high risk neonate

• High-Risk Newborn


  Newborn with complications related to gestational age or maternal conditions
• Problems related to high-risk newborns

  • Maturity
  • Gestational weight
  • Detect early
  • Keep the baby warm
  • Provide immediate supportive care
  • Report/ refer promptly

  
• Basic Nursing actions for high-risk newborns

  • Lethargy/ Failure to thrive
  • Cyanosis
  • Excessive mucus/ Drooling
  • Sac/ Dimpling in the lower back
  • Absence or sluggish moro reflex

  
• Danger signs of distress in high-risk newborns

  • Twitching, seizures/ tremors
  • Bile-stained vomitus
  • Jaundice
  • Meconium-stained skin and nails
  • No passage of stools (1-2 days post delivery)

  
• Risk factors


  HPN, Anemia
• Intrauterine Growth Retardation (IUGR)


  • Chronic - Small head, body (proportional body with head)
  • Sub-acute - Big head, small body (not proportional)

  
• Premature or Preterm Infant

  • Cause: UNKNOWN
  • Factors: Poor prenatal care, Multiple pregnancies, Gestational hypertension, Placental problems
• Premature or Preterm Infant


  • Very small
  • Lacks glycogen stores
  • Head large
  • Minimal creases on the palms and soles of feet
  • Often inactive and listless posture of extension (not well-flexed)
• Physical Assessment of Premature or Preterm Infant

  • Skin is pink and thin (small blood vessels visible under skin)
  • Lacks fat deposits (regular and brown fat)
  • Pliable ear cartilage
  • Lanugo present

  
• Altered Physiology of Premature or Preterm Infant

  • Respiratory system: Immature lungs/ lack of surfactant (LS ratio=<2:1)
  • Thermoregulation: Immaturity of the hypothalamus
  • Digestive system: Immature cardiac sphincter, Poor sucking reflex
  • Liver function: Inability to convert Indirect bilirubin to direct bilirubin
  • Renal system: Increase sodium excretion → dehydration
  • Nervous system: Decrease reflexes
  • Immune system: Decreased due to immaturity – prone to infection
  • Integumentary system: Translucent – fray easily = prone to infection
• Nursing Care for Premature or Preterm Infant

  • Maintain respiration at less than 60/min
  • O2 therapy (100% humidified) – tent/ croupette
  • Complication to O2: Retrolental fibroplasia
  • Suctioning PRN
  • Administer artificial surfactant (Survanta)
  • Kangaroo mother care
  • Maintain thermoneutral body temperature & prevent cold stress
  • Meet nutritional, fluids and electrolytes need
  • Feed according to abilities/ demand
  • Do not overfeed (prone for aspiration)
  • Elevate head; burp
  • Prevent bleeding: Vitamin K 0.05ml to vastus lateralis
  • Prevent infection: Handwashing, Peersonal Protective Equipment (PPE), Screen and limit visitors
  • Initiate phototherapy as required
• Post Mature or Post Term Infant


  • Problem: progressive inefficiency of the aging placenta
  • LGA, AGA, SGA

  
• Complications of Post Mature or Post Term Infant

  • Meconium Aspiration Syndrome
  • Polycythemia
  • Hypoglycemia
• Physical Assessment of Post Mature or Post Term Infant

  • Skin: dry, desquamation, plantar creases
  • Absence of lanugo
  • Absence of vernix caseosa
  • Abundant scalp hair
  • Long fingernails
  • Thin, elongated appearance
  • Respirations: 60>
• Nursing Care for Post Mature or Post Term Infant

  • Manage MAS
  • Suction mouth and nares while head is on the perineum and before the first breath is taken; after drying the baby, do direct tracheal suctioning
  • Obtain serial blood glucose measurements
  • Provide early feeding if not contraindicated
  • Maintain skin integrity
  • Keep skin clean and dry
  • Avoid: use of powders, creams, lotions
• Small for Gestational Age (SGA) Infant

  Infant whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on the intrauterine growth chart

  
• Clinical Manifestations of Small for Gestational Age Infant

  • Soft tissue wasting and dysmaturity
  • Loose, dry and scaling skin
  • Perinatal asphyxia
  • Polycythemia, respiratory distress and CNS aberrations and persistent acrocyanosis
  • Congenital anomalies
• Laboratory and Diagnostic Study for Small for Gestational Age Infant

  • Glucose testing: decreased glucagon stores which increases the risk for hypothermia and hypoglycemia
  • Hematocrit level may be increased (65%): indicates polycythemia as a result of chronic fetal hypoxia
• Nursing Care for Small for Gestational Age Infant

  • Provide adequate fluid and electrolytes and nutrition
  • High calorie formula for feeding
  • Promote breastfeeding
  • Decrease metabolic demands when possible
  • Small frequent feedings
  • Gavage feedings if no steady weight gain
  • Neutral thermal environment
  • Prevent hypoglycemia
  • Monitor glucose screening
  • Provide early feedings; frequent feedings (every 2-3 hours)
  • Administer IV glucose
  • Maintain neutral thermal environment
  • Monitor hematocrit and provide hydration
• Large for Gestational Age (LGA) Infant

  Birth weight falls above the 90th percentile on intrauterine growth charts, weighs more than 4000g, have been subjected to an overproduction of growth hormone in utero

  
• Predisposing Factors for Large for Gestational Age Infant

  • Genetic predisposition
  • Excessive maternal weight gain during pregnancy
  • Poorly controlled maternal diabetes

  
• Large for Gestational Age Infant

  • Larger than 9 lbs
  • Large body-plump full face
  • Body size is proportionate
  • Poor motor skills
  • Difficulty in regulating behavioral state (arouse to quiet alert state)
• Complications of Large for Gestational Age Infant

  • Fetal: Stillbirth, anomalies, shoulder dystocia
  • Neonatal: Low APGAR score, hypoglycemia, birth injury, hypocalcemia, polycythemia, jaundice, feeding difficulties
  • Long-term: Obesity, type 2 diabetes, neurologic or behavioral problems
• Nursing Care for Large for Gestational Age Infant

  • Observe for potential complications
  • Monitor blood glucose