratory grunting Breath sounds decreased Crackles on auscultation  Nursing: Respiratory assessment & support Minimize O2 demands…how? O2 as ordered Hypoxemia and acidosis may decrease surfactant production further. ThePostandCurrier Patent airway - suction Worldpress.com Assess breath sounds If endotracheal tube, assess placement Princetonhcs.org Suction airway as needed shutterstock.com may stimulate vagal nerve → bradycardia, hypoxemia, or bronchospasm Retinopathy of Prematurity ↑ risk younger gestation - = Management Abnormal blood vessel growth that eye exams can cause scarring of the retina Treatment based on severity Risk increases as gestational age and Nursing actions- reduce risks birth weight decrease. O2 based on pulse oximetry Risks O2 blenders Cair + 02 Start 821 % hypoxia Infections Multiple gestation  Necrotizing Enterocolitis Results in inflammation and necrosis of the bowel Causes: altered blood flow in intestines, impaired GI defense, alterations in inflammatory response Fatal in 10-30% of cases Symptoms: abnormal V.S., abdominal Signs distension, abd discoloration, feeding Lethargy intolerance Apnea and bradycardia Blood in stool Human milk reduces risk Temperature instability Abd distension, tenderness - got rest if suspicious Visible bowel loop Clavicle Fracture Humerus Fracture (most common) Birth Trauma https://europepmc.org/article/pmc/pmc6491540 Brachial Plexus Injury Facial Injury d/t Forceps Facial Paralysis (palsy) Sciencebasedmedicine.org Risk Factors for Birth Trauma Types of Birth Trauma -head] pelvis Cephalopelvic disproportion Soft tissue injuries Scleral and retinal hemorrhage Maternal age under 16 or over 35 Skull Fracture Primigravida Shoulder dislocation Pre-term or post-term labor Clavicle fracture Prolonged or precipitous labor Brachial plexus injuries - no cushion cord Facial paralysis Oligohydramnios around Caput succedaneum/cephalhematoma Vacuum extraction Intracranial hemorrhage Forceps-assisted delivery  note any injury ? - Key Nursing Assessments for Injuries - capput : crosses Suture Head: swelling/bruising/molding Does the swelling cross a suture line? Caput succedaneum swelling - Cephalohematoma eblecting Conjunctival hemorrhage Bruising, erythema, petechiae, abrasions, lacerations Movement of extremities/reflexes - symmetrical ? Symmetry of facial movements Crepitus Alertness/cry Different types of hemorrhage Cephalohematoma Does not cross suture line Should suspect skull fracture Can contribute to jaundice - blood breakdown Subgaleal Hemorrhage Extends to neck Bleeding continues for days Can cause jaundice, blood volume -call HCP ! loss, and worse Elevated heart rate https://europepmc.org/article/pmc/pmc6491540 Decreased blood pressure, in infants Respiratory distress Diminished tone - can cause jaundice - ↓ BP =↑ HR  Outcomes for infants with injury - stabilize Protection from further injury - pain Yiliphotography.com Comfort - Sweatease/Tylend pulses? - Adequate perfusion to affected limb - - eat ? rest ? J - able to Ability to feed - a re we able Pinterest.com Maintenance of blood volume to get bili out Elimination of bilirubin from hemolysis  Myelomeningocele Most serious form of spina bifida Requires surgical repair See Table 17-7 pg 582 for common congenital anomalies - cover positioning - - FA intake!" ↳ supplement ↳ cereal , grains  Jaundice (Hyperbilirubinemia) Increased bilirubin in blood Increased Bilirubin Production Or - Decreased Bilirubin Clearance Hemolytic Disease (ABO Prematurity incompatibility) - immature liver Breastfeeding Polycythemia (a RBC) - amount Metabolic disorder Bleeding/Bruising Rh incompt -. Jaundice (Hyperbilirubinemia) Physiologic (immature liver, breastfeeding) Increased unconjugated bilirubin Peaks at 3-5 days, depending on ethnicity Ja after Pathologic (ABO/RH incompatibility, infections) Present within 24 hours of birth Persists beyond 10 days if untreated, can lead to kernicterus J-24h - mor serious - goal to prevent - Coorbs  Newborn Jaundice Red blood cells are needed to transport O2 Babies need a lot of RBCs to carry oxygen through fetal circulation Once they breath they don’t need a huge amount of RBCs NB RBCs have a shorter life span, so the RBCs break down and produce bilirubin When bilirubin builds up in the body, it causes Jaundice  Risk Factors Neonatal Maternal Delayed cord clamping Asian, Native American, Greek Delayed or infrequent feedings ABO incompatibility Excessive weight loss RH incompatibility Bruising Breastfeeding Prematurity Diabetes Infections Cold stress Hemolytic Disease of Newborn- RH incompatibility- less common, more severe Britanica.com ABO Incompatibility- more common, less severe If mom is blood type O she will develop anti A and Anti B IgG ↓ Anti A will pass through placenta and attack infants RBC ↓ Causes increase in hemolysis Can occur in first pregnancy -patho jaundice. Management of Jaundice Management is same for different types of jaundice Tests Nursing Interventions Transcutaneous Review for risk factors Serum bilirubin Assessments Coombs (DAT) > - antibodies Testing per protocol present ? Help with feedings Phototherapy Implement phototherapy Feedings Education Exchange transfusion Follow up in 1-2 