Nursing Care of a

Family with a High

Risk Newborn
Fiancee Lee A. Banzon May 04, 2023
 01
Newborn
Priorities in
First Days of
Life
01 Newborn
Priorities
All newborns have eight priority needs in the first few days of
life:

1. Initiation and maintenance of respirations

2. Establishment of extrauterine circulation

3. Control of body temperature

4. Intake of adequate nourishment

5. Establishment of waste elimination
6. Prevention of infection
7. Establishment of an infant–parent relationship
8. Developmental care, or care that balances physiologic
needs and stimulation for best development

These are also the priority needs of high-risk

01 Initiating and Maintaining Respirations
The prognosis of a high-risk
newborn depends primarily
on how the first moments of
life are managed

Most deaths occurring during the

first 48 hours after birth
01 Resuscitation and Airway
Resuscitation follows an organized process:
(a) establish and maintain an airway,
(b) expand the lungs, and

(c) initiate and maintain effective ventilation.

• bulb syringe suction, which removes mucus and prevents aspiration of any mucus and amniotic fluid
present in the mouth or nose with the first breath
• If a newborn does not draw in a first breath spontaneously, suction the infant’s mouth and nose with
a bulb syringe again and rub the back to see if skin stimulation initiates respira_x0002_tions.
• Slide a catheter (8F to 12F) over the infant’s tongue to the back of the throat
• Do not suction for longer than 10 seconds at a time (count seconds as you suction) to avoid removing
excessive air from an infant’s lungs.
• immediate laryngoscopy to open the airway, endotracheal tube insertion
01 Drug Theraphy
01 Drug Theraphy
01 Establishing Extrauterine Circulation
closed-chest massage
Depress the sternum approximately
one third of its depth (1 or 2 cm) at a rate of 100 times per
minute (AHA, 2008).
If heart sounds are not resumed 0.1 to 0.3 mL/kg epinephrine
01 Maintaining Fluid and Electrolyte Balance
Infants with hypoglycemia are treated initially with 10% dextrose
Dehydration may be monitored by urine output
01 Regulating Temperature
• newborns in a neutral-temperature
• after birth, wipe an infant dry, cover the head with a cap, and
place the baby immediately under a prewarmed radiant
warmer or in a warmed incubator (36.5° C).
01 Radiant Heat Sources
• Radiant heat warmers are open beds that have an overhead
ra_x0002_diant heat source.
01 Incubators
01 Skin-to-Skin Care
• kangaroo care, skin-to-skin care
• Establishing Adequate Nutritional Intake
• Establishing Waste Elimination
• Preventing Infection
• Establishing Parent–Infant Bonding
 02
The Newborn at
Risk Because of
Altered
Gestational Age
or Birth Weight
02 The Small-for-Gestational-Age Infant
• SGA in_x0002_fants may be born preterm (before week 38
• SGA infants are small for their age because they have
experienced intrauterine growth restriction (IUGR)
• Etiology
• woman’s nutrition
• Pregnant adolescents
• Placental damage
• Women who smoke heavily or use narcotics
02 The Large-for-Gestational-Age Infant
• An infant is LGA (also termed macrosomia) if the birth
• weight is above the 90th percentile on an intrauterine growth
• Etiology
• women with diabetes mellitus or women who are obese
• Multiparous women
• Beckwith syndrome (a rare condition characterized by
overgrowth),
• Cardiovascular Dysfunction.
02 A Preterm Infant
• A preterm infant is traditionally defined as a live-born infant
born before the end of week 37
• All preterm infants need intensive care
• A preterm infant is immature and small but well proportioned
for age.
• Etiology;
• rarely known
02 Preterm Infant Potential Complications
• Anemia of Prematurity.- infant will appear pale and may be
lethargic and anorectic.
• Kernicterus.- destruction of brain cells by invasion of indirect
bilirubin
02 The Postterm Infant
• born after the 42nd week of a pregnancy
• A fetus who remains in utero with a failing placenta may die
or develop postterm syndrome
• dry, cracked, almost leather-like skin from lack of fluid, and
absence of vernix.
• Fingernails will have grown well
 03
ILLNESS in the
Newborn
03 Respiratory Distress Syndrome
• (RDS) of the newborn, for_x0002_merly termed hyaline
membrane disease
• This membrane prevents ex_x0002_change of oxygen and
carbon dioxide at the alveolar–capil_x0002_lary membrane.
• cause of RDS is a low level or absence of surfactant
03 Respiratory Distress Syndrome
Therapeutic Management
• Surfactant Replacement
• Oxygen Administration
• Ventilation
• Supportive Care
03 Meconium Aspiration Syndrome
• Meconium is present in the fetal bowel as early as 10 weeks’

gestation. If hypoxia occurs, a vagal reflex is stimulated, resulting

in relaxation of the rectal sphincter.
Meconium cause severe respira_x0002_tory distress in three
ways:
1. it causes inflammation of bron_x0002_chioles because it is a
foreign substance;
2. it can block small bronchioles by mechanical plugging;
3. cause a decrease in surfactant productionde_x0002_crease in
03 Meconium Aspiration Syndrome
Therapeutic Management
Amnioinfusion to dilute the amount of meco_x0002_nium in
amniotic fluid
After birth and tracheal suction
Antibiotic therapy
03 Apnea
• a pause in respirations longer than
20 seconds with accompanying
bradycardia.
• shaking an infant or flicking the
sole of the foot often stimulates
the baby to breathe again
• maintain a neutral thermal
environment
• Careful burping
03 Sudden Infant Death Syndrome (SIDS)
SIDS is sudden unexplained death in infancy.
Although the cause of SIDS is unknown, in addition to
prolonged but unexplained apnea, other possible contribut_x0002_ing factors include:
• Viral respiratory or botulism infection

