Acute Conditions of the Neonates ✔ Whose mothers had antepartum

• Respiratory Distress syndrome bleeding

• Meconium Aspiration syndrome
• Sepsis Complications/associated problems
• Hyperbilirubinemia • Hypoxia
• Sudden Infant Distress syndrome (SIDS) • Retrolental fibroplasia
• From O2 of high concentration,
Respiratory Distress Syndrome (RDS) greater than 40%
• Hyaline membrane disease • Atelectasis
• Difficult respiration due to deficient • Bronchopulmonary dysplasia
surfactant, leading to collapsed lungs Assessment/Findings
(atelectasis), w/c prevent adequate gas • Use Silverman-Andersen Scale for scoring
exchange difficult respiration
• ETIOLOGY: ✔ 0 = normal respiration
- Immature lungs w/ decreased ✔ 10 = most difficult respiration, RDS
surfactant
• Hyaline membrane disease Major Signs:
• Due to immaturity of the lungs • Expiratory grunting – major sign; late-
• Decreased gas exchange occuring
• Etiology: • Flaring of the nares – early sign
• Deficient synthesis or release of • Retractions (sternal and intercostals)
SURFACTANT • Due to use of accessory muscles to
- High in lecithin and fatty protein aid respiration
necessary for absorption of oxygen • See-saw breathing
in the lungs • flattening of the chest during
RDS Manifestations: inspiration w/bulging of abdomen
• RR: 60 breaths/min or more • Tachypnea: RR > 70/min – an early sign
• Rapid respirations with grunt-like sounds, Minor signs
• Nasal flaring, • Cyanosis
• Cyanosis, • Tachycardia
• Intercostal and substernal retractions • Falling body temperature; color: pale gray
• Severe: edema, lassitude, apnea • Dyspnea
• Decreased activity level
Treatment / MGT: • Respiratory acidosis
• Corticosteroids (bethamethasone) • Auscultation: fine rales, diminished breath
✓ IM, 1 – 2 before delivery sounds o Decreased urine; edema of
✓ Preterm Newborns: via endotracheal tube (ET) extremities
at birth or when symptoms of RDS occur • Decreased muscle tone; absent bowel
• Improvement of lung function w/in 72 hours sounds
• VS monitored closely • Periods of apnea
• Arterial blood gases analyzed
• Warm incubator w/ gentle or minimal handling Diagnosis
• IVF – nurse observes for signs of • History
overhydration or dehydration • Assessment findings (Silverman)
• O2 therapy via hood or ventilator in • Blood gas studies
concentrations necessary to maintain adequate
tissue perfusion Nursing Implementation
• Keep airway patent/promote respiration
Incidence o Suction ET 1 – 2 hours as needed
• Common in preterm newborns, especially o In preterm: < 5 seconds per
those weighing bet. 1000 – 1500 gms. suctioning
• Also high in babies: o Use sterile catheter
✔ Of diabetic mothers • Maintain and monitor O2 concentration
✔ Delivered by CS, and o Maintain humidity; maintain in
supine position w/ head slightly
 extended to improve respiratory 1st few breaths after delivery in a term
funtion neonate
o Do not hyperextend the neck • Etiology:
• Administer prescribed O2 under CPAP
• Safety: Mouth-to-mouth resuscitation Manifestations:
• Frequent evaluation/monitoring: • RDS s/symptoms – primary sx
• VS, color, breath sounds, and blood • Rales and ronchi
gases • Tachypnea that persists for several weeks
• Maintain hydration and nutrition • NPO for • TREATMENT:
tachypnea • Supportive care w/ warmth
• Monitor I&O, daily weight • Supplemental O2
• Provide for IV therapy, gavage feeding • Energy-conserving plans of care
(when infant is unable to suck or tires • Intubation and mechanical ventilation
easily) or hyper alimentation
• Hyperalimentation MAS Etiology:

