HIGH RISK NEWBORN

CATHERINE V. STA. MONICA, RN

Preterm Newborn
Description
Primary concern is immaturity of all body systems

Assessment
Respirations irregular, with periods of apnea Body temperature below normal Poor suck and swallow reflexes Diminished bowel sounds Thin extremities, with minimal creasing on soles and palms No maintenance of flexion in extremities Lanugo present

Preterm Newborn (continued)

Assessment Thin skin, with visible blood vessels and minimal subcutaneous fat pads; skin may appear jaundiced Undescended testes in boys, narrow labia in girls Interventions Monitor vital signs every 2 to 4 hours Maintain cardiopulmonary function; administer oxygen as prescribed Monitor intake, output, electrolyte balance, daily weight Maintain neutral thermal environment Handle newborn carefully, changing position every 1 to 2 hours Avoid exposure to infections

Post-term Newborn
Description
Neonate born after 42 weeks gestation

Assessment
Hypoglycemia; parchment-like skin without lanugo; long fingernails, extended over fingers; profuse scalp hair; long, thin body; wasting of fat and muscle in extremities; meconium staining on nails and umbilical cord

Interventions
Provide normal newborn care Monitor for meconium aspiration Monitor for hypoglycemia Maintain newborns temperature

Small for Gestational Age

Description
Neonate plotted at or below tenth percentile on intrauterine growth curve

Assessment
Fetal distress; irregular temperature; hypoglycemia; signs of polycythemia, including ruddy appearance, cyanosis, jaundice; signs of infection; signs of aspiration of meconium; physical abnormalities

Interventions
Monitor for signs of respiratory distress Initiate early feedings, monitor for signs of aspiration Provide stimulation

Large for Gestational Age

Description
Neonate plotted at or above the ninetieth percentile on intrauterine growth curve

Assessment
Birth trauma or injury, respiratory distress, hypoglycemia

Interventions
Monitor for signs of hypoglycemia Initiate early feedings Monitor for infection; initiate measures to prevent sepsis Provide stimulation, such as touch and cuddling

Respiratory Distress Syndrome (RDS)

Description
Serious lung disorder caused by immaturity and inability to produce surfactant, resulting in hypoxia and acidosis

Assessment
Tachypnea Flaring nares Expiratory grunting Retractions Decreased breath sounds Apnea Pallor and cyanosis Hypothermia Poor muscle tone

Respiratory Distress Syndrome (RDS) (continued)

Interventions Monitor color, respiratory rate, degree of effort in breathing, arterial blood gases, oxygen saturation Support respirations as prescribed; suction every 2 hours and PRN Position newborn on side or back, with neck slightly extended Administer surfactant replacement therapy into endotracheal tube Administer respiratory therapy as prescribed Provide nutrition as prescribed Encourage mother to pump breasts for future nutrition Encourage bonding of parents and newborn

Meconium Aspiration Syndrome

Description
Aspiration can occur in utero or with first breath

Assessment
Signs of respiratory distress Yellow-stained nails, skin, umbilical cord

Interventions
Suctioning immediately after head is delivered

Sepsis
Description
Generalized infection resulting from presence of bacteria in blood

Assessment
Pallor Tachypnea Tachycardia Poor feeding Abdominal distention Temperature instability

Sepsis (continued)
Interventions
Assess for periods of apnea or irregular respirations Administer oxygen as prescribed Monitor vital signs Maintain neutral thermal environment Monitor intake and output, daily weights Monitor for diarrhea Assess feeding and suck reflex Assess for jaundice Administer antibiotics as prescribed

Hyperbilirubinemia
Description At any serum bilirubin level, appearance of jaundice during first day of life indicates pathological process Assessment Jaundice; elevated serum bilirubin levels; hepatomegaly; poor muscle tone; lethargy; poor suck reflex Interventions Monitor for presence of jaundice Maintain well-hydrated status Administer early, frequent feedings as prescribed Report any signs of jaundice in first 24 hours to physician

Hyperbilirubinemia (continued)
Phototherapy Expose as much of newborns skin as possible, except for shielding eyes and genital area Remove shields, patches at least once per shift and assess eyes for infection or irritation Monitor skin temperature frequently Increase fluid intake as prescribed Educate parents that stools and urine may be green Reposition newborn every 2 hours Provide stimulation to newborn

SIDS
Sudden Infant Death
Syndrome Known as CRIB death Causes: Hypoxemia theory and Apnea theory Assessment: Autopsy: mottled complexion and extremely cyanotic lips and fingertips Diagnostic: (autopsy) petechiae over the visceral surfaces of the pleura, edematous pulmonary artery , congested lungs fully expanded , stomach curd inside the stomach

SIDS
Nursing mgt.: provide emotional support Other measures to prevent SIDS : infant on his back when sleeping No smoking anywhere near the infant Remove pillows, stuffed toys in crib Use a firm mattress with a snug-fitting sheet Make sure the infants head remains uncovered