CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS

MATERNAL AND CHILD HEALTH NURSING LECTURE

BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023

GLOBAL HEALTH GOALS  Increasing health insurance coverage

 End poverty and hunger.  Dependent on countries policy on HC.
 Achieve universal primary education.  Increasing alternative settings & styles for HC
 Promote gender equality and empower women.  Satellite clinics & hospitals, health centers,
 Reduce child mortality. SPED.
 Improve maternal health.  Increasing use of technology
 Combat HIV/AIDS, malaria, and other diseases.  E-consult (Serious MD).
 Ensure environmental sustainability.  Meeting work needs of pregnant &
 Develop a global partnership for development. breastfeeding women
2020 NATIONAL HEALTH GOALS  Milking room, extended maternity leave
Intended to help citizens more easily understand  Regionalizing intensive care
the importance of health promotion and disease  Increasing use of alternative treatment
prevention. modalities
The two main overarching national health goals  Increasing reliance on home care
are:  Increasing concern for QoL
 Increase quality and years of healthy life.  Increasing awareness of the individuality and
 Eliminate health disparities. diversity of clients
MEASURING CHILD HEALTH  Empowerment of health care consumers
CHILD MORTALITY RATE PROBLEMS RELATED TO MATURITY
 Probability a newborn would die before 5 years PRETERM INFANT
of age (per 1,000 lives).  Defined as a live-born infant before the end of
 PH data – 17.544 deaths/1000 live births. week 37 of gestation.
CHILDHOOD MORBIDITY RATE  Early preterm (born between 24 and 34 weeks),
 Rate at w/c disease or illness occurs in a and late preterm (born between 34 and 37
population. weeks).
COMMON CHILDHOOD MORBIDITY  Neonatal assessments such as inspection of
(ILLNESS) sole creases, skull firmness, ear cartilage, and
 Congenital anomalies neurologic development plus the mother’s
 Chronic Respiratory Disease report of LMP along with a sonographic
 Non communicable disease estimation of age all can be helpful to
 Acquired heart disease determine gestational age.
 Childhood Cancer  Preterm birth occurs in approximately 10% of
 Diabetes live births of non-Hispanic White infants. In
 Obesity African American infants, the rate is
COMMON CAUSE OF CHILDHOOD approximately 17.47%.
MORBIDITY (ILLNESS)  Prone to hypoglycemia.
 Infectious disease  Lack of lung surfactant – Respiratory Distress
 Preterm birth Syndrome (RDS).
 Asphyxia & trauma COMMON FACTORS ASSOCIATED W/
 Congenital anomalies PRETERM BIRTH
TRENDS IN HEALTHCARE ENVIRONMENT  Low socioeconomic level
 Initiating cost containment  Poor nutritional status
 Cost effectiveness.  Lack of prenatal care
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023
 Multiple pregnancy
 Previous early birth
 Race (nonwhites have a higher incidence)
 Cigarette smoking
 Age of the mother (younger than age 20
years)
 Order of birth (1st & 4th)
 Closely spaced pregnancies
 Abnormalities of the mother’s reproductive
system
 Infections
 Pregnancy complications (PRoM, PSP)
 Early induction of labor
 Elective cesarean birth
POTENTIAL COMPLICATIONS OF
PREMATURE INFANTS
1. ANEMIA OF PREMATURITY
 All babies have some anemia when they are
born. Normalizes around 3-6 months.
 There is a low level of hemoglobin w/ the
infant.
 Due to excessive blood drawing for electrolyte
or blood gas analysis (iatrogenic blood loss).
 S & SX: lethargy, difficult to feed, not very
active.
 Nrsg mgt: monitoring.
 Mgt: BT, iron (Fe), erythropoietin (EPO) as last
resort.
2. ACUTE BILIRUBIN ENCEPHALOPATHY
(KERNICTERUS)
 High level of bilirubin may cause seizures
leading to brain cell damage.
 May cause problems w/ vision, teeth, &
intellectual disabilities.
 S & SX: lethargy, drowsiness, poor feeding
habits, fever, shrill high-pitched cry, absence of
moro reflex.
 Mgt: phototherapy, or exchange transfusion.
3. NECTROTIZING ENTEROCILITIS (NEC)
 Premature GI tract.
 Intestinal dysfunction that develops in
approximately 5% of all infants in intensive
care nurseries.
 Bowel develops necrotic patches, interfering
with digestion and possibly leading to a
paralytic ileus, perforation, and peritonitis.
OTHER PROBLEMS RELATED TO
PREMATURITY
 RETINOPATHY OF PREMATURE INFANT
(ROP)
 Eye disease that can happen in babies who are
premature, or who weigh less than 3 lbs.
 ROP happens when abnormal blood vessels
grow in the retina.
 Caused by vasoconstriction of immature retinal
blood vessels.
 S & SX: wandering eye, eye doesn’t follow
objects, pupils look white, trouble recognizing
faces.
 Mgt: regular check-up, surgery for severe
cases.
 TEMPERATURE INSTABILITY
 Preterm infants are prone to rapid heat loss &
consequent hypothermia because of large
surface area to body mass ratio, decreased
subcutaneous fat, immature skin, high body
water content, poorly developed metabolic
mechanism & altered skin blood flow.
 Heat loss via: evaporation, convection,
conduction, radiation.
 Premature brain, heart, lungs & kidneys.
POTENTIAL COMPLICATIONS OF
PREMATURE INFANTS
1. PERSISTENT PDA (AO-PA)
 PDA (Patent Ductus Arteriosus) is important
during fetal circulation.
 It should close after the baby is delivered (2-3
days).
 Mgt: indomethacin or ibuprofen may be used.
 Surgical or interventional catheterization to
close PDA.
2. PERIVENTRICULAR / INTRAVENTRICULAR
HEMORRHAGE
 Bleeding in the brain of infant.
 Rapid change in cerebral blood pressure.
MEDICAL INTERVENTION
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023

