ch 17 - neonate complis (NICU)

what is a direct trip to the NICU

any baby that is prematurely born

premature timeline

• extreme: less then 28 wks

• very: 32-33 wks

• premature: 32-33 wks

• late premature: 34-36 wks

preterm neonate risk factors

• mom’s having hx of preterm birth (unless baby dad different)

• multiple gestation

• teen/mature pregnancy

• IVF

• ethnicity

prematurity is the primary reason for

low birth weight

preterm neonates have a high risk for

brain bleeds

ballard score

determines gestational age

• v prominent in NICU babies

assessment findings in preterm neonates

• thin skin — high risk of infection/tearing

• not a lot of subcutaneous fat, and can’t shiver — keep them warm!

• v little lanugo

• hands and feet are creased (indications of how young)

• eyes fused if v young

what can babies not do before 34 wks and what do you till then

cannot s*ck, swallow, and breathe at the same time

• must feed through the IV instead

what will be delayed, or much later due to their age?

milestones and reflexes

neonate resp and cardio to know

• babies will have a lot of secondary apnea

• heart murmurs bc everything is still open (should still be in the womb!)

• very low bp!

• baby wants to be in fetal circulation but is in neonatal circulation

what tests assess lung maturity

LS ratio and PG

• determines if baby can survive outside the womb and if mom needs to deliver early

  • shows if baby is not doing well inside the womb

• blood gases should be the same as adult

neonatal respiratory distress syndrome

life threatening emergency

• d/t lungs not mature enough — insufficient surfactant and underdeveloped alveoli

• sx: hypoxemia, hypercarbnia (too much CO2), rt to lt shunt, vasoconstriction

• baby is not doing well outside of womb

signs of respiratory distress

• tachypnic

• nasal flaring

• retracting

• low o2 sat, cyanosis

• audible expiratory grunting

• no urine output

medical management of respiratory distress syndrome (RDS)

surfactant replacement

• to help close the alveoli

respiratory distress syndrome (RDS) nursing actions

• patent airway

• maintain neutral thermal environment (NTE) to prevent cold stress

• suction to remove secretions

• administer O2

• monitor I&O, VS, abx

no O2 can cause the baby to what

go blind

RDS can lead to

Brochopulmonary dysplasia (BPD)

Brochopulmonary dysplasia (BPD)

affects neonates treated with prolonged mechanical ventilation and oxygen

• can’t get rid of it after they get it

• chronic lung disease

Brochopulmonary dysplasia (BPD) risk factors

• young baby

• prolonged periods of mech vent

• too much O2 (force of intubation)

• infection

Brochopulmonary dysplasia (BPD) complications

• CHF

• pneumonia

• bronchitis/bronchospasm

• developmental delays/cerebral palsy

• inability to be weaned from ventilator or oxygen suppleentation

Brochopulmonary dysplasia (BPD) assessment findings

• chest retractions, nasal flaring

• audible wheezing, rales, rhonchi

• hypoxia

• respiratory acidosis

• bronchospasm

• chest x ray shows lung disease

Brochopulmonary dysplasia (BPD) medical management

meds that help with lung perfusion, not so much emphasized

• bronchodilators

• corticosteroids

• diuretics

Brochopulmonary dysplasia (BPD) nursing actions

• mech vent and o2 admin

  • wean neonate from mech vent

• chest physiotherapy to clear secretions from lungs

• fluids, fluid restriction, meds

• daily weights & I&Os

patent ductus arteriosus

ductus arteriosus remains open

• can hear murmur

patent ductus arteriosus complications

• very hard to get the baby off the vent

• CHF, chronic lung disease, renal insufficiency, feeding intolerance

patent ductus arteriosus assessment findings

• heart murmur heard

• tachycardia and tachypnea

• recurrent apnea

• widened QRS

• increased demand for O2 and went

intraventricular hemorrhage

brain bleeds!

stage 1: small BB

stage 4: big BB — harder to stop

intraventricular hemorrhage risk factors

being premature!

• bc no clotting factors (no vit k), traumatic birth, low H&H

intraventricular hemorrhage assessment findings

• low bp, low o2, seizures, brady, brain swelling

intraventricular hemorrhage nursing actions

• blood transfusions

• fluid volume replacement, monitor VS esp bp

what is the condition that affects infants who have received mechanical ventilation?

bronchopulmonary dysplasia

• fatal complication from mech vent and O2 in neonates

necrotizing endocolitis

only found in formula fed babies!

