Preterm 2

High-Risk Newborn: Conditions and Complications

Overview of High-Risk Newborns

• High-risk newborns may present in different sizes and conditions, influenced by maternal factors among others.

Small for Gestational Age (SGA)

• Definition: Babies who fall below the 10 percentile in size when compared to other infants of the same gestational age.

• Conditions: Can be term, preterm, or post-term.

• IUGR/FGR:

  • Symmetric growth restriction (proportionally small)

  • Asymmetric growth restriction (the head and length are normal but body is thin)

Common Complications for SGA/IUGR Babies

• Increased risk of SGA:

  • Hypothermia (have less fat)

  • Breathing issues-Asphyxia

  • Polycythemia (from hypoxia)

  • Hypoglycemia (low glycogen storage)

  • Aspiration syndrome

• Specific to Intrauterine Growth Restriction (IUGR):

  • Potential for intrauterine infections impacting growth.

  • Congenital malformations

  • Continued growth difficulties

  • Cognitive difficulties

Large for Gestational Age (LGA)

• Definition: Newborns above the 90th percentile in growth chart measurements.

• Commonly associated with:

  • Diabetic mothers and genetic factors.

  • Multiparous mothers

  • Males tend to be larger than females

• Complications:

  • Higher likelihood of difficult delivery (e.g., increased chance of cesarean section).

  • Birth trauma caused by shoulder dystocia (cephalopelvic disproportion)

  • increase need for oxytocin induced births.

  • Polycythemia and hyperviscosity.

  • Potential hypoglycemia; necessitates monitoring for signs of low blood sugar.

Characteristics of Infants of Diabetic Mothers

• Often macrosomic (larger than normal).

• Increased body fat and potential complications:

  • Thick umbilical cord and large placenta due to excess maternal glucose.

  • Decreased total body water

  • Enlarged organs like cardiomegaly. The only organ not affected is the brain.

• Causes

  • Elevated insulin production in response to high sugar exposure.

• Compliments

  -hypoglycemia

  -Hyperbilirubinemia-result from polycythemia.

-birth trauma

-Polycythemia as a result of hypoxia prior to birth

-Respiratory distress syndrome

-Cognitive birth defects

Drug and Alcohol Exposures in Newborns

• Newborns exposed to substances may experience withdrawal after birth and congenital anomalies.

• Fetal Alcohol Syndrome (FAS)

  -Leading cause of mental retardation that is preventable

  • Characteristics include:

  • Heart problems (septal and valvular defects)

  • Small and far-apart eyes also optic nerve hypoplasia

  • Ears-hearing loss

  • Kidney defects

  • Hip dislocations

  • Musculoskeletal abnormalities

  • Jitteriness and inability to settle easily.

• Nursing Care:

  • Emphasize thermal regulation, feeding, and minimizing sensory stimuli to aid recovery.

Signs of Withdrawal in Newborns

• Symptoms can include:

  • Jitteriness

  • abnormal reflexes

  • abdominal distension

  • seizures,

  • excessive sucking behavior.

  • Sleeplessness

  • Excessive arousal

  • Inconsolable high pitched cry

  • Hyperactive rooting

• Greatest risk for fetus of drug-abusing mother

  • Intrauterine asphyxia

  • Intrauterine infections

  • Alterations in birth weight

  • Low Apgar Score-Narcan is contraindicated because it may cause acute withdrawal of the infant.

  • Respiratory distress

  • Jaundice

  • Congenital anomalies and growth restriction

  • Behavior abnormalities

  • Withdrawal

  • *Finnegan scoring system or neonatal abstinence scoring tool used to assess the level of symptoms and when to initiate pharmacological management*

Apgar Score

• Importance in measuring immediate health post-birth.

• Scores of 7 and above typically indicate stable health.

• Monitoring is crucial, particularly for low scores, which may require interventions.

Respiratory Distress in Newborns

• Common causes include prematurity and surfactant deficiency disease, which is the lack of surfactant necessary for proper lung function.

• The risk of respiratory issues is higher than cardiac issues in neonates.