days Uptodate.com Phototherapy Education Continuous treatment Maintain eye mask for eye protection Only diaper No lotions of ointments Monitor newborn temperature Frequent feedings  Kernicterus Acute bilirubin encephalopathy Irreversible chronic sequela of bilirubin toxicity All hyperbilirubinemia care is aimed at preventing this! Bilirubin normally bound to albumin (and carried to liver to be conjugated) Healthjade.net Once albumin binding sites are saturated, unconjugated (indirect) bilirubin circulates freely and is lipid soluble and capable of crossing blood brain barrier, becomes toxic to brain  - themoreg. Fetal pancreas secretes insulin – Infant of a Mother with Diabetes - - blood catch suger hypoglycemia episodess 10-14 weeks Responds to maternal High maternal glucose ->delayed Concern? hyperglycemia surfactant production d/t high fetal Assessment? insulin &/or glucose Secretes large amounts of insulin After birth: What happens? What assess for? Acts as growth hormone Excess stores of glycogen, protein and Macrosomia Assessment r/t the adipose tissue large size? Newborn with hypoglycemia Nursing Interventions Feed and reassess Signs of Administer glucose gel > - feedings don't > In mouth work - hypoglycemia Monitor for seizure activity Jittery Tachypneic Prevention is key!! Apneic Early and regular Flushed feedings Cq2H) Cyanotic Parent education if sls of hypoglycemia Wake to feed if necessary  Assessment findings Post term infant Dry, peeling, cracked skin Lack of vernix >42 weeks Hair Higher risk of mortality and Long fingernails morbidity Meconium staining aging placenta > - doesn't function as should Complications Meconium aspiration Hypoxia - late decels  Infections in the Newborn - dormant “Early onset sepsis” (congenital) “Late onset sepsis” Presents 24-72 hours after birth Presents 7-30 days of age Transmitted during birth process Syphilitic lesions Transmitted prenatally or during Hand hygiene birth Acquired through contacts or medical TORCH interventions Toxoplasmosis (parasite) Nosocomial…attend to what nurse can do Other (hep B, syphilis, varicella- to decrease incidence zoster, parvovirus, HIV) Rubella CMV (cytomegalovirus) Herpes Group Beta Strep transmitted prenatal/ birth Primary cause of neonatal sepsis and - meningitis in U.S. (Sepsis Calculator) CMV  Neonatal Infection Nursing Interventions infection now ? an -prevent Assess maternal and newborn Importance of prevention Signs of Infection history for risk factors Astute assessment of Fever or hypothermia newborn Jaundice Obtain cultures, as ordered Increased work of breathing Administer Apnea antibiotics/antivirals as Tachycardia ordered Hypotension Administer feedings, parental Decreased perfusion nutrition, and IV fluids, as Lethargy/irritability ordered Vomiting diarrhea Breastfeeding, except in HIV Abdominal distension Educate parents Petechiae and rashes Neonatal Abstinence Syndrome Can manifest late (7-10 days of age) Irritability Diarrhea Temp instability Care of Infant Experiencing Yawning Astute assessment of withdrawal signs (scoring) Tremor Minimize stimulation and environmental stimuli! Cluster care> - lessstimulation Increased muscle tone/reflexes Swaddling Provide for rest during feedings Skin breakdown Assess feedings; gavage if needed Vomiting Daily weights Monitor v.s. Assess maternal-newborn interaction Textbook Educate mom; involve her in newborn care Signs of withdrawal: p. 578-579 F Newborns exposed to substances Alcohol Opioids: Amphetamines Congenital abnormalities Most popular: morphine, Preterm Fetal Alcohol Syndrome heroin, meperidine, SGA Withdrawal (tremors, oxycodone, codeine, fentanyl, Infections hypertonia, poor feeding) Withdrawal symptoms Poor weight gain Failure to thrive Cognitive, memory, motor skill problems Tobacco Heroin Marijuana Preterm IUGR/Prematurity Preterm IUGR/SGA Meconium Aspiration IUGR Abruption Neurodevelopmental Low birth weight PPROM problems ADD Increased Risk of SIDS NAS Social interaction problems ADD SIDs Caffeine Cocaine Miscarriage Placental abruption Low birth weight Decreased blood flow Preterm/IUGR/LBW  The 6 Ss to Calm a baby 1. Skin to Skin 2. Swaddle 3. Sucking 4. Shushing 5. Side lying 6. Swinging OHSU- Project Nurture  Neonatal Abstinence Scoring Finnigan scoring tool – most common tool used Q3hours or with feeds You are caring for a newborn male who was delivered three hours ago. A review of the mother’s history reveals that she is a G2 P1, has Type I diabetes and is GBS positive. She came into the Labor and Delivery unit two hours before she delivered so was not treated for her GBS during labor. The infant was 9 lbs. 8 oz. and was delivered vaginally. His mother ran a temperature of 101.6 while in labor. You have been working with him since his admission and notice that he is developing a yellow appearance to his skin with blanching. What are your concerns in this scenario? The infant has not been feeding well and is now jittery. What are you concerned about? What are your priority interventions? Newborn Assessment Finding Requires follow up No follow up needed Vernix Caseosa Caput Succedaneum Yellow hue to skin Intercostal retractions Respirations 65 Blood Sugar 39 Erythema Toxicum