Nursing Implementation
Prevent infection by:
• Hand washing
• Wearing proper attire
• Antibiotics as ordered
• Avoiding exposure to infected personnel Meconium can cause severe respiratory
• Isolating infected Newborns distress in 3 ways:
Keep warm • Causes Inflammation of bronchioles
• Maintain in isolette w/ high humidity o Because it is a foreign substance
✔ Incubator: 40 -70% • Can block small bronchioles by mechanical
✔ High humidity: 55 – 65% plugging
• Monitor temp per axilla o Ball-valve action: air is allowed in but
• Prevent heat loss cannot be exhaled
o hyperinflated lungs
Give supportive care to parents o 􏰀􏰀ed pulmonary perfusion
• Allow verbalization of feelings and concern o 􏰀􏰀ed hypoxia
• Explain special procedures • Causes 􏰀 in surfactant production thru lung
• Inform of results and progress trauma
• Encourage participation in care; provide
positive feedbacks Assessment
• May demonstrate signs of fetal distress during
Meconium Aspiration Syndrome (MAS) labor and delivery
• Group of symptoms that occur when the • Apgar score less than 6 @ 1 and 5 minutes o
fetus or newborn aspirates meconium- Immediate signs of respiratory distress @
stained amniotic fluid into the lungs • delivery (cyanosis, tachypnea, retractions) o
• Etiology: Over-distended, barrel-shaped chest
• prolonged labor 􏰀 fetus expels • Diminished breath sounds
meconium into amniotic fluid (esp. • Yellow staining of skin, nails, umbilical cord
w/ cord compression)
• If Asphyxia and acidosis occur Priority Dx: Ineffective gas exchange
􏰀fetus gasps 􏰀drawing meconium- Interventions:
stained amniotic fluid into lungs • Suction oropharynx then nasopharynx after
• 1st breath before nose and mouth is neonate’s head is born to remove as much
suctioned 􏰀meconium-stained fluid meconium as possible
in upper airway passages is drawn • Place infant under radiant warmer
into the lungs • Administer O2 to maintain adequate PO2 and
• Aspiration of meconium into the • O2 saturation
tracheobronchial tree in utero or during the • Perform chest physiotherapy routinely
Sepsis
• Systemic response to infection with bacteria o Risk factors
Can also result from viral or fungal infections • Resolution of enclosed hemorrhage
• Causes SYSTEMIC Inflammatory Response (cephalhematoma, large amount of bruising
Syndrome (SIRS) due to the endotoxin of the from difficult delivery)
bacteria that causes tissue damage • Infection/sepsis
• If untreated 􏰀septic shock, multi-organ • Dehydration
dysfunction syndrome, DEATH • Breastfeeding – pregnanediol in breast milk
renders glucorynyl transferase ineffective in
Manifestations: conjugating bilirubin
• Fever, chills, tachypnea, tachycardia, • Poor meconium/stool passage
neurological signs (lethargy)
• Hypotension – ominous/threatening sign Assessment
✔ Indicates body is unable to compensate • Pathologic jaundice
adequately ✔ Occurs in the 1st 24 hours
and cardiorespiratory arrest is about to occur ✔ Duration: lasts more than a week
• Lab tests: ✔ Dangerous levels @ w/c kernicterus may set
✔ (+) blood cultures it:
✔ Reduced fibrinogen and thrombocyte levels • Full-term: 20 mg/100 mL or above
✔ Presence of immature WBC • Preterm: 15 mg/ 100 mL or above
✔ Neutropenia (neutrophil 􏰀1000/mm3)
Assessment: Kernicterus
Nursing Responsibilities ✔ Signs of kernicterus:
• Monitoring neurological status and VS • Sluggish-to-absent Moro reflex
• Observing for shock; • Opisthotonus
• Maintaining strict standard and expanded • Severe lethargy
precautions (masks, gowns, gloves) • Projectile vomiting
• Antibiotics IV • Tense, bulging fontanel; high-pitched cry •
Apnea
• Immunization against H. influenzae (Hib)
• Convulsion – late sign
bet. 2 mos. – 4 years
• Irritability
HYPERBILIRUBINEMIA • Increasing serum bilirubin
• HYPER - “excess”; BILIS – “bile”; RUBOR
– “red”; EMIA – “blood” Nursing Diagnoses :
• Excessive levels of serum bilirubin greater • Fluid volume deficit r/t decreased intake,
than 12 – 13 mg/100 mL loose stools, and increased insensible
▪ Normal: 2 – 6 mg/100 mL, not to water loss
exceed 12 mg/100 mL • Impaired parenting r/t interruption in
bonding between infant and parents
Physiology secondary to separation

