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(ACUTE OR CHRONIC)
LGA AND SGA COMPLICATIONS
A. FETAL
Large for Gestational Age
1. Shoulder Dystocia
➢ LGA babies are those whose birth weight
2. Hypoglycemia
is above the 90th percentile for their
3. Hypothermia
gestational age, meaning that they weigh
4. Meconium Aspiration
more than 90% of babies at the same
B. MATERNAL
gestational age.
1.Uterine Rupture
➢ Does not correlate with an increased risk
2.Uterine Atony
of mortality.
3.Birth Injury
Small for Gestational Age
SGA
➢ SGA babies are those whose birth weight 1. Reduced Body Fat
is below the 10th percentile for their 2. Reduced Body Muscle
gestational age, meaning that they weigh 3. Dry and Loose Skin
less than 90% of babies at the same 4. Thin and Dry Umbilical Cord
gestational age. 5. Wide Skull Suture

➢ Increased chance of infant mortality. COMPLICATIONS

➢ LBW -Low Birth Weight; < 2,500 g A. FETAL

1. Hypoglycemia
➢ VLBW -Very Low Birth Weight; < 1,500 g
2. Hypothermia
➢ ELBW -Extremely Low Birth Weight; < 3. Hypocalcemia
1,000 g 4. Polycythemia
5. Perinatal Asphyxia
CAUSE AND RISK FACTORS
NURSING MANAGEMENTS
LGA
LGA
• GDM
- Preventive care: Includes maternal
• Maternal Obesity
nutrition education to prevent excessive
• Genetics
weight gain and strict control of
• Post-term
gestational diabetes to avoid fetal
• Baby Boy
impact.
SGA
- Assist laboring mother into the lithotomy
• IUGR
position to increase pelvic outlet.
• Genetics
- Assess the newborn to detect birth
• Multiple Gestation
trauma (i.e., clavicle fracture or
• Pre-term
paralysis).
SIGNS, SYMPTOMS & COMPLICATIONS
- Monitor temperature. Provide warmth if
LGA needed.
1. Increased Body Fat
2. Lethargic

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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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- Monitor glucose level. IV glucose may be ✓ Smoking
needed if glucose level can’t be ✓ Ascending infection
maintained. ✓ PROM
SGA ✓ Previous miscarriage
- Preventive care: Includes maternal ✓ Decidual hemorrhage
nutrition education to prevent inadequate ✓ Maternal stress
weight gain and nutrition, and maintain ✓ Previous preterm labor
resting in a proper position. Nursing Interventions
- Provide family teaching regarding the ➢ Respiratory support: Providing support
need for ongoing monitoring of growth to help the baby breathe, such as
and development with appropriate support oxygen therapy or mechanical
for the family and infant if developmental ventilation.
delay is noted. ➢ Nutritional support: Providing
- Monitor temperature and maintain warm specialized nutrition to meet the
environment to prevent cold stress. baby's growth and development needs,
Incubator post birth for temperature such as parenteral nutrition or enteral
control if hypothermia is noted. feeding.
- Monitor for skin breakdown. ➢ Maintaining warm environment:
- Monitor glucose level. IV glucose maybe Preterm babies have difficulty
be administered if glucose level can’t be regulating their body temperature.
maintained. ➢ Educating parents on how to care for
- Monitor calcium level. their preterm baby, including feeding,
bathing, and monitoring for signs of
complications.
PRETERM AND POSTTERM ➢ Prevent infection
PRETERM Treatment
- refers to a baby born before 37 weeks of - Preterm infants often need specialized
pregnancy, which can cause health medical care in a neonatal intensive care
problems due to underdevelopment. unit (NICU). This is a specific part of the
Signs and Symptoms of Preterm Newborn hospital for babies in critical condition.
- Low birth weight Neonatologists are healthcare providers
- Weak muscle tone who specialize in newborn care. Some
babies stay in the NICU for weeks or
- Less body fat
months.
- Increase Lanugo
- Preterm infants often need help with:
- Jaundice ➢ Breathing.
- Small size ➢ Feeding.
PATHOPHYSIOLOGY ➢ Gaining weight.
✓ Multiple pregnancy ➢ Maintaining their own body
✓ Fertility treatment temperature.

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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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POSTTERM 2. Induction of labor: If a postterm baby
- is a newborn who is born after 42 weeks has not been born by 42 weeks, induction
of gestation, which is two weeks or more of labor may be recommended to reduce
beyond the expected due date. the risk of complications.
Signs and Symptoms of Postterm Baby 3. Cesarean delivery: In some cases, a
- Decreased fetal movement cesarean delivery may be necessary to
- Meconium-stained amniotic fluid ensure the safe delivery of a postterm
- Excessive weight baby.
- Dry, peeling skin 4. Meconium aspiration syndrome treatment:
- Low amniotic fluid levels If a postterm baby has aspirated
Pathophysiology meconium (a baby's first bowel
✓ No Ultrasound movement), treatment may involve
✓ No LMP suctioning the baby's airways to remove
✓ Wrong calculations of AOG any meconium and provide oxygen support.
✓ Genetics 5. Hypoglycemia management: Postterm
✓ Maternal Age >35 yrs. Old babies may be at risk of low blood sugar
✓ Maternal obesity levels (hypoglycemia), which can be
✓ Baby boy managed with frequent feedings and/or
Nursing Management glucose monitoring.
➢ Monitor the newborn's vital signs,
including temperature, heart rate, and SUDDEN INFANT DEATH SYNDROME
respiratory rate, and report any (SIDS)
abnormalities to the healthcare provider
SUDDEN INFANT DEATH SYNDROME
➢ Ensure that the newborn is kept warm
(SIDS)
and dry.
➢ Monitor blood glucose levels and provide - Sudden infant death syndrome (SIDS) is
appropriate feeding or glucose a sudden unexplained death in infancy. It
supplementation as needed. tends to occur at a higher than usual rate
➢ Provide emotional support to parents, who in infants of adolescent mothers, infants
may be anxious or worried about their of closely spaced pregnancies, and
postterm baby's health and well-being. underweight and preterm infants.
➢ Encourage parents to spend time with - The peak age of incidence is 2 to 4
their newborn and provide support and months of age.
education on infant care and development. - SIDS also tends to be slightly more
TREATMENT common in baby boys.
1. Monitoring: Postterm babies are typically
POSSIBLE CONTRIBUTING FACTORS
monitored closely for signs of distress or
complications. This may involve frequent • Sleeping prone rather than supine
checks of the baby's heart rate, • Viral respiratory or botulism infection
breathing, and oxygen levels. • Exposure to secondary smoke

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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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• Pulmonary edema ➢ avoidance of soft bedding, overheating,
• Brainstem abnormalities and exposure to tobacco smoke, alcohol,
• Neurotransmitter deficiencies and illicit drugs
• 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 infant rebreathes expired
carbon dioxide)
PATHOPHYSIOLOGY

SIGNS AND SYMPTOMS

• SIDS has no symptoms or warning signs.
Babies who die of SIDS seem healthy
before being put to bed. They show no
signs of struggle and are often found in
the same position as when they were
placed in the bed.
NURSING MANAGEMENT HOW CAN A FAMILY COPE AFTER LOSING
(based on AAP recommendation) A BABY TO SIDS?
➢ Put newborns to sleep on their back, the • Ask the family to join a grief support
incidence of SIDS has declined almost group.
50% to 60%. • Advise them to get help from a
➢ use of a firm sleep surface counsellor, a psychologist, or a
➢ breastfeeding; room sharing without bed psychiatrist.
sharing • Advise them to talk with a close family
➢ routine immunizations member, a friend, or a spiritual adviser.
➢ consideration of using a pacifier
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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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• Autopsy reports should be given to CAUSES OF APNEA
parents as soon as they are available.
- Bleeding in or damage to the brain
• They need support to see them through
- Lung problems, infections, and changes in
the first few months of the second
body temperature
child’s life, particularly until past the
- Digestive problems and heart or blood
point at which the first child died.
vessel problems
• A new baby born to a family in which a
- Too low or too high levels of chemicals in
SIDS infant died can be screened using a
the body and triggering reflexes
sleep assessment as a precaution
MEDICAL MANAGEMENT

APNEA OF PREMATURITY ➢ Blood oxygen level

➢ Blood test
APNEA ➢ Laboratory test
- Absence of breathing ➢ X-ray, ultrasounds, or other imaging
- Apnea of prematurity refers to what studies
happens when a child doesn’t breathe for NURSING MANAGEMENT
more than 20 secs.
- More common on premature ✓ Position the infant's head and neck in a
- Causes bradycardia neutral position.
- Begin after 2 days of life and last up to ✓ Avoid prolonged suctioning; Discourage
2-3mons after Birth taking rectal temperatures and tube
feedings.
PATHOPHYSIOLOGY ✓ Administer methylxanthines (e.g.,
- Disorder caused by immaturity of (theophylline, caffeine) as prescribed.
neurologic and mechanical of the ✓ Anticipate the use of nasal Continuous
respiratory positive airway pressure (CPAP).
✓ Administer continuous nasal airflow or
3 TYPES OF APNEA CPAP via a nasal mask, or a face mask.
CENTRAL APNEA- caused by immaturity ✓ Prepare the infant for assisted
of medullary respiratory control centers mechanical ventilation as indicated.
OBSTRUCTIVE APNEA- caused by ✓ Maintaining fluid and electrolyte balance
obstructed airflow ✓ Skin-to-skin care
MIXED APNEA- combination of central ✓ Regulating temperature
and obstructive apnea ✓ Educate the parents on the use of apnea
monitor and allow for a return
SIGNS AND SYMPTOMS
demonstration of the application, to
- Cyanosis setting, alarms, power source, inform of
- Decreased heart rate when and how to respond to changes
- Low oxygen level in respiration and heart rate.

