High—Risk Newborn:

Complications Associated with

Gestational Age and
Development
Pauline Kaye S. De Leon, MD
Late Preterm Infants

 born between 34 0/7 and 36 6/7 weeks of gestation

 more stable than preterm infants
 physiologically and metabolically immature and have higher mortality and
morbidity rates than full-term infants.
Late Preterm Infants

 Incidence and Etiology

 Contributing factors in late preterm birth include
 elective and medically indicated inductions and cesarean birth
 preterm labor
 premature rupture of membranes
 Preeclampsia
 multifetal pregnancies
 Obesity
 assisted reproductive technology
 advanced maternal age
 naccurate estimate of gestational age before birth
Late Preterm Infants

 often look like full-term infants

 At risk for respiratory disorders, problems with temperature maintenance,
hypoglycemia, hyperbilirubinemia, feeding difficulties, acidosis, and infection
(such as respiratory syncytial virus)
 at risk for long-term neurodevelopmental disorders as well as cognitive and
behavioral problems
 Therapeutic management varies according to the problems presented
Late Preterm Infants

 Nursing considerations
 need closer monitoring for complications
 Thermoregulation
 nurses should be more vigilant in watching for thermal instability in these infants
 Feedings
 assess feeding sessions to ensure swallowing is occurring
 Urine and stool output are monitored as indications of adequate intake
 at risk for hypoglycemia, and blood glucose measurements should be performed
Late Preterm Infants

 Discharge
 ensure infants are feeding adequately and have had normal vital signs for at least
24 hours.
 teach signs of common complications such as jaundice or dehydration
 Teaching should include the need for keeping the infant warm
 teach signs of overstimulation and how to minimize them
Preterm Infants

 born before the completion of 37 weeks gestation

 Disorders related to short gestation and LBW are the second leading cause of
infant mortality
 exact causes of preterm birth are not known
 Prevention is best accomplished by provision of adequate prenatal care
 Characteristics
 Characteristics of preterm infants vary, depending on gestational age
Preterm Infants

 Appearance
 appear frail and weak
 less developed flexor muscles and muscle tone compared with full-term infants
 lack subcutaneous or white fat, which makes their thin skin appear red and
translucent
 Behavior
 behavior of preterm infants varies, depending on gestational age.
Preterm Infants

 Problems with respiration

 preterm newborns have immature lungs
 Infants born before surfactant production is adequate develop respiratory distress
syndrome (RDS).
 have a poorly developed cough reflex and narrow respiratory passages
 Assessment
 respiratory status should be observed constantly
 differentiates periodic breathing from apneic spells
Preterm Infants

Assessment
 Periodic breathing is the cessation of breathing for 5 to 10 seconds without
other changes followed by 10 to 15 seconds of rapid respirations
 Apneic spells involve absence of breathing lasting more than 20 seconds or
less if accompanied by cyanosis, pallor, bradycardia, or hypotonia
 observe the effort required for breathing and the location and severity of
retractions
 Grunting may be an early sign of RDS
Preterm Infants

Nursing Interventions
 Working with respiratory equipment
 An oxygen hood is often used for infants who can breathe independently but need
extra oxygen
 Oxygen also may be given by nasal cannula to the infant who breathes well
independently
 Continuous positive airway pressure (CPAP) may be necessary to keep the alveoli
open and improve expansion of the lungs
 observe the infant’s increasing or decreasing dependence on breathing assistance
and need for oxygen during activity
Preterm Infant

 Positioning the infant

 side-lying and prone positions facilitate drainage of respiratory secretions and
regurgitated feedings
 prone position increases oxygenation, enhances respiratory control, improves lung
mechanics and volume, and reduces energy expenditure
 Suctioning secretions
 weak or absent cough reflex and very small air passages make the preterm infant’s
airways susceptible to obstruction by mucus.
 infant is suctioned only as necessary
Preterm Infant