1. CARDIAC CATHETERIZATION PROBLEMS RELATED TO GESTATIONAL

 Procedure in which a small radiopaque catheter WEIGHT
is passed through a major vein in the arm, leg, SMALL FOR GESTATIONAL AGE (SGA)
or neck into the heart to secure blood samples  Infant w/ BW below 10th percentile.
or inject dye, is a major method used to  Intrauterine growth restriction.
evaluate cardiac function.  Infant could be born preterm, term, or
 Diagnostic/interventional. postterm.
 PDA closure.  Thermal regulation problem.
 Pacemaker insertion.  Hypoglycemia.
2. HEART SURGERY IN CHILDREN LARGE FOR GESTATIONAL AGE (LGA)
Open-heart or intracardiac catheterization surgery  Infant w/ BW above 90th percentile.
remains the chief cure for congenital heart disease.  Infant could be born term, or postterm.
 Extracorporeal Membrane Oxygenation (ECMO).  They tend to be infants of diabetic women, and
 Vascular Assistive Devices (VAD). they are particularly prone to birth trauma.
 PDA closure. LUBCHENCO CHART
 Heart transplant.  To determine maturity.
PROBLEMS RELATED TO MATURITY
POSTTERM INFANT
 More than 42 weeks of gestation.
 Prone to hypoglycemia and intracranial
hemorrhage.
 Prone to meconium stain/meconium
aspiration.
POSTTERM SYNDROME
 Dry, cracked, leather like skin, & absence of
vernix caseosa.
 LGA, less amniotic fluid at birth & may be
meconium stained.
 Grown fingernails beyond the end of the
fingertips.
 May demonstrate an alertness much more like a
2-week-old baby than a newborn.
PROBLEMS RELATED TO POSTTERM
INFANTS
A. Meconium stain
B. Meconium aspiration
C. Difficult extraction
D. Temperature regulation
E. Polycythemia ALTERATION IN OXYGENATION
Illness that occur in New Born:
F. Utero placental insufficiency
 Respiratory Distress Syndrome (RDS)
G. Oligohydramnios
 Meconium Aspiration
H. Increased risk for intra uterine infection
 Transient Tachypnea of NB (TTN)
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023