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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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MECONIUM ASPIRATION SYNDROME → Risk of injury (brain injury) related to
hypoxemia.
MECONIUM → Ineffective thermoregulation related to
immature temperature regulation
→ Is present in the fetal bowel as early as 10
weeks of gestation. mechanism.
→ Baby born breech → Risk of infection related to deficient
→ Meconium staining occurs in approximately immunological defence.
10% to 20% of all births; in 2% to 4% of these
births, infants will aspirate enough
meconium to cause meconium aspiration
syndrome (MAS).
→ Does not occur in ELBW
→ Aspirate either in utero or with the first
breath at birth.

SIGNS & SYMTOMPS (Causes: severe respiratory

distress)

1. Tachypnea - Rapid breathing.

2. Retractions - Area between the ribs and neck
sinks attemps to inhale.
3. Grunting - body’s way to keep air in the lungs
so they will stay open.
4. Pneumothorax - A collapsed lung occurs when
air escapes from the lungs.
5. Pneumomediastinum - A condition in which air Nursing Management
is present in the mediastinum. → Thorough oropharyngeal suctioning
6. Pulmonary interstitial emphysema (PIE) - When → If no severe risk, keep under warmer.
air gets trapped in the tissue outside air sacs in Oxygen and observe for vital signs.
the lungs. → If depressed baby, intubation to be
initiated. PPV should be avoided. Do
thorough laryngotracheal toileting.
→ Thorough stomach wash with Normal
saline.
→ Nurse the baby in a thermoneutral
environment with oxygen.
→ Restricted IV fluids to prevent pulmonary
edema.
→ Prophylactic antibiotics after taking blood
culture sample.
→ Assisted ventilation to be provided if
Nursing Diagnosis
respiratory failure occurs.
→ Ineffective breathing pattern related to → Chest drainage if pneumothorax occurs.
surfactant deficiency, alveolar instability.
→ Impaired gas exchange related to immature
pulmonary function.

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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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Medication ● Breath sounds typically are clear
→ Using light or little sedation, administering the ● Bluish skin color (cyanosis)
smallest dose necessary to manage pain, and ● Rapid breathing, which may occur with
monitoring for managing posible delirium noises such as grunting
symptoms Risk Factors
Rehabilitation Maternal
✓ delivery before completion of 39 weeks
→ Due to the high prevalence of respiratory and
gestation
cardiovascular problems in patients after ICU
✓ cesarean section without labor
release, pulmonary or cardiovascular
rehabilitation is recommended ✓ gestational diabetes
✓ maternal asthma
TRANSIENT TACHYPNEA OF THE Fetal
NEWBORN (TTN) ✓ male gender
✓ perinatal asphyxia
- wet lungs
✓ prematurity
- self-limiting
✓ small for gestational age
- transient (short-lived) within 2 hours
✓ large for gestational age infants
after birth
✓ Differential Diagnosis
- faster than normal breathing rate > 60
✓ Congenital Pneumonia
cpm
✓ Meconium Aspiration Syndrome
- in the lungs, not the airways
✓ Respiratory Distress Syndrome (RDS)
- a breathing disorder seen shortly after
✓ Neonatal Sepsis
delivery, most often in early term or late
✓ Pneumomediastinum
preterm babies
✓ Pneumothorax
✓ Persistent Pulmonary Hypertension
✓ Congenital heart disease
✓ Polycythemia
✓ Anemia/hypovolemia
Management
➢ Given TTN is a self-limited condition,
supportive care is the mainstay of
treatment.
Clinical Features ➢ Medical care of transient tachypnea of
● At the time of birth & within 2 h. after the newborn (TTN) is supportive. As the
delivery retained lung fluid is absorbed by the
● Tachypnea (RR > 60 b/min.) infant's lymphatic system, the pulmonary
● Flaring nostrils or movements between status improves. Supportive care includes
the ribs or breastbone known as intravenous fluids and gavage feedings
retractions until the respiratory rate has decreased
● Increased anterior-posterior diameter enough to allow oral feedings.

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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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➢ Rule of 2 hours: Two hours after onset ACUTE RESPIARTORY DISTRESS
of respiratory distress, if an infant’s SYNDROME (ARDS)
condition has not improved or has
worsened, consider transferring infant RDS

to a center with a higher level of - occurs in babies born early (premature)

neonatal care. whose lungs are not fully developed.
Respiratory Management: - The earlier the infant is born, the more
- Oxygenation , CPAP likely it is for them to have RDS and need
Nutrition: extra oxygen and help breathing.
- NPO, IV fluids, Tube feeding - The pathologic feature of RDS is a
Infection: hyaline like (fibrous) membrane formed
- Antibiotics such as ampicillin and from an exudate of an infant’s blood that
gentamicin begins to line the terminal bronchioles,
Medications: alveolar ducts, and alveoli. This membrane
- Furosemide and epi prevents the exchange of oxygen and
- Salbutamol carbon dioxide at the alveolar-capillary
Prognosis membrane, interfering with effective
● Overall prognosis is excellent with most oxygenation.
of the symptoms resolving within 48
Causes RDS of the New Born
hours of onset. In some case reports,
malignant TTN has been reported in  RDS is caused by a lack of surfactant in
which affected newborns develop the lungs. The lungs of a fetus start
persistent pulmonary hypertension due to making surfactant during the third
a possible elevation of pulmonary vascular trimester, which starts after the 26th
resistance due to retained lung fluid. week of pregnancy. Surfactant is a foamy
substance that keeps the lungs fully
expanded so that newborns can breathe
in air once they are born. This surfactant
does not form until the 34th week of
gestation.

 Other causes include:

1. Meconium Aspiration Syndrome

2. Sepsis
3. Slow transition to extrauterine life
4. Pneumonia

RISK FACTORS

- Siblings that had RDS.

- Twin or multiple births.

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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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- C-section (cesarean) delivery. 2. Oxygen Administration
- Mother that has diabetes.
 The administration of oxygen is often
- Infection.
necessary to maintain correct PO2 and
- Baby that is sick at the time of
pH levels following surfactant
delivery.
administration.
- Cold, stress, or hypothermia. Baby
cannot keep body temperature warm HYPERBILIRUBINEMIA
at birth.
HYPERBILIRUBINEMIA
SIGNS AND SYMPTOMS - Hemolytic disease of the newborn
- The term “hemolytic” is Latin for
1. Subtle signs that may appear include:
“destruction” of red blood cells.
2. Low body temperature
- Hemolytic disease is present when there
3. Nasal flaring
is an excessive destructions of red blood
4. Sternal and subcostal retractions
cells, which lead to elevated bilirubin
5. Tachypnea
levels (hyperbilirubinemia)
6. Cyanotic mucous membranes
Signs and Symptoms
PATHOPHYSIOLOGY ● Yellowing of your baby’s skin and the
whites of his or her eyes. This often
 Neonatal respiratory distress syndrome
starts on a baby’s face and moves down
(RDS) occurs from a deficiency of
his or her body. (JAUNDICE)
surfactant, due to either:
● Poor feeding
1. inadequate surfactant production ● Lack of energy
2. surfactant inactivation in the context
of immature lungs

Prematurity affects both these factors,

thereby directly contributing to RDS.

THERAPEUTIC MANAGEMENT

1. Surfactant Replacement

 RDS can be largely prevented by the

administration of surfactant at birth for
an infant at risk because of low
gestational age. Immediately after birth,
synthetic surfactant is administered into PHYSIOLOGIC JAUNDICE
an endotracheal tube by using a syringe • Most common
or catheter (lung lavage). • After 24 hours of age
• More common in LPI (late preterm)
and preterm infants
• Rapid breakdown of RBC

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• Immature liver ● - Erythroblastosis Fetalis – immature
• Dehydration erythrocytes
PATHOLOGIC JAUNDICE ● - Worst with consecutive pregnancies
• Before 24 hours of age ● - RhoGam (immunoprophylaxis) given for
• Greater than 14 days of life Rh - mothers
• Associated with bilirubin ● - Significant decrease in incidence of Rh
encephalopathy or kernicterus incompatibility
• Causes: ● - Given at 28 weeks and if any incidence
• ABO incompatibilities of bleeding
• Maternal infections Nursing Care Priorities
• Maternal diabetes • Increase PO intake
• Maternal ingestion of • Phototherapy-position light at least 10 cm
sulfonamides, diazepam or from infant
salicylates near term • Protect eyes
ABO Incompatibility • Skin care – frequent stools
● Most common cause of hemolytic disease • Make sure no ointments or creams applied
● Of the 20% with ABO incompatibility, to body when receiving phototherapy
only 5% with clinical effects • Reposition frequently
● Risk factors: • Discharge Teaching
○ Occurs with Maternal type O • Feed frequently
blood & fetal type A, B, or AB • Observe for lethargy
● Mothers immune system may react -> • Count number of diapers (bilirubin is
forms antibodies against baby’s RBC excreted through urine & stool)
● Diagnosed by: Coombs’ test/ Direct wet – 6-8/day
antiglobulin test (DAT) soiled diapers 1/day
● Can cause: • Follow up appointments
○ Mild Anemia How is hyperbilirubinemia in a newborn
○ Hyperbilirubinemia diagnosed?
● Treatment: Phototherapy, fluids, IVIG, The timing of when your child’s jaundice first
occasionally exchange transfusion starts matters. It may help his or her
Rh Incompatibility healthcare provider make a diagnosis.
● - Occurs when maternal antibodies are
• First 24 hours. This type of jaundice is often
present or develop in response to
serious. Your child will likely need treatment
exposure to an antigen (different blood
right away.
type) • Second or third day. This is often physiologic
- Maternal sensitization jaundice. Sometimes it can be a more serious
- Maternal antibodies cross the placenta type of jaundice. It's important to be sure the
● - Causes hemolysis of fetal RBC’s baby is getting enough milk at this point.
● - Isoimmunization – leading to fetal • Toward the end of the first week. This type
anemia of jaundice may be from breastmilk jaundice