 Suctioning secretions
 procedure causes changes in heart rate, blood pressure, and cerebral blood flow.
Suction should be applied for only 5 to 10 seconds at a time, and increased oxygen
should be provided before and after each suction attempt.
 Maintaining hydration
 Adequate hydration is essential to keep secretions thin
 Fluid intake should be increased, as ordered by the provider
Preterm Infant

 Problems with thermoregulation

 Heat loss is more significant in preterm infants than in full term infants
 Assessment
 temperature is monitored continuously by a skin probe attached to the heat control
mechanism of the radiant warmer or incubator
 skin temperature is usually maintained at 36°C to 36.5°C and should be checked
every 30 minutes until stable, then every hour
 axillary temperature for a preterm infant should remain between 363°C and 369°C
Preterm Infant
Preterm Infant

 Nursing Interventions
 Maintaining a Neutral Thermal Environment
 important to prevent the need for increased oxygen to maintain the infant’s body
temperature.
 delivery room should be warm to decrease heat loss at birth
 Radiant warmers or incubators are used until infants can maintain normal body
temperature alone
 Weaning to an Open Crib
 Incubator’s temperature is usually decreased gradually
 temperature is assessed at gradually increasing intervals until the infant’s
temperature is stable
Preterm Infant

 Problems with Fluid and Electrolyte balance

 Preterm infants lose fluid very easily, and the loss increases with the degree
of prematurity
 ability of the kidneys to concentrate or dilute urine is poor, causing a fragile
balance between dehydration and overhydration
 Normal urinary output is 1 to 3 mL/kg/hr for preterm infants for the first few
days.
 After 24 hours of life, output less than 0.5 mL/kg/hr is considered oliguria
Preterm Infant

 Assessment
 Monitoring intake and output of fluids helps determine fluid balance
 Urine output
 Weighing diapers is less harmful to the infant.
 Specific gravity should be checked to determine whether urine is more
concentrated or dilute than expected
 Weight
 Changes in the infant’s weight can give an indication of fluid gain or loss,
 Signs of dehydration or Overhydration
 observe for signs that indicate the infant has received too little or too much fluid
Preterm Infant
Preterm Infant

 Nursing interventions
 Intravenous (IV) fluids should be carefully regulated using infusion control devices
 IV sites should be assessed at least every hour for signs of infiltration
 Problems with the Skin
 Preterm infants have fragile, permeable, easily damaged skin.
 Assessment
 frequently assess the condition of the infant’s skin and record any changes
Preterm Infants

 Nursing Interventions
 Adhesives should be removed slowly and gently by pulling horizontally parallel to
the skin.
 interface between the adhesive and the skin should be wet with gauze or saline
pledgets
 Preterm infants usually should not be bathed every day.
 Warm water without soap should be used for infants younger than 32 weeks of
gestational age
Preterm Infants

 Problems with infection

 incidence of infection in preterm infants is 3 to 10 times greater than that in
full-term newborns
 Factors that contribute to the high rate of infection include
 exposure to maternal infection
 lack of adequate passive immunity from the transfer of immunoglobulin G (IgG)
from the mother during the third trimester
 immature response to infection.
 Assessment
 Observe for signs and symptoms of sepsis at all times
Preterm Infants

 Nursing interventions
 Handwashing to prevent hospital-acquired infections
 scrupulous cleanliness and maintenance of the infant’s skin integrity
 Early signs of infections should be identified and reported
Preterm Infants

 Problems with pain

 Infants undergo many painful
procedures and treatments
 Assessment
 pain assessment is performed whenever
vital signs are taken
Preterm Infants

 Nursing interventions
 prepare infants for potentially painful procedures by waking them slowly and
gently and using containment
 Containment simulates the enclosed space of the uterus, prevents excessive and
disorganized motor activity, and is comforting to infants.
 KC and breastfeeding also are used to reduce pain.
 discuss the infant’s pain with the primary care provider to ensure that medications
are available for long-term and more severe pain
Common Complications of Preterm
Infants
 Complications of prematurity increase as the infant’s gestational age and
birth weight decrease.
Respiratory Distress Syndrome

 condition caused by insufficient production of surfactant in the lungs

 occurs most often in preterm infants under 28 weeks of gestation
 Pathophysiology
 Surfactant is a phospholipid that lines the alveoli.
 Surfactant decreases surface tension to allow the alveoli to remain open when air
is exhaled.
 It must be continuously produced as it is used.
 Sufficient surfactant is usually produced beginning at 34 to 36 weeks of gestation
to prevent RDS
Respiratory Distress Syndrome

