Ch. 25- High Risk Newborns: Acquired and Congenital (9)

Topics to Review

Transient Tachypnea of the Newborn

Rapid Respirations too soon after birth from inadequate absorption of fetal lung fluid

• Resolves w/in 24-48 hours

• most common respiratory cause of admission to NICU

Transient Tachypnea of the Newborn

• Risk Factors

• C-Section

• Excessive Sedation of mom

• Macrosomia

• Twins

• Prolonged or precipitous labor

• males

• Asthmatic mother

Transient Tachypnea of the Newborn

• Manifestations

Seen in the first few hours of life and Resolves Faster than RDS

• Grunting

• Retractions

• nasal Flaring

• Mild Cyanosis

Diagnostics

• Hyperinflation, engorged lymphatics

• fluid in the fissures between lobes

Transient Tachypnea of the Newborn

• Therapeutic Management

1. O2 and Continuous Positive Airway Pressure (CPAP)

2. Gavage Feedings

   1. RR >60 to prevent aspiration and preserve energy

3. Observe SS of RDS and SEPSIS

   1. ABX until Sepsis Ruled OUT

Transient Tachypnea of the Newborn

• Nursing Considerations

ID the Signs and Notify the Provider and Carry Out Treatments

Phototherapy

Placing jaundiced infant under special fluorescent lights to break excess bilirubin into water soluble products to be excreted by bile and urine

• Preterm Infant, Therapy is bugun with lower bili levels to prevent toxicity

Phototherapy

• Nursing Considerations

Infant dressed in just diaper and eye patch for maximum exposure and protect eyes from injury

• if levels are dangerously high, diaper can be takes off

Levels must be checked frequently

Use Phototherapy blankets so parents can hold infant

Phototherapy

• Side Effects

1. Frequent LOOSE Green Stools (Watch dehydration and skin irritation)

• Increase Fluids by 25% during therapy

• Sunken Fontanels is LIFE_THREATENING

2. Hyper/Hypothermia→ frequent temperature checks

3. Rebound Bilirubin

   1. common in first 24 hours of treatment

      1. EDU family its expected and Dr will order more blood tests before discharge

Sepsis

• Early Onset

Acquired during birth, bc complications of labor

• Prolonged labor, prolonged Rupture of Membranes, Triple I

• S/S w/in 3 days

  • RAPID progression multisystem

  • High Morbidity and mortality

Sepsis

• Late-Onset

Acquired During or After Birth, Before or After Discharge

• Most common after First Week

• RF: Preterm birth

Sepsis

• Treatment

At Onset of Symptoms→ Broad Spectrum IV until cultures come back

• 10- 14 days

• 21 days if Meningitis

Meet other needs

• O2

• Fluid balance

  • Hourly Urine Output

• BP

Sepsis

• Signs

• Temperature Instability

• Tachypnea, Respiratory Distress, Apnea

• Color Changes, Tachy-, Brady-, Hypotension, Decreased Cap Refill

• Decreased Feeding, Vomiting, Diarrhea, Abdominal Distention, Hypo- and Hyperglycemia

• AMS, lethargy, Jitteriness, Full Fontanel, High-Pitched Cry

ADVANCED SIGNS

• Jaundice, Hemorrhage, Anemia, Enlarged Liver and Spleen, Resp. Failure, Shock, Seizures

Group B Streptococcal infection

Sudden Onset of Respiratory Distress, Temperature Instability, Pneumonia, Shock, meningitis

• Early ID to prevent death

• ABX to mom during labor and to infant

Infant of Diabetic Mother

• Signs

The face will be round, skin is red, body obese, poor muscle tone when sleeping, irritable and possible tremors

• they have been having getting so much glucose from mom and are now losing that without adequate production on their own

Infant of Diabetic Mother

• Screening

BG levels <45 is considered low

• Monitor in first 2-3 hours

Primary Apnea

Stimulation helps

Secondary Apnea

Stimulation Does NOT HELP

• Resuscitation measures required

• Ventilation is MOST IMPORTANT

Intrauterine Drug Exposure

• Assessment

What Substances?

Last Dose?

H

Intrauterine Drug Exposure

• Behavioral Signs

• Irritability, Jitteriness, Tremors, Rigid or Restless, Excessive Activity

• Exaggerated Prolonged High Pitched Cry

• Difficulty sleep

Easily Overstimulated and Stressed, Gentle Handling

Intrauterine Drug Exposure

• Feeding Signs

• Excessive Sucking, Uncoordinated Sucking and Swallowing

• Frequent Vomiting, Diarrhea, and Weight Loss

Intrauterine Drug Exposure

• Cardiovascular and Respiratory Issues

Nasal Stuffiness, Sneezing, Tachypnea, Apnea, Retractions, tachycardia

Coombs Test

When an infant is jaundiced, a blood type and direct Coombs test is done to indicate if the mother formed antibodies and they were attached to the infants RBC during pregnancy