Ch. 8 Mini Lecture: Health Problems Of Newborns

Vocabulary flashcards covering maternal and intrapartum risk factors, birth injuries, head trauma, cranial and craniofacial deformities, dermatological conditions, metabolic disorders, and teratogenic factors in newborns.

Maternal and Intrapartum Factors

Uterine Dysfunction, prolonged and precipitous labor, cephalopelvic disproportion (CPD), Dystocia, macrosomia, multifetal gestation, and instrument-assisted deliveries are all maternal and intrapartum factors that can lead to complications during childbirth and affect the health of the newborn.

Uterine dysfunction

Ineffective uterine contractions, either too weak or too strong, that can cause rapid fetal descent during labor.

Prolonged labor

Extended labor that exposes the fetus to prolonged compression and decreased perfusion.

Precipitous labor

Abnormally short labor that causes rapid passage through the birth canal, increasing the risk of trauma.

Cephalopelvic Disproportion (CPD)

A condition occurring when the fetal head is too large and the maternal pelvis is too small for safe passage.

• Increases the likelihood of instrument-assisted delivery 

Dystocia

Difficult labor often caused by abnormal fetal presentation, maternal anatomy, or uterine issues.

• Increases the likelihood of instrument-assisted delivery 

Macrosomia

A large baby born with an increased likelihood of experiencing shoulder dystocia, clavicle fractures, and nerve injuries.

Multifetal gestation

twins or triplets may present abnormally or compete for space

Instrument-assisted delivery

forceps, vacuum extraction; these tools can be life-saving, but they also increase the likelihood of scalp trauma, nerve injuries, and fractures

Maternal and Intrapartum Factors NCLEX Pearl:

When seeing any of these risk factors mentioned, assume the likelihood of head trauma, nerve injury, fractures, or soft tissue damage

Soft tissue injuries

The most common and least concerning birth injuries, often caused by pressure during labor or prolonged pushing (e.g., petechiae, ecchymosis, lacerations).

• Nursing priority: maintain asepsis, document the injury, assess, and reassure parents

Petechiae

Tiny red or purple spots on the skin caused by small capillary ruptures during delivery.

Ecchymosis

Bruising that occurs when blood accumulates under the skin.

Lacerations

Skin cuts that may occur in newborns due to instrument-assisted deliveries or sharp fingernails immediately after birth.

Soft Tissue Injury NCLEX Pearl

Soft tissue injuries are usually benign, but accurate documentation and parental reassurance are essential nursing responsibilities 

Head Trauma Types

include caput succedaneum, cephalohematoma and subgaleal hemorrhage

Caput Succedaneum

Soft, edematous swelling of the scalp that crosses suture lines; benign and resolves on its own within a few days without treatment (least concerning).

• Caused by prolonged pushing/pressure during labor or vacuum extraction

Cephalohematoma

A collection of blood between the skull bone and the periosteum that does not cross suture lines; increases the risk of hyperbilirubinemia and jaundice.

• Monitor bilirubin levels closely; may require phototherapy if jaundice develops

Subgaleal Hemorrhage

A dangerous accumulation of blood in the subgaleal space that can lead to hypovolemic shock.

• These infants can lose enough blood to develop hypovolemic shock. Signs include pallor, tachycardia, hypotension, and a rapidly enlarging head circumference; this requires immediate medical attention 

Head Trauma NCLEX Pearl

Cephalohematoma increases jaundice risk, a subgaleal hemorrhage is a shock risk, a caput succedaneum is benign

Fractures and Nerve injuries

Often occur during difficult deliveries, especially those involving macrosomia or shoulder dystocia 

• Include clavicle fractures, facial paralysis, Brachial Palsy (Erb), and phrenic nerve paralysis

• Nursing care focuses: feeding support, positioning, and patient ed. (reassurance that most of these conditions improve significantly with time and care) 

Clavicle fracture

The most commonly fractured bone in newborns, characterized by decreased arm movement on one side, crepitus, or an asymmetrical Moro reflex.

