NCMA219

• Neonatal Respiratory Distress Syndrome (RDS)

  Serious lung disorder caused by immaturity and inability to produce surfactant

  
• Hyaline Membrane Disease

  Another name for Neonatal Respiratory Distress Syndrome
• Pathogenesis of RDS

  Deficiency of surfactant → Diffuse alveolar atelectasis of the lungs → Higher surface tension at the alveoli → Interferes with normal oxygen and carbon dioxide exchange

  
• Major Signs of RDS

  • Tachypnea (>60 breaths/min)
  • Flaring nares
  • Expiratory grunting
  • Chest retractions
  • Seesaw respirations

  
• Newborn Vital Signs

  • Pulse: 120-160 bpm, as low as 80 bpm during sleep, up to 180 bpm when crying
  • Respirations: 30-60 breaths/min, predominantly diaphragmatic
  • Blood Pressure: 80/60 to 100/50 mmHg
  • Temperature: 36.5-37.5°C (97.7-99.4°F)
• Minor Signs of RDS

  • Tachycardia
  • Dyspnea
  • Pallor and cyanosis
  • Hypothermia
  • Decreased activity level
  • Oliguria

  
• Diagnostic Evaluation for RDS

  • ABG: Umbilical cord
  • Respiratory acidosis
  • Culture: Blood, CSF
  • Radiographic findings: Diffuse granular pattern resembling ground glass
• Therapeutic Management of RDS

  • Artificial Surfactant - Intrathecal, spray, or nebulization
  • Oxygen Therapy - ECMO
• Nursing Care for RDS

  • Monitor color, RR and breathing effort
  • Maintain airway and cardiopulmonary function
  • Monitor ABG and O2 saturation
  • Suction every 2 hours or as needed
  • Position newborn on side or back with neck slightly extended
  • Administer chest physiotherapy
• Meconium Aspiration Syndrome (MAS)

  Aspiration of amniotic fluid containing meconium into fetal or newborn trachea in utero or at first breath

  
• Assessment of MAS

  • Respiratory distress: Tachypnea, cyanosis, retractions, nasal flaring, grunting, crackles, rhonchi
  • Meconium stained nails, skin, and umbilical cord

  
• Nursing Care for MAS

  • Suctioning
  • Oxygen support (Severe: Extracorporeal membrane oxygenation)
  • Administer antibiotics: Ampicillin, Gentamicin, Amikacin
• Neonatal Sepsis

  Bacterial infection in the bloodstream of infants during the first month of life
• Initial Assessment of Neonatal Sepsis

  • Poor sucking and feeding
  • Weak cry
  • Lethargy
  • Irritability

  
• Subsequent Assessment of Neonatal Sepsis

  • Pallor, cyanosis, or mottling
  • Decreased pain response
  • Hypotension
  • Tachycardia
  • Irregular respirations
  • Jaundice
  • Dehydration
  • Temperature instability

  
• Laboratory and Diagnostic Studies for Neonatal Sepsis

  • Blood culture
  • Urine culture and CSF analysis
  • CBC: Increased WBC
  • ESR and C-reactive protein: Increased

  
• Management of Neonatal Sepsis

  • Antibiotic Therapy: Ampicillin, Gentamicin
  • Circulatory Support: IVF, BT
  • Respiratory Support: Oxygen
  • Immunotherapy: Antiviral medications
• Nursing Care for Neonatal Sepsis

  • Maintain patent airway
  • Provide neutral thermal environment
  • Protect from increased infection
  • Provide adequate nutrition
  • Administer antibiotics as prescribed
  • Monitor for signs of impending shock
• Hyperbilirubinemia


  Excessive level of accumulated bilirubin in the blood, characterized by jaundice

  
• Assessment of Hyperbilirubinemia


  • Jaundice
  • Elevated serum bilirubin levels
  • Enlarged liver
  • Poor muscle tone
  • Lethargy
  • Poor sucking reflex

  
• Nursing Care for Hyperbilirubinemia

  • Monitor presence of jaundice
  • Keep hydrated
  • Encourage early, frequent feeding
  • Report any signs of jaundice in first 24 hours
  • Prepare for and monitor phototherapy

  
• Phototherapy


  Use of intense fluorescent lights to reduce serum bilirubin levels in newborns
• Nursing Care during Phototherapy

  • Expose much of the newborn's skin
  • Cover genital area and eyes
  • Monitor temperature and skin color
  • Increase fluids
  • Expect loose green stools and urine
  • Reposition every 2 hours
  • Provide stimulation
  • Turn off during blood extraction
• Sudden Infant Death Syndrome (SIDS)


  Sudden unexpected death of any infant younger than 1 year of age, usually during sleep

  
• Etiology of SIDS


  • Hypoxemia
  • Apnea
  • Immature nervous system
  • Brainstem abnormality in cardiorespiratory control
  • Prone sleeping causing oropharyngeal obstruction or affecting thermal balance/arousal

  
• Infants at High Risk for SIDS

  • Premature neonates
  • Infants with apneic episodes
  • Infants with prenatal drug exposure
  • Siblings of SIDS victims
  • Infants exposed to maternal smoking
  • Infants of adolescent mothers
  • Infants of closely spaced pregnancies
  • Underweight infants
• Management of SIDS


  • Monitor infants at risk for apnea
  • Teach parents to minimize SIDS risk
  • Avoid smoking during/after pregnancy
  • Encourage supine or side-lying position
  • Avoid co-sleeping, soft mattresses, pillows, blankets
• Apnea of Newborn


  Lapse of spontaneous breathing for 20 seconds or longer, may be followed by bradycardia, oxygen desaturation, color change
• Causes of Apnea of Newborn

  • Preterm: Fatigue and immaturity
  • Secondary: Infection, hypoglycemia, hypothermia
  • Anemia, hypocapnia, hypoxemia, polycythemia
• Nursing Management of Apnea of Newborn

  • Arouse by flicking soles and back
  • Resuscitation
  • Apnea monitor, apnea belt
  • Maintain neutral environment
  • Decrease fatigue
  • Gentle suctioning, avoid vagus nerve stimulation
  • Theophylline: Bronchodilator, muscle relaxant, improves respiratory function
• Absence of sluggish moro reflex

  • We evaluate moro reflex by startling them
  • While neonate is sleeping, we clap loudly or shake the basinet
  • The reaction of the neonate is that the neonate must move all of his/her extremities
• Pathologic jaundice


  If seen in the 1st 24 hours. Indicates liver problems
• Physiologic jaundice


  Because of liver immaturity. Will appear later on
• Risk Factors for IUGR

  • HPN
  • Anemia
• CHRONIC IUGR


  • 5th month pregnancy / early HPN
  • Small head, body (proportional body with head)
• SUB-ACUTE IUGR


  • Late 8th month / HPN
  • Big head, small body (not proportional)
• Small for Gestational Age (SGA)

  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 SGA

  • Soft tissue wasting and dysmaturity
  • Loose, dry, and scaling skin
  • Polycythemia, respiratory distress, and CNS aberrations and persistent acrocyanosis
  • Congenital anomalies
• Laboratories and Diagnostic Study for SGA

  • Glucose Testing
  • Hematocrit level may be increased (65%)
• Decreased glucagon stores in SGA

  Increases the risk for hypothermia and hypoglycemia