Additional Reviewers

• Coverage


  • High-risk newborn
  • Intrauterine Growth Restriction / Small for Gestational Age / Large for Gestational Age / Preterm
  • Respiratory Distress Syndrome
  • Meconium Aspiration Syndrome
  • Sudden Infant Death Syndrome
  • Hyperbilirubinemia
  • Neonatal Sepsis
  • Necrotizing enterocolitis
  • Glucose-6-Phosphate Dehydrogenase Deficiency
  • Congenital Hypothyroidism
  • Phenylketonuria
  • Galactosemia
  • Atrial Septic Defect / Ventricular Septic Defect / Patent Ductus Arteriosus
  • Tetralogy of Fallot
  • Rheumatic fever / Rheumatic Heart Disease
  • Kawasaki Disease
  • Streptococcal pharyngitis
  • Tonsillitis
  • Sickle Cell Anemia / Iron Deficiency Anemia
  • CROUP syndrome / Laryngotracheobronchitis / Epiglottitis
• Premature infant


  Infant born <38 weeks gestation, birth that takes place more than three weeks before the baby's estimated due date, occurs before the start of the 37th week of pregnancy
• Premature infant


  • Lanugo covers the entire back and face, Soles has few creases and scrotum has little rugae, Thin and pinkish skin, plenty of lanugo and relaxed posture
• Postmature infant


  Infant delivered after 42 weeks of gestation
• Postmature infant


  • Abundant scalp hair, Visible creases on palms and soles of feet with minimal fat deposits, Absence of lanugo
• Intrauterine Growth Restriction


  Infants whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on the intrauterine growth chart
• Causes of Intrauterine Growth Restriction

  • Poor nutrition during pregnancy
  • Placental defects (perinatal hypoxia) and complications
  • Teenage pregnancies
  • Hypertensive mother
  • Age: under 18 or over 35 years of age
  • Maternal condition – HPN, anemia, DM
• Priority Nursing Care in the First Few Days for Small for Gestational Age Infants

  • Initiation and maintenance of respirations
  • Maintenance of hydration and normal glucose
  • Control of body temperature
• Large for Gestational Age Infants

  Birth weight falls above the 90th percentile on the intrauterine charts, Weighs more than 4000g, Have been subjected to an overproduction of growth hormone in utero
• Large for Gestational Age Infants

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

  • 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
• Respiratory Distress Syndrome


  Condition of surfactant deficiency and physiologic immunity of the thorax
• Diagnostic Exam for Respiratory Distress Syndrome

  • X-ray
  • Blood glucose
  • Arterial Blood Gas Analysis (ABG)
  • Fetal Lung Maturity Assay

  
• Diagnostic Findings / Radiographic Findings for Respiratory Distress Syndrome

  • Diffuse granular pattern like broken glass appearance on chest x-ray, Hypoxemia, Increased carbon dioxide, Respiratory acidosis on ABG

  
• Medications for Respiratory Distress Syndrome

  • Artificial surfactant
  • Nitric oxide – dilates the pulmonary bronchus

  
• Clinical Manifestations of Respiratory Distress Syndrome

  • Tachypnea 60>
  • Flaring nares
  • Expiratory grunting, dyspnea
  • Chest retractions – sternal and subcostal
  • Seesaw respirations

  
• Meconium Aspiration Syndrome


  Aspiration of amniotic fluid containing meconium into fetal or newborn trachea in utero at first breath, Occurs primarily in full-term and post-term infants during relaxation of the anal sphincter and passage of meconium into amniotic fluid due to intrauterine stress

  
• Assessment of Meconium Aspiration Syndrome


  • Widened anteroposterior diameter of the chest (barrel-chest), Greenish stains on the skin, umbilical cord and nail

  
• Priority Nursing Care for Meconium Aspiration Syndrome

  • Assist in tracheal suctioning
  • Suctioning – oropharyngeal and tracheal
  • O2 support
  • Exogenous surfactant administration
  • IV fluid administration
  • Administer systemic antibiotics as prescribed