Signs and Symptoms of Respiratory Distress

• Visual indicators of distress can include:

  • Asymmetrical chest movements vs. seesaw movements

  • Retractions, nasal flaring, grunting, or apnea.

  • Tachypnea: rapid breathing patterns.

  • Cyanosis

  • Pallor or Mottling

  • Jaundice

  • Apnea no breathing for at least 20 seconds

Nursing Interventions for Respiratory Distress

• Administer surfactant via endotracheal route.

• Monitor oxygen levels vigilantly, being cautious of ROP (Retinopathy of Prematurity).

• May need a oxygen via a mechanical vent or CPAP

• Use IV fluids carefully to prevent overhydration.

• Correct acidosis-correct cause (sepsis, hypo ventilation)

• Inhaled nitric oxide therapy (pulmonary vasodilator)

Post-term Newborns (born after 42 weeks)

• Associated Risks:

  • Placental insufficiency may lead to hypoxia or asphyxia.

  • Complications include:

  • Hypoglycemia, meconium aspiration, polycythemia, anomalies, and seizures.

Transient Tachypnea of the Newborn (TTN)

• Common in larger infants and those delivered via C-section.

• LACK OF SQUEEZE! Mucus and lung fluid is failed to clear from airway.

• Usually resolves 12-72 hours post-delivery.

  Happens a short term after birth and resembles RDS

• Expiration grunting

• Flaring of the nostrils

• Mild cyanosis

• Resp >60

• Mild respiratory and metabolic acidosis may be present 2-6 hours of age.

  *Nursing care is the same as RDS*

Meconium Aspiration Syndrome

• Occurs when a newborn inhales meconium-stained amniotic fluid during or after delivery.

• Risks include:

  • Obstruction (ball-valve action-air in but not out)

  • Chemical pneumonia is-secondary pneumonia.

  • Pulmonary vasoconstriction-hypertension

  • Inactivates meconium

• Key signs to monitor:

  • Weak heartbeat, cyanosis, abnormal respiratory rates, apnea,<6 low apgar score, diminished air movement, liver displacement,

• Management

  •When meconium is noted in the amniotic fluid-notify nursery and NICU

  •if depressed respirations and HR is under 100: direct endotracheal suctioning to remove meconium(done by NICU)

Thermal Regulation in Newborns

• Newborns are prone to hypothermia due to lack of body fat and ability to shiver.

• Suggested nursing practices include:

  • Management of immediate temperature, swaddling, and warmth via incubators-warm infant slowly because too fast can cause BP to go down. Warm IV fluids.

  • Monitoring for signs of excess heat loss or cold stress.

•Signs of cold stress:

-Tachypnea

-Restless

-Pallor, mottling and cool skin

-lethargic

-hypoglycemia

-Apnea

-tremors

-seizures

Jaundice in Newborns

• Newborn jaundice results from the breakdown of hemoglobin and may be a normal condition.

• Types:

  • Physiologic Jaundice (normal transition to extrauterine life):

  • Appears after 24 hours and typically resolves within 14 days.

  • Pathologic Jaundice:

  • Occurs within the first 24 hours, posing risks of brain damage and necessitating intervention.

Assessment of Jaundice

• Visual checks using a finger press over bony prominences under natural light.

• Laboratory and further diagnostic measures may be needed to confirm diagnoses.

Infection Risks in Newborns

• Newborns are susceptible to various infections due to immature immune systems and can experience:

  • Increased susceptibility to viral and bacterial infections.

  • Signs indicating severe infection include:

  • Elevated heart rate, tachypnea, hypoglycemia, and jaundice.

• Special focus on maternal infections (e.g., Group B strep, STIs).

Nursing Assessment and Care

• Importance of careful assessments to identify and manage conditions where infection is suspected.

• Strategies for infection control and preventive measures in mothers and newborn care.

Final Considerations in Neonatal Care

• Newborns thrive on swaddling for comfort.

• Encouragement of parent interaction and skin-to-skin contact as part of nursing care efforts.