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 NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM
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but may be due to an infection or other rare DEFINITION
serious problems.
• Is a serious gastrointestinal problem that
• In the second week. This is often caused by
breastmilk jaundice but may be caused by rare mostly affects PREMATURE BABIES.
liver problems. • The condition inflames intestinal tissue,
causing it to die.
MEDICAL MANAGEMENT • A HOLE may form in baby's intestine.
PHOTOTHERAPY • -Bacteria can leak into the abdomen
- Bilirubin absorbs light. High bilirubin (belly) or bloodstream through the hole.
levels often decrease when a baby is put • -Usually develops within 2-6 weeks after
under special blue spectrum lights birth.
Fiber optic blanket
- A fiber optic blanket is another form of WHO MIGHT GET NECROTIZING
phototherapy. The blanket is usually put ENTEROCOLITIS?
under your baby. It may be used alone or
- Born before 37th week of pregnancy
with regular phototherapy.
- Fed through a tube in the stomach
Exchange transfusion
• Weighing less than 5 1/2 pounds at
- This treatment removes your baby’s blood - birth
that has a high bilirubin level. It replaces - •Rarely, affects in full term infants
it with fresh blood that has a normal
DIAGNOSIS
bilirubin level.
- Client's history
Feeding with breastmilk - Physical assessment
- Abdominal X-ray
- The American Academy of Pediatrics says
- Blood Test
that you should keep breastfeeding a
- Fecal Test
baby with jaundice. If your baby has not
been getting enough milk at the SIGNS & SYMPTOMS
breast, you may need to supplement with
pumped breastmilk or formula. ✓ Abdominal pain and swelling
✓ Red or tender belly
✓ Change in HR, BP, BT and breathing
NECROTIZING ENTEROCOLITIS (NEC) ✓ Diarrhea with Bloody Stool
NECROTIZING ENTEROCOLITIS (NEC) ✓ Green or yellow vomit
✓ . Lethargy
▪ "NECROTIZING" means the DEATH OF ✓ -Refusing to eat and weight loss
TISSUE
▪ "ENTERO" refers to SMALL 4 TYPES OF (NEC)
INTESTINE ➢ Classic
▪ "COLO" refers to the LARGE - This most common type of NEC tends
INTESTINE to affect infants born before 28
▪ "ITIS" means inflammation

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weeks of pregnancy. Classic NEC RETINOPATHY OF PREMATURITY (ROP)
occurs three to six weeks after birth.
→ an acquired ocular disease that leads to partial
➢ Transfusion-associated
or total blindness in children, is caused by
- An infant may need a blood vasoconstriction of immature retinal blood
transfusion to treat anemia (lack red vessels.
blood cells). About 1 in 3 premature
→ Originally it was called retrolental fibroplasias
babies develop NEC within three days
(RLF), named for the end-stage of the disease
of getting a blood transfusion. in which a white, vascularized plaque could be
➢ Atypical seen behind the lens in an eye that was often
- Rarely, an infant develops NEC in the completely blind.
first week of life or before the first
feeding.
➢ Term infant
- Full-term babies who get NEC usually
have a birth defect. Possible causes
include congenital heart condition,
gastroschisis (intestines that form
outside of the body) and low oxygen
levels at birth.

MANAGEMENT

01

- Stopping all regular feedings. The

baby receives nutrients through an
intravenous (IV) catheter.
Signs and symptoms
02
Subtle changes in a baby's retina aren't easily detected
- Checking stools for blood. and can't be seen by parents or pediatric doctors and
nurses. Only a pediatric ophthalmologist, a doctor who
03 specializes in eye care, can detect signs of retinopathy
of prematurity by using special instruments to examine
- If abdominal swelling interferes with
the baby's retina.
breathing, providing oxygen or
mechanically assisted breathing. Severe and untreated ROP may cause some of the
following symptoms:
04
→ White pupils, called leukocoria
- Starting antibiotic therapy. → Abnormal eye movements, called nystagmus
→ Crossed eyes, called strabismus
→ Severe nearsightedness, called myopia

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Risk factors for ROP telemedicine purposes. The advantages of this
method are that fewer screening
ROP is essentially a disease of prematurity.
ophthalmologists would be needed, making it
The emergence of retinopathy of prematurity depends ideal for more remote or rural areas.
on the interaction of multiple factors, such as:
Surgical & Medical Management
→ gestational age
1. Cryotherapy
→ low birth weight
2. Laser photocoagulation
→ Hypoxia
→ duration of oxygen supplementation Treatment modalities after retinal detachment:
→ respiratory distress syndrome
→ Open-sky vitrectomy,
→ twin pregnancy
→ Scleral buckling procedures (SBPs),
→ Anemia
→ Closed vitrectomy and lensectomy with or
→ blood transfusions
without SBPs.
→ Sepsis
→ intraventricular haemorrhage The success rate for surgery to reattach the retina in
→ Hypotension infants with ROP is poor as there is rapid degeneration
→ hypothermia of the photoreceptor cells after retinal detachment.
Infants who are most immature and most ill (and Other Modalities of Treatment:
consequently receive the most oxygen) are at the
highest risk for developing ROP → Anti-VEGF therapies ( bevacizumab)

Diagnosis Nursing Management

The only way to determine if babies have ROP is to 1. Nursing interventions can reduce the risk
examine the inside of their eyes for abnormalities in the regarding oxygen and light. Currently, our best
retina. nursing efforts include support and education
for the family and developmental-based nursing
Ophthalmologists trained in the diagnosis and interventions for the infant or child blinded or
treatment of ROP will examine your baby's eyes. visually impaired by ROP.
2. Careful control of oxygen saturation,
Current recommendation for a screening eye
normalisation of serum IGF-1 concentrations
examination is for all infants born at less than or equal
3. Provision of adequate nutrition
to 32 weeks gestation, and/or weighing less than 1500 g
4. Curbing the negative effects of infection and
at birth. This is to ensure that all infants at significant
inflammation
potential risk are screened.
5. Judicious use of oxygen in delivery room and the
1. Indirect Ophthalmoscopy: Examination of the NICU
retina is performed using the binocular indirect 6. A reduction in blood transfusion in the NICU
ophthalmoscope (a head-mounted scope with could promote adequate postnatal growth and
light source) and a lens for focusing. improve neural and vascular development of the
retina.
2. Use of RetCam and telemedicine : The RetCam is
a camera used to photograph the retina of
infants. This camera do not require a dilated
pupil or contact with the eye. Retinal images
taken by the camera can be stored, transmitted
to expert, reviewed, analyzed and sequentially
compared over time and are useful for
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→ signs of infection around the time of labor or
delivery (such as fever in the mother)
→ prolonged labor

TREATMENT/MANAGEMENT

HIGHEST PRIORITY

→ The most common antibiotic to treat group B

strep is penicillin or ampicillin.
→ PROVIDE SUPPORT AND EDUCATION

BETA-HEMOLYTIC AND GROUP B

STREPTOCOCCUS INFECTION OPHTHALMIA NEONATORUM
DEFINITION OPHTHALMIA NEONATORUM
→ KNOWN AS "GBS" - Neonatal conjunctivitis, also known as
→ It is a bacterial infection babies can get during
ophthalmia neonatorum, is a type of eye
delivery or in their first weeks of life.
infection that affects newborn babies,
→ It is caused by bacteria typically found in a
person's vagina or rectal area or the GI tract. specifically in their first month of life.
→ It can cause serious complications.
SIGNS AND SYMPTOMS
→ Pregnant people are screened for group B strep
during pregnancy. • Edema of the eyelids
→ Antibiotics can treat the infection if tested • Redness and chemosis of the
positive.
conjunctiva
SIGNS AND SYMPTOMS • Purulent discharge
CAUSES/ETIOLOGY
1. EARLY-ONSET
→ Tachypnea Chemical
→ Apnea
• silver nitrate (90% infants)
→ Extreme paleness
• povidone-iodine solution,
→ Hypotension/hypotonia
• erythromycin 0.5%, or tetracycline
2. LATE-ONSET 1%
→ Lethargy Bacterial
→ Fever • Chlamydia trachomatis,
→ Loss of appetite • Neisseria gonorrhoeae
→ Bulging fontanelles from increased intracranial
• Staphylococcus aureus,
pressure
• Streptococcus pneumoniae,
RISK FACTORS • Escherichia coli,
→ a GBS-positive swab in a previous pregnancy • and other gram-negative bacteria
→ a previous baby with GBS infection Viral
→ pre-term labor • Herpes simplex virus
→ rupturing of the membranes well before the
onset of labor (18 hours or more)

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COMPLICATIONS

- Corneal complications
- HSV: Keratitis, keratouveitis
- Vision impairment

DIAGNOSIS

MICROBE IDENTIFICATION

• N. gonorrhoeae and Chlamydia:

Swab drainage for culture and
sensitivity

• HSV: Giemsa stain, PCR

CBC - Eosinophil count

TREATMENT/MANAGEMENT

Medical Management
CARE OF NEWBORN WITH MOTHER
POSITIVE WITH HEPATITIS B
• Gonococcal disease: IV/IM
ceftriaxone What is Hepatitis B?