  
• Sudden Infant Death Syndrome


  Sudden unexpected death of any infant younger that 1 year of age, Death usually occurs during sleep – "crib death", Most common cause of death in children ages 1 month to 1 year
• Nursing Management for Sudden Infant Death Syndrome

  • Teach parents how to minimize the risk of SIDS: Avoid smoking during and after pregnancy, Encourage supine position or side-lying, Avoid co-sleeping, soft beddings, use of pillow, blankets on the crib, Maternal smoking
• Hyperbilirubinemia


  Excessive level of accumulated bilirubin in the blood and is characterized by jaundice, Pathologic Jaundice – first 24 hrs of life, Physiologic Jaundice – after 24 hrs of life, Complications – kernicterus
• Nursing Care for Hyperbilirubinemia

  • Cover the eyes and genitalia
  • Check skin turgor for hydration
  • Turn the infant q 2 hrs
  • Instruct the mother to continue breastfeeding q 2-4 hrs
• Sepsis


  Early Onset – occurs less than 3 days after birth, caused by maternal infection, Late Onset – occurs on the 4th up to 7th days after birth, nosocomial infection
• Clinical Manifestations of Sepsis

  • Pallor, cyanosis, or mottling
  • Hypotension
  • Tachycardia
  • Irregular respirations
  • Jaundice
  • Dehydration
  • Temperature instability
• Laboratory and Diagnostic Study for Sepsis

  • Blood culture
  • Urine and CSF analysis
  • Complete Blood Count – WBC increased due to infection
  • Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein – increased

  
• Necrotizing Enterocolitis


  Acute inflammatory disease of the bowel, Preterm neonates manifesting abdominal distention and vomiting
• Signs of Necrotizing Enterocolitis

  • Poor feeding
  • Distended abdomen
  • Blood in the stool
  • Vomiting
  • Apnea
• Nursing Management for Necrotizing Enterocolitis

  • Assessing patient for presence of abdominal distention
  • Reporting to the doctor any episode of gastric residuals
  • Placing the patient on NPO as per doctor's order if symptoms of NEC is observed

  
• Newborn Screening


  Procedure to determine if the newborn infant has a heritable congenital metabolic disorder
• Glucose-6-Phosphate Dehydrogenase Deficiency


  Lack of enzyme resulting to premature destruction of RBC leading to hemolytic anemia, Without G6PD, RBC's undergo hemolysis when exposed to oxidative stress
• Symptoms of Glucose-6-Phosphate Dehydrogenase Deficiency


  • Jaundice
  • Dark colored urine
  • Back pain
  • Anemia
• Complications of Glucose-6-Phosphate Dehydrogenase Deficiency


  • Severe anemia
  • Hyperbilirubenemia
• Management of Glucose-6-Phosphate Dehydrogenase Deficiency


  Avoid food, drug, and chemicals that cause oxidative stress
• Congenital Hypothyroidism


  Results from the absence or lack of development of the thyroid gland causing absence of thyroxine needed for metabolism and growth of the body and brain
• Signs and Symptoms of Congenital Hypothyroidism

  • Short stature
  • Macroglossia
  • Delayed closure of the fontanelles
  • Hypotonia
• Management of Congenital Hypothyroidism

  • Medication will be needed throughout the child's lifetime, Administration of thyroid hormone will prevent problems, If managed early will not cause mental retardation
• Medication for Congenital Hypothyroidism

  Synthyroid – taken in the morning, Report signs of tremors (toxicity)
• Phenylketonuria


  Deficiency or absence of enzyme needed to metabolize essential amino acid like phenylalanine, Diagnostic Test – Guthrie Test, If managed early, it will prevent mental retardation or cognitive impairment, The goal of treatment – meeting the child's nutritional needs for optimal growth, If untreated – results to failure to thrive (FTT), absence of adequate melanin pigmentation, unpredictable and erratic behavior
• Galactosemia


  People with galactosemia are unable to fully break down the simple sugar galactose, Galactose makes up one half of lactose, the sugar found in milk, If an infant with galactosemia is given milk, substances made from galactose build up in the infant's system, These substances damage the liver, brain, kidneys, and eyes