Interventions and management

• Phototherapy
▪ Transports bilirubin from skin to the
blood, then to bile where it is excreted
Pathophysiology and passed out thru the stool
▪ Light tubes 16 inches (42 – 45 cm)
• Before birth – unconjugated bilirubin is
away from baby
eliminated by the placenta
▪ Prepare for phototherapy:
• After delivery – converted to conjugated
bilirubin in the liver and is excrete via bile ✔ Undress newborn
ducts into the intestines ✔ Cover eyes and genitalia
• Can be reabsorbed from the intestines if
peristalsis slows Phototherapy
• KERNICTERUS – complication • Provide continued care during the
treatment
✔ Feed regularly (Q 2 – 3 hours) to prevent ✓ Multiple pregnancies w/ short intervals bet.
metabolic acidosis them
• Remove infant from under the light, remove ✓ Low socio-economic status, crowded living
eye shield, then cuddle him during feeding conditions
✔ Turn q 2 hours for maximum exposure of skin ✓ Poor prenatal care and limited weight gain
surfaces during pregnancy
✔ Increased fluid intake; give fluids in between
feedings
Preventive measures
✔ Monitor temperature q 2 hours • Put infant on his back to sleep
• Not smoking anywhere near an infant
Assess for S/S, and manage as necessary: • Remove pillows, quilts, stuffed toys, or other
• Bronze skin (explain to parents: temporary) o soft surfaces that may trap exhaled air from
Dark, concentrated urine (Increased fluids; crib or sleeping environment
sterile water between regular milk feedings) • Use firm mattress w/ snug-fitting sheet
• Bright, green, loose stools from excess bilirubin • Make sure infant’s head remains uncovered
excretion (explain: not diarrhea) while sleeping
• Priapism (turn to prone) • Keep warm while sleeping but not overheated
• Retinal damage (prevent by shielding eyes)
• Dehydration Nursing Care
• Elevated temp/fever (monitor temp; provide • Assist parents in the grieving process
adequate hydration) • Stay calm and let parents express their
feelings
SUDDEN INFANT DEATH SYNDROME (SIDS) • May express anger or blame others
• Clinically defined as: • Reassure them that disease cannot be
• Sudden, unexpected death of an predicted nor prevented, and “they are not
apparently healthy infant bet. 2 weeks & 1 responsible” for the death
year of age for which routine autopsy fails • Allow them to say goodbye to the infant:
to identify the cause • Let them touch, hold and rock the infant • May
• “Crib death” assist in burial preparations
• Peak incidence: bet. 2 & 4 months of age

Clinical features
• Death occurs during sleep, and
• Infant does not cry or make other sounds of
• distress
• How it happens?
• Current theories focus on neurologic
immaturity related to the infant’s inability to
sense and regulate oxygenation status
􏰀ultimately leading to respiratory arrest

Risk factors for SIDS

Infant risk factors
✓ Prematurity
✓ Low birth weight
✓ Twin or triplet
✓ Male
✓ Age bet. 2 – 4 mos
✓ Passive smoke exposure
✓ Hx. of respiratory compromise
✓ Hx. of a sibling who died of SIDS
Maternal risk factors
✓ Age under 20 years
✓ Smoking or illicit drug use
✓ Anemia