→ Hepatitis B is a viral infection that attacks the

• Chlamydial disease: Oral
liver and can cause both acute and chronic
erythromycin, azithromycin disease
• HSV: Acyclovir → The virus is most commonly transmitted from
mother to child during birth and delivery, as
PREVENTION well as through contact with blood or other
body fluids during sex with an infected partner,
- Routine neonatal prophylaxis with unsafe injections or exposures to sharp
erythromycin 0.5 % ointment instruments.

Nursing Management ACUTE VS. CHRONIC HEPATITIS B

• Treat neonate's mother, sexual Acute hepatitis B infection - lasts less than six months.
partner Your immune system likely can clear acute hepatitis B
from your body, and you should recover completely
• Maternal prenatal screening within a few months.

Chronic hepatitis B infection - lasts six months or

longer. It lingers because your immune system can't
fight off the infection. Chronic hepatitis B infection may
last a lifetime, possibly leading to serious illnesses such
as cirrhosis and liver cancer

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Hepatitis B is In → HBV DNA testing for HBsAg-positive pregnant
persons at 26-28 weeks to guide the use of
→ Blood
maternal antiviral therapy during pregnancy.
→ Semen
→ Routine vaccination of all infants with the
→ Vaginal fluid
hepatitis B vaccine series, with the first dose
→ Anal fluid
administered within 24 hours of birth
HBV is spread by → Providing hepatitis B immune globulin and
hepatitis B vaccine to their infants within 12
→ Mother to child hours of birth
→ Sex w/out condoms
→ Sharing drug injecting equipment How to protect baby from hepatitis B?
→ Unsterilized tattoo and piercing equipment
→ Baby should get the first dose of hepatitis B
→ Sharing razors, toothbrush and ceremonial
vaccine and a shot called hepatitis B immune
tools
globulin (HBIG) within 12 hours of being born.
Risk for perinatal complications and poor maternal/ → All the hepatitis B shots are necessary to help
fetal outcomes such as ; keep the baby from getting hepatitis B. –
Infants receive 3–4 doses of HBV vaccine
→ Intrauterine Infection → Make sure the baby gets tested after
→ IUGR completing the series of shots.
→ Premature Delivery
→ Intrauterine Fetal Demise Nursing Management – maternal

Mother to Newborn Transmission → Provide dietary education: high-carbohydrate,

high-calorie, low- to moderate-fat and low- to
→ Transplacental transmission of HBV in utero moderate-protein diet and small, frequent
→ Natal transmission during delivery meals to promote nutrition and healing
→ Postnatal transmission during care or through → Educate the mother and family regarding
breast milk measures to prevent transmission of disease
Signs and Symptoms with others at home Provide comfort
measures.
→ Rash → Warn the patient to avoid trauma that may
→ Low grade fever cause bruising.
→ Joint Pain → Encourage gradual resumption of activities and
→ Abdominal pain mild exercise during convalescent period
→ Dark urine and light colored stool → Limit client activity (bedrest) in order to
→ Sucking will be poor promote hepatic healing.
→ Yellowing skin and white eyes ( jaundice)
→ Weakness and fatigue

Physiologic Jaundice - Usually appears between 3–4

days after delivery.

If jaundice occurs within 24 hrs after birth - It' s

presence could indicate a blood incompatibility
between the infant and a mother

Prevention of mother to child transmission

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NEWBORN GENITAL HERPES  Because newborn babies have
SIMPLEX VIRUS INFECTION underdeveloped immune systems, they
can quickly become
What is herpes simplex in newborn? seriously ill after catching the virus.
 Neonatal herpes is a herpes infection in a • is lethargic or irritable
young baby. The younger the baby, the • is not feeding
more vulnerable they are to the harmful • has a high temperature (fever)
effects of infection. • has a rash or sores on the skin, eyes and
 Herpes can be very serious for a young inside the mouth
baby, whose immune system will not have  These are early warning signs that your
fully developed to fight off the virus. baby may be unwell.
 Neonatal herpes, which is rare in the UK, • is lacking in energy (listless)
is caused by the herpes simplex virus. • is becoming floppy and unresponsive
This virus is very common and causes cold • is difficult to wake up from sleep
sores and genital ulcers in adults. • has breathing difficulties or starts
How does a newborn baby catch herpes? grunting
 During pregnancy and labor • breathes rapidly
 If you had Genital herpes for the first • has a blue tongue and skin (cyanosis) –
time within the last 6 weeks of your • if they have brown or black skin this may
pregnancy, your newborn baby is at risk be easier to see on their lips, tongue and
of catching herpes. gums, under their nails and around their
 There's a risk you will have passed the eyes
infection on to your baby if you had a How is neonatal herpes treated?
vaginal delivery.  Neonatal herpes is usually treated with
After birth antiviral medicines given directly into the
 The herpes simplex virus can be passed baby's vein (intravenously).
to a baby through a cold sore if a person  This treatment may be needed for
has a cold sore and kisses the baby. several weeks.
 The herpes virus can also be spread to  Any related complications, such as fits
your baby if you have a blister caused by (seizures), will also need to be treated.
herpes on your breast and you feed your  You can breastfeed your baby while
baby with the affected breast or they're receiving treatment,
expressed breast milk from the affected unless you have herpes sores around your
breast. nipples.
 A baby is most at risk of getting a herpes How serious is herpes for a baby?
infection in the first 4 weeks after birth  Sometimes neonatal herpes will only
You should not kiss a baby if you have a cold affect the baby's eyes, mouth or skin.
sore to reduce the risk of spreading infection.  In these cases, most babies will make a
What are the warning signs in babies? complete recovery with antiviral
treatment.

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 But the condition is much more serious if
it has spread to the baby's organs.
 Many infants with this type of neonatal
herpes will die, even after they have been
treated.
 If widespread herpes is not treated
immediately, there's a high chance the
baby will die.

How can neonatal herpes be prevented?

 If you're pregnant and have a history of
genital herpes, tell your doctor or
CARE OF NEWBORN AND MOTHER
midwife.
POSITIVE ON HIV
 You may need to take medicine during
the last month of pregnancy to prevent What is HIV?
an outbreak of vaginal sores during → HIV (human immunodeficiency virus) is a virus
labour. that attacks cells that help the body fight
 Delivery by caesarean section is infection, making a person more vulnerable to
recommended if the genital herpes has other infections and diseases.
occurred for the first time in the last 6 → It is spread by contact with certain bodily fluids
of a person with HIV, most commonly during
weeks of your pregnancy.
unprotected sex.
If you develop a cold sore or have any signs
→ HIV enters the bloodstream by way of body
of a herpes infection, take these precautions: fluids, such as blood or semen. Once in the
• do not kiss any babies blood, the virus invades and kills CD4 cells. CD4
• wash your hands before contact with a cells are key cells of the immune system.
baby
HIV is transmitted in three routes:
• wash your hands before breastfeeding
• cover up any cold sores, lesions or signs → sexual contact
→ exposure to infected body fluids or tissues
of a herpes infection anywhere on your
→ from mother to child during pregnancy,
body to avoid passing on the virus
delivery or breastfeeding

Signs and Symptoms:

→ Some develop flue like symptoms days-weeks

after exposure
→ Early HIV symptoms
- Fever
- Headache
- Enlarged lymph nodes
- Abdominal cramping
- Skin rash

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- Weight loss → Breastfeeding is absolutely contraindicated for
mothers who are HIV positive.
→ Pregnant women should be offered screening
for HIV early in pregnancy because appropriate
antenatal interventions can reduce MTCT of
HIV infection.

INFANT OF A DIABETIC MOTHER

Infant of a Diabetic Mother

- Infants of mothers with diabetes

(IDMs), have a higher risk of
developing fetal and neonatal
complications, including growth
MEDICAL MANANGEMENT:

→ All pregnant women with HIV should take

HIV medicines throughout pregnancy for
their own health and to prevent perinatal
transmission of HIV.
→ Most HIV medicines are safe to use during
pregnancy.
→ Generally, pregnant women with HIV can
use the same HIV treatment regimens
recommended for non-pregnant adults—
unless the risk of any known side effects to
a pregnant woman or her baby outweighs
the benefits of a treatment regimen.
→ All pregnant women with HIV should start
taking HIV medicines as soon as possible
during pregnancy. In most cases, women who abnormalities, respiratory
are already on an effective HIV treatment
distress, and metabolic
regimen when they become pregnant should
complications, in addition to
continue using the same regimen throughout
their pregnancies. preterm delivery.
→ A scheduled cesarean delivery (sometimes Causes and risk factors:
called a C-section) to prevent perinatal
transmission of HIV is recommended for Diabetes occurs when the body’s ability to
women who have high or unknown viral loads produce or respond to the hormone insulin is
near the time of delivery impaired, resulting in higher blood glucose levels.
NURSING MANAGEMENT 2 types of diabetes in pregnancy:
→ Educate the HIV positive mother on methods to 1. Pregestational- which is where diabetes is
reduce the risk of transmission to her diagnosed before pregnancy;
developing fetus/infant.

