Newborn Patients at Risk

What is the birthweight range of a AGA newborn?

2,500-4,000 grams; between 10th and 90th percentile

What are common causes of SGA?

Factors that affect the maternal-placental-fetal unit such as smoking, malnutrition, hypotension

What are five common signs of SGA in newborn?

Large head, wasted appearance, loose dry skin, reduced fat stores, scaphoid abdomen

How does the umbilical cord look in SGA or postterm newborn?

Thin umbilical cord

What are four complications in SGA?

Chronic hypoxia, hypothermia, hypoglycemia, polycythemia

What causes polycythemia in SGA?

Chronic fetal hypoxia stimulates RBC production

Why is polycythemia a complication in SGA?

It causes blood to become sludgy/thicker viscosity, making oxygen and glucose delivery slower

What are four signs of polycythemia in SGA?

Ruddy unusually red skin, poor feeding, lethargy, cyanosis

What is the nursing management for SGA and LGA newborns?

Provide early, frequent feedings, measure growth, monitor CBC and glucose

What are four common causes of LGA?

Gestational DM or maternal DM, maternal obesity, post term gestation

What are complications of LGA?

Birth trauma, hypoglycemia, polycythemia, hyperbilirubinemia

Why are infants of diabetic mothers at risk of hypoglycemia?

Infants stop receiving high amounts of glucose, but still maintains high insulin levels

What are seven signs of hypoglycemia in newborn?

Jitteriness, poor feeding, weak or high-pitched cry, apnea, cyanosis, seizure, temperature instability

What is the gestational age of a late preterm newborn?

34 weeks to 36 weeks

Why are late preterm newborns at risk and what complications can it cause?

Contains immature organ systems that leads to respiratory distress syndrome, hypoglycemia, jaundice, poor feeding, infection, temperature instability

Why do late preterm newborns have feeding difficulties?

Suck-swallow-breathe reflex is immature, potentially leading to aspiration risk

What is the gestational age of a postterm newborn?

>42 weeks (294 days)

Why are postterm newborns at risk for FGR, hypoxia, or even death?

Aging placenta degenerates with reduced blood flow causes decreased oxygen and nutrient delivery

What are three common characteristics of a postterm newborn?

Dry cracked wrinkled peeling skin, minimal vernix caseosa or lanugo, prominent creases across soles

Can postterm newborns be LGA or SGA?

Yes depending on if the placenta is working well or not

What is the nursing management for postterm newborn?

Monitor vitals, blood glucose, initiate early feedings or IV dextrose if indicated, CBC to assess polycythemia

Why are newborns more susceptible to hyperbilirubinemia?

Higher RBC count and shorter lifespan with an immature liver that doesn’t conjugate bilirubin efficiently

What is neonatal jaundice?

Excess bilirubin in blood with TSB over 5 mg/dl causing visible jaundice

What is benign neonatal hyperbilirubinemia?

Physiologic jaundice that occurs after 24 hours since birth due to normal RBC breakdown with immature liver

What are three causes of pathologic jaundice (first 24 hours)?

ABO or Rh incompatibility, prematurity, ineffective bilirubin clearance

What is unconjugated bilirubin and why is it dangerous?

Fat-soluble bilirubin that isn’t processed by liver yet; able to cross the BBB and damage brain tissue

What is conjugated bilirubin?

Bilirubin processed by liver that is water-soluble, being able to be excreted via urine or stool

What is the Coombs test for newborns?

Detects attached antibodies that are against RBCs

What is the nursing management for hyperbilirubinemia?

Encourage early, frequent breastfeeding (8-12 times) and/or formula to promote stooling

What are signs of inadequate feeding that causes hyperbilirubinemia?

Signs of dehydration, less wet diapers, lower amount of stools

What is kernicterus?

Permanent brain injury caused by severe amounts of unconjugated bilirubin entering brain tissue

What does elevated reticulocyte count suggest in a jaundiced newborn?

Increased RBC production in response to RBC destruction suggests possible hemolysis

How does phototherapy treat jaundice?

Blue visible light (not UV) converts unconjugated bilirubin into other forms that can be eliminated without liver conjugation

What is the nursing management for phototherapy?

Expose as much of the skin as possible by turning q2hrs, eye protection, monitor temp q2hrs neuro skin/eye irritation

What are some education for parents for photoherapy?

Encourage feeds q2-3 hours, remove infant from overhead lights for feeds; newborns will be irritable from treatment

What blood glucose is considered hypoglycemia in newborn?

<40 mg/dL

What are common risk factors for hypoglycemia in newborns?

GDM, DM, preterm, postterm, IUGR

What is the nursing management for hypoglycemia?

Early frequent breastfeeding or formula, oral dextrose gel, or IV dextrose for severe cases or inability to feed

What is neonatal opioid withdrawal syndrome (NOWS)?

Withdrawal symptoms occurring after birth when prenatal opioid exposure ends

What is assessed in toxicology screening for NOWS?

Meconium, urine, or umbilical cord tissue/blood

What are CNS signs of NOWS?

Hyperactive reflexes, tremors, loud high-pithced cry, seizures, irritability

What are GI/nutrition signs of NOWS?

Poor feeding, frantic sucking, N/V, poor weight gain from increased energy use

What are autonomic/respiratory signs of NOWS?

Fever, sweating, sneezing, yawning, nasal stuffiness, tachypnea, apnea

What are sleep/behavior signs of NOWS?

Disturbed sleep or difficulty being consoled due to increased sensitivity

What is first-line nursing management for NOWS?

Reduce stimulation with quiet dim environment and small frequent feedings on demand

What complications should be monitored for in NOWS?

Skin breakdown from frequent stools, seizures, respiratory issues, temperature instability

What medications are used when nonpharmacologic care isn’t working or in severe cases for NOWS?

Morphine, methadone, or buprenorphine

What causes transient tachypnea (TTN) of the newborn?

Delayed clearance of lung fluid, decreasing lung compliance and gas exchange

What are risk factors for TTN?

C/S birth and rapid delivery

What are five common signs of TTN?

Tachypnea (>60 RR/min), grunting, retractions, nasal flaring, cyanosis

What is the nursing management (supportive treatment) for TTN?

Maintain warmth and blood glucose to prevent excess oxygen/glucose use, give IV feeds, provide O2 if needed

What causes respiratory distress syndrome (RDS) in newborns?

Immature lungs and insufficient surfactant that are common in premature infants

What are risk factors for RDS?

Preterm birth, asphyxia, sepsis, C/S, cold stress and diabetes

How does asphyxia cause RDS?

Oxygen deprivation from asphyxia impairs surfactant production

What are common signs of RDS?

Tachypnea, grunting, nasal flaring, retractions; severe cases shows seesaw respirations, hypoxemia, failure

How does CPAP help manage RDS?

Provides continuous positive airway pressure to keep airways and alveoli open

How does PEEP help manage RDS?

Maintains pressure at the end of exhalation, helping prevent alveolar collapse

How is exogenous surfactant administered to replace deficient surfactant?

Endotracheal tube