 Manifestations
 tachypnea, tachycardia, nasal flaring, and cyanosis
 Retractions of accessory muscles are common
 Audible grunting on expiration is characteristic
 Chest radiographs show the “ground glass” reticulogranular appearance of the
lungs
Respiratory Distress Syndrome

 Therapeutic management
 Surfactant is instilled into the infant’s trachea shortly after birth
 Other treatment is supportive, including oxygen, continuous CPAP or mechanical
ventilation, inhaled nitric oxide, correction of acidosis, IV fluids, and care of other
complications
 Nursing considerations
 observe for signs of developing RDS at birth and during the early hours after birth
 Changes in the infant’s condition are constantly assessed
Bronchopulmonary Dysplasia (Chronic
Lung Disease)
 chronic condition in which damage to the infant’s lungs requires prolonged
dependence on supplemental oxygen
 occurs most often in infants younger than 32 weeks of gestational age and in
one-third of VLBW infants.
 common definition of BPD is when an infant requires oxygen 28 days after
birth
 Pathophysiology
 Injury to bronchial epithelium and interfere with alveolar development
 result is inflammation, atelectasis, edema, and airway hyperreactivity with loss of
cilia, thickening of the walls of the alveoli, and fibrotic changes
Bronchopulmonary Dysplasia (Chronic
Lung Disease)
 Manifestations
 an increased need for or an inability to be weaned from respiratory support
and oxygen
 Therapeutic management
 use of maternal steroids to reduce prematurity and RDS
 minimizing exposure to oxygen and pressure with ventilation as much as possible
 avoidance of fluid overload
 increased nutrition
 Treatment is supportive with antibiotics and bronchodilators
Intraventricular Hemorrhage

 called germinal matrix hemorrhage and periventricalar-intraventricular

hemorrhage
 Approximately 30% of preterm infants weighing less than 1500 g (3 lb 5 oz)
develop intraventricular hemorrhage
 Pathophysiology
 IVH results from rupture of the fragile blood vessels in the germinal matrix, located
around the ventricles of the brain.
Intraventricular Hemorrhage

 Manifestations
 may be subtle or remarkable
 Lethargy
 poor muscle tone
 Bradycardia
 deterioration of respiratory status with cyanosis or apnea
 drop in hematocrit
 Acidosis
 Hyperglycemia
 tense fontanel
 seizures
Intraventricular Hemorrhage

 Therapeutic management
 Treatment is supportive and focuses on maintaining respiratory function and
dealing with other complications
 Nursing care
 avoid situations that may increase the risk for IVH as much as possible
 daily measurement of the head circumference and observation for changes in
neurologic status
Retinopathy of Prematurity

 injury to the blood vessels in the eye leads to growth of new blood vessels
that abnormally develop and may result in visual impairment or blindness
 Pathophysiology
 exact cause of ROP is unknown, but high levels of oxygen in the blood are a
risk factor.
 Prolonged ventilation, acidosis, sepsis, shock, IVH, and fluctuating blood
oxygen levels have been associated with ROP
Retinopathy of Prematurity

 Therapeutic management
 Laser surgery to destroy abnormal blood vessels is the current treatment of choice.
 Cryosurgery or reattachment of the retina also may be necessary
 screen to detect changes of the eye. The frequency of repeat examinations is
determined by the results of screenings.
 Nursing considerations
 check the pulse oximetry readings frequently for any infant receiving oxygen.
 Oxygen should be titrated to keep oxygen saturation levels within prescribed
limits.
Necrotizing Enterocolitis

 serious inflammatory condition of the intestinal tract that may lead to

cellular death of areas of intestinal mucosa
 Pathophysiology
 exact causes are unknown; however, immaturity of the intestines is a major
factor in preterm infants
 Previous hypoxia of the intestines may be a causative factor.
 incidence of NEC is much higher after infants have received feedings.
Necrotizing Enterocolitis

