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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