9+10 - High Risk Neonates

Preterm Infant

born before 37 completed weeks of gestation regardless of birth weight

Late Preterm Infant

born between 34 0/7 and 36 6/7 weeks of gestation, regardless of birth weight

Term Infant

born between 37 and 42 weeks gestation, regardless of birth weight

Post-term Infant

Born after 42 completed weeks of gestation regardless of birth weight

Symmetrical IUGR

growth restriction in which the weight, length, and head circumference are all affected

Asymmetrical IUGR

Growth restriction in which the head circumference remains within normal parameters, as does length, while birth weight falls below the tenth percentile.

Ballard Score

Scoring system that looks at a neonates physical (skin, eyes, etc.) and neuromuscular (posture, flexion, etc.) maturity.

Scarf Sign

Evaluation of neonate/infant muscle tone where arm is moved across chest to opposite shoulder.

Spontaneous Preterm Birth

Risk factors include previous preterm birth, periodontal disease, short cervical length, infection or inflammation and low maternal BMI.

Late Preterm Births

Higher risk problems related to:

• Thermoregulation

• Hypoglycemia

• Hyperbilirubinemia

• Respiratory Distress

• Poor feeding and discharge delays

Respiratory Distress

in late preterm, look for cardinal signs in addition to presence of apnea, especially during feedings. Monitor oxygenation, provide supplemental.

Thermal Instability

in late preterm, monitor temp every 30 mins postpartum until stable; then every 1-4 hours. Int: Provide skin-skin for stable newborn, bathe only after thermal stability has been maintained for 1 hour.

Hypoglycemia

in late preterm, assess feeding latch, monitor glucose in infants with additional risk factors. Int: initiate early feedings, avoid dextrose water feedings, provide IV dextrose as necessary.

Jaundice

in late preterm, observe for in first 24 hours. Assess feeding methods and intake/voiding and stooling patterns. Int. monitor bilirubin.

Feeding Difficulties

in late preterm, assess ability to coordinate suck-swallow, breathing, latch, and determine weight loss. Int. initiate early feedings, ensure maternal knowledge.

Neurodevelopmental Issues

in late preterm, assess respiratory distress, jaundice, hypoglycemia, thermal instability, neurological status, seizure activity. Int. perform screenings, encourage follow-ups.

Infection

in late preterm, evaluate maternal-fetal history for risk factors that may contribute to neonatal septicemia. Int. use routine hygiene practices, maintain thermal stability, admin vaccines, encourage breastfeeding.

Respiratory Distress Syndrome (RDS)

Syndrome that predominantly affects preterm infants, resulting from an insufficient production of surfactant that leads to respiratory distress.

Respiratory Distress Syndrome (RDS)

Symptoms: Tachypnea, nasal flaring, grunting, cyanosis, retractions.

Respiratory Distress Syndrome (RDS)

Treatment: surfactant therapy oxygen therapy, CPAP, thermoregulation/fluid management.

Retinopathy of Prematurity

eye disease that occurs when abnormal blood vessels grow in the retina of premature babies.

Bronchopulmonary Dysplasia

chronic lung disease that affects predominantly preterm infants, resulting from underdeveloped lungs that become easily irritated or inflamed.

Large for Gestational Age (LGA)

Risk Factors:

• Excessive weight gain in pregnancy

• Fetal exposure to high estrogen

• High maternal birth weight

• LGA in previous infants

• Maternal diabetes, obesity, multiparity

Large for Gestational Age (LGA)

an infant with a birth weight above the 90th percentile.

Meconium Aspiration Syndrome

Occurs when a newborn breathes a mixture of meconium and amniotic fluid, leading to breathing difficulties.

Meconium Aspiration Syndrome

Treatment: Not enough evidence to suggest routine tracheal intubation and suctioning of meconium below the cords for non-vigorous infants w/ MSAF. Instead, gentle oropharyngeal suctioning of the mouth and nose, as required, is indicated. Presence of thick meconium that appears to obstruct the newborn’s airway may require intubation for suctioning and establishing airway clearance.

Meconium Staining of the Amniotic Fluid (MSAF)

meconium is passed in utero, staining the placental fluid. May be present in MAS with atypical or abnormal fetal heart rate problems indicative of stress in utero. Presence requires monitoring of MAS even with no symptoms.

Hypoglycemia

Signs: jitteriness or tremors, tachypnea, lethargy, apnea, seizures, diaphoresis, weak or high-pitch cry, difficulty feeding, eye rolling, hypothermia.

Hypoglycemia

For Infants at risk of _____

• Perform CBG at 2 hrs of age after first feeding; if initial CBG is 2.6mmol/L or greater, repeat CBG every 3-6 hours and encourage feeds.

• Monitor for signs and symptoms of hypoglycemia

• If parameters fall below, follow specific nursing actions and communicate findings with pediatricians.