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2. Gestational - which is where mothers Diagnosis:
without previously
Starts with prenatal history and physical
diagnosed diabetes have high blood
assessment of both mother and baby. During
glucose levels during pregnancy, especially
pregnancy, maternal blood glucose levels and
during their third trimester.
intrauterine fetal growth is part of the diagnosis.

Newborn assessment
Clinical manifestations: Identifying any problems that may require
• most infants of mothers with diabetes immediate attention, including:
have a macrosomic appearance, with a • measuring blood glucose levels - to screen
round puffy face, plethoric or ruddy for hypoglycemia;
skin, a larger body, and a higher than
normal birth weight. • hematocrit levels - to check
for polycythemia;
• On the other hand, infants with IUGR
typically present with low birthweight, • measuring bilirubin levels;
decreased subcutaneous fat and muscle • assessing for any electrolyte imbalances,
mass, and a thin umbilical cord. such
Newborn with: as hypocalcemia and hypomagnesemia.

Hypoglycemia: • Chest X-ray - to identify birth trauma

• Irritability • echocardiogram – to identify congenital

heart anomalies.
• jitteriness
Treatment:
• lethargy
- In cases where preterm birth is expected,
• difficulty feeding treatment includes giving maternal
• seizures steroids before birth to help the fetal
lungs mature and reduce the risk of
Hyperbilirubinemia: respiratory distress.
• the infant’s skin and mucous membranes - In cases of fetal macrosomia, plans are put
can take on a yellowish color (neonatal in place for cesarean birth if vaginal
jaundice). delivery is not possible.
Impaired lung development: - Newborns with hypoglycemia are given
(may exhibit signs of respiratory distress) glucose orally, by gavage tube, or by IV

• tachypnea - If no other significant complications are

found, then routine newborn care should
• respiratory retractions be provided
• nasal flaring shortly after birth

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Nursing Management: - Continue to monitor their temperature
until thermal stability is achieved, and
Priority goals:
begin the process of weaning the infant to
1. maintain stable blood glucose levels an open crib.

2. provide supportive care ➢ Provide client and family teaching

➢ Once the infant has been stabilized after - Begin by explaining to the infant’s parents
delivery: or caregivers how diabetes can affect the
fetus and newborn. Explain that
- quickly check the glucose level
hypoglycemia, respiratory difficulties, and
➢ If the infant is asymptomatic with other problems are temporary and can
glucose levels within normal limits: resolve with treatment.

- place the infant skin-to-skin with the - Review the plan of care for their baby,
mother, cover them with a warm blanket, including the frequency of glucose
assist with breastfeeding, and continue to measurements and feedings, and stress
closely monitor the infant. the importance of keeping their infant
warm to avoid chilling and hypoglycemia
➢ If glucose levels are low, but the infant
is asymptomatic: - Teach them to recognize signs of
hypoglycemia, and to call for assistance if
- follow your facility’s protocol for feeding
their infant is lethargic, jittery, having
and glucose monitoring.
trouble feeding, or increased respirations.
➢ If the infant’s blood glucose is low and the
➢ When the baby is ready for discharge:
infant is also symptomatic:
- Review teaching for newborn care,
- immediately report these findings to the
including their baby’s feeding schedule.
healthcare provider, and administer IV
glucose, as prescribed. - Emphasize the importance of keeping all
follow up appointments with their
➢ Support thermoregulation to prevent
pediatrician to monitor their
cold stress
child’s growth and development.
- by placing a hat on the infant’s head
- Teach them about postpartum care at
- swaddling them in a warm blanket. home, including diabetes self-care,
especially during future pregnancies.
- Check their temperature frequently and
report signs of cold stress, including
an axillary temperature of less than 96.8°
F or 36° C, pallor,
FETAL ALCOHOL SYNDROME (FAS)
cyanosis, lethargy, tachypnea, or poor WHAT IS FETAL ALCOHOL
feeding. SYNDROME(FAS)?
- Place the infant under a radiant warmer
- Fetal alcohol syndrome (FAS) is a
and slowly rewarm the infant according to
condition that develops in a fetus
your facility’s protocol.
(developing baby) when a pregnant person

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drinks alcohol during pregnancy. Alcohol • Undergoing behavior and education
use during pregnancy can interfere with therapy for emotional and learning
the baby’s development, causing physical concerns.
and mental defects. • Training you as a parent to best help your
child.
SYMPTOMS OF FAS:

- Abnormal facial features, including a

INTUSSUSCEPTION
smooth ridge between the nose and upper What is intussusception?
lip, a thin upper lip, and small eyes.
✓ Intussusception refers to the
- Low body weight.
invagination of a part of the intestine
- Short height.
into itself, like a telescope causing bowel
- Sleep and sucking difficulties.
obstruction.
- Small head size.
- Vision or hearing problems. ✓ Intussusception is the most common
cause of intestinal blockage in children
ETIOLOGY
between ages 6 months and 3 years.
- Fetal Alcohol Syndrome (FAS) is caused by a ✓ Most common in males than females.
woman consuming alcohol while pregnant.
Alcohol enters the bloodstream and crosses the ✓ It occurs most often near the ileocecal
placenta to the growing fetus, resulting in a junction
much higher concentration in the baby’s blood.

NURSING INTERVENTIONS

• Perform complete assessment of systems

including heart and lung auscultation
• Assess infant for signs of withdrawal
• Obtain history of pregnancy from
patient’s mother
• Measure head and abdominal
circumference of infant SIGNS AND SYMPTOMS
• Minimize external stimuli
• Provide education and counseling for VOMITING
parents/caregivers - Initially, vomiting is nonbilious and
reflexive, but when the intestinal
TREATMENT
obstruction occurs, vomiting becomes
• Using medications to treat some bilious.
symptoms like attention and behavior ABDOMINAL PAIN
issues.
- Pain in intussusception is colicky, severe,
and intermittent. Episode may occur in

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15-20-minute intervals. Sudden crying, NURSING MANAGEMENT
draw their knees up to their chest.
➢ Administer IV fluids. Infants with
BLOODY STOOL intussusception may become
dehydrated due to vomiting and
- Stool is described as having a “red
diarrhea. IV fluids are necessary to
currant jelly” appearance due to the
replace lost fluids and maintain
blood and mucus it contains.
adequate hydration.
Pathologic
➢ Monitor I&O. Replace volume lost as
- Meckel’s Diverticulum ordered, and monitor the intake and
- Polyp output accordingly.
- Bowel tumors
➢ Provide post-procedure care. After
- Hypertrophy of Peyer patches
the procedure, the infant may
Cause experience discomfort and abdominal
distension. The nurse should provide
- Most cases are considered idiopathic.
post-procedure care, such as pain
Risk Factors management and monitoring of vital
signs, to ensure the infant is stable
- Most common < 24 months old
and comfortable.
- Previous intussusception
- Intussusception in sibling ➢ Education. Educate the family
- Intestinal malrotation caregivers on what happens during
intussusception and about the
DIAGNOSIS AND TREATMENT
surgery, and answer questions to
DIAGNOSTIC IMAGING reduce the anxiety.

