CMCA LEC LESSON 1: Pediatric
Appropriate for gestational age (AGA) -
THE HIGH-RISK NEONATE
- can be defined as newborn, regardless of
gestational age, who has a greater than
average chance of morbidity or
mortality.
- Because of conditions or circumstances
superimposed on the normal course of
events associated with birth and the
adjustment to extrauterine existence.
- The high-risk period of encompasses
human growth and development from
the time of viability up to 28 days
following birth and includes threats to
life and health that occur during the
prenatal, perinatal and postnatal
periods.
Note: Kapag pinag uusapan natin ang high risk
newborn eto yung mga bata na nahirapan na
mag adjust sa extrauterine life or naapektuhan
ang kanilang health.
CLASSIFICATION OF HIGH-RISK NEWBORN
Classified according to:
1. Birth Weight
2. Gestational Age
3. Mortality
BIRTH WEIGHT
1. Low birthweight (LBW) – an infant
whose birth weight is LESS than 2500g,
regardless gestational age.
2. Very low birthweight (VLBW) – an infant
whose birth weight is LESS than 1500g.
3. Extremely low birthweight – an infant
whose birth weight is LESS than 1000g.
4.
an infant whose birth weight is FALLS
BETWEEEN the 10th and 90th
percentiles on intrauterine growth
curves.
5. Small-for-date (SFD) – also called as
“small-for gestational age (SGA) infant.
▪ an infant whose rate of
intrauterine growth was slowed
and whose birth weight FALLS
BELOW the 10th percentile on
intrauterine growth curves.
6. Intrauterine growth restriction (IUGR) –
found in infants whose intrauterine
growth is restricted.
▪ Symmetric IUGR – growth
restriction in which the weight,
length, and head circumference
are all affected.
▪ Asymmetric IUGR – growth
restriction in which the head
circumference REMAINS within
normal parameters while the
birth weight FALLS BELOW the
10th percentile.
7. Large-for gestational age (LGA) – an
infant whose birth weight FALLS ABOVE
the 90th percentile on intrauterine
growth curves.
Note:
• Neonate - 24 hours to 28 days or 1
month.
• Infant - 1 month to 1 year.
• Toddler – 1to 3 years.
• Preschooler – 3 to 6 years.
• School age – 6 to 12 years.
• Adolescent
 GESTATIONAL AGE
1. Premature (PRETERM) infant – an infant
born BEFORE completion of gestation,
regardless of birth weight.
2. Full term infant – an infant born
BETWEEN the beginning of the 38 weeks
and the completion of the 42 weeks of
gestation, regardless of birth weight.
3. Postmature (POSTERM) infant – an
infant whose born AFTER 42 weeks of
gestational age, regardless of birth
weight.
MORTALITY
1. Live birth – birth in which the neonate
manifests any heartbeat, breathes, or
displays voluntary movement,
regardless of gestational age.
2. Fetal death – death of the fetus AFTER
20 weeks of gestation and before
delivery, with absence of any signs of life
after birth.
3. Neonatal death – death that occurs in
the first 27 days of life.
▪ Early neonatal death - occurs in
the first weeks of life.
▪ Late neonatal death - occurs at
7 to 27 days.
4. Perinatal mortality – total number of
fetal and early neonatal deaths per 1000
live births.
THE RISK OF NEONATES
PRETERM
- Born BEFORE the 38th week or before
completing 37 weeks of gestation
regardless birth weight.
ETIOLOGY OF PRETERM BIRTH
✓ Low socioeconomic level
✓ Poor nutritional status
✓ Lack of prenatal care
✓ Multiple pregnancy
✓ Previous early birth
✓ Race (highest incidence of prematurity
than whites)
✓ Cigarette smoking
✓ Age of the mother (highest incidence is
in mothers YOUNGER than age of 20
years)
✓ Order of birth
✓ Closely spaced pregnancies
✓ Abnormalities of the mother’s
reproductive system
▪ Such as: Intrauterine septum
✓ Infections like UTI
✓ Pregnancy complications
▪ Such as: Premature rupture or
premature separation of the
placenta.
✓ Early induction of labor
✓ Elective cesarean birth
CHARACTERISTICS OF PREMATURE INFANTS
✓ Small and appear scrawny
✓ Large head in relation to the body
(Cephalocaudal direction of growth)
✓ The skin is bright pink (Translucent,
Edematous)
 ✓ The fine lanugo hair is abundant over the - Prolong apnea (more than
body 20 secs)
✓ The ear cartilage is soft and pliable - Cyanosis
✓ The sole and palms have minimal - Asphyxia.
creases, smooth appearance. ▪ Symptoms:
✓ The bones of the skull and ribs feel soft, - Nasal flaring – because they are
and the eyes maybe closed. “obligate nasal breathers”
✓ Male infants have few scrotal rugae, and - Fast breathing – more than 60.
the testes are undescended, and the - Chest indrawing
- Grunting – most accurate sign
labia and clitoris are prominent in
“umuungol” (sounds like a near
females. collapsed lungs upon expiration)
✓ Inactive and listless.
▪ If the nose is suctioned first –
✓ Reflex activity is only partially
stimulation of pharyngeal reflex leads to
developed: aspiration of secretions.
▪ Sucking is absent, weak, or
▪ Symptoms or respiratory distress not
ineffective.
visible immediately after birth.
▪ Swallow, gag, and cough
reflexes are absent or weak. ▪ Body Temperature – a more immediate
✓ Physiologically immature, unable to problem (within 1 minute might have
hypothermia)
maintain body temperature.
✓ A pliable thorax, immature lung tissue
MANAGEMENT
and regulatory center lead to
✓ Assist MD in inserting ET
hypoventilation and periodic apnea.
▪ Neonatologist
✓ Have biochemical alterations such as
▪ Serve as an accessible route for
hyperbilirubinemia and hypoglycemia.
admission of surfactants.
✓ Neurologic impairment as
✓ Artificial Intelligence surfactant given via
intraventricular Hemorrhage, and
ET (Survanta / Liquivent)
cerebral palsy.
✓ Give O2 by CPAP or Continuous Positive
COMMON PROBLEMS OF PRETERM INFANTS Airway Pressure/Ventilator
RESPIRATORY DISTRESS ▪ Prolonged ventilator