 Apnea  Low APGAR score, limp, tachypneic, shallow

RESPIRATORY DISTRESS SYNDROME retractions, tachycardic.
(RDS)  Chest X-ray: course, irregular patchy infiltrates,
 Often occurs in preterm infants, infants of snow storm pattern.
diabetic mothers, infants born by CS, or those  Labs: abnormal ABGs, SGPT, Crea.
who for any reason have decreased blood  Mgt: close monitoring, high O2, ET intubation.
perfusion of the lungs.  Prognosis: poor.
 Cause of RDS is a low level or absence of
surfactant, the phospholipid that normally lines
the alveoli and reduces surface tension to keep
the alveoli from collapsing on expiration.
 S & SX:
 Low body temperature, nasal flaring, sternal
and subcostal retractions.
 Tachypnea (more than 60 breaths/min),
cyanotic mucous membranes.
 Mgt:
 Surfactant replacement therapy
 Oxygenation TRANSIENT TACHYPNEA OF NB (TTN)
MECONIUM ASPIRATION  Rapid RR due to late absorption of placental
 Meconium staining occurs in approximately fluids in the lungs.
10% to 20% of all births.  S & SX:
 In 2% to 4% of these births, infants will  Tachypnea, retractions, cyanosis,
aspirate enough meconium to cause MAS. desaturation.
 S & SX:  May be same presentation w/ pneumonia.
 Tachypnea an coarse bronchial sounds  Usually resolves in 2-3 days.
 Chest retractions  Mgt:
 Chest X-ray may reveal pneumonia  Close observation & monitoring.
 PE – barrel chest (anteposterior)  O2 support as needed.
 Poor gas exchange evidenced by a decreased APNEA
O2 and an increased Pco2.  As a result of fatigue or the immaturity of their
 Mgt: respiratory mechanisms.
 O2 support (intubation, CPAP)  High incidence of apnea is common on babies
 Antibiotics with secondary stresses ie. infection,
 MECONIUM ASPIRATION PNEUMONIA hyperbilirubinemia, hypoglycemia, hypothermia.
 Good APGAR score, active, tachypneic, shallow  S & SX:
retractions, tachycardic.  Pause in respirations longer than 20 seconds
 Chest X-ray: course, irregular patchy infiltrates, with accompanying bradycardia.
snow storm pattern.  Mgt:
 Labs: normal ABGs, SGPT, Crea.  Gently shaking an infant or flicking the sole of
 Mgt: monitoring, none-low O2 therapy. the foot often stimulates the baby to breathe
 Prognosis: good. again.
 MECONIUM ASPIRATION SYNDROME
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023

 Maintain a neutral thermal environment and

use gentle handling to avoid excessive
fatigue.
 Always suction gently to minimize
nasopharyngeal irritation, which can cause
bradycardia because of vagal stimulation.
CONGENITAL HEART DISEASE
 CHDs are present at birth & can affect the
structure of a baby’s heart & the way it works.
 8% of term infants and 9% - 10% of preterm
infants are born with a congenital
cardiovascular abnormality.
 CHDs can affect the blood flows through the
heart & out of the rest of the body.
 CHDs happen due to failure of the heart
structure to progress beyond an early stage of
embryonic development.
 CHDs can vary from mild to severe.
 Small hole in the heart to missing or poorly
formed parts of the heart.
 ASD: Atrial Septal Defect
 VSD: Ventricular Septal Defect
 PDA: Patent Ductus Arteriosus
 AVCD: Atrioventricular Canal Defect
 COA: Coarctation of Aorta
 PVS: Pulmonary Valve Stenosis
 AVSD: Atrioventricular Septal Defect
 TOF: Tetralogy od Fallot
 TGA: Transposition of the Great Arteries
 TA: Tricuspid Atresia
 TrA: Truncus Arteriosus
 HLHS: Hypoplastic Left Heart Syndrome
FETAL CIRCULATION
 Umbilical vein delivers oxygenated blood
from the placenta to the fetus.
 Umbilical arteries transport deoxygenated
blood away from the fetal tissue & back
towards the placenta for re-oxygenation.
 Ductus venosus allows blood from the
placenta to bypass the highly demanding, but
inactive liver.
 Ductus arteriosus is the fusion of the
primitive PA (Pulmonary Artery) to the AO
(Aorta), allowing blood to pass straight from
the RV (Right Ventricular) in to the AO and
bypass the inactive lungs.
 Foramen ovale creates a shunt between the
RA (Right Atrium) and LA (Left Atrium) so
oxygenated blood from the placenta can move
to the left atrium. This allows for the
oxygenated blood to pass through the LV (Left
Ventricular) and into the ascending AO,
oxygenating the brain.

