5.2

• neonatal abstinence syndrome: prenatal drug exposure that causes withdrawal signs in infant after birth; common with opiates (heroin or meth), amphetamines, antidepressants (SSRIs)
• neonatal abstinence syndrome S&S: CNS manifestations (high-pitched cry, irritability, tremors, hyperactivity, increased DTRs, increased tone, convulsions), metabolic / vasomotor / respiratory (nasal congestion, mottling, retractions, apnea, tachypnea, sweating), and GI (poor feeding, diarrhea)
• neonatal abstinence long term complications: feeding difficulties, CNS dysfunction, ADD, language difficulties, microcephaly, delayed growth
• preterm: greater then 20 weeks but less then 37 weeks
• preterm characteristics: extension, lack of fat, skin translucent and blood vessels visible, absent plantar creases <32 weeks, abundant lanugo and vernix
• preterm complications: respiratory distress syndrome, ineffective thermoregulation, bronchopulmonary dysplasia, aspiration, apnea of prematurity, intraventricular hemorrhage, retinopathy of prematurity, patent ductus arteriosus, necrotizing entercolitis
• preterm nursing care: assess and adapt nutritional needs, monitor I&O and daily weight, monitor for bleeding, maintain thermoregulation, minimize stimulation (cluster care), skin assessment
• respiratory distress syndrome (RDS): surfactant deficiency
• RDS manifestations: tachypnea, tachycardia, nasal flaring, cyanosis, retractions, grunting, chest asymmetry
• RDS risk factors: prematurity, asphyxia, maternal DM, narcotics close to birth, white males
• RDS complications: related to oxygen therapy and mechanical ventilation; pneumothorax, retinopathy, bronchopulmonary dysplasia, infection, intraventricular hemorrhage (VP shunt)
• RDS treatment: suctioning, thermoregulation, vent support (if respiratory acidosis), sodium bicarb (if metabolic acidosis), TPN, decrease stimuli, medications (lung surfactants via ETT)
• necrotizing entercolitis: inflammation of intestine d/t intestinal immaturity
• necrotizing entercolitis S&S: increased abdominal distention, increased gastric residuals, decreased or absent bowel sounds, vomiting, abdominal discoloration
• necrotizing entercolitis treatment: breastmilk for prevention, discontinuation of oral feedings, continuous or intermittent gastric suction, use of TPN to rest intestines, surgery and possible ostomy (last resort)
• late preterm complications: hypothermia, hypoglycemia, hyperbilirubinemia, respiratory distress, infection
• SGA/IUGR causes: chromosomal abnormalities, maternal infections, disease, malnutrition, gestational hypertension, type 1 dm, maternal substance use, multiple gestations, placental factors
• SGA/IUGR complications: perinatal asphyxia, meconium aspiration, hypoglycemia, polycythemia, temperature instability