▪ Immature alveoli with less ▪ Might develop

amount of surfactant. bronchopulmonary dysplasia
▪ PROBLEMS:
▪ P. aeruginosa
- Atelectasis
✓ Monitor pulse oximeter (danger of
retinopathy of prematurity/retrolental
fibroplasia)
✓ O2 NOT greater than 40%
▪ On NPO during respiratory
distress.
▪ Good uterine output = good
cardiac output = 1.1.5
cc/kgbw/hour.
REGULATION OF BODY TEMPERATURE
• Immature hypothalamus
• Less amount of subcutaneous tissue
• Poikilothermia – can go very HIGH LOW
(dependent on the environment due to
immature hypothalamus)
MANAGEMENT
✓ Don’t put in radiant warmer
✓ Put in incubator – provides neutral
temperature.
✓ KMC – Kangaroo Mother Care
NUTRITIONAL DIFFICULTIES
• Prone to aspiration / gastric distention
• Hypoglycemia
CAUSES:
▪ Poor suck and gag – must NOT
be removed.
▪ Uncoordinated swallowing –
must NOT be removed.
▪ Small gastric capacity
MANAGEMENT
✓ Gavage OGT feeding inserted at the
mouth
▪ Orogastric feeding
▪ Breastmilk or formula
▪ Special preemie formula (25 cal
/oz)
- O-lac, Pre-Nan
- Similac Special Care
• Small frequent feeding
Preemie
Nipple (shorer,
If observed to
Refer smaller,
be sucking
opening is
cross cut)
• Upright position during feeding
• Right Lateral position after feeding
promote gastric emptying
HEMATOLOGIC DIFFICULTIES
✓ Immature liver function
✓ Jaundice due to indirect bilirubin due to
hemolysis, liver cannot convert.
PROBLEM:
▪ Early and prolong jaundice
▪ Prone to kernicterus
▪ Bleeding
▪ Photoisomerization = more skin
exposed.
 MANAGEMENT PROBLEM:
✓ Phototherapy as ordered
▪ Sepsis Neonatorum (Nosocomial
✓ Phototherapy
Infection)
✓ Maximum exposure except the eyes and
genitals MANAGEMENT

▪ Increase in temperature leads to ✓ Note for SIGNS of infection

vascular engorgement that ▪ Note for signs of infection
could lead to priapism - FEVER – not sign for
(continuous erection of the PRETERM (Immature
penis) Hypothalamus)
✓ Cover eyes to prevent loss of moisture - Hypothermia – sign for
▪ Regular turning to ALL sides: preterm.
- Front Back - Poor feeding
- Side to Side every 30 ✓ Strict compliance with Nursery aseptic
minutes protocol
▪ Check temperature regularly ✓ Antibiotics as ordered
▪ Promote feeding and hydration ***At risk because of immature liver
✓ Prevent Hydration (Post Antibiotic Hepatitis)
✓ Promote faster elimination of bilirubin
COMPLICATION OF PRETERM INFANTS
✓ Promote bonding / breastfeeding if
allowed • Anemia of prematurity –
✓ Breastfeeding jaundice – mas matagal normochromic, normocytic due to
mawala pag breastfed (PRENANEDIOLE immaturity of hematopoietic system,
decreases GLUCORONYL transferase). low vitamin e and excessive blood
✓ Physiologic jaundice – normal after 1 drawing.
day, if not maternal antibody destroys. • Acute bilirubin encephalopathy –
✓ Bilirubin can go to the brain causing destruction of brain cells or indirect
KERNICTERUS. bilirubin.
• Persistent patent ductus arteriosus –
LOW RESISTANCE TO INFECTION
decrease surfactant leads to non-
✓ Most common CAUSE OF DEATH
compliant lungs and pulmonary
✓ Immature immune system
 hypertension and interfere with closure ✓ Fetal distress
of ductus arteriosus. ▪ Restlessness of the baby –
• Periventricular / Intraventricular earliest sign.
Hemorrhage - Seizure disorders and might
• Respiratory Distress Syndrome develop cerebral palsy
• Retinopathy of prematurity - Cold stress due to less