• heal quickly with minimal intervention; usually just gentle handling and positioning

Facial Paralysis

May occur after forceps delivery and typically resolves over time

Brachial palsy (Erb)

Nerve injury causing decreased movement of the affected arm, leading the infant to hold the arm in a characteristic 'waiter's tip' position.

• early physical therapy and proper positioning are essential  

Phrenic Nerve paralysis

A serious nerve injury that affects breathing, leading to respiratory distress or asymmetric chest movement in the newborn.

• requires close monitoring and respiratory support 

Cranial Deformities

conditions can be congenital or acquired and often require early intervention to prevent long-term complications

• Such as microcephaly and craniostenosis

Microcephaly

A condition where head circumference is significantly smaller for gestational age, often reflecting underlying brain growth restriction.

• Closely monitor developmental milestones and support families as they navigate early intervention strategies 

Craniostenosis

Premature closure of one or more cranial sutures, which compresses the brain and increases intracranial pressure, requires surgical correction.

• Management: early identification, monitor H/H (hematocrit/hemoglobin) post-op because blood loss can occur, helmet therapy to guide skull shaping, family support

Cranial Deformities NCLEX Pearl

Persistent abnormal head shape, delayed or early closure sutures requires further evaluation; early intervention is key to prevent complication 

Craniofacial Deformities

Primarily effect feeding and airway stabilization

• Pierre Robin Sequence, Cleft Lip, and Cleft Palate

Pierre Robin sequence

A condition characterized by a small lower jaw, a tongue that falls back toward the throat, and often a cleft palate, presenting high risk for airway obstruction when supine.

• Many infants do better in a prone or side-lying position to keep the airway open 

Cleft Lip

A common congenital abnormality where the primary challenge for the infant is maintaining a good seal during feeding.

Cleft Palate

A common congenital abnormality where the primary challenge for the infant is generating suction during feeding.

Cleft Lip and Cleft Palate

• Nurses play a big role in teaching parents how to use modified nipples, support the cheeks and chin, and maintain a stable feeding rhythm

• Post-op care: protect suture line is top priority after surgery, protect airway, positioning, and pain control… avoid anything that could disrupt healing such as pacifiers, spoons, and no fingers in the mouth

• Infants should not be placed prone after surgery because pressure on the face can damage repair; pain control is essential to prevent crying which can damage repair and increase tension on the suture 

Post-op Cleft Repair NCLEX Pearl

Protect the airway, protect the suture line, and prevent oral devices

Dermatological conditions

These are common, and most are benign, however, some require prompt treatment to prevent complication

• Ex: Erythema toxicum, Candidiasis (thrush), HSV (Herpes Simplex Virus), Bullous impetigo, and Birthmarks

Erythema toxicum

A harmless, self-limiting 'newborn rash' appearing as small yellow or white papules surrounded by red skin, typically resolving within a week without treatment; the most important nursing intervention is reassurance

Candidiasis (thrush when it appears in the mouth)

An infection appearing in the mouth as a white plaque that does not wipe off, requiring treatment with Nystatin and sterilization of nipples, pacifiers, and bottle parts to prevent infection; the parent also needs treatment if they have symptoms

HSV (Herpes Simplex Virus)

Much more serious; infants can acquire this during delivery if the birthing parent has active lesions

• HSV can cause localized skin lesions or progress the systemic infection including encephalitis (infection of the brain)

• Infant requires anti-viral treatment and close monitoring, early recognition is critical 

Bullous impetigo

A highly contagious bacterial skin infection characterized by fluid-filled blisters that requires antibiotic treatment and strict hygiene.

Birthmarks

Ex hemangioma or Café-au-lait spots

• may require monitoring based on size and location; some birth marks are associated with genetic syndromes; documentation and follow-up are important

Thrush NCLEX Pearl

Thrush = plaque that does not wipe off; treat infant and sterilize equipment 

Hyperbilirubinemia

One of the most important topics in newborn care: physiologic Jaundice appears after the first 24 hrs of life due to immature liver enzymes and increased red blood cell turnover.