 Manifestations
 increased abdominal girth caused by distention
 increased gastric residuals
 decreased or absent bowel sounds
 loops of bowel seen through the abdominal wall
 Vomiting
 bile-stained residuals or emesis
 abdominal tenderness and discoloration
 signs of infection
 occult blood in the stools
Necrotizing Enterocolitis

 Therapeutic management
 encouraging results using probiotics as a means of establishing normal intestinal
flora and preventing NEC
 antibiotics, discontinuation of oral feedings, continuous or intermittent gastric
suction, and use of parenteral nutrition to rest the intestines.
 Surgery may be necessary if perforation or continued lack of improvement occurs.
 Nursing considerations
 encourage interested mothers to provide breast milk for their infants
 Early recognition of signs of NEC is essential to decrease mortality
Short Bowel Syndrome

 caused by congenital malformations of the GI tract or surgical resection that

decreases the length of the small intestines.
 Pathophysiology
 decreased mucosal surface area causes inadequate absorption of fluids,
electrolytes, and nutrients
 Manifestations
 most common symptoms of SBS are malabsorption, diarrhea, and failure to thrive.
Short Bowel Syndrome

 Therapeutic management
 effort is made to preserve as much of the small bowel length as possible
 fluid and electrolyte balance must be restored and stabilized
 TPN is begun as the primary source of nutrition
 Nursing care
 manage the infant’s TPN and enteral feedings
 Strict asepsis should be used when performing central line dressing changes
and when administering TPN
 carefully assess and document tolerance of enteral feedings noting any signs
of dehydration, electrolyte imbalances, and nutritional deficits.
Postterm Infants

 born after the 42nd week of gestation.

 Assessment
 If the infant is large, the nurse should observe for injury and hypoglycemia.
 The infant with postmaturity syndrome may have an apprehensive look
associated with hypoxia
 may be thin with loose skin and little subcutaneous fat
 abundant hair on the head and long nails.
 skin is wrinkled, cracked, and peeling
 should be assessed for hypoglycemia because of rapid use of glycogen stores.
Postterm Infants

 Therapeutic management
 Focuses on prevention and symptomatic treatment
 Nursing considerations
 prevention of complications, where possible, and monitoring of changes in status.
 Respiratory problems may necessitate continued assessment and care.
 Infants with any indications of postmaturity should be tested for hypoglycemia
 Temperature regulation may be poor
Small-for-gestational-age Infants

 those who fall below the tenth percentile in size on growth charts.
 SGA infants may be preterm, full-term, or postterm.
 Causes
 Congenital malformations, chromosomal anomalies, genetic factors, multiple
gestations, and fetal infections such as rubella or cytomegalovirus
 Poor placental function
 Illness in the expectant mother
 Smoking, drug or alcohol abuse, and severe maternal malnutrition also impair fetal
growth
Small-for-gestational-age Infants

Scope of the problem

 higher perinatal morbidity and a mortality rate that is 10 to 20 times that of
infants who are not growth restricted
 Death may occur from asphyxia before or during labor
 Hypoglycemia is common because of inadequate storage of glycogen in the
liver
Small-for-gestational-age Infants

Characteristics
 appearance of the SGA infant varies, depending on whether the cause of
growth restriction began early or late in the pregnancy.
 Variation occurs because growth restriction affects the weight first. If it
continues, the length and then the head size eventually will be affected
 Symmetric growth restriction involves the entire body
 Asymmetric growth restriction is caused by complications such as
preeclampsia that begin in the third trimester and interfere with
uteroplacental function.
Small-for-gestational-age Infants

