CB7

What are the birth related stressors?

• Asphyxia

• Respiratory distress

• meconium aspiration

• complication of respiratory therapy

• cold stress

Neonatal asphyxia def

deprivation of oxygen to the baby’s brain and organs during the birth process. which can cause long term disabilities and developmental delays

risk factors for neonatal asphyxia

• nonreassuring FHR tracing

• altered blood flow through placenta/cord

• maternal conditions (asthma, cardiac disease, preeclampsia) which decrease o2

• complications of labor or birth process

• prematurity

• fetal conditions - multiples, SGA, LGA, IUGR, IDM, congenital heart disease

interventions for neonatal asphyxia : how to prepare?

• find babies who maybe at risk

• get needed supplies ready at delivery

  • o2 source

  • infant warmer/warm blankets

  • resuscitation bag or T piece resuscitator

• have trained people on hand (NRP training)

interventions for neonatal asphyxia : how to resuscitate?

if no to term, breathing, good muscle tone = RESUSCITATION

• warming, positioning, clearing airway, dry, stimulate, positive pressure vent,

• no chest comp or meds

respiratory distress syndrome def?

alveoli in lungs collapse after each exhaled breath bc of loss of pulmonary surfactant

what factors are associated with respiratory distress syndrome?

• prematurity (all preterm babies and babies born to diabetic mothers are at risk)

• surfactant deficiency syndrome

when is surfactant usually made?

starting 24 weeks of gesttaion

complications regarding respiratory distress syndrome?

• hypoxia

• respiratory acidosis

• metabolic acidosis

what will the chest x ray show in respiratory distress syndrome?

diffuse bilateral “ground glass” appearance

what interventions will be needed for respiratory distress syndrome?

• prevent premature delivery

• administer steroids if premature

• monitor for s/sx

• cpap or peep for o2

meconium aspiration syndrome def?

meconium stained amniotic fluid inhaled into baby’s inhaled in baby’s lungs

meconium aspiration can cause what?

• mechanical obstruction of airways

• chemical pneumonitis

• inactivation of surfactant

meconium stained amniotic fluid can have what colors to them?

• yellow/green/brown

• pea soup like consistency

clinical manifestations of meconium aspiration syndrome?

• change of color

• fetal hypoxia in utero (FHR tracing changes)

• signs of respiratory distress at birth

interventions done for meconium aspiration

• if baby not vigorus at birth- suction airway to clear of meconium

• provide breathing support (o2, vent, supp surfactant)

• o2 sat, abg, chest x ray

further complications when it comes to meconium aspirations?

• pulmonary air leaks

• seizures

• chf, dic (disseminated intravascular coagulation)

• pneumonia , sepsis

• intestinal necrosis

complications with resp therapy

• pulmonary intestinal emphysema

• pneumothorax

• bronchopulmonary dysplasia

pulmonary intestinal emphysema?

acc. of trapped air in lungs

pneumothorax?

• acc of air b/w parietal and visceral membranes lining the thorax- could compress heart, lungs, blood flow

bronchopulmonary dysplasia (chronic lung disease of prematurity)

• inflammatory response to premature delivery associated w/ pulmonary infection and leading to continuing injury and poor dev of lung tissue.

cold stress?

newborn lose more heat than bodies produce

what are some conditions that are present at birth?

• congenital anomalies

• fetal alcohol syndrome

• opiate dependency

• infections

what are congenital anomalies?

physical differences which are present at birth. cosmetic - life threatening

ex of congenital anomalies?

• polydactyly

• talipes equinovarus

• cleft lip/palate

• hydrocephalus

• chonanal atresia

• diaphragmatic hernia

• myelomeningocele

• heart defects

how to prevent myelomeningocele?

folate, b9 supps during childbearing yrs

how to care for a newborn with congenital anomalies?

• physcial support to baby

• any additional anomalies?

• report to np/pediatrician

• emotional support to parents

• edu to parents of problem

fetal alcohol syndrome?

• physcial, behavioral, cognitive abnormalities bc of alcohol exposure during pregnancy

what is the leading cause of preventable nongentic intellectual disability?

exposure to alcohol during pregnancy

how much alcohol is ok during pregnancy?

NONE

True/false - some opioids cross the placenta?

False - all opioids cross the placenta

When do s/sx appear on a baby who is going through withdrawal?

24-48 hours; but can continue for several days- few weeks

How many % of pregnant women engage in misuse of one substance in pregnancy?

4.4%

What do we now call babies born to opioid addicted mothers?

NOWS- neonatal opioid withdrawal syndrome

Neonatal abstinence syndrome NAS

withdrawal symptoms experienced y newborns who are exposed to substances in utero. (increaed by 300% in 30yr)

NAS babies stay in hospital for how long?

17-23 days

s/sx of NAS babies?

• hypersensativity of CNS,

• high pitched cry,

• increased muscle tone,

• tremor,

• convulsions,

• poor feeding

• tachypnea,

• excessive sucking

• nasal congestion

• vomiting

• frequent yawning

how many babies exposed to opiates in pregnancy will have withdrawal symptoms?

60-90%

nursing management of NAS/NOWS

• quiet, dimly lit area

• neonatal abstinence scoring

• small frequent feedings

• administer meds as ordered

• swaddle with hands near mouth, gave pacifier

• gentle rocking of infant if crying

• protect from excoriation using clothing with mittens

• protective barrier to groin area every diaper change

until how old are newborn susceptible to infection?

• up to one month of age

whats considered the leading cause of morbidity and mortality in newborns?

sepsis

common causes of sepsis in newborns?

• prenatal acquisition - herpes, CMV, rubella

• postnatal acquistion

  • early onsent

  • late onset

early onset in postnatal acquisition?

24-72 hrs : group b haemophilus influenza, e coli, strep pnemonaie

late onset of postnatal acquistion

7-30 days of age : klebsiella, enterococci, e coli, psudomonas, candida

s/sx of neonatal sepsis

• nonsepcific

• lethargy

• poor feedng

• irritability

• temp instability

• apnea

• tachycardia/bradycardia

how to manage sepsis

Maintain- neutral thermal environment

Monitor VS & IOs

Obtains labs as ordered

Administer IVFs & Antibiotics as ordered

Support parents

How to prevent HIV/AIDS in baby

• prenatal testng, med therapy during pregnancy, scheduled c/s

• NO breastfeeding

how to treat baby with hiv/aids

• 4 week prophylactic regimen of zdv/azt

• monitor baby for infections

• supportive care

• PPE!

Zidovudine (ZDV) anf Azidothymidine (AZT)

different names for same antiviral