1. ATRIAL SEPTAL DEFECT

CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023
 Birth defect of the heart in w/c there is a hole
in the wall that divides the upper chambers of
the heart.
 Hole can vary in size & may close on its own.
 Echocardiography will generally reveal the
enlarged right side of the heart and the
increased pulmonary circulation.
 Volume problem- oxygen remains normal in
early stages.
 Acyanotic because the pressure of LA is higher
than the pressure of RA, so blue discoloration is
not highly evident.
THERAPEUTIC MANAGEMENT:
 Interventional catheterization to close the
disorder is usually done electively by cardiac
catheterization between 1 and 3 years of age.
 The edges of the opening in the septum are
approximated and filled in with a septal occlude
device (amplatzer).
2. VENTRICULAR SEPTAL DEFECT (VSD)
 Most common type of congenital cardiac
disorder, occurs in about 4 to 5 of every 1,000
live births.
 Birth defect of the heart in w/c there is a hole
in the wall that separates the 2 lower chambers
of the heart.
 The extra blood being pumped into the lungs
forces the heart & lungs to work harder.
S & SX:
 SOB, fast/heavy breathing, sweating, tiredness
while feeding, poor weight gain.
 PE: whooshing sound (heart murmur).
 85% of VSDs are so small they close
spontaneously.
 Many children are managed only by close
observation.
MX MGT:
 Diuretics or digoxin to help prevent fluid from
accumulating in the lungs.
 Surgery or cardiac to help prevent fluid from
accumulating in the lungs.
 Complications include: pulmonary HPN,
arrhythmias, or stroke.
3. PATENT DUCTUS ARTERIOSUS (PDA)
 Persistent opening between 2 major blood
vessels leading from the heart (PA-AO).
 DA – ductus arteriosus is part of a baby’s blood
flow system in the womb. It usually closes after
birth.
 Small PDA often doesn’t cause problems and
might never need treatment.
S & SX:
 Poor eating/poor growth, fast breathing, easy
tiring, rapid heart rate.
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023
 Complications includes: pulmonary HPN
(hypertension), CHF (Congenital Heart Failure),
heart infection (endocarditis).
MGT:
 Ibuprofen or indomethacin.
 Surgery & cardiac catheterization.
4. ATRIOVENTRICULAR CANAL DEFECT
(AVCD)
 Comprise a spectrum of defects including
ventricular or atrial defects, septal defects, AV
anomalies, & endocardial cushion defects.
 Happens when valves & septum do not form
completely while baby is still in the womb.
 Maybe complete or partial.
 COMPLETE: have a combination of 3
separate defects (ASD, VSD, 1 large valve
between atrium & ventricle).
 PARTIAL-HOLE: hole in the atrial septum
(ASD), & partial abnormality or “cleft” in the
left valve (mitral valve).
 Common in children with Down syndrome
(Trisomy 21).
S & SX:
 Slow/poor growth, undernourishment, hard &
fast breathing pattern, sweating while eating,
and weight loss.
 Dx tests: ECG/EKG, chest X-ray,
echocardiogram.
 Close monitoring of VS & O2 sat.
 Treatment: surgery.
5. COARCTATION OF AORTA (COA)
 Is a birth defect in w/c a part of the AO is
narrower than usual.
 If the narrowing is severe enough &
undiagnosed, the baby may have serious
problems & may need surgery or other
procedures soon after birth.
 The narrowing blocks normal blow flow to the
body. This can back up flow into the LV.
 Narrowing of AO is usually located after arteries
branch to the upper body, coarctation can lead
to normal or high blood pressure & pulsing of
blood in the head & arms, weak pulses in the
legs & lower body.
 Is often considered a critical congenital heart
defect.
 Extra work on the heart can cause walls of the
heart to become thicker in order to pump
harder (this weakens the heart muscle & may
lead to heart failure).
S & SX:
 Pale ski, irritability, profuse sweating, DOB.
 PE: noticeable weak pulse in the legs or groin,
heart murmur.
 Older children often have high BP in the arms.
 Dx test: echocardiogram (primary), ECG/EKG,
cardiac catheterization.
 Mx/Tx: surgery or cardiac catheterization
(balloon angioplasty).
MGT:
 Regular check-up.
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023