 Therapeutic management
 focused on prevention
 good prenatal care to identify and treat problems early
 increased their risk for problems with temperature stability
 Nursing considerations
 care of the SGA infant should be adapted to meet the specific problems presented
 observe for complications that commonly accompany growth restriction
 assess for hypoglycemia, especially in asymmetric, growth-restricted infants.
Large-for-gestational-age Infants

 infants are those who are above the 90th percentile for gestational age on
intrauterine growth charts.
 may have macrosomia (weigh more than 4000 to 4500 g)
 Causes
 Infants who are LGA may be born to multiparas, large parents, mothers who are
obese, and members of certain ethnic groups (Asian, Black, and Hispanic
 Diabetes in the mother also may cause increased size
Large-for-gestational-age Infants

Scope of the problem

 more likely to go through a longer labor, suffer injury during birth, or need a
cesarean birth
 dystocia may occur because the shoulders are too large to fit through the
pelvis.
 Fractures of the clavicle or skull, injury to the brachial plexus or the facial
nerve, cephalhematoma, subdural hematoma, and bruising
Large-for-gestational-age Infants

 Therapeutic management
 Delivery problems may lead to use of vacuum extraction, forceps, or cesarean
birth.
 Birth injuries and complications are treated as they arise
 Nursing considerations
 assist in a difficult delivery or cesarean birth
 infant is carefully assessed for injuries or other complications such as
hypoglycemia or polycythemia
High—Risk Newborn: Acquired
and Congenital Conditions
Pauline Kaye S. De Leon, MD
Asphyxia

 insufficient oxygen and excess carbon dioxide in the blood and tissues.
 may occur in utero, at birth, or later and results in ischemia to major organs.
 Maternal factors include complications such as hypertension, infection, and
drug use.
 Asphyxia in utero may be caused by placental conditions such as placenta
previa, placental abruption, or postmaturity.
 Cord problems, infection, premature birth, and multifetal gestation are
among the fetal causes of asphyxia.
Asphyxia

Manifestations
 rapid respirations are followed by cessation of respirations (primary apnea)
and a rapid fall in heart rate
 If asphyxia continues without intervention, gasping respirations may resume
weakly until the infant enters a period of secondary apnea
 In secondary apnea, the oxygen levels in blood continue to decrease, the
infant loses consciousness, and stimulation is ineffective.
 Resuscitative measures should be initiated immediately to prevent permanent
injury to the brain or death
Asphyxia

 Neonatal Resuscitation
 be prepared for situations in which asphyxia may develop
 Effective ventilation is the most important element in resuscitation
 Nurses begin resuscitation measures as necessary and assist the physician or
nurse practitioner with intubation, insertion of umbilical vein catheters, and
administration of medications.
 Maintenance of thermoregulation is very important throughout care
 continue to assess for changes.
Transient Tachypnea of the Newborn
(Retained Lung Fluid)
 develop rapid respirations soon after birth from inadequate absorption of
fetal lung fluid
 usually resolves within 24 to 48 hours
 Risk factors
 cesarean birth with or without labor
 Macrosomia
 multiple gestation
 excessive maternal sedation
 prolonged or precipitous labor
 male gender
 maternal diabetes or asthma
Transient Tachypnea of the Newborn
(Retained Lung Fluid)
 tachypnea develops within 6 hours of birth
 Grunting, retractions, nasal flaring, and mild cyanosis also are present
 Treatment is supportive and may include oxygen for cyanosis
Meconium Aspiration Syndrome

 a condition in which there is obstruction, chemical pneumonitis, and air

trapping caused by meconium in the lungs
 occurs most often when hypoxia causes increased peristalsis of the intestines
and relaxation of the anal sphincter before or during labor
 Obstruction of the airways may be complete or partial
Meconium Aspiration Syndrome