• Necrotizing enterocolitis subcutaneous fats

- Meconium aspiration
POST MATURE INFANT
✓ Due to respiratory distress
- Born MORE THAN 41 weeks in gestation. ✓ Infection
▪ Polycythemia causing
- Post term syndrome: NB decrease
weight due to DECREASE supply of hyperbilirubinemia
nutrients from placenta. ✓ Not critical for KERNICTERUS

Problem: ✓ Phototherapy but not as long as that of

a preterm
▪ Placental degeneration causing
decreased utero-placental SMALL FOR GESTATIONAL AGE
perfusion.
- Newborn who is PLOTTED at or BELOW
Etiology:
the 10th percentile on the intrauterine
▪ UNKNOWN. growth.

Manifestations: ASSESSMENT:

▪ Long but thin 1. Fetal distress

▪ Dry cracking skin 2. Decreased or elevated body
▪ No vernix and lanugo temperature
▪ Long hair and nails 3. Physical abnormalities
▪ Alert look 4. Hypoglycemia
▪ Possible IUFD 5. Signs of polycythemia
▪ Hermit Look a. Ruddy appearance

ASSOCIATED PROBLEMS b. Cyanosis

c. Jaundice
✓ Hypoxia due to placental insufficiency
6. Signs of infection
✓ Hypoglycemia due to decrease glycogen
 7. Signs of aspiration of meconium

NURSING INTERVENTION:

1. Maintain airway and cardiopulmonary

function
2. Maintain body temperature
3. Observe for signs of respiratory distress
4. Monitor for infection and initiate
measures to prevent sepsis
5. Monitor for hypoglycemia
6. Initiate early feedings and monitor for
signs of aspiration

LARGE FOR GESTATIONAL AGE

- Newborn who is PLOTTED at or ABOVE

the 90th on the intrauterine growth
curve.

ASSESSMENT:

1. Birth Trauma or Injury

2. Respiratory Distress
3. Hypoglycemia

NURSING INTERVENTION:

1. Monitor vital signs and for respiratory

distress
2. Monitor for hypoglycemia
3. Initiate early feedings
4. Monitor for infection and initiate
measures to prevent sepsis
CMCA Lesson 2: Acute Conditions of the Neonates SIGN AND SYMPTOMS

RESPIRATORY DISTRESS SYNDROME

✓ Difficulty of breathing
✓ Respiratory grunting and nasal
- COMMON to:
flaring
▪ Preterm infant
✓ Low body temperature
▪ Infant with dm mothers
✓ Sternal and subcostal retraction
▪ Cs delivery or situation that
decrease blood perfusion in the ✓ Tachypnea

lungs in mas. ✓ Cyanotic mucous membrane

- Also known as Hyaline Membrane Disease. ✓ Desaturation of blood oxygen
- Deficiency of surfactant (formed at 34 ✓ Seesaw respirations (on inspiration,
weeks) the anterior chest wall retracts, and
- Betamethasone may be administered to
the abdomen protrudes; on
enhance surfactant if premature labor
expiration, the sternum rises
cannot be arrested.
✓ Heart failure, evidenced by
PATHOPHYSIOLOGY OF RDS decreased urine output and edema

