1. Dr.Bahareh Imani Assistant Professor Of Pediatrics-MUMS
High Risk Neonatal Nursing Care
Dr.Bahareh Imani Assistant Professor Of Pediatrics-MUMS

3. Appearance of Preterm Infant 24-36 weeks
Small, underdeveloped, head disproportionately large; skin thin & ruddy [little subcut. fat]; veins noticeable; prolonged acrocyanosis. vernix depends on gest.age.
< 24 wks.vernix not formed.
None/few sole creases.
Ear cartilage immature; no quick rebound of pinna.
Extensive lanugo.
Suck/swallow absent, weak cry < 33 wks. Ballard Gestational scale to estimate age.
Infection – decreased maternal antibodies
Skin fragile; rinse with water. Handwashing a must !

4. Respiratory Distress Syndrome (RDS)
Deficiency or absence of surfactant
Atelectasis
Hypoxemia, hypercarbia, acidemia
May be due to prematurity or surfactant deficiency

5. RDS: Nursing Care Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
Education and support of family

7. Transient Tachypnea of the Newborn (TTN)
Failure to clear lung fluid, mucus, debris
Exhibit signs of distress shortly after birth
Expiratory grunting and nasal flaring
Subcostal retractions
Slight cyanosis

8. TTN: Nursing Care Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
Support and educate family

9. Meconium Aspiration Syndrome (MAS)
Mechanical obstruction of the airways
Chemical pneumonitis
Vasoconstriction of the pulmonary vessels
Inactivation of natural surfactant

10. Hypoglycemia
Definition: Neonatal hypoglycemia is usually defined as a serum glucose value of < mg/dl. For the preterm infant a value of < 30 mg/dl is considered abnormal (hypoglycemia).

11. Hypoglycemia Symptoms
Lethargy or jitteriness
Poor feeding and sucking
Vomiting
Hypothermia and pallor
Hypotonia, tremors
Seizure activity, high pitched cry, exaggerated moro reflex

12. Hypoglycemia: Nursing Care
Routine screening for all at risk infants Early feedings D10W infusion

13. Physiologic Hyperbilirubinemia
Appears after first 24 hours of life
Disappears within 14 days
Due to an increase in red cell mass

14. Pathologic Hyperbilirubinemia
Appears within first 24 hours of life
Serum bilirubin concentration rises by more than 0.2 mg/dL per hour
Bilirubin concentrations exceed the 95th percentile
Conjugated bilirubin concentrations are greater than 2 mg/dL
Clinical jaundice persists for more than 2 weeks in a term newborn

15. Phototherapy: Nursing Care
Maximize exposure of the skin surface to the light
Periodic assessment of serum bilirubin levels
Protect the newborn’s eyes with patches
Measure irradiance levels with a photometer
Good skin care and reposition infant at least every 2 hours
Maintain adequate hydration and nutrition

17. Anemia Hemoglobin of less than 14 mg/dL (term)
Hemoglobin of less than 13 mg/dL (preterm)
Nursing management
Observe for symptoms
Initiate interventions for shock

18. Clinical Manifestations of Sepsis
Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit
Monitor for signs of distress
Assist with exchange transfusion
Temperature instability
Feeding intolerance
Hyperbilirubinemia
Tachycardia followed by apnea/bradycardia

19. Important Notes about Hypoxic Ischemic Encephalopathy (HIE)
Grade I HIE: - Alternating periods of lethargy and irritability, hyper-alertness and jitteriness. - Poor feeding. - Exaggerated and/or a spontaneous Moro reflex. - Increased heart rate and dilated pupil. - No seizure activity. - Symptoms resolved in 24 hours.

20. Grade II HIE: - Lethargy. - Poor feeding, depressed gag reflex
Grade II HIE: - Lethargy. - Poor feeding, depressed gag reflex. - Hypotonia. - Low heart rate and papillary constriction. - 50-70% of infants display seizures, usually in the first 24 hours after birth. - Oliguria.

21. Grade III HIE: - Coma. - Flaccidity. - Absent reflexes
Grade III HIE: - Coma. - Flaccidity. - Absent reflexes. - Pupils fixed, slightly reactive. - Apnea, bradycardia, hypotension. - Oliguria. - Seizures are uncommon.

22. NEC NEC: necrotizing enterocolitis; common in PT baby;
can result in ulcers/tissue necrosis in intestinal wall.
Bacteria in bowel>infection>destroys bowel tissue>
sepsis.
Primary risk factor: prematurity & tube feedings;
RDS, congenital heart defects.
S/S abd. swelling, septic infant, emesis, blood in stool.
Tx: stop tube feedings, start IVF & TPN, AB [sepsis],
ventilator, platelet transfusion [control bleeding]
Prevention: Delayed /Slow feedings: advance < 20 ml/kg/day; Enteral Antibiotics; Antenatal Steroids; enteral IgG, IgA; Human Milk Feedings.