 Signs of mild to severe respiratory distress are present at birth, with

tachypnea, cyanosis, retractions, nasal flaring, grunting, crackles, and, in
severe cases, a barrel-shaped chest from hyperinflation.
 Suctioning the infant’s secretions as soon as the head is born has not been
found to reduce the incidence of MAS.
 Infants with depressed respirations and muscle tone should be moved to a
radiant warmer and suctioned with a bulb syringe
 Notify the primary care provider when meconium is noted in the amniotic
fluid
Persistent Pulmonary Hypertension of
the Newborn
 condition in which pulmonary vasoconstriction occurs after birth and elevates
vascular resistance of the lungs
 most often in infants who are term or postterm.
 often associated with hypoxemia and acidosis from conditions such as
asphyxia, MAS, sepsis, polycythemia, diaphragmatic hernia, and RDS
 Tachypnea, respiratory distress, and progressive cyanosis often become worse
with handling
Persistent Pulmonary Hypertension of
the Newborn
 Management involves treating the underlying cause of poor oxygenation and
relieving pulmonary vasoconstriction
 Nursing care is similar to care of other infants with severe respiratory disease
 Assessment for hypoglycemia, hypocalcemia, anemia, and metabolic acidosis
is important.
Hyperbilirubinemia (Pathologic
Jaundice)
 Nonphysiologic jaundice may be seen in the first 24 hours of life
 may lead to bilirubin encephalopathy
 most common cause of pathologic jaundice is hemolytic disease of the
newborn from incompatibility between the blood of the mother and that of
the fetus.
 Other causes of nonphysiologic jaundice include infection, hypothyroidism,
glucuronyl transferase deficiency, polycythemia, glucose-6-phosphate
dehydrogenase deficiency, and biliary atresia
Hyperbilirubinemia (Pathologic
Jaundice)
Treatment
 prevention of bilirubin encephalopathy and kernicterus
 Phototherapy
 most common treatment for jaundice and involves placing the infant under special
fluorescent lights
 Exchange Therapy
 are seldom necessary but are performed when phototherapy cannot reduce
dangerously high bilirubin levels quickly enough.
 removes maternal antibodies, unconjugated bilirubin, and antibody-coated
(sensitized) RBCs
Sepsis Neonatorum

 Infection that occurs during or after birth may result in sepsis neonatorum, a
systemic infection from bacteria in the bloodstream.
 Common causative agents of neonatal sepsis
 GBS
 Escherichia coli
 coagulase-negative Staphylococcus
 Staphylococcus aureus
 Haemophilus influenzae
 Candida albicans
Sepsis Neonatorum

Therapeutic management
 treated with broad-spectrum antibiotics, given intravenously until culture and
sensitivity results are available
 Other care is supportive to meet the infant’s specific needs.
Sepsis Neonatorum

Nursing care
 identify infants at risk for infection
 Prematurity and low birth weight are the most important risk factors
 Infants of mothers who have rupture of membranes longer than 12 to 18
hours.
 prolonged or precipitous labor
 signs of maternal infection before or during labor
 chorioamnionitis (also known as “Triple I”)
 foul-smelling amniotic fluid
Sepsis Neonatorum

Nursing interventions
 Preventing Infection
 Providing Antibiotics
 Providing Other Supportive Care
 Supporting Parents
Polycythemia

 increased viscosity of the blood causes resistance in the blood vessels and
decreases blood flow
 may occur when poor intrauterine oxygenation causes the fetus to
compensate by producing more erythrocytes than normal
 minimal or no signs of polycythemia
 Symptomatic infants may have a plethoric color, lethargy, irritability, poor
tone, and tremors. Abdominal distention, decreased bowel sounds, poor
feeding, hypoglycemia, and respiratory distress also may be present
Polycythemia

 Treatment is primarily supportive.