1. Decrease pulmonary surfactant of the extremities

2. Increase surface tension ✓ Pale gray skin

3. Alveolar walls will not separate ✓ Periods of apnea

4. Lack of expansion of affected alveoli ✓ Bradycardia

5. Decreased alveolar ventilation ✓ Pneumothorax

6. Inadequate exchange of oxygen and ✓ Shock

carbon dioxide DIAGNOSTIC TEST

7. Hypoxia ✓ Chest X Ray: Diffuse radiopaque ground

8. Lactic acid formation glass like haziness

9. Increased capillary permeability which ✓ ABG analysis: respiratory acidosis

causes effusion from the pulmonary ✓ Culture and sensitivity for B hemolytic

capillaries into the alveoli and terminal streptococcus infection - severe in

bronchioles newborn that inhibit surfactant

10. Hyalik - like membrane found in the production.

alveoli and bronchioles composed ✓ May give Aminoglycoside (Amikacin,

mainly of fibrin Kanamycin) or penicillin and ampicillin

11. Atelectasis
 while waiting for the result of blood 9. Encourage parental involvement in care
culture. 10. Administer surfactant via endotracheal
MANAGEMENT tube and other medications as ordered
✓ Surfactant administration MECONIUM ASPIRATION SYNDROME
✓ Sprayed in the ET tube by syringe or - Occurs in term or post term newborns.
catheter / lung lavage
- Aspiration - can occur in utero or with
✓ Position: upright
the first breath.
✓ Avoid suctioning
✓ Oxygen administration ASSESSMENT:

✓ Simple cannula, mask CPAP or assisted

1. Respiratory distress is present at birth
ventilation with PEEP, ventilator
✓ Muscle relaxant ▪ Tachypnea
▪ Cyanosis
✓ Liquid ventilation
▪ Retractions
NURSING MANAGEMENT ▪ Nasal flaring and grunting
1. Maintain body temperature at 36.5C to ▪ Crackles and rhonchi
37.7C
2. The newborn’s nails, skin, and umbilical
2. Provide sufficient caloric intake for size, cord may be stained a yellow-green
age, and prevention of catabolism; color.
orogastric tube may be used
NURSING INTERVENTIONS:
3. Organize care for minimal handling of
infant 1. If the newborn is delivered in an active,
4. Administer oxygen as ordered crying state with no evidence of
respiratory distress, no intervention is
• Monitor concentration every 2-4
necessary.
hours
• Use nasal prongs, intubation, 2. If the newborn is delivered and exhibits
inactivity and lack of cry, endotracheal
mask, or hood
suctioning is performed.
• Atmospheric or increase pressure
• Warmed and humidified 3. If the newborn also exhibits lack of
5. Monitor blood gases respiratory effort and a low heart rate,
6. If intubated, suction PRN additional interventions will be needed.
7. Auscultate breath sounds
8. Chest physiotherapy, postural drainage,
and percussion if ordered
 4. Newborns with severe meconium - Respiratory condition that results from
aspiration syndrome may benefit from incomplete reabsorption of fetal lung
extracorporeal membrane oxygenation. fluid in full-term newborns.

▪ Extracorporeal Membrane - Usually disappears within 24 to 48 hours.

Oxygenation – is a therapy uses
a modified heart-lung machine ASSESSMENT:
and provides oxygen to the
circulation, allowing the lungs to 1. Tachypnea
rest and decreasing pulmonary 2. Expiratory grunting
hypertension and hypoxemia. 3. Retractions
4. Nasal flaring
BRONCHOPULMONARY DYSPLASIA 5. Fluid breath sounds per auscultation
6. Cyanosis
- A chronic pulmonary condition affects
newborn who have experienced NURSING INTERVENTIONS:
respiratory failure or have been oxygen-
dependent for more than 28 days. 1. Supportive care
2. Oxygen administration
- X ray findings - are abnormal, indicating
areas of overinflation and atelectasis. NECROTIZING ENTEROCOLITIS (NEC)
- Acute inflammatory disease of the
ASSESSMENT:
gastrointestinal tract.

1. Tachypnea
- Usually occurs 4 to 10 days after birth,
2. Tachycardia
and is most frequently seen in preterm
3. Retractions
newborn
4. Nasal flaring
5. Labored breathing
ASSESSMENT:
6. Crackles and decreased air movement
7. Occasional expiratory wheezing 1. Increased abdominal girth
2. Decreased or absent bowel sounds
NURSING INTERVENTIONS: 3. Bowel loop distension
4. Vomiting
1. Monitor airway and cardiopulmonary 5. Bile-stained emesis
function; provide oxygen therapy 6. Occult blood in stool
2. Fluid restriction may be prescribed