• Pulmonary edema

• Brain stem abnormalities

• Neurotransmitter deficiencies
• Heart rate abnormalities
• Distorted familial breathing patterns
• Decreased arousal responses
• Possible lack of surfactant in alveoli

• Sleeping in a room without moving air currents (the in_x0002_fant rebreathes expired carbon dioxide)
03 Apparent Life-Threatening Event
Some infants have been discovered cyanotic and limp in their

beds but have survived after mouth-to-mouth resuscitation

by parents. An episode of this kind is called an apparent life_x0002_threatening event
03 Periventricular Leukomalacia
(PVL) is abnormal formation

of the white matter of the brain (Tsukimori et al., 2007). It

is caused by an ischemic episode that interferes with circula_x0002_tion to a portion of the brain.

Infants may die

of the original insult; they may be left with long-term effects

such as learning disabilities.
03 Hemolytic Disease of the Newborn
03 Rh Incompatibility
03 ABO Incompatibility
03 Hemorrhagic Disease of the Newborn
results from a defi-
ciency of vitamin K (McNinch, Busfield, & Tripp, 2007).

Vitamin K is essential for the formation of prothrombin by

the liver. Lack of it causes decreased prothrombin function
and impaired blood coagulation.
03 Twin-to-Twin Transfusion
Twin-to-twin transfusion is a phenomenon that can occur if

twins are monozygotic (identical; share the same placenta) or

if abnormal arteriovenous shunts occur that direct more
blood to one twin than the other
03 Necrotizing Enterocolitis
(NEC) develops in approximately
5% of all infants in intensive care nurseries (Carter, 2007).
The bowel develops necrotic patches, interfering with
di_x0002_gestion and possibly leading to a paralytic ileus.
Perforation
and peritonitis may follow.
03 Retinopathy of Prematurity
• Retinopathy of prematurity (ROP), an acquired ocular disease
that leads to partial or total blindness in children, is caused by
vasoconstriction of immature retinal blood vessels.
• high concentration of oxygen established as the causative
agent
 04
The newborn at
risk because of
Maternal
Infection or
Illness
04 Maternal Infection
_x0004_

Hemolytic, Group B Streptococcal Infection

(GBS).

Assessment.
• after prolonged rupture of membranes

• womans vaginal culture is positive for GBS

Pneumonia may develop, infants who contract
the infection die within 24 hours of birth.
meningitis; late-onset type occurs at 2 to 4
weeks
Therapeutic Management.
Gentamicin, ampicillin, and penicillin
04 Maternal Infection
_x0004_

Ophthalmia Neonatorum
- eye infection, Neisseria gonorrhoeae and
Chlamydia trachomatis.
-corneal ulceration and destruction,
resulting in opacity of

the cornea and severe vision impairment.

Assessment.
• conjunctivae become fiery red, with thick
pus.
• The eyelids are edematous.

• occurs on day 1 to day 4 of life

Prevention.
prophylactic instillation of erythromycin
ointment .
Therapeutic Management.
• intravenous ceftriaxone (Rocephin)
• penicillin are effective drugs.

• ophthalmic solution of erythromycin

• eyes are irrigated with sterile saline solution

to clear the copious discharge.
04 Maternal Infection
_x0004_

Hepatitis B Virus Infection-

04 Maternal Infection
_x0004_

Generalized Herpesvirus Infection

04 Maternal Infection
_x0004_

Human Immunodeficiency Virus Infection

04 An Infant of a Woman Who Has Diabetes Mellitus
• (macrosomia)-results from overstimulation of pituitary growth
hormone and extra fat deposits created by high levels of insulin
during preg_x0002_nancy.
• Caudal regression- syndrome (hypoplasia of the lower extremities) is
a syndrome that occurs almost exclusively in such infants
• have a cushingoid (fat and puffy) ap_x0002_pearance.
Complications:
• birth injury
• Hyperbilirubinemia
• Hypocalcemia
04 An Infant of a Drug-Dependent Mother
• Infants of drug-dependent women tend to be SGA.
• will show with_x0002_drawal symptoms (neonatal abstinence
syndrome)
• drugs used to counteract withdrawal symp_x0002_toms
include paregoric, phenobarbital, methadone,
chlor_x0002_promazine (Thorazine), and diazepam (Valium).
• Infants who are exposed to drugs in utero may have
long_x0002_term neurologic problems
04 An Infant With Fetal Alcohol Exposure

fetal alcohol syndrome

 THANK YOU !
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Reporter XXX TIME 202X.01.25

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