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High Risk Newborn; Neonatal Problems

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S Lim

on 2 December 2012

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Transcript of High Risk Newborn; Neonatal Problems

By: Elizabeth Kessler,
Sophie Lim, Tanisha Matthews and Sally Nguyen High Risk Newborn
Neonatal Hypoglycemia is the most common problem in neonates
In children, a blood glucose level less than 40 mg/dL = hypoglycemia
In first 24 hours of life, a plasma glucose level of less than 30 mg/dL and less than 45 mg/dL thereafter constitutes hypoglycemia in the newborn NEONATAL CONGENITAL HEART DEFECTS Cold Stress Causes:
Inappropriate changes in hormone secretion
Inadequate substrate reserve in form of hepatic glycogen
Inadequate muscle stores as a source of amino acids for gluconeogenesis
Inadequate lipid stores for the release of fatty acids Newborns at risk:
Premature, have a serious infection, or needed oxygen right after delivery
Mother has diabetes
Rare genetic disorders
Poor growth in the womb during pregnancy
Small for gestational age (SGA) Medical Management:
Monitor blood glucose; abnormal results are confirmed by laboratory analysis of plasma glucose
If hypoglycemic (less than 40 mg/dL) the newborn should be fed, and monitored again 30 minutes after feeding to evaluate response to treatment
This should be performed initially within 1-2 hours of age after feeding Nursing Actions:
Monitor blood glucose per agency protocol
Provide early and frequent feedings to treat and prevent hypoglycemia
Maintain a neutral thermal environment to reduce energy needs Symptoms:
May be asymptomatic, but some symptoms include:
Bluish-colored or pale skin
Breathing problems, such as pauses in breathing (apnea), rapid breathing, or a grunting sound
Irritability or listlessness
Loose or floppy muscles
Poor feeding or vomiting
Problems keeping the body warm
Tremors, shakiness, sweating, or seizures
Can result in CNS and cardiopulmonary disturbances Pain Neonates are subjected to a variety of painful stimuli during their transition to extrauterine life (e.g., injections, heel sticks for blood samples, and circumcision). Pain Assessment Tool
Premature Infant Pain Profile (PIPP) and Neonatal Infant Pain Scale (NIPS) have been developed to assess for neonatal pain.
Commonly look at state of arousal, cry, motor activity, respiratory pattern, and facial expressions.
Some tools may also include blood pressure and oxygen saturation level. Medical Management
Opioids to treat pain associated with procedures that cause moderate to severe pain such as with surgical procedures Nursing Actions
Manage Pain
Assess the neonate for signs of pain frequently, and especially during painful procedures. Instruments to measure neonatal pain among preterm neonates are available and should be integrated into routine care.
Administer sucrose and promote nonnutritive sucking during painful procedures.
Administer opioids as per orders to treat pain associated with procedures that cause moderate to severe pain.
Evaluate the effectiveness of nonpharmacological and pharmacological interventions. Ventricular Septal Defect (VSD)
Opening in the septum between the right and left ventricles of the heart.

Incidence & Treatment:
1 in 3000 live births
Up to 75% of VSDs close without treatment
Treat with digoxin and diuretics if congestive heart failure is present.
Surgical repair Atrial Septal Defect (ASD)
Opening in the septum between the right and left atria.

Incidence & Treatment:
1 in 5000 live births
ASDs may close without treatment.
Treat congestive heart failure with medication.
Surgical repair may be needed. Coarctation of the Aorta
Narrowing of the aorta at the transverse aortic arch or in the area of the ductus arteriosus.

Incidence & Treatment:
1 in 10,000 live births
Medical management of congestive heart failure.Surgical repair. Tetralogy of Fallot
Consists of four defects:
Aorta overriding VSD
Pulmonary stenosis
Hypertrophy of the right ventricle

Incidence & Treatment:
1 in 5000 live births
Medical management includes propranolol for cyanotic infants.
Prostaglandin E1 may be administered to maintain a patent ductus arteriosus until surgery, for infants with severe tetralogy of Fallot.
Surgical repair. Transportation of Great Vessels
The positions of the great arteries are reversed from the normal position. Aorta emerges from the right ventricle and the pulmonary artery emerges from the left ventricle.

Incidence & Treatment:
1 in 5000 live births
This defect results in a medical emergency.
Stabilization-treat acidosis.
Administer prostaglandin E1 to maintain patent ductus arteriosus until surgery is performed.

Nursing Actions
Provide emotional support for parents and family.
Provide information on support groups.
Provide information on need for follow-up care. The excessive heat loss leading to hypothermia, and the utilization of compensatory mechanisms to maintain the neonate’s body temperature. The Thermoregulatory System Neutral Thermal Environment (NTE):
An environment that maintains body temperature (36.4-37.2˚C / 97.5-99˚F) with minimal metabolic changes and/or oxygen consumption. Brown Fat:
Highly dense vascular brown adipose tissue unique to neonate (non-shivering thermogenesis)
Location: neck, thorax, axillary area, intrascapular area, around adrenal glands and kidneys.
Metabolism of brown fat = heat production
Rapidly depleted by periods of cold stress
Limited in preterm neonate Neonate responds to cold by:
Increase metabolic rate
Increase muscle activity
Peripheral vasoconstriction
Metabolism of brown fat Neonates have higher risk of thermoregulatory problems due to:
Higher body surface area to body mass ratio
Higher metabolic rate
Thin skin with blood vessels close to surface
Limited and immature thermoregulatory abilities Factors that affect thermoregulation negatively:
Decrease subcutaneous fat
Preterm neonates (decrease brown fat)
Large body surface
Loss of body heat from
Evaporation: heat loss from water on skin converts to vapor
Convection: heat loss to cooler air currents
Conduction: heat transfer to cooler surface in direct contact
Radiation: heat transfer to cooler objects not in direct contact Nursing Actions:
Dry neonate thoroughly immediately after birth/bath (decrease evaporation)
Skin-to-skin contact with warm blanket over (decrease radiation and conduction)
Remove wet blankets (decrease radiation and conduction)
Swaddle in warm blanket (decrease radiation and conduction)
Stocking caps on head (decrease radiation and convection)
Maintain NTE (decrease radiation and convection)
Action when signs/symptoms of cold stress are present:
Skin-to-skin contact with warm blanket over, reassess temperature
Swaddle in warm blanket, reassess temperature
Stocking caps on head
Place under preheated radiant warmer
Set at 36.5˚C (97.7˚F)
Attach servo-controlled probe to neonate’s abdomen/area closest to radiant source (avoid bony areas and brown fat areas)
Monitor neonate’s temperature, RR, and HR q5mins (never leave unattended)
Monitor temperature per institutional protocol
Obtain heel stick to assess for hypoglycemia (glucose < 40mg/dl)
Treat hypoglycemia Risk Factors:
Prolonged resuscitation efforts
Neurological, endocrine, or cardiorespiratory problems Signs and Symptoms:
Axillary temperature ≤ 36.5˚C (97.6˚F)
Cool skin
Hypotonia (low muscle tone)
Weak suck Process
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