•  Breastfeeding patterns can also contribute if intake is low in the first few days

• Key concern is the risk of bilirubin crossing the blood-brain barrier, leading to kernicterus (a form of permanent brain damage); early recognition and treatment are essential

• primary treatment is phototherapy; this helps convert bilirubin into a form that can be excreted 

• Management: phototherapy, hydration, eye protection, monitor temperature, check bilirubin levels frequently, keeping the infant undressed except for a diaper to maximize skin exposure

Kernicterus

A form of permanent brain damage caused by excess bilirubin crossing the blood-brain barrier.

Jaundice NCLEX Pearl

Jaundice before 24 hrs is pathological and requires immediate intervention, jaundice after 24 hrs is physiological and requires monitoring 

Hemolytic Disease

Occurs in newborns when maternal and fetal blood types are incompatible, leading to the destruction of fetal RBCs

• Two major causes: Rh incompatibility and ABO incompatibility 

Rh incompatibility

A hemolytic disease occurring when an Rh-negative mother develops antibodies against an Rh-positive fetus, potentially leading to severe anemia, Hydrops fetalis, or fetal death in subsequent pregnancies.

• If isoimmunization occurs during pregnancy, the fetus may require intrauterine transfusion and after birth infants may need exchange transfusion to remove the antibody coated red blood cells and reduce bilirubin levels

• The most important intervention is prevention: RhoGAM

RhoGAM

An injection given to Rh-negative mothers at 28 weeks and within 72 hours postpartum if the infant is Rh-positive to prevent isoimmunization.

• Rh-negative mothers receive RhoGAM at 28 weeks and within 72 hrs post-partum in infant is Rh-positive; RhoGAM prevents the mother from forming antibodies  

ABO incompatibility

A mild hemolytic disease occurring when the mother has type O blood and the fetus has type A or B blood, commonly leading to jaundice.

• Less severe; but typically do not experience severe anemia

RhoGAM NCLEX pearl

Rho Gam prevents iso-immunization, give within 72 hrs post-partum

Neonatal Hypoglycemia

A state where newborn blood glucose is $<40\text{ mg/dL}$ in a term infant, with jitteriness as the hallmark sign, requiring immediate feeding as first-line intervention.

• Other s/s: lethargy, poor feeding, apnea, cyanosis, or even seizures; symptoms can be subtle so nurses must be vigilant, a jittery newborn must always prompt a glucose check

• Breastfeeding or bottle-feeding is the first-line intervention for mild hypoglycemia, if the infant cannot feed effectively or if the insulin levels remain low, we may also use glucogel (Glucose gel) or initiate IV dextrose; goal is to stabilize glucose levels and prevent neurologic injury  

• Nursing responsibilities include: identifying the underlying cause, reducing environmental stressors, supporting effective breastfeeding, and monitoring for comorbidities such as hypothermia or respiratory distress

Hypoglycemic Risk Factors

• having a diabetic mother: they are exposed to high maternal glucose levels in utero which stimulates their pancreas to produce extra insulin, after birth the maternal glucose supply stops abruptly but the infants insulin remains high causing a rapid drop in blood glucose 

• SGA infants 

• Preterm infants 

• Infants experiencing prenatal stress such as birth asphyxia or sepsis 

Hypoglycemic NCLEX Pearl

A jittery baby is hypoglycemic until proven otherwise and the first intervention is to feed the infant 

Neonatal Hyperglycemia

Elevated blood glucose is defined as $>125\text{ mg/dL}$ in term infants or $>150\text{ mg/dL}$ in preterm infants, which can cause glycosuria, dehydration, and osmotic fluid shifts.

