PEDIAAAAA

• Problems related to Maturity

  • Preterm
  • Post term
• Problems related to Gestational Weight


  • SGA
  • LGA
• Preterm


  Neonate born before 37 weeks of gestation
• Preterm


  • Primary concern relates to immaturity of all body systems
  • Cause is unknown
• Maternal Factors for Preterm

  • Age
  • Smoking
  • Poor nutrition
  • Placental problem
  • Preeclampsia/Eclampsia
• Fetal Factors for Preterm


  • Multiple pregnancy
  • Infection
• Other Factors for Preterm

  • Poor socioeconomic status
  • Environmental exposure to harmful substances
• Assessment of Preterm


  • Thin extremities with minimal creasing
  • Extension of extremities and does not maintain flexion
  • Abundance of lanugo hair
  • Narrow labia in girls
  • Undescended testes in boys
• Preterm babies have a square window wrist due to underdeveloped bones
• Preterm babies have a scarf sign - bringing the arms across the neck
• Common/Special Problems of Preterm Neonates

  • Respiratory Distress Syndrome
  • Hyperbilirubinemia
  • Infection
  • Cold Stress
  • Anemia
  • Hypothermia
• Respiratory Distress Syndrome


  Due to lung immaturity and deficient in surfactant

  
• Hyperbilirubinemia


  High level of bilirubin in the blood causing jaundice due to immaturity of the liver
• Types of Jaundice


  • Physiologic
  • Pathologic
• Bilirubin


  Produced when the liver breaks down old red blood cells
• Hyperbilirubinemia


  Abnormally high level of bilirubin in the blood demonstrated by jaundice, lethargy, and associated with liver and hemolytic disease
• Jaundice


  Excess of bilirubin in the blood causing yellow coloration of the eyes and skin
• Kernicterus


  Severe condition where high bilirubin levels move from the blood into brain tissues, causing brain damage and permanent injury
• Management of Preterm


  • Improving respiratory function
  • Maintaining body temperature
  • Preventing infection
  • Promoting nutrition
  • Promoting sensory stimulation
• Nursing Interventions for Preterm

  • Monitor vital signs
  • Administer oxygen and humidification
  • Monitor intake and output
  • Monitor daily weight
  • Maintain newborn in warming device
  • Reposition every 1-2 hours
  • Avoid exposure to infections
  • Provide appropriate stimulation
  • Suction secretions as needed
  • Monitor for signs of infection
  • Provide skin care
  • Provide explanations for parents
• Post term


  Neonate born after 42 weeks of gestation
• About 12% of all infants are post-term
• Maternal Factors for Post term

  • First pregnancies 15-19 years old
  • Woman older than 35 years
  • Multiparity with small babies
• Fetal Factors for Post term

  • Fetal anomalies such as anencephaly
• Assessment of Post term

  • Depleted subcutaneous fat
  • Parchment-like skin
  • Long fingernails
  • Abundant scalp hair
  • Long and thin body
  • Sign of meconium staining
• Complications of Post maturity

  • Placental aging
  • Intrauterine hypoxia
  • Meconium aspiration syndrome
  • Hypoglycemia
  • Polycythemia
• Management of Post term

  • Ultrasound evaluation
  • Suctioning of mouth and nose
• Nursing Management of Post term

  • Monitor cardiopulmonary status
  • Administer supplemental oxygen
  • Monitor blood sugar
  • Provide thermoregulated environment
• Suctioning of the mouth and nose

  1. Reduce the chance of meconium aspiration

  2. Suction upon delivery of newborn's head

  3. Suction just before the baby takes his first breath
• Suction mouth and nose


  • Remove the secretions (meconium)
  • Suction mouth before nose
  • Clear the mouth first since a baby's first breath is through the mouth (by crying)
• Cut ang cord


  • Blood flow initiates the baby to cry
  • Pag cry, mulanghap ug air which is through the mouth
  • If naay secretions pwede maadto sa lungs which is a foreign body so, dili maka work ug tarong ang alveoli because of the meconium in the lungs
• NURSING MANAGEMENT


  • Closely monitor the newborn cardiopulmonary status
  • Administer supplemental oxygen therapy as needed
  • Frequent monitoring of blood sugar; assess for sign of hypoglycemia
  • Provide thermoregulated environment – use of isolette or radiant heat warmer
  • Monitor for signs of meconium aspiration syndrome
• Decrease in body temp


  Happens when the baby is not thermoregulated which can cause apneic episodes
• Differences between preterm and post term

  • Posture
  • Sole
  • Female genitalia
  • Male genitalia
  • Scarf sign
  • Grasp reflex
• Small for Gestational Age (SGA)


  Babies whose birth weight lies below the 10th percentile for that gestational age
• SGA babies may be

  • Premature (born before 37 weeks of pregnancy)
  • Full term (37 to 41 weeks)
  • Post term (after 42 weeks of pregnancy)
• Intrauterine growth restriction (IUGR)

  The most common cause and underlying condition leading to SGA newborn
• Maternal factors leading to SGA

  • High blood pressure
  • Chronic kidney disease
  • Advanced diabetes
  • Heart or respiratory disease
  • Malnutrition, anemia
  • Infection
  • Substance use (alcohol, drugs)
  • Cigarette smoking
  • Placental anomaly
• Fetal factors leading to SGA

  • Multiple gestation
  • Infection
  • Chromosomal abnormality
• Assessment of SGA


  • Respiratory distress
  • Loose and dry skin, little fat, little muscle mass
  • Wasted Appearance (payat)
  • Small liver
  • Head is larger compared to body
  • Wide skull sutures
  • Poor skin turgor
  • Sunken abdomen