1. Ultrasound, abdominal X-ray, CT scan FAILURE TO THRIVE

- Telescoped intestine: visualized as “bull’s Failure to thrive
eye” image - is a unique syndrome in which an
- Intestinal obstruction signs infant falls below the 5th percentile
for weight and height on a standard
TREATMENT growth chart or is falling in
1. Air or contrast enema percentiles on a growth chart.
The condition is usually divided into two
2. Surgery categories:
COMPLICATIONS Organic Cause: refers to growth failure that is
due to an acute or chronic medical condition that
- Ischemic Bowel interferes with normal food intake, absorption
- Sepsis or digestion of food, or is due to increased
- Bowel Perforation calorie need to keep up or help growth.
- Peritonitis
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Nonorganic Cause: up to 80% of all children with 4. Monitoring and follow-up: Require
FTT have Non-organic type FTT and occurs when ongoing monitoring and follow-up to
there is inadequate food intake or there is a lack ensure that they are growing and
of environmental stimuli. developing properly.
Management for Nonorganic Causes
Assessment
1. Family therapy: May be necessary to
✓ On physical examination, these infants address the underlying psychosocial
usually demonstrate typical factors contributing to the child's failure
characteristics such as: to thrive. This may involve working with a
✓ Lethargy with poor muscle tone, a loss of mental health professional to identify and
subcutaneous fat, or skin breakdown address issues within the family system
✓ Lack of resistance to the examiner's that may be contributing to the child's
manipulation, unlike the response of the lack of growth and development.
average infant 2. Parenting education and support: To
✓ Rocking on all fours excessively, as if help them better meet their child's
seeking stimulation needs and provide a nurturing
✓ Possibly a greater reluctance to reach for environment.
toys or initiate human contact than is 3. Early intervention: To provide the child
demonstrated by the average infant; with additional stimulation and support to
diminished or nonexistent crying promote growth and development.
✓ Staring hungrily at people who approach 4. Nutritional support: To promote growth
them as if they are starved for human and development.
contact 5. Child protective services: In cases
✓ Little cuddling or conforming to being where neglect or abuse is suspected, to
held ensure the child’s safety and well-being.
✓ Delays in sitting, pulling to a standing 6. Monitoring and follow-up: To ensure
position, crawl-ing, and walking because that they are growing and developing
the child spends so much time alone properly.
✓ Markedly delayed or absent speech Failure to Thrive is not a specific
because of the lack of interaction medical condition, but rather a term
Management for Organic Causes used to describe a pattern of
1. Identifying and treating the underlying inadequate growth and development in
medical condition: This may involve infants and children. It can be caused
diagnostic testing such as blood work, by a wide range of factors, including
imaging studies, or other medical medical conditions, nutritional
interventions. deficiencies, and psychosocial factors
2. Nutritional support: To promote growth such as neglect or abuse.
and development. It is important to identify the
3. Parent education and support: To help underlying cause of failure to thrive in
them manage their child's condition. order to provide appropriate
management and support. Failure to
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thrive can have long-term consequences → Incomplete or no burping after feeding
for a child's physical, cognitive, and → Overfeeding and Underfeeding
emotional development, so early → Food allergy or intollerances
intervention is crucial. → Early form of childhood migraine
COLIC → Imbalance of healthy bacteria in the
digestive tract
COLIC
Risk factors for colic are not well-
→ Colic is frequent, prolonged and intense
understood. Research has not shown
crying or fussiness in a healthy infant.
differences in risk when the following factors
→ Colic can be particularly frustrating for
were considered:
parents because the baby's distress
→ Sex of the child
occurs for no apparent reason and no
→ Preterm and full-term pregnancies
amount of consoling seems to bring any
→ Formula-fed and breast-fed babies
relief.
→ Infants born to mothers who smoked
→ These episodes often occur in the
during pregnancy or after delivery have
evening, when parents themselves are
an increased risk of developing colic.
often tired.
Complications
→ Episodes of colic usually peak when an
Colic does not cause short-term or long-term
infant is about 6 weeks old and decline
medical problems for a child. Research has
significantly after 3 to 4 months of age
shown an association between colic and the
Colic is a poorly understood phenomenon;
following problems with parent well-being:
it is equally likely to occur in both
→ Increased risk of postpartum depression
breastfed and formula-fed infants.
in mothers
→ This condition is encountered in male and
→ Early cessation of breast-feeding
female infants with equal frequency.
→ Feelings of guilt, exhaustion, helplessness
Signs & symptoms:
or anger
→ Intense crying that may seem more like
SHAKEN BABY SYNDROME
screaming or an expression of pain
→ The stress of calming a crying baby has
→ Crying for no apparent reason, unlike
sometimes prompted parents to shake or
crying to express hunger or the need for
otherwise harm their child. Shaking a
a diaper change
baby can cause serious damage to the
→ Extreme fussiness even after crying has
brain and death. The risk of these
diminished Predictable timing, with
uncontrolled reactions is greater if
episodes often occurring in the evening
parents don't have information about
→ Facial discoloring, such as skin flushing or
soothing a crying child, education about
blushing
colic and the support needed for caring
→ Body tension, such as pulled up or
for an infant with colic.
stiffened legs, stiffened arms, clenched
fists, arched back, or tense abdomen
CAUSES:
NURSING MANAGEMENT:
→ Digestive system is not fully developed
ASSESSMENT:
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→ History → One factor that increases the risk for
→ Physical exam having a baby with Down syndrome is the
INTERVENTIONS: mother’s age.
→ Reduce or relieve pain → Women who are 35 years or older when
→ Introduce herbal remedies they become pregnant are more likely to
→ Soothing strategies have a pregnancy affected by Down
→ Feeding practices syndrome than women who become
→ Changes in the diet (Formula change & pregnant at a younger age.
Maternal diet) COMPLICATIONS
→ Educate parents about colic and how to Potentially serious complications — The most
manage colic serious complications of Down syndrome include:
→ Educate parents on how to enhance → Heart defects
parenting skills and knowledge → Blood disorders
TRISOMY 21 → Immune system problems
→ Stomach and digestive system
TRISOMY 21
→ Hormonal disorders
→ Also known as Down syndrome, trisomy 21 → Skeletal problems
is a genetic condition caused by an extra Other complications (Less serious complications)
chromosome. Most babies inherit 23 include:
chromosomes from each parent, for a → Intellectual disability
total of 46 chromosomes. Babies with → Height and weight
Down syndrome however, end up with → Vision
three chromosomes at position 21, → Hearing loss
instead of the usual pair. → Skin
SIGNS & SYMPTOMS → Behavior
→ Distinctive facial features DIAGNOSTIC TESTS FOR NEWBORNS
→ Mild to moderate intellectual disabilities → After birth, the initial diagnosis of Down
→ Heart, kidney and thyroid issues syndrome is often based on the baby's
→ Skeletal abnormalities, including spine, appearance. But the features associated
hip, foot and hand disorders with Down syndrome can be found in
→ Less responsive to stimuli babies without Down syndrome, so your
→ Vision and hearing impairment health care provider will likely order a
→ Inwardly curved little finger test called a chromosomal karyotype to
→ Wide space between the great and confirm diagnosis
second toe TREATMENT & MANAGEMENT
→ Single, deep crease on the soles of the There is no cure for Down syndrome. But a child
feet and one or both hands with Down syndrome may need treatment for
CAUSES & RISK FACTORS problems such as:
Heart defects
→ There are some Minor defects can be
treated with medicines or they will fix
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themselves on their own. Others may
need surgery. All babies with Down
syndrome should have an echocardiogram
(heart ultrasound) and be looked at by a
pediatric cardiologist. This exam and test
should be done shortly after birth. This
is so that any heart defects can be found
and treated correctly.
Intestinal problems
→ Some babies with Down syndrome are
born with intestinal problems that need
surgery.
Vision problems
→ Common problems include crossed eyes,
nearsightedness or farsightedness, and
cataracts. Most eyesight problems can be
made better with eyeglasses, surgery, or
other treatments. Your child should see
an eye doctor (pediatric ophthalmologist)
before they turn 1 year old.
CLEFT PALATE
CLEFT PALATE
→ is a split or opening in the roof of your
mouth that forms during fetal
development.
→ it occurs when the palatal process does SIGNS & SYMPTOMS
not close as usual at approximately 9 to → Aspiration
12 weeks of intrauterine life. → Difficulty with feedings
→ a cleft palate can be on one or both sides → Vomiting
of the roof of the mouth. It may go the → Excessive air swallowing
full length of the palate. → Escape of food in to the nose
→ more common in females. → Chronic ear infections
Class 1- Invoving only soft palate → Fatigue
Class 2- Involving soft palate and hard palate → Irritability
but not the alveolus. → Poor weight gain
Class 3- Soft palate, Hard palate and alveolus on → Coughing or choking
one side → Nasal regurgitation
Class 4- Soft and hard palate and alveolus on RISK FACTORS
both side of premaxilla → Lack of folic acid during pregnancy
→ Genetics/ Hereditary

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→ Smoking or drinking alcohol during IMPORPHERATED ANUS
pregnancy
IMPERFORATED ANUS
→ Nutritional disturbances during
→ A stricture or the absence of the anus.
development
→ A congenital defect in which the opening to the
→ Defective vascular supply
anus is either blocked or missing.
→ Effects of certain drugs such as anti-
→ Fecal elimination may be impossible until surgery is
seizure medications and steroids.
performed.
DIAGNOSIS
→ PATHOPHYSIOLOGY
→ Physical Examination at birth
WHY ARE BABIES BORN WITH AN
→ Ultrasound
IMPERFORATED ANUS?
- CAUSE: underdevelopment of fetus
MEDICAL & SURGICAL MANAGEMENT
- Can be associated with other birth
Management of Cleft palate involves the care of
defects
a multidisciplinary health care team to provide
- Present in approximately 1 in 5,000 live
optimum results, this includes: Pediatrics,
births, more
Orthodontics, Speech Pathology, Audiology and
common in boys than in girls.
Surgeon.
IN WEEK 7 OF INTRAUTERINE LIFE…
Surgery - soft palate repair at 3-6 months of
→ upper bowel elongates to pouch and
age, hard palate repair at 6-18 months of age.
combine with pouch invaginating from the
→ Speech theraphy
perineum. These two sections of bowel
→ Dental Care
meet, the membranes between them are
→ Palatal Obturator
absorbed.
NURSING MANAGEMENT
→ HOWEVER, if these motion toward each
- Encourage genetic counseling to the
other does not occur/membrane between
parents
2 surfaces does not dissolve, an
- the defect evokes negative reaction and
imperforate anus occurs.
shock to the parents, the nurse must
→ The disorder can be relatively minor,
explain about the possibility of defect
requiring just surgical incision of the
correction.
persistent membrane, or much more
- Promote family coping
severe, involving sections of the bowel
- Mother and are family should be
that are many inches apart with no anus.
demonstrated the various techniques of
feeding the baby
There may be an accompanying fistula to the
- Explain to parents about the risk of
bladder in boys and to the vagina in girls
aspiration
(retrovaginal fistula), further complicating a
- Use of specialy nipples or feeding bottle
surgical repair.
to allow the baby to latch properly
COMPLEX (rare defects)
- Baby must be given essential care
■ Rectovaginal fistula
including immunization, warmth, and
■ Persistent cloaca
hygiene.