3. Medications include surfactant at birth, PREVENTION:

bronchodilators and possibly diuretics 1. Withhold feedings from 24 to 48 hours
and corticosteroids
from infants believed to have suffered
TRANSIENT TACHYPNEA OF THE NEWBORN birth asphyxia.
 ▪ Breast milk - is the preferred
nutrient after this time period.
2. The use of probiotics with enteral
feedings and breast milk has shown
evidence of prevention of NEC.
3. Administration of corticosteroids to the
mother prior to birth to promote early
gut closure and maturation of the gut
mucosa.
NURSING INTERVENTIONS:
1. Hold oral feedings
2. Insert gastric tube to decompress the
abdomen intravenous antibiotics
3. Intravenous fluid, electrolyte, and acid-
base imbalances
4. Surgery if indicated
HYPERBILIRUBINEMIA
- Elevated serum bilirubin level.
- Evaluation - is indicated when serum
levels are greater than 12 mg/dL (180
mcmol/L) in a term newborn.
- Therapy - is aimed at preventing
kernicterus, which results in permanent
neurological damage resulting from the
deposition of bilirubin in the brain cells.
ASSESSMENT:
1. Jaundice
2. Elevated serum bilirubin level
3. Enlarged liver
4. Poor muscle tone
5. Lethargy
6. Poor sucking reflex
NURSING INTERVENTIONS:
1. Monitor for the presence of jaundice;
assess skin and sclera for jaundice.
▪ Examine the newborn’s skin
color in natural light.
▪ Press finger over a bony
prominence or tip of the
newborn’s nose to press out
capillary blood from the tissues.
▪ Note that jaundice starts at the
headfirst and spreads to the
chest, abdomen, arms and legs,
and hands and feet, which are
the last to be jaundiced.
2. Keep the newborn well hydrated to
maintain blood volume
3. Facilitate early, frequent feeding to
hasten passage of meconium and
encourage excretion of bilirubin.
4. Report to the PHCP any signs of jaundice
in the first 24 hours of life and any
abnormal signs and symptoms.
5. Prepare for phototherapy (bili-light or
bili-blanket), and monitor the newborn
closely during the treatment
NOTE: At any serum bilirubin level, the
appearance of jaundice during the first day of life
indicates a pathological process.
PHOTOTHERAPY
- is the use of light to reduce serum
bilirubin levels of the newborn.
- ADVERSE EFFECTS from treatment such
as:
1. Eye Damage
2. Dehydration
3. Sensory Deprivation
▪ Follow specific instructions for
phototherapy and bili-blanket
care.
▪ Expose as much of the newborn’s
skin as possible.
▪ Cover the genital area and
monitor the genital area for skin
irritation or breakdown.
▪ Cover the newborn’s eyes with
eye shields or patches; ensure
that the eyelids are closed when
shields or patches are applied.
▪ Remove the shields or patches at
least once per shift (during a
feeding time) to inspect the eyes
for infection or irritation and to
allow for eye contact and
bonding with the parents.
▪ Measure the lamp energy output
to ensure efficacy of the
treatment (done with a special
device known as a uncovered under fluorescent
PHOTOMETER).
▪ Monitor skin temperature
closely.
▪ Increase fluids to compensate for
water loss.
▪ Expect loose green stools.
▪ Monitor the newborn’s skin color
with the fluorescent light turned
off, every 4 to 8 hours.
▪ Monitor the skin for bronze baby
syndrome, a grayish brown
discoloration of the skin,
complication of phototherapy.
▪ Reposition the newborn every 2
hours; monitor the newborn
closely.
▪ Provide stimulation.
▪ If treatment is done at home,
teach the parents about care and
indications of the need to notify
the PHCP.
▪ After treatment, continue
monitoring for signs of
hyperbilirubinemia, because
rebound elevations can occur
after therapy is discontinued.
▪ Turn off the phototherapy lights
before drawing a blood specimen
for serum bilirubin levels, and do
not leave the blood specimen
lights (to prevent the breakdown
of bilirubin in the blood
specimen)
CMCA Lesson 3: RH Incompatibility • Rh (+) not allowed because of the
presence of antibodies
RH INCOMPATABILITY
• Mother cannot donate because
- ABO / RH (erythroblastosis fetalis)
antibodies came from her
- Orientals - 99% have Rh (+) (D antigen)
• PREVENTION is the best intervention If
- Rh (-) = no Rh factor (D antigen); can only mommy and baby are not compatible.
receive (-)
▪ After first baby, COOMB’s TEST
- Rh (+) = can receive blood from Rh (+)
(baby).
and (-)

PATHOPHYSIOLOGY ▪ Determines presence of maternal

antibody on the baby’s blood.
- Uteroplacental barrier - prevents blood
of baby and mother to mix.
▪ If mother is not compatible with
baby and coomb’s is negative,
▪ Through pinocytosis, antibodies
then Rhlg (RHOGAM) is given to
cross membrane
mother within 72 hours after
▪ Mother (-) and baby (+) First baby
delivery or abortion on an
not affected
incompatible fetus.
▪ Birth of placenta
▪ Baby’s blood goes into mommy’s
▪ If Coomb’s test is (+) do
blood
EXCHANGE TRANSFUSION.
▪ Production of antibody (anti-Rh
(+))
▪ Can be given during pregnancy.
▪ Second pregnancy
▪ Uteroplacental barrier allows ERYTHROBLASTOSIS FETALIS
antibodies to cross membrane
- is the destruction of red blood cells that
▪ Hemolysis
results from an antigen/antibody
▪ Destruction of baby’s blood
reaction.
MANIFESTATIONS:
- The disorder is characterized by
• Jaundiced / alive but with pathologic
hemolytic anemia or hyperbilirubinemia.
jaundice

