Chapter 34 - High Risk NB

Preterm Infants

Born < 37 weeks

Extremely LBW

< 2.2 lb (1000g)

Periodic Breathing

• 10 sec resp pauses followed by rapid resp

Minimal Enteral Nutrition (MEN) Feeding

• stimulates GI system

• protects against sepsis

Corrected Age

• adding gestational age & postnatal age

What does the preterm infant experience the 1st two years?

• Catch up body growth

Preterm D/C Criteria

• 36-40 wks

• cry vigorously when hungry

• appropriate weight gain

What infants are placed in polyethylene bag?

ELBW infants to decrease heat and water loss

Why should rewarming be slow?

Rapid changes → apnea and acidosis

Why should free flow o2 not be used?

Concentration fluctuates too much

Bubble CPAP

• sending o2 bubbling thru water to the infant

High Frequency Ventilation (HFV)

• Deliver smaller volumes more frequently

High Frequency Ventilation (HFV) Indications

• Meconium aspiration

• others lol

What isn’t produced in sufficient amounts before 28 weeks?

Surfactant

Artificial Surfactant

• admin thru ET tube, via trachea

• moa: promotes lung maturity

Inhaled Nitric Oxide (iNO)

• pulmonary vasodilation

• binds with hgb in rbcs

ECMO

• Blood pumped thru membrane lung where its oxygenated and warned to be returned to systemic circulation

  • provides o2 and allows lungs to rest!

When is ECMO contraindicated?

Infants < 34 wks

• anticoagulant therapy is REQUIRED, ⬆ risk for IVH

What does BF promote?

Improved sucking coordination

LBW Preferred Nutrition

• Prepared human milk fortifier added to human milk

T/F: preterm infants have higher water content

TRUE

When a preterm infant has unexplained abdominal distention, what should be ruled out?

NEC

Gavage Feeding

• feeding thru NG or OG tube

• spares infant work of sucking (tires them less)

Nonnutritive Sucking

• improves oxygenation

• decreases energy use

• improves sucking skills

NICU Stay Effects

• cochlear damage

• long term speech and language deficits

• na: hearing screen b4 d/c

What does the prone position promote?

• Flexion of extremities

• calms infant

• decreases stimulation

Simplest calming technique for preterm?

Using both hands to contain infants extremities close to the body

What does infant massage promote?

Weight gain

What may anticipatory grief in nicu parents permit?

• opportunity to plan

• chance to say goodbye in special way

After NICU d/c, what are parents advised?

To limit visitors

Patent Ductus Arteriosus

When the fetal ductus arteriosus fails to close after birth

Active Precordium

• chest area displays strong, visible pulsations

  • etiol: ⬆ left ventricular SV

Germinal Matrix

Network of tiny fragile thin vessels

What should RN keep in mind after admin muscle paralyzer, vecuronium?

The infant cannot express pain thru facial expression but still feels it

CRIES

Infant pain assessment tool

Since preterm infants have more CNS branches…

They have a heightened pain threshold and sensitivity FOR LIFE

Late Preterm Infants

Born btwn 34 to 36 wks

In LPIs, hypothermia is

Early sign of sepsis

Many LPIs fall asleep b4

Consuming adequate volumes of milk

Postmature Infants

• Born beyond 42wks

Dysmaturity

wasted appearance in postmature infants

T/F: Mortality is higher in postmature infants

TRUE

• ⬆ oxygen demand

• insufficient gas exchange from aging placenta

Tx for meconium aspiration syndrome?

Exogenous surfactant

Hypoglycemia Causes

• decreased glycogen supply

• inadequate gluconeogenesis

• depleted glycogen stored

Polycythemia/Hyperviscocity

• etiol: feta hypoxia triggers RBC production

• s/s: compromised blood flow, tachycardia, hyperbili

• tx: exchange transfusion

LGA are at risk for

Congenital heart abnormalities

STABLE Training Program

• post cpr stabilization of neonates

  • Sugar & safe care

  • Temp

  • Airway

  • Blood pressure

  • Lab work

  • Emotional support