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 care
 Exposure to environmental dangers
 Preexisting maternal conditions
 Maternal factors such as age or parity
 Medical conditions related to pregnancy
 Pregnancy complications
Congenital Anomalies
Small-for-gestational-age
 Maternal factors
 Maternal disease
 Environmental factors
 Placental factors
 Fetal factors
Impact of Maternal Diabetes
Mellitus (DM) on the Newborn
 LGA
 SGA
 Hypoglycemia
 Hypocalcemia
 Hyperbilirubinemia
 Birth trauma
 Polycythemia
 RDS
 Congenital malformations
Postmaturity Syndrome
 Hypoglycemia
 Meconium aspiration and oligohydramnios
 Polycythemia
 Congenital anomalies
 Seizures
 Cold stress
Preterm Infant: Respiratory
Alterations
 Inadequate surfactant production
 Muscular coat of pulmonary blood vessels is not
completely developed
 Greater risk for the ductus arteriosis to remain open
Preterm Infant: Alterations in
Thermogenesis
 Unavailability of glycogen and brown fat
 Inability to increase oxygen consumption
 High ratio of body surface area to body weight
 Extended position increases body surface area
 Decreased ability to vasoconstrict superficial blood
vessels
Preterm Infant:
GI Alterations
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Poorly developed gag reflex
Incompetent esophageal cardiac sphincter
Poor sucking and swallowing reflexes
Difficulty meeting caloric needs for growth
Inability to handle the increased osmolarity of formula protein
Difficulty with absorbing saturated fats
Difficulty with lactose digestion
Deficiency of calcium and phosphorous
Increased basal metabolic rate and increased oxygen
requirements
 Feeding intolerance
 Potential 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 fluid
 Excrete 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 rapidly
 Glycogen stores are affected by asphyxia and cold
stress
 Low iron stores
 Conjugation is impaired
Preterm Infants:
Other Alterations
 Immunologic
 Lack of passive IgG antibodies
 Skin is easily excoriated
 Neurologic
 Increased risk for IVH & ICH
 Delayed or absent reactivity
Assessment of the
Preterm Newborn
 Physical characteristics
 Gestational age
 Maternal prenatal risk factors
 Delivery risk factors
 Physical assessment
 Family assessment
Hydrocephalus:
Nursing Assessments
 Occipital-frontal baseline measurements
 Daily head circumferences
 Skin integrity
 Signs and symptoms of infection
 Signs of widening of suture lines
Hydrocephalus:
Nursing Interventions
 Assist with head ultrasounds and transillumination
 Change position frequently
 Clean skin creases
 Keeping a sheepskin under the head
 Postoperatively position head off the operative site
Choanal Atresia:
Nursing Assessment
 Cyanosis and retractions at rest
 Nosy respirations
 Difficulty breathing during feeding
 Thick mucous
 Patency of the nares
 Pass feeding tube to confirm the diagnosis
Choanal Atresia:
Nursing Interventions
 Assist with taping the airway in the mouth
 Elevate the head to improve air exchange
Cleft Lip and/or Palate:
Nursing Assessment
 The extent of the cleft
 Difficulty in sucking
 Expulsion of formula through the nose
Cleft Lip and/or Palate:
Nursing Interventions
 Provide nutrition through feedings with a special
nipple
 Monitor weight gain
 Clean the cleft with sterile water
 Supporting parent coping
 Provide role modeling
 Position infant prone or side-lying
Tracheoesophageal Fistula:
Nursing Assessments
 Excessive oral secretions
 Constant drooling
 Abdominal distention
 Periodic choking and cyanosis
 Immediate regurgitation of feeding
 Inability 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 incubator
 Keep infant quiet and elevate head of bed 20-40
degrees
 Maintain fluid and electrolyte balance
 Provide parent education and information
Diaphragmatic Hernia:
Nursing Assessments
 Barrel chest and scaphoid abdomen
 Asymmetric chest expansion
 Absent breath sounds
 Displacement of heart sounds to the right
 Spasmodic attacks of cyanosis and difficulty feeding
 Bowel sounds heard in thoracic cavity
Diaphragmatic Hernia:
Nursing Interventions
 Maintenance of adequate respiratory status
 Gastric decompression
 Involve parents in care
 Place infant in high semi-Fowler’s position
 Turn to affected side to allow unaffected lung
expansion
Nursing Care of the
Drug-Exposed Newborn
 Neonatal abstinence scoring
 Monitoring VS and pulse oximetry until stable
 Small frequent feedings
 IV therapy if needed
 Positioning on the right side-lying or semi-Fowler’s
 Monitoring frequency of diarrhea and vomiting
Nursing Care of the
Drug-Exposed Newborn
 Weigh infant every 8 hours during withdrawal
 Swaddle infant
 Protect face and extremities from excoriation
 Place infant in quiet, dimly lighted area of the nursery
 Administration of medications
Infants Born to HIV/AIDS
Infected Mothers: Consequences
 Prematurity
 SGA
 Failure to thrive
 Enlarged spleen and liver
 Swollen glands
 Recurrent respiratory infection
 Rhinorrhea
 Recurrent GI problems
 Persistent or recurrent candidiasis
Nursing Care of the Infant Born
to HIV/AIDS Infected Mothers
 Provide comfort
 Keep the newborn well nourished
 Keep the infant protected from infections
 Facilitate growth, development, and attachment
Congenital Cardiac Disease:
Symptoms
 Cyanosis
 Heart murmur
 Signs of congestive heart failure
Cardiac Defects
Cardiac Defects
Cardiac Defects
Cardiac Defects
Nursing Care of the Newborn
with Inborn Errors of Metabolism
 Assessment of signs of the disorder
 State-mandated newborn testing
 Referral of parents to support groups
 Referral of parents to centers for education
 Dietary management
The End of Part V