7. ATRIOVENTRICULAR SEPTAL DEFECT

(AVSD)
 Is a congenital heart condition in w/c there is a
hole at the center of the heart.
6. PULMONARY VALVE STENOSIS (PVS)  Incidence rate is about 2/10,000 babies.
 Narrowing of the valve between the lower right  There is no clear reason why it occurs, but
heart chamber & lung arteries. most are related to genetic condition such as
 In a narrowed heart valve, the valve flaps may down syndrome.
become think or stiff w/c reduces blood flow. S & SX:
S & SX:  Fast breathing, SOB when feeding, arrhythmia,
 Depends on how much blood flow is blocked. fatigue, and palpitations.
 Mild PS doesn’t have symptoms.  Untreated, AVSD can cause heart failure &
 Severe PS: whooshing sound (heart murmur), pulmonary HPN.
fatigue, SOB during activity, chest pain, MGT:
fainting.  Surgery (6 y/o and above).
 Echocardiography will reveal right ventricular
hypertrophy.
 Dx: ECG/EKG, echocardiogram, cardiac
catheterization.
MX & TX:
 Balloon angioplasty by way of cardiac
catheterization is the procedure of choice for
severe PS.
 Pulmonary valve replacement (surgery or
cardiac catheterization).
 Following the procedure, although children may
always have residual heart murmur, they can
expect to have a normal life span.
 Children who have had surgery need to take
antibiotics before dental procedure or other
surgeries to prevent endocarditis.

8. TETRALOGY OF FALLOT
 Is a CHD that affects the normal blood flow
through the heart.
 Made up of 4 defects of the heart & blood
vessels.
 VSD, PSD, enlarged aortic valve, & RV
hypertrophy.
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023
 TOF can cause decreased O2 in the blood that
flow to the rest of the body.
S & SX:
 Infants w/ TOF may develop sudden episodes
of bluish discoloration during crying or feeding
called “tet spells.”
 Infants w/ TOF are prone to endocarditis,
arrhythmia, seizure, & delayed growth.
 Dx: TOF is often diagnosed after the baby is
born.
 NB screening (low pulse ox),
echocardiography.
MX & TX:
 Surgery can be done right after the baby is
born.
 PV replacement, PA replacement, patch
replacement on VSD.
9. TRANSPOSITION OF THE GREAT
ARTERIES
 TGA is a birth defect of the heart in w/c the 1
main arteries (PA & AO) carrying blood out of
the heart are switched in positions.
 In babies w/ TGA, unoxygenated blood from
the body enters the R side of the heart. But,
instead of going to the lungs, blood is pumped
directly back out to the body through the AO.
 Oxygenated blood from the lungs entering the
heart is pumped straight back to the lungs via
the main PA.
S & SX:
 Pounding heart, weak pulse, ashen or
bluish skin color, breathing problems, poor
feeding.
MGT:
 Surgery (arterial switch operation or atrial
switch operation).
10. TRICUSPID ATRESIA
 A birth defect of the heart where the valve that
controls the blood flow from the R upper
chamber of the heart to the right lower
chamber of the heart does not form at all.
 Blood cannot flow correctly through the heart &
the rest of the body.
 No blood can go from the atrium through the
RV to the lungs for oxygenation.
 Since blood cannot directly flow from RA to RV,
blood must use other routes to bypass the
unformed tricuspid valve.
 TA is common on in infants w/ Down syndrome.
 Familial tendency and viral illness (rubella).
 Is a critical congenital heart defect and needs
procedures & surgery soon after birth.
S & SX:
 Problem breathing, ashen or bluish skin color,
poor feeding, extreme sleepiness.
 Evident murmur (whooshing sound).
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023