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NON-COMPLEX (common defects) COMPLICATIONS
■ Rectovestibular fistula → Bowel control problems.
■ Rectoperineal fistula → Bladder control problems.
→ Stool incontinence.
→ Constipation.
→ Problems with sexual function.
ASSESSMENT
→ Condition can be detected with/by a
prenatal sonogram.
→ Meconium-filled black membrane
protrudes from the anus/anal region
if inspection at birth reveals no anus
in a newborn.
→ Wink reflex
→ Through X-ray sonogram –
positioning the baby slightly head-
SIGNS AND SYMPTOMS down to allow swallowed air to rise at
→ Opening of anus is missing or not in the the end of the blind pouch of the
right/usual place. In girls, it may be close bowel.
to the vagina. DIAGNOSIS
→ No passage of poop within 24 hours of → Diagnosis is made through Physical
birth. exams and Imaging tests
→ Poop passes through another opening. → Doctors conduct head to toe
→ (such as in Urethra for boys, Vagina for assessment, after which, diagnosis is
girls) made.
→ Abdominal distention/swollen belly. → Imaging tests include: Ultrasound, X-
RISK FACTORS ray, and MRI.
■ Increased in incidence of Trisomy 13, NURSING MANAGEMENT
18, and 21. → Follow-up care by parents to assess
■ Associated anomalies whether infant is defecating.
–(Genitourinary, Vertebral/Spinal Cord, → Ask parents to collect a urine specimen to
Craniofacial, Cardiovascular, Gastrointestinal.) examine for presence of meconium to
■ Paternal smoking, maternal overweight, help determine whether the infant has a
obesity, and diabetes. rectal-bladder fistula.
■ VACTERL Syndrome → Placing a urine collector bag over the
→ -Vertebral defects vagina in girls may reveal meconium-
→ -Anal defects stained discharge, revealing the presence
→ -Cardiac defects of a rectovaginal fistula.
→ -Tracheoesophageal fistula → Administration of fluids and nutrition
→ -Renal defects through an IV line.
→ NGT or Orogastric feeding.
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→ Maintaining adequate hydration with 2. Long-segment HD - nerve cells are missing
moist mucous membrane, skin turgor, and from most of the large intestine affects’ men
capillary refill good. and women equally
→ Maintaining normal vital signs. What causes Hirschsprung's Disease?
TREATMENT 1. Mutation of genes (RET, EDNRB,
→ The degree of difficulty of repair in an EDN3)
imperforated anus depends on the extent 2. Inheritance
of the problem. 3. Associated conditions: Downs
→ If the baby’s rectum ends very near the syndrome, Neurofibromatosis.
normal site of the anus, your baby may Waardenburg Syndrome, Multiple
need only 1 operation within their first endocrine neoplasia
few days of life: Laparoscopy with Risk factors:
anastomosis - Having a sibling who has
→ Surgery may be more complex if the Hirschsprung's disease.
rectum ends higher. Hirschsprung's disease can be
→ Your baby may also need surgery to inherited. If you have one child who
repair any channels that connect their has the condition, future biological
rectum to other body structures, such as siblings could be at risk
the urinary or genital tract. In this case, - Being male. Hirschsprung's disease is
your baby will need other operations more common in males
before anal repair. - Having other inherited conditions.
HIRSCHSPRUNG’S DISEASE Hirschsprung's disease is associated
can be inherited. If you have one child
Hirschsprung's Disease
who has the condition, future
- Absence of ganglionic innervation to
biological siblings could be at risk.
the muscle of a section of the bowel.
with certain inherited conditions, such
- A congenital condition where nerve
as Down syndrome and other
cells of the myenteric plexus are
abnormalities present at birth, such
absent in the distal bowel and rectum.
as congenital heart disease.
- It is characterized by persistent
Signs and symptoms
constipation resulting from partial or
1. Abdominal distention - Infants with
complete obstruction of mechanical
aganglionic megacolon show tympanitic abdominal
origin
distention and symptoms of intestinal
Myenteric Plexus
obstruction.
- principally responsible for the
2. Chronic constipation - Older infants and
peristaltic movement of the bowels.
children with Hirschsprung's disease usually
TWO MAIN TYPES:
present with chronic constipation
1. Short-segment HD - nerve cells missing from
3. Palpable intestinal loops - Upon abdominal
only the last segment of the large intestine most
examination, these children may demonstrate
common four times more common in men than
marked abdominal distention with palpable
women
dilated loops of colon.
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4. Absence/delayed passage of meconium - segment, degree of colonic dilation,
During the newborn period, infants affected and presence of enterocolitis.
with Hirschsprung's disease may present with - > Ostomy surgery
failure of passage of meconium. - > Pull-through procedure
5. Vomiting - Repeated vomiting is present due Nursing care
to intestinal obstruction. - Promote adequate bowel elimination
6. Malnourishment - Poor nutrition results from monitor for complications
the early satiety, abdominal discomfort, and - Provide supportive care, including the
distention associated with chronic constipation psychosocial need of the child's
Diagnosis and Tests parents or caregivers
1. PLAIN ABDOMINAL RADIOGRAPHY - Postoperative:
performed when signs and symptoms of - NPO
abdominal obstruction arise - Maintain nasogastric tube, or NG
2. CONTRAST ENEMA - use of xray images tube, at low-intermittent suction.
and enema solution with a contrast - Administer IV fluids, antibiotics, and
solution also called barium enema pain meds as ordered closely monitor
3. ANORECTAL MANOMETRY - checks how clients' V/S, fluid intake and output,
well a child's rectum is working done measure abdominal circumference
ONLY ON OLDER CHILDREN - Report signs of enterocolitis, including
4. RECTAL BIOPSY - used to confirm or fever, abd. pain, distension, or
rule out a diagnosis of Hirschsprung explosive, foul smelling diarrhea
Disease In cases of temporary colostomy:
2 types of rectal Biopsy - Assess site, noting normal findings,
- 1. Rectal suction biopsy such as pink or rosy red stoma with
- 2. Full thickness rectal biopsy minimal swelling or bleeding, stoma
Management & Treatment that stays above the level of skin with
Medical Management the colostomy bag securely in place,
- Initial therapy and intact skin surrounding the stoma.
- Decompression Diet - REPORT IMMEDIATELY to HCP if
Pharmacologic management you noticed increased bleeding or
- Drug therapy currently is not a swelling, signs of ischemia, signs of
component of the standard of care retraction, and flattening of stoma
for this disease itself; however, some if peristalsis returns:
medications may be used to treat - d/c the NG tube and start client on
complications of Hirschsprung disease clear liquids
like antibiotics - -closely monitor the color,
Surgical treatment consistency, and amount of stool
- The surgical options vary according to - report if client presents signs of
the patient’s age, mental status, obstruction, including vomiting,
ability to perform activities of daily abdominal distention, or an absence of
living, length of the ganglionic gas or stool
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- attend to psychosocial need of the 3 TYPES OF SPINA BIFIDA
child's parents or caregivers 1. SPINA BIFIDA OCCULTA
- encourage them to participate in - OCCULTA- means “hidden”
child's care, to ask questions, and - Mildest and most common
express their feelings about the - Spina bifida occulta results in a small
diagnosis separation or gap in one or more of
Prognosis the bones of the spine (vertebrae).
- about 90% of children with 2. MENINGOCELE
Hirschsprung’s have no major - Least common type/rare type of spina
complications or difficulties. Of the bifida
10% who do have problems, most - Characterized by a sac of spinal fluid
eventually get better with help from bulging through an opening in the
their doctor and other health spine.
professionals and go on to live a - Babies with meningocele may have
perfectly normal life some minor problems with functioning,
- Reports of long-term outcomes after including those affecting the bladder
definitive repair for Hirschsprung and bowels.
disease are conflicting. Some 3. MYELOMENINGOCELE
investigators report a high degree of - Also known as “open spina bifida”
satisfaction, whereas others report a - Most severe type
significant incidence of constipation - This makes the baby prone to life-
and incontinence. Ingeneral, more threatening infections and may also
than 90% of patients with cause paralysis and bladder and bowel
Hirschsprung disease report dysfunction.
satisfactory outcomes; however, many SIGNS AND SYMPTOMS
patients experience disturbances of ● Tuft of hair
bowel function for several years ● Small dimple or a birthmark
before normal continence is ● Movement problems
established CAUSES:
- Approximately 1% of patients with • Lack of folic acid intake
Hirschsprung disease have • Certain medication
debilitating incontinence requiring a • Genetics
permanent colostomy. TREATMENT:
SPINA BIFIDA • Initial surgery to repair the spine
• Physiotherapy
What is Spina Bifida?
Nursing Management:
SPINA- “spine” BIFIDA- “split”
• Physical examination. When collecting
• Is a birth defect that occurs when the
date during the examination, observe the
spine and spinal cord don’t form properly.
movement and response to stimuli of the
• A type of neural tube defect
lower extremities; carefully measure the
• Most common in baby girls

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head circumference and examine the after surgery, continue this positioning
fontanelles. until the surgical site is well healed.
• Assessment of knowledge regarding the HYDROCEPHALUS
defect. Determine the family’s
knowledge and understanding of the Hydrocephalus
defect, as well as their attitude - Derived from the Greek word “Hydro”
concerning the birth of a newborn with meaning “water”, and “Cephalus”

such serious problems. meaning “Head”.