MANAGEMENT: - Exchange of fetal and maternal blood

• Exchange transfusion - remove blood
• Removal of baby’s blood and
replacement with fresh whole blood (Rh
Negative)
occurs primarily when the placenta
separates at birth.
- Antibodies - are harmless to the mother
but attach to the erythrocytes in the
fetus and cause hemolysis.
 5. Temperature instability

NURSING INTERVENTIONS:
1. Assess for periods of apnea or irregular
- Sensitization - is rare with the first
pregnancy and ABO incompatibility is respirations.
usually less severe. 2. If apnea is present, stimulate by gently

ASSESSMENT: rubbing the chest or foot.

3. Administer oxygen as prescribed.
1. Anemia
2. Jaundice that develops rapidly after 4. Monitor vital signs; assess for fever.
birth and before 24 hours 5. Maintain warmth in a radiant warmer.
3. Edema
6. Provide isolation as necessary.
NURSING INTERVENTIONS: 7. Monitor intake and output and obtain
1. Administer Rho (D) immune globulin to daily weight.
the mother during the first 72 hours
8. Monitor for diarrhea.
after birth if the Rh-negative mother
delivers a Rh-positive fetus but remains 9. Assess feeding and sucking reflex, which
unsensitized. may be poor.

2. Assist with exchange transfusion after 10. Assess for jaundice.

birth or intrauterine transfusion as 11. Assess for irritability and lethargy.
prescribed.
12. Prepare for blood cultures and
3. The newborn’s blood is replaced with administer antibiotics as prescribed, and
Rh-negative blood to stop the
destruction of the newborn’s red blood observe carefully for toxicity because a
cells; the Rh-negative blood is replaced newborn’s liver and kidneys are
with the newborn’s own blood
gradually. immature
RETINOPATHY OF PREMATURITY
4. Provide support to the parents.
- Formally referred to as retrolental
fibroplasia, retinopathy of prematurity
SEPSIS
(ROP) proliferative retinopathy that
- Generalized infection resulting from the occurs primarily in low-birth infants
presence of bacteria in the blood, such
- Vascular disorder involving gradual
as Group B streptococcal infection.
replacement of retina by fibrous tissue
ASSESSMENT: and blood vessels.

1. Pallor - Acquired ocular disease that leads to

2. Tachypnea, Tachycardia partial or TOTAL BLINDNESS in children
3. Poor feeding
4. Abdominal distention
 - It is caused by VASOCONSTRICTION of ▪ Infants of narcotic-dependent mothers
immature retinal blood vessels.
▪ The peak age of incidence is 2 to 4
- It was first recognized as an EYE months of age
DISORDER in 1942, but only later was a
CONTRIBUTING FACTORS
high concentration of oxygen
established as the causative agent. 1. Prolonged unexplained apnea
2. Sleeping prone rather than supine
- Infants who are most immature and
most ill - are at the HIGHEST RISK of 3. Viral respiratory or botulism infection
developing ROP.
4. Exposure to secondary smoke
ASSESSMENT: 5. Pulmonary edema
1. Leukocoria (white tissue on the 6. Brain stem abnormalities
retrolental space) 7. Neurotransmitter deficiencies
2. Vitreous hemorrhage 8. Heart rate abnormalities
3. Strabismus 9. Distorted familial breathing patterns
4. Cataracts (check for red reflex in 10. Decreased arousal response

