Normal and The High
Risk Newborn
Transition to ExtraUterine Life
Prof. Carole A. Devine RN.MSN.
1
A. Respiratory System:
Initiation of Breathing
Successful Transition:
 Pressure Changes in Lungs
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S/S of Respiratory Distress
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Prevention of Aspiration /Airway
Management
Prof. Carole A. Devine RN.MSN.
2
Meconium Aspiration Syndrome

Can Cause Severe Respiratory Distress in
Three Ways:
1.
Inflammation
Obstruction
Decreased Surfactant Production
2.
3.
Outcome= Hypoxia and CO2 Retention
and Possible Pneumonitis
Prof. Carole A. Devine RN.MSN.
3
Meconium Aspiration Syndrome
Cont.
 Assessment

Therapeutic Management

Prognosis

Complication
Prof. Carole A. Devine RN.MSN.
4
Immune System/Integumentary
System

Prevention of
Infection
Safety
Issues/Newborn
Care
Prof. Carole A. Devine RN.MSN.
5
Sepsis Neonatorum
Definition:
 Transmission/Etiology
 Types:
 Early Onset vs Late Onset
 S/S
 Management

Prof. Carole A. Devine RN.MSN.
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THERMOREGULATION
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Necessity of A Neutral Thermal Environment
Too Hot = Must decrease metabolism to cool their body
Too Cool =Must Increase Metabolism to stay warm
This effects the Preterm Baby especially Because:
Has a large surface area per pound of body Wt.
Extended body rather than flexed
Decreased subcutaneous fat
Poor Muscular Development
Limited amt. of brown fat
Prof. Carole A. Devine RN.MSN.
7
Thermoregulation Cont.

Maintain a Neutral Thermal
Environment/Prevent Hypothermia
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Newborn Care:
Drying Infant after Birth
Cover Head
Use A Heated Radiant Warmer
Kangaroo Care
Breast Feeding !!!!
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Prof. Carole A. Devine RN.MSN.
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Endocrine System
 Potential
Risk for Hypoglycemia

Definition of Hypoglycemia for a
Newborn: Glucose < 30-40 during
first 72 hrs. of life in full term
infant
 Problem/S/S
 Newborn
Care:
Prof. Carole A. Devine RN.MSN.
9
Cardiovascular /Hematopoietic System
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Potential Risk For Hemorrhage/
Cardiovascular Compromise
Newborn care:
Administer Vitamin K (Phytonadione) give
0.5mg -1.0 mg IM in the Vastus Lateralis
Muscle at birth
V.S. every 15 min. after birth for one hour,
then every ½ hour x 2,then every two hours
until stable
Prof. Carole A. Devine RN.MSN.
10
Renal /G.I.System
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Potential for Inadequate Elimination Patterns
Newborn Care:
Daily Wt.
Nutrition /Fluid and Electrolyte Balance
Premie.Vs Full Term:
Calorie Concentration in formula fed Infants
will be different i.e.
Full Term = 20 cal./fl. ounce
Premie. = 24 cal./fl. ounce
Breast Feeding: Advantages
Prof. Carole A. Devine RN.MSN.
11
Hepatic System
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Bilirubin
Hyperbilirubinemia ( Jaundice):
Definition:
Conjugated vs. Unconjugated:
Unconjugated =Fat soluble=Indirect
Conjugated = H2O soluble=Direct
Etiology/Normal Conjugation of Bilirubin:
S/S
Complications
Prof. Carole A. Devine RN.MSN.
12
Types of Jaundice
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Physiologic
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Onset : occurs on the
2-3rd day of life
Cause:
Bili. Level: <10-12
Tx. Encourage feeding
and elimination
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Pathologic:
Onset: during first
24 hrs. of life
Cause:
Bili. Level: 13 and> in
full term; 15 in Premie
Tx. Phototherapy i.e.
(Bili-lights)
Exchange
Transfusions
Prof. Carole A. Devine RN.MSN.
13
Jaundice (Cont.)
 Breast
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Milk Jaundice:
Onset: Between the 4 -7th day after Birth
Bilirubin Levels Can peak at two weeks up
to 15-20
Causes:
Tx. D/C Breast Feeding temporarily for 2448 hrs. and place infant in a sunny window
Prof. Carole A. Devine RN.MSN.
14
Gestational Age Assessment
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Indicators of Maturity in the Newborn
Dubowitz and Ballard Scales are used to
Determine
Categories: SGA (small for Gestational Age)
IUGR (Intrauterine Growth Restriction)
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VS
LGA (Large for Gestational Age)
(Macrosomia)
Prof. Carole A. Devine RN.MSN.
15
Small for Gestational Age Neonates
(SGA)
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Definition/Appearance:
Etiology:
Diagnosis:
Risk Factors/Common Cause:
Nursing Management:
Developmental Outcome:
Prof. Carole A. Devine RN.MSN.
16
Large For Gestational Age Neonate
(LGA)
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Definition/Appearance:
Etiology:
Diagnosis:
Risk Factors/Common Cause:
Nursing Management:
Developmental Outcome:
Prof. Carole A. Devine RN.MSN.
17
The Premature (Preterm) Infant
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Criteria/Definition:
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Wt. <2500G ( 5 1/2 lbs ) at
Birth
Infant born between the
20th week and <end of 37th
week Gestation
General Appearance:
Small and underdeveloped
Head is large
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General Appearance
cont:
Ruddy skin-little
subcutaneous fat
Veins are readily
noticeable
Extensive lanugo with
little vernix
Little or no creases on
sole of foot
Prof. Carole A. Devine RN.MSN.
18
Collaborative Problems of the
Preterm Infant
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Respiratory Distress Syndrome (RDS)
Definition/Etiology
Underdevelopment of lungs
Chief feature= fibrous membrane formed by
exudate of infant’s blood that forms lining of
respiratory tract (prevents exchange of CO2 and
O2)
Problem: decrease production of Surfactant
L/S ratio is low (Lecithin/Sphingomyelin)
Management
Prevention
Prof. Carole A. Devine RN.MSN.
19
Collaborative Problems Cont.

