High Risk Newborn

High Risk Newborn
The Preterm Newborn
Delivery prior to 37 weeks gestation
Factors
Multiple gestation
PROM
incompetent cervix
Maternal disease
Preterm Newborn Complications

Patent
ductus arteriosus (PDA)
Apnea
Respiratory
Distress Syndrome
Intraventricular hemorrhage (IVH)
Retinopathies of prematurity (ROP)
Auditory, speech & neurologic defects
Postdates Newborn
Born after 42 weeks
Postdates are prone to:
Hypoglycemia
Meconium aspiration
Polycythemia
Congenital anomalies
Seizures
Cold Stress
Nursing management for postdates

Serial
O2
Glucose Testing
therapy
Thermoregulation
Lab
work
techniques
Large for Gestational Age (LGA)

Infants
>90th percentile for weight at birth
Factors
Maternal diabetes
parental obesity
male infants,
multiparous
Genetics
Erythroblastosis fetalis
Large for Gestational Age (LGA)

Complications
Difficult delivery, birth trauma, hypoglycemia,

polycythemia high risk for cesarean births due to
CPD and breech
Nursing
implications
Assess for birth injury

Vital signs
Monitor for hypoglycemia
Educate the family
Small for Gestational Age (SGA)

At
or below the 10th percentile
Contributing
factors:
Genetics
Malnutrition
Vascular changes in PIH/DM
Maternal factors
Environmental factors
Placental factors
Fetal factors
SGA Complications
Perinatal
asphyxia
Aspiration Syndrome
Hypothermia
Hypoglycemia
Polycythemia
Hypothermia (Cold Stress)
Excessive heat loss that requires a newborn to use

compensator mechanisms to maintain core body
temperatures
Who is at risk?
Preterm and SGA newborns
Signs and Symptoms
Decreased temperature
Increased respiration
S/S of hypoglycemia
Hypoglycemia
Blood
glucose is less than 40 mg/dL

Signs & Symptoms
Lethargy/jitteriness
Poor feeding
Vomiting
Pallor
Apnea
Tremors
High pitched cry
Exaggerated moro reflex
Nursing Interventions for

Hypoglycemia
Check
blood glucose levels:

Q1H x 4hrs then Q4H x 24 hrs
If high risk infant- 2,4,6,12,24,48hrs
Early feeds
IV D10W based on body weight
Sepsis in the Newborn

Immature
immune system and lack of

factors for phagocytosis put neonates at
risk for infection
Signs & Symptoms

Pallor/dusky
looking
Lethargy
Temperature
fluctuations - hypothermia
Decreased intake - vomiting, poor feeding
Hyperbilirubinemia
Treatment
Preventative
Strict hand washing

Reverse isolation
Individual equipment
Limited visitors
Turning, ROM
Labwork
treatment includes:
- cultures, WBC
Spinal tap
Double antibiotic therapy (amp & gent)
Jaundice
Yellow
Two
pigment deposited in lipid tissue.
types:
Physiologic jaundice
Pathologic jaundice
Types of Jaundice
Physiologic
Seen in second or third day of life

Treated with phototherapy
Pathologic
Jaundice
Jaundice
Seen in first 24 hrs. Level above 12 mg/dL

May require exchange transfusion &/or
phototherapy
Care of the Neonate

Phototherapy
Exposure to high intensity light decreases the serum
bilirubin levels in the skin.
High volume feeds. Increase fluids

Cover newborn eyes, genital area
Monitor I & O
Provide stimulation
Hydration status
Skin care
Safety - burns
RDS Respiratory Distress

known
as hyaline membrane disease.
Caused
by the absence of surfactant

which prevents alveolar collapse on
expiration.
Respiratory Distress
Early symptoms
include:
Hypothermia
Nasal flaring
Expiratory grunting
Sternal and/or
subcostal retractions
Tachypnea(>60
respirations)
Worsening symptoms
include:
See saw breathing
Decreased urinary
output
Pallor/ ashy grayish
color
Periods of apnea(>15
secs)
Bradycardia
Managing RDS
Surfactant
replacement and/or steroid
therapy
Oxygen
administration and monitoring
Ventilator
Prevent
management (CPAP,HFOV)
hypothermia, hypoglycemia, stress

during care of infant - minimal touch
therapy
Drug/Alcohol abused infants

Common Complications
Respiratory Distress
Jaundice
Congenital abnormalities
Growth retardation
Behavioral abnormalities
Withdrawal
Metabolic Conditions
Hereditary
disorders - increased
metabolites toxic to the newborn
PKU - phenylketonuria
Galactosemia
Hypothyroidism
Others
MST - Done in first 72 hrs of birth

High Risk Newborn

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What are some common complications seen in preterm newborns?

What are some common complications seen in preterm newborns?

What conditions can postdates newborns be prone to?

What conditions can postdates newborns be prone to?

High Risk Newborn

The Preterm Newborn

Delivery prior to 37 weeks gestation

Preterm Newborn Complications

ductus arteriosus (PDA)

Born after 42 weeks

Postdates are prone to:

Nursing management for postdates

Large for Gestational Age (LGA)

>90th percentile for weight at birth

Large for Gestational Age (LGA)

Difficult delivery, birth trauma, hypoglycemia,

Assess for birth injury

Small for Gestational Age (SGA)

or below the 10th percentile

Hypothermia (Cold Stress)

Excessive heat loss that requires a newborn to use

Preterm and SGA newborns

Signs and Symptoms

glucose is less than 40 mg/dL

Nursing Interventions for

blood glucose levels:

Sepsis in the Newborn

immune system and lack of

Signs & Symptoms

Strict hand washing

pigment deposited in lipid tissue.

Seen in second or third day of life

Seen in first 24 hrs. Level above 12 mg/dL

Care of the Neonate

High volume feeds. Increase fluids

RDS Respiratory Distress

as hyaline membrane disease.

by the absence of surfactant

replacement and/or steroid

administration and monitoring

hypothermia, hypoglycemia, stress

Drug/Alcohol abused infants

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