Bruckner’s test) 11. Possible lack of surfactant in alveoli

NURSING INTERVENTIONS: 12. Sleeping in a room without moving air

1. Laser photocoagulation surgery currents (the infant rebreathes expired

2. Cryosurgery carbon dioxide)
▪ Affected infant are well
SUDDEN INFANT DEATH SYNDROME (SIDS) nourished.
- Sudden unexplained death in infancy. ▪ Infant usually found dead after
CAUSE: Unknown putting infant at bed or for a
OCCURRENCE: nap.
▪ Infants of adolescent mothers ▪ No sound made when they die
▪ Infants of closely spaced pregnancies which indicates that they died
▪ Underweight and preterm infants with laryngospasm.
▪ Infants with bronchopulmonary ▪ Infant found blood flecked
dysplasia sputum or vomitus on their
▪ Twin pregnancy mouth or bedclothes as a result
▪ Race (Native American Infants Alaskan of death.
Native Infants) ▪ Autopsy reveals petechiae in the
▪ Poor black infants lungs and mild inflammation
 and congestion in respiratory ✓ Tend to have incidence of
tract. apnea.
MANAGEMENT MANAGEMENT
1. Sleeping on their back decrease the risk ✓ Close monitoring of the newborn done
of SIDS by 50 to 60% to detect apnea.
2. Use of firm sleep surface ✓ Stimulation of infants thru gentle
3. Breastfeeding shaking or flicking the sole of the foot to
4. Room sharing without bed sharing breathe again.
5. Routine immunization ✓ Ventilatory support
6. Use of pacifiers PREVENTION
7. Avoidance of soft bedding ✓ Maintain neutral thermal environment
8. Overheating ✓ Minimal handling to relieve fatigue
9. Exposure to tobacco smoke, alcohol, and ✓ Suction gentle to relieve nasopharyngeal
illicit drug irritation
10. Emotional support to parents ✓ Monitor infant after feeding (pressure
11. Screening using sleep assessment as on stomach increase intrathoracic
precaution within 2 weeks of life pressure)
12. Continuous apnea monitoring ✓ Burping after feeding
APNEA ✓ NEVER use rectal thermometer
- Pause in respirations longer than 20 (stimulate vagal stimulation) leads to
seconds with accompanying bradycardia bradycardia
(cyanosis may also be present). ✓ Theophylline or caffeine sodium
benzoate may be prescribed to stimulate
- COMMON to preterm infants have respirations
periods of apnea as a result of fatigue or APPARENT LIFE-THREATENING EVENT
the immaturity of their respiratory - Some infants have been discovered
mechanisms. cyanotic and limp in their beds but have
survived after mouth-to-mouth
- Babies with secondary stresses such as: resuscitation by parents.
✓ Infection ▪ Apnea
✓ Hyperbilirubinemia ▪ Preterm infants
✓ Hypoglycemia or hypothermia ▪ SIDS
 MANAGEMENT
• Apnea monitoring with sound alarm
(alert set if NB developed apnea > 20
second or decrease heart rate to 80
bpm)
• Health teaching for Apnea monitoring at
home
▪ Ensure alarm can be heard to all parts of
the house
▪ Caution to loud noises (loud TV, radio,
vacuum cleaner, hair dryer)
• Ensure health teaching to CPR
• Community or home referral
CMCA LEC Lesson 4: MATERNAL CONDITIONS THAT
CAUSES ILLNESS TO NEONATES
DRUG ADDICTED NEONATES (DAN’S)
- Unborn child is passively addicted to the
drug
- Neonates are born SGA and may show
signs of withdrawal 12-24 hours after
birth
MANIFESTATIONS OF WITHDRAWAL:
• GIT Irritability
EARLIEST:
▪ Diarrhea - hypokalemia, dehydration
▪ Regurgitation
▪ Vomiting
▪ anorexia
✓ Diazepam - muscle relaxant
SEIZURE PRECAUTION:
✓ Airway is maintained - give whiffs of O2
✓ DO NOT suction while having a seizure
✓ Refer mother to social service of the
hospital - can go to rehab
FETAL ALCOHOL SPECTRUM DISORDER (FASD)
- are a group of conditions caused by
maternal alcohol use during pregnancy.
- The disorders are a result of
teratogenesis.
- FASDs cause COGNITIVE and PHYSICAL
DELAYS.
- Fetal alcohol syndrome is the MOST
FATAL of the FASDs.

• CNS Irritability NOTE: The other disorders included in this

category are:
▪ Tremors
1. Alcohol-related neurodevelopmental
▪ Irritability
disorder (ARND)
▪ High-pitched cry 2. Alcohol-related birth defects (ARBDS)

▪ Restlessness ASSESSMENT:

▪ Seizures • Facial features

✓ Hypoplastic maxilla
MANAGEMENT
✓ Hypoplastic philtrum
✓ Environmental modulation to decrease ✓ Short palpebral fissures
external stimuli ✓ Thin upper lips
✓ Placed in incubator for sound incubation
✓ Providing adequate nutrition and • Neurologic symptoms
hydration (IV line) ✓ Microcephaly
✓ Mental retardation
DRUG THERAPY:
✓ Growth
✓ Phenobarbital – anticonvulsant ✓ Prenatal growth retardation
✓ Chlorpromazine (Thorazine) - CNS (SGA)
depressant / antipsychotic ✓ Persistent postnatal growth lag
 ✓ Irritability and hyperactivity, ✓ Increased production of insulin
restlessness
✓ Intrauterine hyperinsulinism
✓ No withdrawal
✓ More glucose absorption
MANAGEMENT
✓ Macrosomia (above 4000 gm)
✓ Monitor for respiratory distress.
✓ Position the newborn on the side to ✓ Uterine stretch reach maximum point
facilitate drainage of secretions, initiate
✓ Contractions
seizure precautions.
✓ Keep resuscitation equipment at the ✓ Preterm delivery, fractured clavicle
bedside. (greenstick fracture)
✓ Monitor for hypoglycemia.
✓ After birth leads to hypoglycemia
✓ Assess suck and swallow reflex.
✓ Administer small feedings and burp well. ▪ Baby may be diabetic in the
✓ Suction as necessary. future
✓ Monitor intake and output.
▪ Macrosomic baby
✓ Monitor weight and head
circumference. ▪ Large shoulders (broad) - bigger
✓ Decrease environmental stimuli. than head
✓ Make a referral to the local early
intervention system. MANAGEMENT