 Monitoring of bilirubin levels is important to determine whether phototherapy
is necessary.
Hypocalcemia

 total serum calcium concentration of less than 7 mg/dL

 Early-onset hypocalcemia occurs most often in IDMs and in infants with
asphyxia, prematurity, and delayed nutrition.
 Late-onset hypocalcemia is caused by hypoparathyroidism, malabsorption,
low magnesium levels, extensive diuretic therapy, and rickets
Hypocalccemia

 Signs of hypocalcemia include irritability, jitteriness, poor feeding, high-

pitched cry, muscle twitching, apnea, seizures, and electrocardiographic
changes
 IV calcium gluconate is given if feeding alone does not raise the calcium level
 nurse should be alert for signs of hypocalcemia. IV calcium should be
administered slowly and stopped immediately if bradycardia or dysrhythmia
develops
Prenatal Drug Exposure
Prenatal Drug Exposure

 Therapeutic management includes dealing With the complications common to

drug-exposed infants during and after birth
 Medications commonly used include oral morphine and methadone
 Phenobarbital may be used for polydrug exposure
 Medication dosage is gradually tapered until the infant no longer needs
 infant who has been exposed to drugs prenatally needs special care to cope
with drug withdrawal. Care is focused on minimizing withdrawal symptoms,
encouraging feeding, promoting rest, and, ifpossible, enhancing parental
attachment
Prenatal Drug Exposure

Feeding
 Feeding can be difiicult and time consuming. The poor suck and swallow
coordination of drug-exposed infants interferes with caloric intake, yet their
excessive activity increases their caloric needs.
 Gavage feedings may be necessary to conserve the infant’s energy and
prevent aspiration if the infant is excessively agitated, is unable to suck and
swallow adequately, or has rapid respirations
Prenatal Drug Exposure

Rest
 excessive activity and poor sleep patterns of drug exposed neonates interfere
with their ability to rest
 Keep stimulation of the drug exposed infant to a minimum, especially at first
when the infant is excessively irritable
Bonding
 Child neglect, abuse, and failure to respond appropriately to infant signals
and cues are associated with alcohol and drug abuse
 Because the mother may become the infant’s primary caregiver, it is essential
that nurses do whatever they can to enhance mother—infant bonding.
Phenylketonuria

 genetic disorder that causes CNS injury from toxic levels of the amino acid
phenylalanine in blood.
 Severe cognitive impairment occurs in untreated infants and children
 caused by a deficiency of the liver enzyme phenylalanine hydrolase
 Signs of untreated disease may begin with digestive problems and vomiting
and later progress to seizures, musty odor of the urine, and severe cognitive
impairment
Phenylketonuria

 a low-phenylalanine diet that should start immediately after the diagnosis is

made and continue throughout life to avoid irreversible neurologic damage
 nurse should be sure that all newborns are screened for PKU at the
appropriate time in the birth facility
 nurse assists parents in regulating the diet to meet the infant’s changing
phenylalanine needs
Congenital Heart Defects
Acyanotic defects
 obstruction of blood flow from the ventricles or a defect that causes
increased flow of blood to the lungs occurs. Both increase the work of the
heart.
Cyanotic defects
 blood flow to the lungs decreases, or venous blood and oxygenated blood are
mixed in the systemic circulation, or both, decreasing the oxygen carried to
the tissues and resulting in cyanosis
Left-to-Right shunting defects
 allow blood to flow from the higher pressure of the left side of the heart to
the right side or from the aorta to the pulmonary artery. This increases blood
flow to the lungs and is called a left-to-right shunt.
Defects with obstruction of blood flow
 decrease in the blood flow through a vessel or valve occurs because of
stenosis (narrowing)
Defects with decreased Pulmonary blood flow
 impairment in the flow of blood from the right side of the heart to the lungs,
combined with abnormal openings between pulmonary and systemic
circulations, occurs in defects with decreased pulmonary blood flow.
Cyanotic defects with increased pulmonary blood flow
 defects allow survival only if a mixing of venous and oxygenated blood in the
heart occurs
 Manifestations
 Cyanosis
 Heart murmurs
 Tachycardia and Tachypnea
 Therapeutic management involves
diagnosis of the specific defect and
supportive and surgical treatment, as
indicated.
 Nursing care is focused on assessing for
changes in condition and reducing the
infant’s need for oxygen.
Reference

 Foundations of Maternal-Newborn and Women’s Health Nursing