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Abdulmahdi A. Hasan*
*Ph,D, pediatric & psychiatric Mental Health Nursing
Health Problems of the Newborn
 Birth Injuries
Occurs in:
Large infants
Breach deli vary
Forceful extraction
Inexperienced hands
Soft Tissue Injury
Usually in cephalopelvic disproportion like: forceps application on side of face.
Petechiae or echymosis on the presenting part.
Nursing care directed toward assessing the injury and reassure the parents as they
usually fades away without treatment.
 Head Trauma
Intraventricular hemorrhage
Subdural hematoma
Skull fracture
Caput succedaneum
Most common trauma
Edematous tissue of the scapula, the swelling consists of serum or blood or both,
extends beyond bone margins, no specific treatment is needed.
 Cephalic Hematoma
Difficult labor or delivery- bld vessel rupture- blding btw. The bone and periosteumsharply demarcated boundaries and not beyond the bone.
May be in one or 2 parietal bones, less frequent in occipital, rare frontal.
Most cases absorbed in 2 to 3 months.
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No treatment is needed except for severe bld loss.
 Fractures
Clavicle is the most frequent.
May have no symptoms.
May have limited use of the affected arm, asymmetric moro reflex, local swelling or
tenderness, cracking sound.
Fractures of long bones difficult to detect by x-ray.
Skull fx: rare
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 Paralysis
Facial paralysis
Pressure during difficult labor- injury- loss of movement of affected side (inability to
close eye led drooping of affected angle of mouth)
 recovery spontaneous in days to months.
 Brachial palsy: results from forces that alter the relationships of the arm, shoulder,
and neck.
Rx prevent muscle contracture, and maintain correct placement of humeral head.
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f the cause is nerve stretching- recovery occurs in about 3 months.
If the cause is nerve a avulsion, a permanent damage results.
Phrenic Nerve Paralysis
 May occur with brachial pulsy
 Unilateral- diaphragmatic paralysis so lung on the affected side does not expand,
thoracic breathing, cyanosis occur, pneumonia frequent complications.
 Nursing Consideration
If facial paralysis aid the infant to suck, use artificial tears, the led is often taped shut.
Phrenic nerve paralysis deal with the respiratory difficulty.
 Common Problems
Erythema toxicum neonatarum (flee bite dermatitis, or newborn rash)
Unknown cause
Pale yellow or white papules and/or pustules 1-3 mm 1st to 2nd day on face proximal
extremities, trunk and buttocks
Lasts 5-7 days
No treatment is needed.
Candidiasis: caused by candida albicains (yeast like fungus).
Candidal diaper dermatitis:
Rx anti candida ointment, may use oral antifungal.
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Oral Candidiasis:
white patches in tongue , plate, can go to larynx, trachea, and lungs.
Rx 1 ml nystatin QID after meals for 7 days.- source of infection mother cleanliness
and hand washing
 Hypotonia (Floppy Infant Syndrome)
Decrease muscle tone, weak response to reflexes.
Frog posture, Poor sucking, floppy muscles
Causes: cerebral trauma or hypoxia, chromosomal disorder esp.
Down Syndrome.
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 High Risk Newborn
New born who has a greater chance than average chance of morbidity or mortality.
The high risk period encompasses human growth and develop. From the time of
viability up to 28 days.
Premature: < 37 wk gestation
Term infant: bet. 38 – 42 wks gestation.
Post mature: born after 42 wks gestation
 Care of High Risk Newborn
Respiratory support
Provide warmth- neutral thermal environment 36-36.5
Protection from infection- hand washing, clean incubator, universal
precaution, infected personal should not work unless protective equipment used.
Hydration:
Sucking and swallowing coordination occur at 34- 35 wks gestation.
Gavage feeding: flow with gravity boluses or continuous in a feeding pump.
Check residue amt. and color and follow Dr. order.
 Hyperbilirubinemia
Increased bilirubin in the blood, causing jaundice (icterus).
Normal newborn produces 2x as much bilirubin as does an adult while the liver
ability to conjugate bilirubin is reduced.
Possible causes: interference in the balance btw. Formation and removal
1. over production of bilirubin
2. Under excretion of bilirubin
3. Combined 1&2.
4. Associated with breast feeding.
5. Physiologic jaundice (most common, self limited)
** with the 1st 24 hours: hemolytic dz, sepsis, or maternal derived dz.
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In the 2nd or 3rd day, peak on 4th day, decrease in 5th to 7th day:, physiologic
jaundice
After the 3rd day within the first week: Sepsis
High bilirubin highly toxic to neurons- kernicterus due to deposit in brain cells
Rx: Treatment :1- Photo therapy: alter bilirubin to soulable form.
Cover eyes and perform eye care q shift
Cover genital for males.
Change position
Assess for diarrhea
2- Pharmacologic: Phenobarbital stimulates liver maturation & protein synthesis not
rapid best if given early to the mother.
3- Exchange transfusion, for hemolytic diseases.
 Hemolytic Disease of the Newborn
RH incompatibility
-ve RH mother carrying +ve RH baby for first time. During delivary will form
antibodies and will hurt any future RH +ve babies.
In severe forms hydrops fetalis occur.
Mothers must receive anti D within fist 72 hours of birth (Rogam).
 ABO Incompatibility
Maternal blood group
O
B
A
Phototherapy
Exchange transfusion:
Fetal blood group
A or B
A or AB
B or AB
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 IRDS- HMD
Responsible for more deaths than any disease.
Highest risk of long term neurologic complication.
Seen exclusively in preterm infants.
Decrease surfactant- inability to keep lungs inflated- atelectasis,
hypoxemia, hypercapnia- respiratory and metabolic acidosisvasoconstriction- decrease puls circulation.
Rx: Treatment :-
Surfactant administration through ETT. single dose may be enough but
multiple doses may be needed.
Respiratory support ventilation and oxygenation.
 Neonatal Sepsis
Premature – immature immune system
Sepsis = septicemia common in preterm & after difficult labor
Acquired parentally or during birth process from amniotic fluid,
across placenta or direct contact in birth canal
Postnatally across contamination from infants or staff personal.
Blood cultures- umbilicus, nasal, oral, pharyngeal cavity, ear canals,
skin, CSF, stool, urine.
Rx: respiratory support, circulatory supp., aggressive antibiotics.
 NEC
Necrotizing Enterocolitis
Common below 2 kg, or infants who suffered hypoxia, sepsis, or after
exchange transfusion, this reduce bld supply, death of mucosal cellsinability to secrete protective mucus- easy invasion by gas forming
bacteria- pnemotosis intestinalis.
Hypertonic formula –consistent relationship to NEC.
DX: Diagnosis :-
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nonspecific signs, lethargy, poor feeding, hypotension, vomiting,
apnea, decrease urine output, unstable temp.
Specific sy.- distended abd (shiny) bld in stool or gastric content,
Rx: NPO, correct fld & elect. Imbalance & hypoxia.
Abd decompression.
Systemic antibiotic.
Surgical resection if deterioration.