• While fracture is healing = hold figure 8

BABY OF DIABETIC MOTHER
to facilitate fracture healing
- A neonate born to a mother with
• Monitor signs and symptoms of
diabetes
hypoglycemia
- Prone to congenital anomalies (cardiac
▪ Restlessness
anomalies)
▪ Tremors
- Hyperglycemia - is teratogenic to the
growing fetus ▪ Irritability
- Caudal regression syndrome (hypoplasia • Monitor blood glucose level (CBG)
of the lower extremities)
▪ Can be done on great toe
PATHOPHYSIOLOGY
▪ 40-60 mg/dl; 2-3 mmol (normal)
✓ Mother with diabetes
▪ 1 mmol = 20 mg/dl
✓ Decreased insulin
▪ If CBG lower than 40 mg/dl ->
✓ Increased glucose in blood give glucose (D50W in a vial) as
✓ Blood goes to baby ordered; bolus

✓ Glucose supply for baby HYPOGLYCEMIA

 - is an abnormally low level of glucose in - Some can pass through the placental
the blood (<45 mg/dL) barrier and cause infection

▪ Toxoplasmosis
- Normal blood glucose reference interval
is: ▪ Rubella

▪ Syphilis
▪ 45 to 60 mg/dL (2.5 to 3.4
mmol/L) in a 1-day old newborn ▪ Cytomegalovirus

▪ 50 to 90 mg/dL (2.9 to 5.1 - Some can’t pass through, however

mmol/L) in a newborn older exposure to the vaginal canal and
than 1 day (institutional values secretion at birth makes infants
for normal newborn blood susceptible to the disease.
glucose vary). ▪ Beta hemolytic Group B
ASSESSMENT: streptococcal infection

o Common in female genital

1. Increased respiratory rate
2. Twitching, nervousness, or tremors
tract
3. Unstable temperature o Cross infection from baby to
4. Lethargy, apnea, seizures, cyanosis baby due to poor hand
NURSING INTERVENTIONS: hygiene

1. Prevent low blood glucose level through MANAGEMENT

early feedings. ✓ Ampicillin
2. Administer formula orally or glucose COMPLICATION TO NB:
intravenously as prescribed.
EARLY onset: Pneumonia s/sx: tachypnea,
3. Monitor blood glucose levels as apnea, extreme paleness, hypotension or
prescribed. hypotonia, decrease urine output.

4. Monitor for feeding problems. LATE onset: 2-4 weeks: Meningitis s/sx (lethargy,
fever, loss of appetite and bulge fontanelles.
5. Monitor for apneic periods.

6. Assess for shrill or intermittent cries. MANAGEMENT

7. Evaluate lethargy and poor muscle tone. ✓ Penicillin

✓ Cefazolin
THE NEWBORN AT RISK BECAUSE OF A ✓ Clindamycin
MATERNAL INFECTION OR ILLNESS ✓ Vancomycin

MATERNAL INFECTIONS OPHTHALMIA NEONATORUM

- Newborns are at risk to infection due to - An eye infection that occurs at birth or
immaturity of immune system during the first month of life.
CAUSATIVE AGENT: MANAGEMENT

▪ Neisseria gonorrhoeae and ✓ Hepatitis B vaccination

Chlamydia trachomatis from vagina
✓ Bathe NB after delivery
- N. Gonorrhea infection - can lead to
✓ Hepa B Ig
corneal ulceration and destruction leads
to vision impairment. ✓ Continue breastfeeding as long as hepa
B Ig administered (HBV present in the
ASSESSMENT:
breast milk)
1. Red fiery conjunctivitis with pus
2. Edematous eye
3. Occurs 1-4 days of life

PREVENTION:

• Eye prophylaxis: erythromycin eye

ointment

MANAGEMENT

✓ Ceftriaxone

✓ Sterile saline solution lavage of eye

✓ Use sterile saline dropper / bulb syringe

✓ Use barrier protection (goggles)

✓ Direct the stream laterally to prevent

contamination of the other eye

✓ Maternal Complication

✓ Fallopian tube sterility

✓ Pelvic inflammatory disease

HEPATITIS B INFECTION

- Transmission thru exposure to VAGINAL

BLOOD at birth.

- Infected infants becoming chronic

carriers of the virus.

- Risk of developing liver cancer later in

life