MX MGT:  Dx test: echocardiography, pulxe ox (NB

 Surgery. screening).
 SEPTOSTOMY: done within babies few days of TX:
life. Purposely creates or enlarges an ASD.  Surgery to repair the heart & blood vessels.
 BANDING: temporary placement of band 12. HYPOPLASTIC LEFT HEART
around the artery w/ in the baby’s few days of SYNDROME (HLHS)
life to control blood flow to the lungs.  A CHD that affects the normal blood flow
 SHUNT PROCEDURE: surgeons put a bypass through the heart.
from AO to PA.  As the baby develops, the L-side of the heart
 BI-DIRECTIONAL GLENN PROCEDURE: does not form correctly.
performed within 4-6 months of age. Procedure  LV, mitral valve, aortic valve, ascending portion
that creates a direct connection of the main PA of the AO.
to SVC.  Babies w/ HLHS also have ASD.
 FONTAN PROCEDURE: done within 2 yrs. of S & SX:
age. Connection of the main PA with the IVC.  Breathing problem, pounding heart, weak
pulse, ashen/bluish skin color, poor feeding.
MGT:
 3 stages of surgery.
1. NORWOOD SURGERY: done w/ in first 2
weeks of life, doctors create new AO.
2. BI-DIRECTIONAL GLENN SHUNT
PROCEDURE: done w/ in 4-6 months of age.
Doctors create a direct connection PA & SVC.
3. FONTAN PROCEDURE: done w/ in 18months
to 3 years of age. Doctors connect the PA to
11. TRUNCUS ARTERIOSUS (TrA) IVC.
 A rare CHD in w/c a single blood vessel comes
out of the heart, instead of 2 vessels (main PA
and AO).
 It occurs when blood vessel coming out of the
heart in the developing baby fails to separate
completely during development, leaving a
connection between the AO & PA.
 Usually, there’s a hole between the ventricles
(VSD).
 Unoxygenated & oxygenated blood are mixed
together as blood blows to the lungs and the
rest of the body.
S & SX: EINSENMENGER SYNDROME
 Breathing problem, pounding heart, weak  Develops when too much blood flows through
pulse, ashen/bluish skin color, poor feeding, the arteries that carry blood to your lungs from
extreme sleepiness. your heart. The result is pulmonary HPN.
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023
 It also leads to blood shunting between the left
and right sides of your heart. This means
there’s an abnormal connection that causes
blood flow from the left side of your heart to
the right side of your heart.
 Eisenmenger syndrome is usually the result of
one or more untreated congenital (present at
birth) heart defects. Over time, it can lead to
permanent lung damage and other
complications.
NURSING CARE OF HIGH RISK NEWBORN TO
MATURITY
 Meconium aspiration syndrome
 Meconium plug syndrome
 Meconium ileus
 Sepsis
 Hyperbilirubinemia
 Sudden infant death syndrome
A. MECONIUM ASPIRATION SYNDROME
(MAS)
 Meconium is the first feces or stool of the baby.
 MAS occurs when NB breathes a mixture of
meconium and amniotic fluid into the lungs
around the time of delivery.
 A leading cause of severe illness & death in NB
(5-10% of births).
 Occurs when the baby is stressed during labor,
especially when the infant is past its due date.
S & SX:
 Bluish skin color, breathing problem, dark
greenish stain, limpness upon birth.
MGT:
 Antibiotics, O2 therapy, warmer/drop light,
chest clapping.
B. MECONIUM PLUG SYNDROME (MPS)
 Colonic obstruction caused by thick meconium.
 Transient disorder of the NB colon
characterized by delayed passage of meconium
& intestinal dilatation.
 Also termed functional immaturity of the colon,
colonic immaturity, small left colon syndrome, &
functional colonic obstruction.
 1 in 500 live births.
 Associated w/ Hirsch sprung disease & cystic
fibrosis.
 Predominantly affects neonates w/ low BW,
infants of mothers treated w/ MgSo4
(eclampsia, preeclampsia, preterm labor).
S & SX:
 Absence of stool, abdominal distention, &
vomiting.
TX:
 Radiographic contrast enema (therapeutic
effect).
C. MECONIUM ILEUS
 Bowel obstruction that occurs when the
meconium is blocking the last part of the baby’s
small intestine.
 This can happen when the meconium is thicker
& stickier than normal.
S & SX:
 Abdominal distention, greenish vomit, no
passage of meconium.
TX:
 Radiographic enema or laparotomy (ileostomy
w/ lavage).
D. NEONATAL SEPSIS
 Neonatal sepsis is a blood infection that occurs
in infant younger than 90 days old.
 Early onset – 1st week, late onset – 2 weeks
to 3 months of age.
 Occurs when the body has an extreme
response to an infection (inflammation
throughout the body) w/c leads to reduced
blood flow to limbs & vital organs.
PREDISPOSING FACTORS:
 Bacterial infection (E-coli, listeria, strains of
streptococcus).
 Preterm delivery.
 ROM longer than 18hrs before birth.
 Infection of placenta & amniotic fluid
(chorioamnionitis).
OTHER RISK FACTORS:
 Having catheter in blood vessel for a long
time.
CHAPTER 1: CARE OF CHILD AT RISK OF WITH PROBLEMS
MATERNAL AND CHILD HEALTH NURSING LECTURE
BS Nursing 2-1 | PROF. Edwin Rommel Grantoza | SEM 2 2023

