OB exam 3 - anemia, FSA, drug exposure

common causes of neonatal anemia

blood loss during perinatal period

hemolysis

impaired RBC production

long term repeated blood draws

neonatal anemia management

cardiac and respiratory monitoring

transfusion if unstable'adequate hydration

treat underlying cause

risks to newborn of substance abusing mother

respiratory distress

jaundice

congenital things

IUGR

behavioral abnormalities

withdrawal

- high pitched cry, not consolable, jittery movements

fetal alcohol syndrome

ak FAS

non genetic intellectual disability

CNS dysfunction

- microcephaly

- developmental delays

facial malformations

failure to thrive

abnormal palmar creases

cardiac defects

learning difficulties

behavioral problems

newborn treatment for drug exposed infants

serum testing for syphilis, HIV, hep B

urine drug testing

meconium analysis

social service referral

collection of meconium baby passes before first transitional stool

- tells us how long the mother was doing drugs during her pregnancy

nutritional support

what is a common effect of respiratory distress

baby becomes hypoxia so O2 is shunted to vital organs, NOT the gut because the gut is not vital, which leads to NEC (necrotizing enterocolitis)

this is why nutritional support is important with substance abuse because substance abuse can lead to hypoxia then NEC

neonatal abstinence syndrome

aka NAS

may appear normal at birth

when does s/s of withdrawal with heroine occur

12 - 24 hours after birth

when does s/s of withdrawal occur with methadone

1 - 2 days or up to 1 week after birth

when are withdrawal s/s most pronounced

48 - 72hrs

what is methadone used for

to wean a heroin addict off of heroin

effects of cocaine on newborn

neurobehavioral disturbances

marked irritability

poor feeding

exaggerated startle reflex (moro)

labile emotions - irritability, sleeping and hard to wake up

increased risk of SIDS

CNS s/s of newborn withdrawal

irritability

high pitched cry

incessant cry

tremors

hypertonicity

hyperactivity

increased moro reflex

convulsions

disturbed sleep patterns

metabolic s/s of withdrawal

temperature instability

yawning

nasal flaring

tachypnea

sweating

sneezing

GI s/s of withdrawal

poor feeding

vomiting

diarrhea

frantic sucking

regurgitation

NAS management

reduce stimuli

use neonatal abstinence scoring system

phenobarbital, morphine

cluster care

swaddle

tegaderm on knee to protect from abrasion

psychosocial considerations for NAS

neonatal addiction is child abuse

CPS notification

- is positive for neonatal drug screening

- usually not for marijuana use

counseling

court ordered rehab

home services for infant with special needs

divorce common for parents with children with special needs or high maintenance health care

infant of the mother with HIV/AIDS

same care as all newborns but includes

- bath ASAP after birth

* if the baby tests HIV positive it may be a false positive so repeat the HIV testing in 6 months

why does the baby test positive for HIV for first 6 months

the baby's serum levels have the mom's viral load for first 6 months

still give antiviral meds to baby

make sure you protect skin portal entries from opportunistic diseases