High risk newborn part 1

• Transient Tachypnea of the Newborn (TTN)

  -Tachypnea

  -Resolves 1 to 3 days

  -Retractions, nasal flaring, grunting, and mild cyanosis

  -Dx: chest x ray

  -Tx: oxygen and gavage feedings
• Meconium Aspiration

  -Meconium aspiration syndrome -> chemical pneumonitis

  -S/S: tachypnea, cyanosis, grunting, rales, retractions, barrel shaped chest, and greenish staining to nails & skin

  -Dx: chest x-ray (hyper expansion and atelectasis)

  -Tx: (HR, Tone, RR): intubate and suction (non-vigorous), mechanical ventilation/high frequent vent/ECMO, and antibiotics
• Hyperbilirubinemia Jaundice

  -Hemolytic disease of the newborn: Rh sensitivity or ABO incompatability

  -Tx: depends on bilirubin result and age or baby in hours

  -Rx: phototherapy (facilities excretion of unconjugated bilirubin in the bile)
• Physiologic hyperbilirubinemia

  -Increased RBCs

  -Liver immaturity

  -Delayed Feeding

  -Bruising
• Pathologic hyperbilirubinemia

  -Rh or ABO incompatibility (+ Coombs test)

  -Sepsis

  -Cold stress

  -Blocked bile duct
• Hyperbilirubinemia Treatment

  -Hydration/Phototherapy (no lotions)

  Infants with Rh disease:

  -Treat anemia

  -Remove sensitized RBCs that would be destroyed

  -Remove serum bilirubin

  -Provide bilirubin free albumin

  -25 to 48 hours: more than 20

  -49 to 72 hours: more than 25

  -More than 72 hours: more than 25
• Nursing care hyperbilirubinemia

  -Exposure as much skin as possible

  -Frequent feedings

  -Eye protection

  -Frequent diaper changes

  -Monitor I&O

  -Remove eye protection at feedings, promote bonding

  -Check bilirubin levels as orders (total= indirect + direct)
• Infants with HIV

  -Transmitted transplacentally, during birth or via breastmilk (avoid breastfeeding)

  -Transplacental transfer decreases if mom takes zidovudine during pregnancy

  -HIV DNA polymerase chain reaction (PCR) testing at 1-2 months of age

  -Maternal antibodies in infants blood until 15 months old
• HIV infant nursing care

  -Administer ZDV to newborn

  -Assess closely for: infection, weight gain, failure to thrive, and GI problems

  -Use standard precautions

  -Provide standard newborn care
• Neonatal infections

  -S/S: apnea, bradycardia, hypothermia, retractions, cyanosis, lethargy, poor feed and immature to total neutrophil ratio (more than 0.20)

  -Labs: CBC, blood cultures/urine/CSF, and C-reactive protein

  -Dx: positive blood culture

  -Medical management: antibiotics (min 48 hrs to 10-14 days) max 21 days, IV fluids, monitor glucose/electrolytes and ventilation management/oxygenation.
• Infants of diabetic moms

  -SGA (vascular complications): reduced placental blood flow

  -LGA: high levels of maternal glucose
• IDM Nursing Care

  -Feed early if glucose less than 40 mg/dL-> glucose gel

  -Risk for seizures -> IV dextrose
• Maternal substance abuse and effects on newborn

  -Alcohol: fetal alcohol syndrome

  -Cocaine: developmental delays and prematurity

  -Heroin & methadone: irritability and LBW

  -Tobacco: prematurity and developmental delays

  -Marijuana: LBW
• Intrauterine drug-exposed infants

  -Withdrawal (prevention is #1)

  -intrauterine asphyxia/infection

  -alterations in birth weight

  -low Apgar scores

  -RDS

  -jaundice/behavioral abnormalities

  -congenital anomalies
• Neonatal Abstinence syndrome

  -Symptoms: irritable, tremors, increased muscle tone and loose stools

  -Non pharmacologic tx: swaddle, feed, aromatherapy, music therapy and massage

  -Pharmacologic: narcotics
• Substance Exposed Neonate

  -Cord blood

  -Meconium

  -Urine (measures recent exposure)

  -Hair
• Marijuana

  -Tremors

  -Low birth weight, IUGR

  -Increased risk for SIDS

  -long term behavioral issues
• Heroin

  -low birth weight

  -irritable

  -poor response to caregivers

  -hyperactive

  -quicker but more painful withdrawal
• Methadone/buprenorphine

  -Provides safe drug substitute for mother

  -Eliminates drug craving cycle

  -Long half life

  -Alleviates long withdrawal

  -Buprenorphine is superior to methadone causes fewer NAS symptoms
• Cocaine

  -Vasoconstriction can lead to placental abruption or decreased blood flow to the fetus (cerebral infarcts)

  -Preterm labor

  -Neonatal seizures

  -Increased incidence of SIDS

  -IUGR

  -Prematurity

  -Hyperactive, irritable
• Cigarette Smoking

  -Low birth weight

  -SGA

  -birth defects

  -sudden infant death syndrome
• Second hand/ Third hand smoke

  -bronchitis, pneumonia, asthma

  -slowed lung growth

  -ear infections

  -increased illness
• Neonatal abstinence syndrome

  W: wakefulness

  I: irritability

  T: tremors

  H: hyperactive, hypertonia, high pitched cry, hypersensitive to stimulation

  D: diarrhea, diaphoresis, disorganized

  R: runny nose, rub marks

  A: apnea, abdominal dysfunction

  W: weight loss, failure to gain weight

  A: anxious appearance, altered sleep

  L: lacrimation or discharge from eyes
• Nursing care of the drug addicted infant

  *Eat, sleep, and console*
• Treatment of NAS

  -Comfort measures: swaddle, avoid over stimulation, low light

  -Cluster care, pacifiers, frequent small feedings, vertical rocking, skin to skin contact, aromatherapy, music therapy and massage

  -Buprenorphine

  -Methadone

  -Clonidine

  -Phenobarbital for sedative/hypnotic related NAS
• Newborn screening in Arizona

  -CCHD

  -Bilirubin

  -Blood spot detected disorders: blood taken via heel stick at 24-72 hours of life and second sample obtained at 5-10 days of age

  -Hearing testing: all babies tested before leaving the hospital
• Phenylketonuria (PKU)

  -Inability to convert phenylalanine to tyrosine; production of abnormal metabolites leads to mental deficits

  -Treated with low phenylalanine diet until brain growth is complete

  -Pregnant women need to go back on low phenylalanine diet