High Risk Neonatal Nursing Care
High Risk Newborn Nursing Care
Fetal/Neonatal Risk
Factors for Resuscitation
Nonreassuring fetal heart rate pattern
Difficult birth
Fetal scalp/capillary blood sample-acidosis pH<7.20
Meconium in amniotic fluid
Prematurity
Macrosomia or SGA
Male infant
Significant intrapartum bleeding
Structural lung abnormality or oligohydramnios
Congenital heart disease
Maternal infection
Narcotic use in labor
Fetal/Neonatal Risk Factors
for Resuscitation (continued)
An infant of a diabetic mother
Arrhythmias
Cardiomyopathy
Fetal anemia
Respiratory Distress
Syndrome (RDS)
Deficiency or absence of surfactant
Atelectasis
Hypoxemia, hypercarbia, academia
May be due to prematurity or surfactant deficiency
RDS: Nursing Care
Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
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Education and support of family
Transient Tachypnea of
the Newborn (TTN)
Failure to clear lung fluid, mucus, debris
Exhibit signs of distress shortly after birth
Symptoms
Expiratory grunting and nasal flaring
Subcostal retractions
Slight cyanosis
TTN: Nursing Care
Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
Support and educate family
Meconium Aspiration
Syndrome (MAS)
Mechanical obstruction of the airways
Chemical pneumonitis
Vasoconstriction of the pulmonary vessels
Inactivation of natural surfactant
MAS: Nursing Care
Assess for complications related to MAS
Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
Persistent Pulmonary
Hypertension (PPHN
Blood shunted away from lungs
Increased pulmonary vascular resistance (PVR)
Primary
Pulmonary vascular changes before birth resulting in PVR
Secondary
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Pulmonary vascular changes after birth resulting in PVR
PPHN: Nursing Care
Minimize stimulation
Maintain adequate respiratory status
Observe for signs of pneumothorax
Maintain adequate nutritional status
Maintain adequate hydration status
Support and educate family
Cold Stress
Increase in oxygen requirements
Increase in utilization of glucose
Acids are released in the bloodstream
Surfactant production decrease
Cold Stress: Nursing Care
Observe for signs of cold stress
Maintain NTE
Warm baby slowly
Frequent monitoring of skin temperature
Warming IV fluids
Treat accompanying hypoglycemia
Hypoglycemia Symptoms
Lethargy or jitteriness
Poor feeding and sucking
Vomiting
Hypothermia and pallor
Hypotonia, tremors
Seizure activity, high pitched cry, exaggerated moro reflex
Hypoglycemia:
Nursing Care
Routine screening for all at risk infants
Early feedings
D10W infusion
Physiologic
Hyperbilirubinemia
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Appears after first 24 hours of life
Disappears within 14 days
Due to an increase in red cell mass
Pathologic
Hyperbilirubinemia
Appears within first 24 hours of life
Serum bilirubin concentration rises by more than 0.2 mg/dL per hour
Bilirubin concentrations exceed the 95th percentile
Conjugated bilirubin concentrations are greater than 2 mg/dL
Clinical jaundice persists for more than 2 weeks in a term newborn
Causes of Pathologic Hyperbilirubinemia
Hemolytic disease of the newborn
Erythroblastosis fetalis
Hydrops fetalis
ABO incompatibility
Treatment of Pathologic Hyperbilirubinemia
Resolving anemia
Removing maternal antibodies and sensitized erythrocytes
Increasing serum albumin levels
Reducing serum bilirubin levels
Minimizing the consequences of hyperbilirubinemia
Maternal-Fetal
Blood Incompatibility
Rh incompatibility
Rh-negative mother
Rh-positive fetus
ABO incompatibility
O mother
A or B fetus
Phototherapy: Nursing Care
Maximize exposure of the skin surface to the light
Periodic assessment of serum bilirubin levels
Protect the newborn’s eyes with patches
Measure irradiance levels with a photometer
Good skin care and reposition infant at least every 2 hours
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Maintain an NTE and adequate hydration and nutrition
Anemia
Hemoglobin of less than 14 mg/dL (term)
Hemoglobin of less than 13 mg/dL (preterm)
Nursing management
Observe for symptoms
Initiate interventions for shock
Polycythemia
Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit
Monitor for signs of distress
Assist with exchange transfusion
Clinical Manifestations of Sepsis
Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit
Monitor for signs of distress
Assist with exchange transfusion
Temperature instability
Feeding intolerance
Hyperbilirubinemia
Tachycardia followed by apnea/bradycardia
Clinical Manifestations of Syphilis
Rhinitis
Red rash around the mouth and anus
Irritability
Generalized edema and hepatosplenomegaly
Congenital cataracts
SGA and failure to thrive
Syphilis: Nursing
Management
Initiate isolation
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Administer penicillin
Provide emotional support for the family
Gonorrhea
Clinical Manifestations
Conjunctivitis
Corneal ulcerations
Nursing management
Administration of ophthalmic antibiotic ointment
Referral for follow-up
Clinical Manifestationfs of Herpes
Small cluster vesicular skin lesions over the entire body
DIC
Pneumonia
Hepatitis
Hepatosplenomegaly
Neurologic abnormalities
Herpes: Nursing
Management
Careful hand washing and gown and glove isolation
Administration of IV vidarabine or acyclovir
Initiation of follow-up referral
Support and education of parents
Chlamydia
Clinical Manifestations
Pneumonia
Conjunctivitis
Nursing management
Administration of ophthalmic antibiotic ointment
Referral for follow-up
Needs of Parents of
At-risk Infants
Realistically perceiving the infant’s medical condition and needs
Adapting to the infant’s hospital environment
Assuming primary caretaking role
Assuming total responsibility for the infant upon discharge
Possibly coping with the death of the infant if it occurs
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Facilitating Parental
Attachment
Facilitating family visits
Allowing the family to hold and touch the baby
Giving the family a picture of the baby
Liberal visiting hours
Encouraging the family to get involved in the care
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