Ch. 9 The High-Risk Newborn and Family

Vocabulary flashcards covering high-risk newborns, late-preterm infants, Respiratory Distress Syndrome, Neonatal Sepsis, Necrotizing Enterocolitis, Neonatal Seizures, and Neonatal Abstinence Syndrome based on lecture notes.

High-Risk Newborn

A newborn with an increased chance of morbidity or mortality occurring at any gestational age, influenced by prematurity, congenital anomalies, respiratory issues, infection, and metabolic instability.

Gestational Age (Neonatal Outcome Predictor) NCLEX Pearl

The single best predictor of neonatal outcomes, as opposed to birth weight.

Late-Preterm Infants

Infants who often look term, but have immature organs—especially lungs and brain—and struggle with respiratory distress, temperature instability, hypoglycemia, feeding coordination, jaundice, bilirubin clearance, and delayed discharge.

Late-Preterm Infants NCLEX Pearl

At high-risk for hypoglycemia caused by immature hepatic glucose regulation.

Transporting High-Risk Newborns

Stabilize first, regulate temperature, maintain oxygenation, monitor vitals, ensure hydration, use trained transport teams

Primary Transport Threats for High-Risk Newborns

Hypothermia and hypoxia.

Key Assessments in High-Risk Infants

Respiratory status, cardiovascular stability, GI tolerance, GU output, neurologic tone/behavior, temperature, skin integrity

Neonatal Jitteriness vs. Seizures NCLEX Pearl

An assessment distinction where jitteriness that does not stop with gentle flexion suggests seizures, not hypoglycemia.

Feeding Intolerance

Normally the first sign of Necrotizing Enterocolitis (NEC) or Sepsis in a newborn.

Poor Feeding Behaviors S/S

Apnea, bradycardia, and cyanosis accompanying poor feeding in high-risk infants.

Necrotizing Enterocolitis (NEC) Red Flags

Abdominal distention, absent bowel sounds, emesis, and large gastric residuals; requires stopping feeding and notifying the provider immediately.

NEC NCLEX Pearl

High gastric residual + abdominal distention + absent bowel sounds = hold feeding for possible NEC 

Respiratory Distress Syndrome (RDS)

A condition in preterm infants caused by a lack of mature alveoli and surfactant, managed with surfactant replacement and ventilatory support.

• Surfactant replacement improves lung expansion and oxygenation; overuse of oxygen increases the risk of retinopathy, prematurity, or ROP 

• S/S: retractions, nasal flaring, grunting

Retinopathy of Prematurity (ROP) Risk Factor

The overuse of oxygen during hypoxemia management in preterm infants.

Hypoxemia management

surfactant therapy, ventilatory support, judicious oxygen use

Grunting in Infants NCLEX Pearl

The infant creating their own positive expiratory pressure (PEP), serving as an early sign of respiratory failure.

Early-Onset Neonatal Sepsis

Sepsis occurring at $< 3\text{ days}$ of age, resulting from maternal transmission.

Late-Onset Neonatal Sepsis

Sepsis occurring at $1\text{--}3\text{ weeks}$ of age, often hospital-acquired and presenting with temperature instability, poor feeding, lethargy, and respiratory distress.

• Respiratory distress diagnostics: blood, urine, CSF cultures 

Neonatal Sepsis Temperature Sign NCLEX Pearl

Hypothermia (low temperature), rather than fever, which is one of the most common early signs of neonatal sepsis.

• early antibiotics save lives 

Necrotizing Enterocolitis (NEC)

One of the most common GI emergencies in preterm infants; risk factors include prematurity, intestinal ischemia, and pathogenic bacteria.

• NEC Risk factors: prematurity, intestinal ischemia, pathogenic bacteria

Breast Milk Protection Against NEC

Protective effect provided by breast milk against NEC due to its content of IgA and macrophages.

Necrotizing Enterocolitis (NEC) Management

Medical interventions including keeping the infant NPO, NG decompression, IV antibiotics, TPN, and surgery if bowel perforation occurs.

Neonatal Seizures

Often subtle seizure manifestations in newborns including lip smacking, bicycling movements, and eye deviations.

•  require immediate evaluation

• Causes: metabolic issues, infection, trauma, drug withdrawal treatment

• Drug withdrawal treatment: treat underlying cause, phenobarbital, phenytoin, and benzodiazepines 

Neonatal Abstinence Syndrome (NAS)

Withdrawal in newborns that typically begins within $12\text{--}24\text{ hours}$ after birth depending on the substance, presenting with irritability, tremors, a shrill cry, poor feeding, and diarrhea.

• Seizure management: swaddling, low-stimulation environment, morphine or methadone, supportive feeding 

Classic NAS Triad NCLEX Pearl

The combination of high-pitched cry, tremors, and diarrhea indicating Neonatal Abstinence Syndrome.

Discharge Planning for Medically Fragile Infants

An early-initiated process that includes car seat testing, feeding stability, temperature stability, parent education, follow-up appointments, and clear care instructions.