Staying in the hospital for an extended period

  Use frim mattress w/ fitted sheets.
of time.  No fluffy blankets & stuffed animals.
S & SX:  Smoke free environment.
 Body temperature changes, breathing  Ambient room temperature while the baby
problems, diarrhea or decreased bowel sleeps.
movements, low blood sugar, reduced  Proper prenatal care & feeding the baby.
movements, reduced sucking, seizures, slow or
fast heart rate, swollen belly area, vomiting,
yellow skin & whites of the eyes (jaundice).
 Lab tests: blood culture, C-reactive protein, CBC
MX MGT:
 IV antibiotics.
E. HYPERBILIRUBINEMIA
 Happens when there is too much bilirubin in the
baby’s blood.
 60% of term NBs & 80% of preterm NBs get
jaundice (jaune-yellow).
S & SX:
 Yellowing of the skin & whites of eyes.
TX:
 Phototherapy.
F. SUDDEN INFANT DEATH SYNDROME
(SIDS)
 Sudden & unexplained death of a baby younger
than 1 y/o.
 Sometimes called crib death because death is
usually associated w/ sleep.
 Leading cause of post neonatal death of babies
in the USA.
RISK FACTORS:
 Placing baby on his side or stomach to sleep.
 Premature or low birth weight babies.
 Overheating the baby during sleep.
 Sleeping on too soft surface w/ loose
blankets.
 Having a sibling who died of SIDS or family
hx.
OTHER FACTORS:
 Mothers under 20 yrs. of age.
 Smoking during pregnancy.
 Mother w/ little or no prenatal care.
MGT:
 Placing baby on his back to sleep.