(9) NURSING CARE OF A FAMILY WITH A HIGH RISK NEWBORN

ORPEZA

Respirations

Most deaths occurring during the first 48 hours of life after birth results from the newborn’s inability to establish or maintain adequate _______

Cerebral Hypoxia

An infant who has difficulty accomplishing effective breathing experiences residual neurologic morbidities which may be a result of _________

Low birth weight, Intrauterine growth restriction, Maternal history of diabetes, Premature rupture of membrane, Meconium staining

Give 5 factors predisposing infants to respiratory difficulty in the first few days of life

Establish an airway, Expand the lungs, Initiate and maintain effective ventilation

Process for resuscitation

Ductus arteriosus

It would fail to close, it will create ineffective pumping action of the heart. When the heart pumps blood, it carries oxygenated blood. So your blood will not be able to deliver oxygen to the rest of the body, if the heart fails to pump.

Hypoglycemia

Since blood circulation is infected, and the infant is already struggling to breathe, the baby will now induce whatever is the remaining glucose in the body, and will result in _________

100

How many chest compressions in 1 minute for an infant

Valve syringe

is a standard piece of equipment that is mainly used in the birthing room and is often used to suction an infant's nose and mouth—is a routine procedure at some institutions which would stimulate the newborn to breathe.

Bradycardia

Using Valve syringe is no longer recommended unless there is a concern that the airway is obstructed because this can cause

suction catheter

if the mucus or any excess amniotic fluid is not only present in the mouth or nose what kind suction will we use?

No suction is needed

Is suction needed for a breathing newborn with meconium stained amniotic fluid?

Primary apnea

Period of halted respirations in the first few seconds of life when the newborn is severely depressed and takes several weak gasps of air then almost immediately stops breathing, and the heart rate begins to fail.

Primary apnea

The newborn is unable to maintain strong gasps after trying to initiate respirations again after 1-2 minutes of apnea

Secondary apnea

Respiratory effort will become weaker again and HR will fail further until gasping effort will stop altogether.

Intubation

wherein a laryngoscope and an ET insertion should be presented to assist a newborn in breathing.

laryngoscope

is equipped with different size blades usually a size0 or 1 should be available for newborns.

Capillary fragility

The preterm infants are prone to hemorrhage because of ________ _________ so insertion of laryngoscope and ET is done in a gentle manner to prevent hemorrhage.

Newborn’s cry

________is proof of good lung expansion.

40-60

Air or oxygen should be administered at ______ ventilations per minute.

Orogastric tube

If resuscitation is over 2 minutes, what tube is inserted?

Flow-Inflating Bag

requires a compressed gas source for inflation but is able to deliver 100% oxygen

Self-Inflating Bag

which is what we commonly see in the hospital setting; remains inflated at all times and is not dependent on a compressed gas source. It is limited to delivering oxygen concentration of 40% which may be inadequate for resuscitation at birth

> RR, Grunting, Nasal flaring

1st signs of obstruction or respiratory compromise:

Intercostal retractions

if the 1st signs of obstruction or respiratory compromise is present, what do we look for?

Hypoglycemia

which is often a result from the effort of a newborn expended to begin breathing

dehydration

may result from increased insensible water loss which is a result after a newborn experienced rapid respirations

Metabolic acidosis

may develop if with hypovolemia

Kangaroo care

can also be done by the father or any healthcare provider or any support person. Use of skin to skin contact with a parent to maintain body heat

Gavage feedings

__________ __________or manual breast milk extraction for infants who cannot suck effectively

Gastronomy tubes

for long term nutrition concern

Prenatal causes, Perinatal causes, Postnatal causes

Infections in high-risk newborns may occur from:

herpes simplex 2 and hepatitis B

Most prevalent perinatal infections are those contracted from the birth canal such as

Staphylococcus aureus, Enterobacter, and Candida

Late onset or hospital-acquired infections are commonly caused by

Term infants

Born after the beginning of week 38 and before week 42 of pregnancy,Approximately, 90% of all live births fall into this category.

Preterm infants

Born before the beginning of the 38th week of pregnancy

Postterm or postmature infants

Born after the end of week 41 of pregnancy

Appropriate for Gestational age

Infants between the 10th and 90th percentile of weight for their gestational age, whether preterm, term, or post term.

Small for gestational age

Infants below the 10th percentile of right for their age.

Large for Gestational age

Infants below the 10th percentile of right for their age.

Very low birth weight infant

Weighing less than 1,500 grams at birth

Extremely low birth weight infant

Weighing less than 1000 grams at birth

Late preterm

Born between 34 and 37 weeks

Early preterm

Born between 24 and 34 weeks

respiratory distress syndrome

Lacks lung surfactant - does not form until the 34th week of pregnancy, makes them prone to

Low socioeconomic level, Poor nutritional status, Lack of prenatal care, Multiple pregnancy, Previous early birth, Race, Cigarette smoking

Common factors associated with preterm birth

premature infant

is characterized by very little, if any, flexion in the upper extremities and only partial flexion of the lower extremities.

full-term infant

exhibits flexion in all four extremities

90 degree angle

The angle between the hypothenar eminence and the ventral aspect of the forearm is measured. The premature infant at 28-32 weeks’ gestation will exhibiting how many degree?

Minimal or absent

The response of a premature infant to recoil of the extremities?