Broncopulmonary Dysplasia (BPD)

Etiology/Incidence

S/S

Management
Prof. Carole A. Devine RN.MSN.
20
Peri/Intraventricular Hemorrhage
(PVH)(IVH)
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Etiology

Incidence:

S/S

Diagnosis

Management
Prof. Carole A. Devine RN.MSN.
21
Necrotizing Entercolitis
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Etiology/Incidence

S/S
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Diagnosis

Management
Prof. Carole A. Devine RN.MSN.
22
Retinopathy of Prematurity (ROP)
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Definition/Etiology:

S/S:

Management: Prevention:

L/T. Consequences
Prof. Carole A. Devine RN.MSN.
23
Post Term Infant

Definition: Gestational age >
than 42 weeks

Factors assoc. with Post
Term:
Aging Placenta
Oligohydramnios
CPD (Cephalopelvic
Disproportion)
MAS
Factors Cont.
Hypoglycemia
Polycythemia
Thermoregulation
Appearance
Therapeutic Management
Prof. Carole A. Devine RN.MSN.
24
Infant of a Diabetic Mother

Appearance:

Etiology:

Complications:

Management:
Prof. Carole A. Devine RN.MSN.
25
Prenatal Drug Exposure
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Risk Factors:
Effect on
Fetus/Newborn:
Neonatal Abstinence
Syndrome
Management/Nursing
Care
1.
2.
3.
4.
5.
6.
7.
Alcohol
Heroin
Cocaine
PCP
Marijuana
Caffeine
Nicotine
Prof. Carole A. Devine RN.MSN.
26
Torch Infections That Effect The
Fetus/Newborn
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S/S; Nursing Dx.; Management (see handout)
T=Toxoplasmosis
O=Other:
Gonorrhea
Syphilis
Varicella
Hepatitis B Virus
HIV
R= Rubella
C=Cytomegalovirus (CMV)
H=Herpes Simplex Virus (HSV)
Prof. Carole A. Devine RN.MSN.
27
Parenting Issues with a High Risk
Newborn
NSG.DX. High Risk for Altered Parenting
R/T Impaired Parent/Infant Bonding
Promote Bonding
Emotional support
Fetal Demise
Nursing Responsibilities
Care of Infant
Care of Family
Prof. Carole A. Devine RN.MSN.
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THE END Of THE STORY ! !
For Now……
Prof. Carole A. Devine
RN.MSN.
29