• most common GI infection that premies get

inflammation and necrosis of the bowel

necrotizing endocolitis sx

• lethargy, vom, abd dist

• not eating/drinking

• temperature instability

• temp/bp decrease

necrotizing endocolitis tx

• needs surgery

• monitor for inf, stool, eating, bp, VS, sx after

• 30% don’t survive

retinopathy of prematurity (ROP)

baby is on O2 for too long

• causes blindness in babies

• also brain bleeds, open PDA

• babies recover if O2 is stopped in time

retinopathy of prematurity (ROP) long term outcomes

requires routine eye exams, and can cause weaker vision sooner in life

what to know about ROP (retinopathy of prematurity)

externally caused, babies are not born with it

meconium aspiration syndrome (MAS)

cause of respiratory failure in term and post-term neonates

• swallows poop and gets stuck in lungs

• resp therapist must be present to suck out of lungs

meconium aspiration syndrome (MAS) assessment findings

• meconium-stained amniotic fluid

• RDS, cyanotic babies, low O2, low bs, acrocyanosis/cyanosis

meconium aspiration syndrome (MAS) nursing actions

• assist with suctioning and resuscitation

• assess for RDS, admin O2, monitor glucose

• maintain clear lungs, abx if lung infection

• don’t treat baby until baby can breathe correctly

main reason for persistent pulmonary hypertension of the newborn (PPHN)

hypoxia!

• not enough O2 contracts vessels

persistent pulmonary hypertension of the newborn (PPHN)

baby hypertension

leads to decreased blood flow through the lungs

persistent pulmonary hypertension of the newborn (PPHN) risk factors

• sepsis

• meconium aspiration

• polycythemia (lack of O2 inside placenta)

• anything that causes a hypoxia, or non mature lungs

med that pregnant people should not take and why

NSAIDS! only tylenol

• close PDA early which causes newborn circulation inside womb — no O2 sat

• mom only gets 6 doses of indomethacin (closes PDA)

persistent pulmonary hypertension of the newborn (PPHN) assessment findings

• respiratory, cardiac, heart murmurs, hypotension, CHF, tachypnea, cyanosis

• hypoglycemic baby

persistent pulmonary hypertension of the newborn (PPHN) nursing actions

main goal: give baby O2

• give fluids, monitor bp, monitor sugar levels

• monitor lab results, I&Os, WBC

• surfactant to help the lungs

• nitric oxide therapy (reduces HTN in baby)

• watch for bp increase

small for gestational age

• gestational and weight determined after birth

• delivery okay baby js little

• are growing but at a delayed rate

intrauterine growth restriction

determined in the womb still

• US shows that the baby is not growing at all

• can be a placental issue

• if baby has zero growth, baby needs to be taken out

symmetrical IUGR

baby not growing but head and body are measuring same gestation age

asymmetrical IUGR

• baby head is disproportionate to the body

• head is growing, body is not

• head is taking all the blood and O2

IUGR baby risk factors

• chromosomal abnormalities

• any placental issue (previa, abruption)

• environment issues

IUGR mom risk factors

• diabetes, lupus, cardiac

• multiple gestation

• age, hx of IUGR in past

• obesity, anorexia

IUGR outcomes

• labor intolerance, small and not growing

• mainly CS babies

• stressed → meconium aspiration → lung issue

• hypoglycemic, electrolyte imbalance

large for gestational age risk factors

macrosomic babies

• typically older babies

• maternal diabetes

• hx of macrosomic babies

• prolonged pregnancy

large for gestational age outcomes

• high risk of shoulder dystocia

• traumatic births!

• hypoglycemia

• respiratory distress

• meconium aspiration

• vaccum delivery

• skull/ clavicle fractures

meconium aspiration syndrome affects

post-term infants

• happens during birth in utero and can lead to a dangerous respiratory situation

hyperbilirubinemia and types

jaundice bc too much RBCs — two types!

physiological: liver not mature enough, can’t get rid of RBCs

• happens during 1-2 days of baby life

pathological: baby has a liver disease

hyperbilirubinemia risk factors

• Rh- blood or any O blood

• high risk for pathological jaundice — babies who are breast fed

• bruises easily bc lots of RBCs

hyperbilirubinemia outcome and nursing actions

usually resolves via bili lights and feeding the baby

• feeding helps baby poop out RBCs (the jaundice)

• liver will mature eventually

tx: give Rh- pts rhogam to prevent jaundice before it occurs

central nervous sytem injuries

d/t baby being premie or traumatic delivery

• LGA shoulder dystocia

• hypoxia in mom

infants with diabetic mothers

• high risk for CNS injuries

• not a lot of tone to muscles

• hyperglycemic, cannot keep a blood sugar

group b streptococcus (GBS)

neonatal infection

test mom while preganant (34-36 wks)

• vag and rectal swab, if it grows, +

• tx with abx during labor to get rid of flora (penicillin #1 choice)

SARS-COV-2 (covid)

neonatal infection

if mom is sick with covid protect urself

higher risk of PPH

wyd if mom tells u she smoking w**d during preg

patient educate

what should you do before giving any meds to pt who has been abusing substances

drug screen before to see what is in her blood before giving more drugs

car seat challenge

put premie NICU babies in the car seat with 90 mins

• must keep O2 sat above 92%

• baby can’t go home unless they pass this