• Primarily affects preterm infants and those receiving IV glucose; these infants have immature pancreatic function and limited ability to regulate insulin secretion, which makes them more vulnerable to elevated blood sugar levels

• Management: frequent blood glucose monitoring especially in preterm infants or those receiving IV fluids, monitor urine output because glycosuria can lead to dehydration, and provide parent support educate that hyperglycemia is often temporary and manageable

Hyperglycemia NCLEX Pearl

Hyperglycemia is defined differently for preterm and term infants, know the numbers, and monitor urine output closely 

Neonatal Hypocalcemia

Metabolic imbalance newborns can experience, especially during the first few days of life; calcium plays a big role in neuromuscular function so low levels can lead to significant symptoms

• There are two types: early onset and late onset hypocalcemia

• S/S include: jitteriness, seizures, apnea and sometimes stridor due to laryngeal spasm; these symptoms can mimic hypoglycemia which is why nurses must consider both conditions when assessing a symptomatic newborn 

• Management: calcium supplementation, Vitamin D and Phosphorus, and seizure precautions (maintain safe environment, close monitoring, and preparing for an emergency interventions) 

• Nursing responsibilities: identify infants at risk, observe for neuromuscular symptoms, administering supplements as ordered, and providing anticipatory guidance to families

Early onset hypocalcemia

A metabolic imbalance occurring within the first $48\text{--}72\text{ hours}$ of life, common in infants of diabetic mothers, preterm infants, and those experiencing birth asphyxia.

Late onset hypocalcemia

A metabolic imbalance appearing after the first week of life, typically associated with high phosphate intake like cow's milk or underlying endocrine disorders.

Hypocalcemia and Hypoglycemia NCLEX Pearl

Hypocalcemia and hypoglycemia can look identical so always check both in a newborn 

Hemorrhagic Disease of the Newborn

A bleeding disorder caused by Vitamin K deficiency due to immature gut flora and low stores at birth, preventable by a Vitamin K injection shortly after delivery.

• vitamin K is essential for clotting synthesis

• 2 forms: early onset and late onset

• Clinical S/S include: bruising, bleeding from the umbilical stump, gastrointestinal bleeding, or more serious complications like intracranial hemorrhage 

• Most important intervention is prevention: Vitamin K injection shortly after birth which significantly reduces the chances of newborn bleeding 

• Nurses responsibilities: administering Vitamin K, documenting the dose, and educating parents 

• Treatment if hemorrhagic disease does evolve: Vitamin K administration and supportive care, early recognition is essential  

Hemorrhagic Disease Early onset

Occurs within the first 24 hr, often caused by maternal medications that interfere with Vitamin K metabolism, such as an anticonvulsant and an anticoagulant

Hemorrhagic Disease Late onset

Occurs after the first week and is exclusively common in infants that are breastfed and don’t receive Vitamin K prophylaxis

Vitamin K NCLEX Pearl

Vitamin K prevents intracranial hemorrhage, never skip it

Environmental and teratogenic factors

Chemical agent risks: alcohol (most common preventable teratogen), drugs, and medications

• Also infections and radiation

Alcohol

Prenatal alcohol exposure can lead to Fetal Alcohol Spectrum Disorder which includes: growth restriction, microcephaly, and long-term neurodevelopmental challenges.

• most common preventable teratogen

Alcohol NCLEX Pearl

Alcohol is the most common preventable teratogen, early recognition and prevention are key 

Medications

Anticonvulsants, anticoagulants, and acne medications are known to cause congenital anomalies 

• Preconception counseling and careful medication review during pregnancy are essential

Illicit drugs

• opioids, cocaine, methamphetamines can lead to withdrawal symptoms in newborns known Neonatal Abstinence Syndrome (NAS)

• infants may experience irritability, tremors, feeding difficulties, and respiratory issues 

• Nursing care: minimize stimulation, support feeding and monitoring withdrawal scores 

Neonatal Abstinence Syndrome (NAS)

A group of withdrawal symptoms (irritability, tremors, feeding difficulties, respiratory issues) in infants exposed to illicit drugs like opioids, cocaine, or methamphetamines in utero.

Infectious Diseases

Rubella, Cardiomegaly virus, Toxoplasmosis, and Herpes can cross the placenta or be transmitted during delivery; these infections may cause genetic anomalies, growth restriction, or neurologic impairments

• Nurse’s role: identify infants at risk and ensure appropriate testing and follow up

Radiation

High levels of radiation exposure can have mutagenic or teratogenic effects, especially during early pregnancy when organ systems are forming

• Key nursing intervention: prevention and education, assessment of exposed infants, and avoid unnecessary radiation