High Risk Neonates

High Risk Neonates

High Risk NeonatesPresented by Ann Hearn RNC, MSN1A High-Risk Newborn is one who is susceptible to illness (morbidity) or even death (mortality) due to: dysmaturity immaturity physical disorderscomplications of birth

In most cases, the infant is the product of a pregnancy involving one or more predictable risk factors, including the following:Low socioeconomic level of the mother, poor nutritionExposure to environmental dangers such as toxic chemicalsPreexisting maternal conditions such as heart disease, diabetesObstetric factors such as age or parity, other premature birthsMedical conditions related to pregnancy such as hypertension, Premature rupture of membranes, infection, etc.

The High Risk NewbornClassification of High Risk NewbornsGestational Age

Preterm(Late Preterm)TermPosttermGestational Age & Birth Weight

SGAAGALGA

1. What is gestational age?

Ballard Scale or Dubowitz scale Neuromuscular characteristicsPhysical Characteristics

Scoring of all characteristics determines the gestational ageAssessment of Gestational AgeWhat assessment tools are used in determining gestational age? What are the neuromuscular and physical characteristics used in determining gestational age? Associated Complications of:AsphyxiaAspiration syndromeHypothermiaHypoglycemiaPolycythemia

Congenital malformationsIntrauterine infectionsContinued growth difficultiesCognitive difficulties

SGAIUGRNursing Interventions: Monitor heart rate, respiratory rate, temperature and blood glucose.3. What is the relationship between the pretermaturity, SGA, and IUGR?5 Born before 37 weeks gestationThe Premature InfantPhysiologic Challenges of the premature infant

4. What are the characteristics of the preterm infant?

7Physiologic Challenges of the premature infantRespiratory ThermoregulationDigestiveRenal (fluid & electrolyte)InfectionPain

5. What are the physiologic challenges of the premature infant in regard to the following systems and related treatment and nursing care

8Physiologic Challenges of the premature infantRespiratory

Insufficient production of surfactantImmaturity of alveolar systemImmaturity of musculatureRespirations 40-60, shallow, irregular, usually diaphragmatic

Why does the preterm infant have difficulty with breathing?

Physiologic Challenges of the premature infantRespiratory Nursing InterventionsAssess for S/S respiratory distressCyanosisRetractionsExpiratory gruntingNasal flaringApnic episodesMaintain airwayAdminister O2Monitor O2 saturationMonitor heart/respiratory rates

What are the signs of respiratory distress? What is the difference between periodic breathing and apnea? PositioningPosition with head slightly elevated and neck slightly extendedSide-lying or prone

SuctioningOnly use when necessaryBe gentle so as not to damage fragile mucus membranesNursing Care

What are the nursing interventions used to maintain respiratory function in the preterm infant including:Respiratory equipmentPositioningSuctioning secretions

Physiologic Challenges of the premature infantThermoregulation

Increased body surface area compared to body massDecreased brown fatThin skinVessels close to skinDecrease sub-q fatLack of flexion

Why are preterm infants at a greater risk for heat loss? What are complications of heat loss? Axillary temperature 36.9 degrees CAbdominal skin temperature 36.5 degrees CPoor feeding or feeding intoleranceIrritabilityLethargyWeak cry or suckDecreased muscle toneCool skin temperatureSkin pale, mottled, or acrocyanoticSigns of hypoglycemiaSigns of respiratory difficultyPoor weight gain

Signs of Inadequate Thermoregulation13Physiologic Challenges of the premature infantThermal Neutrality Nursing InterventionsIncubator or radian warmerWarm surfacesWarm humidified oxygenWarm ambient humidityWarm feedingsKeep skin dry and head covered

What are the nursing interventions used to maintain a neutral thermal environment?

ISOLETTE/ RADIANT or INCUBATOR OPEN WARMER

15Fluid and Electrolyte BalanceDehydrationUrine output 1.01Weight loss greater than expectedDry skin and mucous membranesSunken anterior fontanelPoor tissue turgorBlood: Elevated sodium, protein, and hematocrit levels

OverhydrationUrine output >5 ml/kg/hourUrine specific gravity