Scarf sign

Hold the baby supine, take the hand, and try to place it around the neck and above the opposite shoulder as far posteriorly as possible. Assist this maneuver by lifting the elbow across the body. See how far across the chest the elbow will go. What sign is being elicited on this test?

premature infant

In the scarf sign, if the elbow reaches near or across the midline, is this characteristic of a full-term or premature infant?

full-term infant

In the scarf sign, if the elbow will not reach the midline, is this characteristic of a full-term or premature infant?

Heel to ear

With the baby supine and the hips positioned on the bed, draw the baby’s foot as near to the ear as it will go without forcing it. Observe between the foot and head as well as the degree of extension at the knee. What test is this?

premature infant

In the heel-to-ear test, if there is very little resistance, is this characteristic of a premature or full-term infant?

Full term infant

In the heel-to-ear test, if there is marked resistance, is this characteristic of a premature or full-term infant?

Premature infant

If the sole of the infant has very few or no creases, is this characteristic of a premature or full-term infant?

34 weeks gestation

At what gestational age does the areola become raised?

36 weeks gestation

When does breast tissue begin to develop in an infant?

5-6 mm

How much breast tissue is typically present at 39-40 weeks?

very flat and relatively shapeless

At fewer than 34 weeks' gestation, how do the ears of an infant appear?

Between 34 and 36 weeks' gestation

At what gestational age does the ear begin to show a slight incurving of the superior part of the ear?

32 weeks

At what gestational age does cartilage begin to appear in the ear?

very high in the inguinal canal

In a premature male infant, where are the testes located?

very few rugae

How does the scrotum of a premature male infant appear?

Many rugae

How does the scrotum of a full-term male infant appear?

very prominent

In a premature female infant, how does the clitoris appear when positioned on her back with hips abducted?

Normochromic, normocytic anemia

What type of anemia is commonly seen in premature infants?

Normochromic, normocytic anemia

meaning the cells are normal in appearance but reduced in number.

Drawing fewer blood sample and delayed cord clamping

What can help reduce the development of anemia in premature infants?

Acute Bilirubin Encephalopathy

The destruction of brain cells caused by high levels of indirect or unconjugated bilirubin in the bloodstream, often due to excessive breakdown of red blood cells at birth. Causes what?

Phototherapy or exchange transfusion

What is the primary management for preventing excessively high levels of indirect bilirubin in preterm infants?

ductus arteriosus

is a blood vessel that remains open in premature infants due to pulmonary hypertension and lack of surfactant, which interferes with normal lung function and blood flow.

Pulmonary hypertension, respiratory distress

What complications can arise due to the lack of surfactant in premature infants?

surfactant

What substance is lacking in premature infants that makes their lungs non-compliant and prone to respiratory distress?

34 weeks

At what gestational age does surfactant production become sufficient?

Persistent Patent Ductus Arteriosus (PDA)

What cardiovascular condition occurs when the ductus arteriosus fails to close after birth?

Pulmonary hypertension

What complication arises due to PDA, making it difficult to move blood from the pulmonary artery into the lungs?

Indomethacin and Ibuprofen

Which two medications are commonly used to help close a PDA in term infants?

Indomethacin

Which medication used for PDA closure must be given cautiously in preterm infants due to its potential side effects?

Decreased renal function, decreased platelet count, gastric irritation

What are three major side effects of Indomethacin in preterm infants?

Urine output and signs of bleeding

What should be monitored when Indomethacin is prescribed to an infant?

Periventricular Hemorrhage

What is the term for bleeding into the tissue surrounding the brain's ventricles?

Intraventricular Hemorrhage

What is the term for bleeding that occurs inside the brain's ventricles?

Fragile capillaries, immature cerebral vascular development

What is the primary cause of periventricular and intraventricular hemorrhage in premature infants?

Very Low Birth Weight (VLBW) infants

Which group of infants is at the highest risk for intraventricular hemorrhage?

Grade 1

What classification of intraventricular hemorrhage involves bleeding in the periventricular germinal matrix or a single ventricle?

Grade 2

Which grade of intraventricular hemorrhage includes bleeding within the lateral ventricles without causing dilation?

Grade 3

Which grade of intraventricular hemorrhage results in ventricular enlargement due to excessive bleeding?

Grade 4

What is the most severe grade of intraventricular hemorrhage, involving both the ventricles and brain tissue?

Respiratory Distress Syndrome (RDS)

What respiratory condition is a potential complication of intraventricular hemorrhage?

Necrotizing Enterocolitis (NEC)

Which gastrointestinal complication can arise in premature infants with intraventricular hemorrhage?

Retinopathy of Prematurity

What eye condition can develop in preterm infants with intraventricular hemorrhage?

Apnea

What is the term for temporary pauses in breathing that can occur as a complication of intraventricular hemorrhage?

Microsomia

What is another term for a Small for Gestational Age (SGA) infant?

10th percentile

An infant is classified as SGA when their birth weight falls below which percentile on the intrauterine growth curve?

Intrauterine Growth Restriction (IUGR)

What is the primary cause of Small for Gestational Age (SGA) infants?

Macrosomia

What is another term for a Large for Gestational Age (LGA) infant?

90th percentile

An infant is classified as LGA when their birth weight is above which percentile on the intrauterine growth chart?

Overproduction of nutrients and growth hormone

What is the primary cause of excessive fetal growth in LGA infants?

Obesity and diabetes mellitus

Which maternal conditions increase the risk of having an LGA infant?