Developed by D. Ann Currie, RN, MSN

The Newborn at Risk: Conditions Present at Birth

Identification of At-risk Newborn

Low socioeconomic level of the mother Limited or no prenatal careExposure to environmental dangersPreexisting maternal conditionsMaternal factors such as age or parityMedical conditions related to pregnancy Pregnancy complications

Congenital Anomalies

Small-for-gestational-age Maternal factorsMaternal diseaseEnvironmental factorsPlacental factorsFetal factors

Impact of Maternal Diabetes Mellitus (DM) on the Newborn LGASGAHypoglycemiaHypocalcemiaHyperbilirubinemiaBirth traumaPolycythemiaRDSCongenital malformations

Postmaturity Syndrome HypoglycemiaMeconium aspiration and oligohydramniosPolycythemiaCongenital anomaliesSeizuresCold stress

Preterm Infant: Respiratory Alterations

Inadequate surfactant productionMuscular coat of pulmonary blood vessels is

not completely developedGreater risk for the ductus arteriosis to

remain open

Preterm Infant: Alterations in Thermogenesis

Unavailability of glycogen and brown fatInability to increase oxygen consumptionHigh ratio of body surface area to body

weightExtended position increases body surface

areaDecreased ability to vasoconstrict superficial

blood vessels

Preterm Infant: GI Alterations

Poorly developed gag reflexIncompetent esophageal cardiac sphincterPoor sucking and swallowing reflexesDifficulty meeting caloric needs for growth Inability to handle the increased osmolarity of formula protein Difficulty with absorbing saturated fats Difficulty with lactose digestionDeficiency of calcium and phosphorous Increased basal metabolic rate and increased oxygen

requirements Feeding intolerancePotential for the development of necrotizing enterocolitis

(NEC

Preterm Infant: Kidney Alterations

Lower glomerular filtration rate (GFR)Limited ability to concentrate urine or

excrete large amounts of fluidExcrete glucose at a lower serum glucose

level Buffering capacity is reduced Excretion time of drugs is longer

Preterm Infants: Liver Alterations

Glycogen stores are used rapidlyGlycogen stores are affected by asphyxia and

cold stressLow iron storesConjugation is impaired

Preterm Infants: Other Alterations

ImmunologicLack of passive IgG antibodiesSkin is easily excoriated

NeurologicIncreased risk for IVH & ICHDelayed or absent reactivity

Assessment of the Preterm Newborn

Physical characteristicsGestational ageMaternal prenatal risk factorsDelivery risk factorsPhysical assessmentFamily assessment

Hydrocephalus: Nursing Assessments

Occipital-frontal baseline measurementsDaily head circumferencesSkin integritySigns and symptoms of infectionSigns of widening of suture lines

Hydrocephalus: Nursing Interventions

Assist with head ultrasounds and transillumination

Change position frequentlyClean skin creasesKeeping a sheepskin under the headPostoperatively position head off the

operative site

Choanal Atresia: Nursing Assessment

Cyanosis and retractions at restNosy respirationsDifficulty breathing during feedingThick mucous Patency of the naresPass feeding tube to confirm the diagnosis

Choanal Atresia: Nursing Interventions

Assist with taping the airway in the mouthElevate the head to improve air exchange

Cleft Lip and/or Palate: Nursing Assessment

The extent of the cleftDifficulty in suckingExpulsion of formula through the nose

Cleft Lip and/or Palate: Nursing Interventions

Provide nutrition through feedings with a special nipple

Monitor weight gainClean the cleft with sterile waterSupporting parent copingProvide role modelingPosition infant prone or side-lying

Tracheoesophageal Fistula: Nursing Assessments

Excessive oral secretionsConstant droolingAbdominal distentionPeriodic choking and cyanosisImmediate regurgitation of feedingInability to pass a nasogastric tube

Tracheoesophageal Fistula: Nursing Interventions

Withholding feedings until esophageal patency is determined

Place on low intermittent suction to control saliva and mucus

Place in a warmed, humidified incubatorKeep infant quiet and elevate head of bed 20-

40 degreesMaintain fluid and electrolyte balanceProvide parent education and information

Diaphragmatic Hernia: Nursing Assessments

Barrel chest and scaphoid abdomenAsymmetric chest expansionAbsent breath soundsDisplacement of heart sounds to the rightSpasmodic attacks of cyanosis and difficulty

feedingBowel sounds heard in thoracic cavity

Diaphragmatic Hernia: Nursing Interventions

Maintenance of adequate respiratory statusGastric decompressionInvolve parents in carePlace infant in high semi-Fowler’s positionTurn to affected side to allow unaffected lung

expansion

Nursing Care of the Drug-Exposed Newborn

Neonatal abstinence scoringMonitoring VS and pulse oximetry until

stableSmall frequent feedingsIV therapy if neededPositioning on the right side-lying or semi-

Fowler’s Monitoring frequency of diarrhea and

vomiting

Nursing Care of the Drug-Exposed NewbornWeigh infant every 8 hours during

withdrawalSwaddle infantProtect face and extremities from excoriation Place infant in quiet, dimly lighted area of the

nurseryAdministration of medications

Infants Born to HIV/AIDS Infected Mothers: Consequences PrematuritySGAFailure to thriveEnlarged spleen and liverSwollen glandsRecurrent respiratory infectionRhinorrheaRecurrent GI problemsPersistent or recurrent candidiasis

Nursing Care of the Infant Born to HIV/AIDS Infected Mothers Provide comfortKeep the newborn well nourishedKeep the infant protected from infectionsFacilitate growth, development, and

attachment

Congenital Cardiac Disease: Symptoms CyanosisHeart murmurSigns of congestive heart failure

Cardiac Defects

Cardiac Defects

Cardiac Defects

Cardiac Defects

Nursing Care of the Newborn with Inborn Errors of MetabolismAssessment of signs of the disorderState-mandated newborn testingReferral of parents to support groupsReferral of parents to centers for educationDietary management

The End of Part V