1. Neonatal Nursing Care Neonatal Complications

2. The Newborn at Risk: Conditions Present at Birth

3. Identification of At-risk Newborn
Low socioeconomic level of the mother
Limited or no prenatal care
Exposure to environmental dangers
Preexisting maternal conditions
Maternal factors such as age or parity
Medical conditions related to pregnancy
Pregnancy complications

4. Congenital Anomalies

5. Small-for-gestational-age
Maternal factors
Maternal disease
Environmental factors
Placental factors
Fetal factors

6. Impact of Maternal Diabetes Mellitus (DM) on the Newborn
LGA
SGA
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
Birth trauma
Polycythemia
RDS
Congenital malformations

7. Preterm Infant: Respiratory Alterations
Inadequate surfactant production
Muscular coat of pulmonary blood vessels is not completely developed
Greater risk for the ductus arteriosis to remain open

8. Preterm Infant: Alterations in Thermogenesis
Unavailability of glycogen and brown fat
Inability to increase oxygen consumption
High ratio of body surface area to body weight
Extended position increases body surface area
Decreased ability to vasoconstrict superficial blood vessels

9. Preterm Infant: GI Alterations
Poorly developed gag reflex
Incompetent esophageal cardiac sphincter
Poor sucking and swallowing reflexes
Difficulty meeting caloric needs for growth
Inability to handle the increased osmolarity of formula protein
Difficulty with absorbing saturated fats
Difficulty with lactose digestion
Deficiency of calcium and phosphorous
Increased basal metabolic rate and increased oxygen requirements
Feeding intolerance
Potential for the development of necrotizing enterocolitis (NEC

10. Preterm Infant: Kidney Alterations
Lower glomerular filtration rate (GFR)
Limited ability to concentrate urine or excrete large amounts of fluid
Excrete glucose at a lower serum glucose level
Buffering capacity is reduced
Excretion time of drugs is longer

11. Preterm Infants: Liver Alterations
Glycogen stores are used rapidly
Glycogen stores are affected by asphyxia and cold stress
Low iron stores
Conjugation is impaired

12. Preterm Infants: Other Alterations
Immunologic
Lack of passive IgG antibodies
Skin is easily excoriated
Neurologic
Increased risk for IVH & ICH
Delayed or absent reactivity

13. Assessment of the Preterm Newborn
Physical characteristics
Gestational age
Maternal prenatal risk factors
Delivery risk factors
Physical assessment
Family assessment

14. Nursing Management…

15. Cleft Lip and/or Palate: Nursing Assessment
The extent of the cleft
Difficulty in sucking
Expulsion of formula through the nose

16. Cleft Lip and/or Palate: Nursing Interventions
Provide nutrition through feedings with a special nipple
Monitor weight gain
Clean the cleft with sterile water
Supporting parent coping
Provide role modeling
Position infant prone or side-lying

18. Congenital Cardiac Disease: Symptoms
Cyanosis
Heart murmur
Signs of congestive heart failure

19. Cardiac Defects

20. Cardiac Defects

21. Cardiac Defects

22. Cardiac Defects

23. Nursing Care of the Newborn with Inborn Errors of Metabolism
Assessment of signs of the disorder
State-mandated newborn testing
Referral of parents to support groups
Referral of parents to centers for education
Dietary management