Hyperbilirubinemia

Elevated serum bilirubin levels. Normal polycythemic state of newborn accounts for nearly 80% of serum bilirubin. Occurs in almost 60% of newborns, due to the liver’s ability to process bilirubin. Onset in 3rd day of life in formula-fed and later in breastfed babies.

Hyperbilirubinemia

Manifestations: yellow discoloration of skin (jaundice)

Hyperbilirubinemia

Risks: excessive serum bilirubin may lead to neurotoxicity and produce kernicterus, which can lead to serious neurological sequelae and death.

Hyperbilirubinemia

Testing: serum bilirubin levels measured in the first 72 hours of life and plotted on a nomogram to determine course of action by the infant’s level of risk.

Hyperbilirubinemia

Factors

• bilirubin produced almost twice as much due to shorter life span of RBCs.

• Immature liver, lack of intestinal flora

• Delayed feeding (transfer of intestinal flora)

• Trauma of birth (bruising or cephalhematoma)

• Metabolic demand (from cold stress or RDS)

Erb Palsy

brachial plexus injury involving the upper nerves (C5-C6), often caused by excessive traction on the neck during delivery. This can result in weakness or paralysis of the shoulder and arm.

Brachial Palsy

injury to the brachial plexus, a network of nerves controlling the arm and hand, often occurring due to trauma during delivery. It can range from temporary weakness to permanent nerve damage.

Facial Nerve Paralysis

seventh cranial nerve is injured, often due to pressure during delivery, especially with forceps-assisted births. It can be temporary or permanent, depending on the severity of the injury.

Phrenic Nerve Paralysis

injury to the phrenic nerve (C3-C5), often from birth trauma or excessive traction on the neck during delivery. This leads to impaired diaphragmatic movement, affecting breathing.

In utero

Neonatal infection caused by the passage of organisms across the placenta (i.e. chorioamnionitis)

During Labor

Neonatal infection caused by bacteria ascend the vagina (i.e. GBS)

After Birth

Neonatal infection from infected mother, family, contaminated equipment

Neonatal Infection

Symptoms: instable thermoregulation, RDS, lethargy, irritability, cyanosis, pallor, GI symptoms, rash, CNS involvement.

Neonatal Infection

Diagnosis: CBC and differential within 2 hours of birth, blood cultures if symptomatic, chest x-ray if RD occurs.

Septicemia

bacteria enters the bloodstream; risk factors include pneumonia, bacterial meningitis, gastroenteritis.

Sepsis

the body’s response to septicemia

TORCH Complex

Refers to a group of congenital infections that can be passed from mother to child.

TORCH Complex

T: Toxoplasmosis

O: Other (HPV, parvovirus, HIV, etc.)

R: Rubella

C: CMV infection

H: Herpes simplex

Neonatal Abstinence Syndrome

Group of problems that occur when a newborn is exposed to various addictive substances in utero. I.e. amphetamines, barbiturates, benzos, cocaine, marijuana, opioids. Scored using Finnegan tool.

Neurological

Signs of withdrawal that include: irritability, seizures, hyperactivity, high-pitched cry, tremors, exaggerated Moro reflex, hypertonicity of muscles

Autonomic

Signs of withdrawal that include: diaphoresis, fever, mottled skin, nasal stuffiness, tachypnea

Gastrointestinal

Signs of withdrawal that include: poor feeding, loose stools, dehydration, vomiting, frantic uncoordinated sucking

Naloxone

the use of ______ is contraindicated in infants born to women addicted to narcotics or on methadone therapy because it may exacerbate NAS and cause seizures.

Neonatal Abstinence Syndrome

Nursing Actions:

• Gently rocking the child

• Reducing noise and lights

• Swaddling the baby in a blanket

• Medication to treat withdrawal symptoms

• Discharge planning to provide a safe and optimal environment for the baby

• Breastfeeding can occur if not contraindicated

Abdominal Wall Defects

abdominal organs protrude through an opening in the abdominal wall. The two main types are gastroschisis (no protective membrane, organs exposed) and omphalocele (organs covered by a sac).

Imperforate Anus

anus is absent or incorrectly positioned, obstructing the normal passage of stool.

Clubfoot

one or both feet are twisted inward and downward, often making weight-bearing on the sole impossible

Developmental Dysplasia of the Hip

hip joint does not develop properly, leading to instability or dislocation of the femoral head from the acetabulum.

Phenylketonuria

genetic disorder where the body cannot metabolize phenylalanine, an amino acid found in proteins. Without treatment, phenylalanine builds up in the brain, leading to intellectual disability and neurological damage. Can be screened for.

Galactosemia

genetic disorder where the body cannot metabolize galactose, a sugar found in milk, due to a deficiency in the enzyme galactose-1-phosphate uridyltransferase. This leads to the accumulation of toxic substances in the body. Can be screened for.

Gavage Feeding

process of delivering nutrition directly into the stomach via a tube, typically used for infants who cannot feed orally due to prematurity, illness, or a medical condition. The tube can be inserted through the nose (nasogastric tube) or mouth (orogastric tube).