• Prevent infection. Monitor the newborn’s - Excessive accumulation of

vital signs, neurologic signs, and behavior cerebrospinal fluid (CSF) resulting in

frequently; administer prophylactic abnormal widening of the spaces in

antibiotic as ordered; carry out routine the brain.

aseptic technique; cover the sac with a
sterile dressing moistened in a warm
sterile solution and change it every 2
hours; the dressings may be covered with
a plastic protective covering.
• Promote skin integrity. Placing a
protective barrier between the anus and
the sac may prevent contamination with
fecal material, and diapering is not
advisable with a low defect.
• Prevent contractures of lower Two main types of hydrocephalus in Infants:
extremities. Newborns with spina bifida ➢ Communicating or Extraventricular
often have talipes equinovarus (clubfoot) Hydrocephalus
and congenital hip dysplasia (dislocation - The Fluid is able to reach the spinal
of the hips); if there is loss of motion in cord.
the lower limbs because of the defect ➢ Obstructive or Intraventricular
conduct range-of-motion exercises to - There is a block to CSF so it
prevent contractures; position the cannot circulate into the subarachnoid space.
newborn so that the hips are abducted Who gets Hydrocephalus?
and the feet are in a neutral position; ➢ congenital hydrocephalus (present at
massage the knees and other bony birth)
prominences with lotion regularly, then ➢ acquired hydrocephalus
pad them, and protect them from (occurs following birth).
irritation. Signs and Symptoms
Changes in the Head
• Proper positioning of the newborn.
• An unusually large head
Maintain the newborn in a prone position
• A rapid increase in the size of the head
so that no pressure is placed on the sac;
• A bulging or tense soft spot (fontanel) on
the top of the head
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• Prominent scalp veins Diagnostic Findings
Physical signs and symptoms Examination in infants may include the following:
• Nausea and vomiting ➢ Computed tomography (CT) scanning.
• Sleepiness or sluggishness (lethargy) ➢ Magnetic resonance imaging (MRI).
• Irritability ➢ Ultrasonography through anterior
• Poor eating fontanelle in infants.
• Seizures ➢ Skull radiography.
• Eyes fixed downward (sun setting of the Surgical Management
eyes) SHUNT - a passage that is made to allow blood
• Problems with muscle tone and strength or other fluid to move from one part of the body
Risk Factors to another. It consists of a long, flexible tube
In many cases, the cause of hydrocephalus is with a valve that keeps fluid from the brain,
unknown. However, a number of developmental flowing in the right direction and at the proper
or medical problems can contribute to or trigger rate.
hydrocephalus. Ventriculoperitoneal (VP) Shunt
Newborns - One end of the upstream catheter is in a
Hydrocephalus present at birth (congenital) or ventricle. The other end of the
shortly after birth can occur because of any of downstream catheter is in the peritoneal
the following: cavity
● Abnormal development of the central Ventriculoatrial (VA) Shunt
nervous system that can obstruct the - Ventriculoatrial shunt placement enables
flow of cerebrospinal fluid cerebrospinal fluid (CSF) to flow from the
● Bleeding within the ventricles, a possible cerebral ventricular system to the atrium of the
complication of premature birth heart.
● Infection in the uterus — such as rubella Medical Management
or syphilis — during pregnancy, which can ➢ Diuretics. Acetazolamide (ACZ) and
cause inflammation in fetal brain tissues furosemide (FUR) treat posthemorrhagic
Pathophysiology hydrocephalus in neonates.
➢ Anticonvulsants. Helps to prevent
seizures.
➢ Antibiotics. For shunt infections such as
septicemia, ventriculitis, meningitis, or
given as a prophylactic treatment.
Nursing Assessment
➢ Head circumference.
➢ Neurologic and vital signs.
➢ Check the fontanelles.
➢ Monitor increase in intracranial pressure.
➢ History taking.

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OTITIS MEDIA - . In newborns, the most common causes
are group B strep, E. coli,and less
commonly, Listeria monocytogenes.
MENIGGITIS 2. VIRAL MENINGITIS
- (also called aseptic meningitis) is more
MENINGITIS common than bacterial meningitis and
- is a swelling (inflammation) of the thin usually less serious
membranes that cover the brain and the - Many of the viruses that cause meningitis
spinal cord caused by bacteria or viruses. are common, such as those that cause
These membranes are called the colds, diarrhea, cold sores, and the flu.
meninges. TREATMENT
- it can affect anyone, but is most common The treatment by type includes:
in babies, young children, teenagers and Bacterial Meningitis
young adults. - this treatment will start as quickly as
SIGNS & SYMPTOMS: possible
- cranky - the healthcare provider will give IV
- feed poorly (intravenous) antibiotics
- sleepy or hard to wake up - also get a corticosteroid medicine
- fever Viral Meningitis
- bulging fontanelle - treatment may be done to help ease
OTHER SYMPTOMS: symptoms
- jaundice - no medicines to treat the viruses
- stiffness of the body and neck - herpes simplex virus - which is treated
- a lower than normal temperature with IV antiviral medicine
- weak suck PREVENTION
- high-pitched cry Vaccines to prevent infections that can lead to
CAUSES OF MENINGITIS bacterial meningitis in babies are:
- Most cases are caused by bacteria or - Haemophilus influenzae type b (Hib)
viruses, but some can be due to certain vaccine.
medicines or illnesses. - Pneumococcal (PCV13) vaccine.
- It is most often caused by bacterial or - Meningococcal vaccine
viral infection that moves into the Vaccines against viruses that can lead to
cerebral spinal fluid (CSF). meningitis are:
- A fungus or parasite may also cause - Influenza.
meningitis. - Varicella.
2 types of Meningitis: - Measles, mumps, rubella (MMR).
1. BACTERIAL MENINGITIS NURSING MANAGEMENT
- is rare, but is usually serious and can be - Monitoring and recording vital signs.
life-threatening if not treated right away - Assess the patient's mental status and
provide psychological support if the
patient is conscious.
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- Elevate the head of the bed to 30 Classification
degrees with a straight neck for venous 1. Simple febrile seizures.
drainage from the brain. - This most common type lasts from a few
- Ensure the patient has an IV line for seconds to 15 minutes. Simple febrile
fluids and medications. seizures do not recur within a 24-hour
- Administer antibiotics as prescribed. period and are not specific to one part of
FEBRILE SEIZURE the body.
2. Complex febrile seizures.
What is Febrile Seizure?
- This type lasts longer than 15 minutes,
- A febrile seizure is a convulsion in a child
occurs more than once within 24 hours, or
that's caused by a fever. The fever is
is confined to one side of your child's
often from an infection. Febrile seizures
body.
occur in young, healthy children who have
Prevention of Febrile Seizure
normal development and haven't had any
- -Administer ibuprofen or acetaminophen
neurological symptoms before.
- -Educate parents about the occurrence
- Associated with high fever (38 to 40
of fever at night.
degrees Celsius)
- -Educate parents to read bottle label
- -Most common type is seen in preschool
carefully before administration to ensure
children, although it can occur as late as
the correct dosage.
7 years of age
- -Teach parents that every child who has a
- Most serious if occur under 6 months of
febrile seizure must be seen by a
age
healthcare provider.
Causes
Therapeutic management
1. A sudden spike in temperature, not a
- -TSB
gradual incline
- -Advise parents not to put the child in a
2. Immunization
bathtub of water.
3. Infection
- Suppositories may be given at the
4. History of other family members having
appropriate dose.
had similar seizures.
- -Caution parents not to apply alcohol or
Symptoms
cold water
- Usually, a child having a febrile seizure
- -Parents should not temp to give oral
shakes all over and loses consciousness.
medication during the seizure.
Sometimes, the child may get very stiff
- -At the healthcare facility, a lumbar
or twitch in just one area of the body
puncture will be performed to rule out
. A child having a febrile seizure may:
meningitis. If warranted, antipyretic
- Have a fever higher than 100.4 F (38.0 C) drugs to reduce fever below seizure
- Lose consciousness levels will be administered.
- Shake or jerk the arms and legs - -Appropriate antibiotic therapy will be
prescribed if infection is documented.

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AUTISM • Meet childs basic human needs
• Utilizes and teaches certain “behavior
Autism
modification technique”, formulate
- is a developmental disorder that appears
schedule and fix up activities
in the first 3 years of life, and affects
• Encourage child to do activities on his
the brain’s normal development of social
own
and communication skills.
• Provide moral support to parents
• Teach child signs, symbol, eye contact
(non verbal)
• Demontrate “communication skills”, “social
skills”. Teach importance of establishing
and maintaining good interpersonal
relationship.
• Encourages, appreciates child, ensures
positive and social reinforcementto the
child fo exhibition of desirable behaviors
Common symptoms in the child with Autism • Motivate child to express or to
spectrum disorder: communicate his needs verbally
• Failure to develop social relations • Clarify and make child to interpret
• Stereotyped behaviors such as hand his/her behavior
gestures • Provide the language training to the child
• Extreme resistance to change in routine • Help child to learn creative activities
• Abnormal responses to sensory stimuli • Give familiar objects to the child
• Decreased sensitivity to pain • Assist child to learn their own body parts
• Inappropriate or decreased emotional • Make the child adjust socially to the
expression environment
• Specific, limited intellectual problem
solving abilities
• Stereotyped or repetitive used of
language
• Impaired ability to initiate or sustain a
conversation
Causes and Risk Factors
• Having a sibling with ASD
• Having older parents
• Having certain genetic conditions
• Being born with a very low birth weight
• Males are 4-5 times more likely to have
ASD than females
Nursing Management
• Serve child one to one basis
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