NCMA 219

• Premature infant


  • Gestation <38 weeks
  • Lanugo covers entire back and face
  • Thin, pinkish skin with few creases on soles and scrotum
  • Relaxed posture
• Postmature infant


  • Gestation >42 weeks
  • Abundant hair on scalp, absence of lanugo
  • Visible creases on soles
  • Minimal fat deposits
• IUGR (Intrauterine Growth Retardation)

  • SGA: birth weight below 10th percentile
  • LGA: birth weight above 90th percentile, >4000g
• Causes of IUGR


  • Poor nutrition during pregnancy
  • Placental defects
  • Age: -18 or +35
  • Maternal condition: hypertension, anemia, DM
• Nursing interventions for IUGR

  1. Initiation and maintenance of respiration

  2. Maintenance of hydration and normal glucose

  3. Thermoregulation

  4. Breastfeeding q 3-4h

  5. Monitor VS, keep hydrated, assess skin integrity for newborns under radiant warmers
• LGA (Large for Gestational Age)

  • Body size is proportionate
  • Poor motor skills
  • Difficulty regulating behavioral state
• Complications of LGA


  • Fetal: stillbirth, shoulder dystocia
  • Neonatal: low APGAR, hypoglycemia, hypocalcemia, polycythemia, jaundice, feeding difficulties
  • Long term: obesity, T2 DM, neurologic/behavioral problems
• Respiratory Distress Syndrome


  Condition of surfactant deficiency and physiologic immaturity of the thorax, common in preterm infants
• Diagnostic exams for RDS

  • X-ray
  • Blood glucose
  • Arterial Blood Gas Analysis
  • Fetal Lung Maturity Assay
• Findings in RDS


  • Broken glass appearance on chest x-ray
  • Hypoxemia
  • Increased CO2
  • Respiratory acidosis
• Medications for RDS


  • Artificial surfactant
  • Nitric oxide
• Clinical manifestations of RDS

  • Tachypnea
  • Flaring nares
  • Grunting
  • Dyspnea
  • Chest retractions
  • Seesaw respirations
• Meconium Aspiration Syndrome


  Aspiration of amniotic fluid containing meconium, occurs primarily in full-term and post-term infants
• Assessment findings in Meconium Aspiration Syndrome

  • Barrel-chest
  • Green stains on skin, umbilical cord, and nails
• Nursing interventions for Meconium Aspiration Syndrome

  1. Assist in tracheal suctioning

  2. O2 support, extracorporeal membrane oxygenation if severe

  3. Exogenous surfactant administration

  4. IVF administration

  5. Antibiotics: Ampicillin, Gentamicin, Amikacin
• Sudden Infant Death Syndrome


  Unexpected death of any infant younger than 1 year, usually during sleep
• Nursing management for SIDS

  • Teach parents to avoid smoking during/after pregnancy
  • Encourage supine or side-lying position during sleep
  • Avoid co-sleeping, soft beddings, pillows, and blankets in crib
• Hyperbilirubinemia


  Excessive bilirubin in the blood, characterized by jaundice
• Types of hyperbilirubinemia


  • Pathologic Jaundice: first 24hrs of life
  • Physiologic Jaundice: after 24hrs of life
• Nursing interventions for hyperbilirubinemia

  • Phototherapy: cover eyes and genitalia, check skin turgor, turn infants q2hrs, breastfeed q2-4hrs
• Sepsis


  Infection in the bloodstream, can be early onset (maternal) or late onset (nosocomial)
• Clinical manifestations of sepsis

  • Pallor, cyanosis, mottling
  • Hypotension
  • Tachycardia
  • Irregular respiration
  • Jaundice
  • Dehydration
  • Temperature instability
• Laboratory and diagnostic tests for sepsis

  • Blood culture
  • UA and CSF
  • CBC
  • Erythrocyte Sedimentation Rate and C-reactive Protein
• Necrotizing Enterocolitis


  Acute inflammatory disease of the bowel, common in preterm infants
• Signs and symptoms of NEC

  • Poor feeding
  • Distended abdomen
  • Blood in stool
  • Vomiting
  • Apnea
• Nursing interventions for NEC

  1. Assess for abdominal distention

  2. Report any episode of gastric residuals

  3. NPO as ordered if symptoms are observed
• Newborn screening is a procedure to determine if the newborn has heritable congenital metabolic disorders
• G6PD Deficiency


  Lack of enzyme leading to premature destruction of RBCs and hemolytic anemia
• Symptoms of G6PD Deficiency


  • Jaundice
  • Dark colored urine
  • Back pain
  • Anemia
• Complications of G6PD Deficiency

  • Severe anemia
  • Hyperbilirubinemia
• Management of G6PD Deficiency


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


  Absence or lack of development of the thyroid gland, causing absence of thyroxine needed for metabolism and growth
• Signs and symptoms of Congenital Hypothyroidism


  • Short stature
  • Macroglossia
  • Delayed closure of fontanelles
  • Hypotonia
• Nursing interventions for Congenital Hypothyroidism

  1. Medication throughout child's lifetime

  2. Administration of thyroid hormone

  3. Early management to prevent mental retardation
• Phenylketonuria


  Deficiency or absence of enzymes needed to metabolize essential amino acids like phenylalanine
• Early management of Phenylketonuria will prevent mental retardation or cognitive impairment
• Goal of treatment for Phenylketonuria


  • Meeting child's nutritional needs for optimal growth
• If left untreated, Phenylketonuria will result in failure to thrive, absence of melanin pigmentation, and unpredictable/erratic behavior
• Galactosemia


  Build up of galactose in the infant's system due to inability to fully break down the substance, which may damage organs
• Atrial Septal Defect


  Hole in the wall (septum) that divides the upper chambers (atria) of the heart, causing left to right shunting