HIGH RISK NEWBORN

DISORDER DESCRIPTION CAUSES SIGNS AND SYMPTOMS MANAGEMENT

 immature
nerulogic system
 infants head
appears
disproportionally
 Early Preterm  latrogenic causes
large (≥3cm
(bet 24&38  low socioeconomic
higher than chest
weeks) levels
size)
 live-born infant  inadequate
 ruddy skin
PRETERM before end of nutrition and  intensive care
 lacking vetrix
week of 37 smoking, alcohol
 Lanugo covering
gestation use
the back forearms,
 late preterm (bet  increase use of
forehead and sides
34-37weeks) invitro fertilization
of the face
 anterior and
posterior
fontanelles will be
small

SMALL FOR  also called  women’s nutrition  if the UCP level is

GESTATIONAL AGE microsomia during pregnancy more than 65-70%
 they have  placental issue; an exchange
experienced underdevelopment transfusion to dilute
intrauterine  severe DM or GH the blood may be
growth restriction  smoking necessary
or failed to grow  Infant with decrease
at the expected glycogen stoves
 may need IV
rate in utero glucose to sustain
blood sugar

 overproduction of
nutrients and
 Macrosomia
growth hormone in
 BW above the  Assess infant’s HR
LARGE FOR the utero
90th percentile on  Assess for
GESTATIONAL AGE  obese women
the intrauterine hypoglycemia in the
 multiparty
growth chart early hours of life
 beckwith-
Wiederman
Syndrome
 sonogram
 born after 41st
POST TERM INFANT  CS Birth
week of
pregnancy  Follow up care
 Non-stress test
RESPIRATORY  hyaline  premature Subtle signs:  surfactant
DISTRESS SYNDROME membrane newborns  decrease body replacement
disease  newborn with temp.  oxygen
MAS  Nasal flaring administration
 sepsis  cyanotic mucous  Ventilation
 pneumonia membrane  Nitric Oxide- potent
 newborn who is  sternal and vascular dilator
slow to transition subcostal  Extracorpureal
to extrauterine life retractions membrane
 heart failure (dec. oxygenation
I/O and edema)  Supportive care
  Pale gray skin
 Periods of apnea
 Bradycardia
 Pneumothorax

 the respiratory
rate doesn’t slow  mild retractions  close observation
as a result of a and some nasal  mild glucosteroid to
TACHYPNEA delayed
 CS birth flaring reduce respiratory
absorption of
alveolar fluid in  difficulty feeding tract inflammation
the lungs

MECONIUM  Meconium is  Meconium may  difficulty  oxygen requirement

ASPIRATION present in the cause severe respi. establishing  Amnioinfusion: to
SYNDROME fetal bones as Distress respirations at dilute the amount of
early as 10 wks of (tachypnea,
birth meconium in the AF
gestation. If retractions, and
hypoxia occurs, a grunting)  low APGAR score  Antibiotic therapy
vagus reflex is  If lung compliance
stimulated is poor, surfactant
resulting in may be administered
relaxation of the
 Observe closely for
rectal sphincter.
signs of heart failure
 Maintain temp. –
neutral envi.
 Chest physiotherapy
with percussion and
vibration: to
 encourage the
removal of remnants

 Babies with  maintain a neutral

secondary stresses thermal envi.
 cessation in such as infection,  suction gently and
respiration lasting hyperbilirubinemia only when needed
longer than 20 , hypoglycemia or
APNEA  used indwelling
secs, sometimes hypothermia
accompanied by nasogastric tube
 fatigue or
bradycardia and  careful burping
immaturity of
cyanosis  Caffeine,
respiratory
nethylscanthine: to
mechanisms
stimulate breathing

SUDDEN INFANT sudden unexplained Occur at high rates  Autopsy reveals  parents counseling
DEATH SYNDROME death in infancy  adolescents mother petechiae in the
 infants of closely lungs and mild
spaced pregnancies inflammation and
congestion in the
 underweight and respi tract
preterm infants
Possible contributing
factors:
 sleeping prone
rather than supine
 viral respi or
botulism infx
 exposure to
secondary smoke
 Pulmonary edema

 Home apnea
monitoring used for
 characterized by a
noticeable color this high-risk infant
APPARENT LIFE change, some during sleep to alert
 apnea
THREATENING EVENT degree of apnea the parents of any
and decreased apnea episodes
tone  cardiopulmonary
resuscitation

 the term
hemolytic is latin
for destruction  Exchange
(lysis) of RBC Transfusion
 Rh Incompatibility  Rising anti-Rh
 present when  initiation of early
 ABO tiler in woman
HYPERBILIRUBINEMIA there is occlusive feeding (bowel
Incompatibility during pregnancy
destruvtion of peristalsis)
RBC, which leads  Phototherapy
to elevated
bilirubin levels

NECROTIZING  Gi diseases  because of anoxia

ENTEROCOLITIS to the bowel and
so may result as a
complication of
exchange
transfusion or an
episode of
 breathing difficulty

 caused by
 immature retinal
vasoconstriction
BV constrict when
of immature
exposed to high  Cryosurgery/ Laser
retinal BV
RETINOPATHY O2 concentration therapy
PREMATURITY (ROP)  acquired ocular
 Blood PO2 levels  Secure oxygen
disease that leads
rise to higher than saturation levels
to partial or total
100 mmHg
blindness

THE NEWBORN AT RISK BECAUSE OF MATERNAL INFECTION OR ILLNESS

 Disorder
Description Causes Signs and Symptoms Management
 Beta-  Born after prolonged  If a newborn displays signs or a blood
hemolytic,grou rupture of membranes screening test is positive, antibiotics are
pB  Woman’s vaginal administered. Gentamicin, ampicillin, and
streptococcal culture is positive for penicillin are all effective against GBS
Beta-Hemolytic, organism GBS infections.
Group B (GBS)  Pneumonia, Tachypnea,  Immunization of all women of childbearing
Streptococcal  Improper Apnea, Signs of Shock- age against streptococcal B organisms
Infection handwashing first day of life  Great deal of support in caring for their
technique  Meningitis infant
-lethargy, fever, loss of
appetite, and bulging
fontanelles

Ophthalmia is an eye infection  The most  The conjunctivae  If gonococci are identified, intravenous
Neonatorum that occurs at birth common become fiery red, with ceftriaxone (Rocephin) and penicillin are
or during the first causative thick pus. effective drugs.
month organisms are  The eyelids are  If chlamydia is identified, an ophthalmic
(MacDonald, Neisseria edematous solution of erythromycin is used.
Mailman, & Desai, gonorrhoeae  In addition to systemic antibiotic therapy,
2008). and Chlamydia the eyes are irrigated with sterile saline
trachomatis. solution to clear the copious discharge.
 The mother of the infected infant needs
treatment for gonorrhea or chlamydia,
before fallopian tube sterility or pelvic
inflammatory disease results
 Sexual contacts of the mother should be
treated also
Prevention
 The prophylactic instillation of
 erythromycin ointment into the eyes of
newborns prevents both gonococcal and
chlamydial conjunctivitis.
Hepatitis B virus contact with infected Liver cancer  Routinely vaccinated at birth
(HBV) can be vaginal blood at birth  Administered immune serum globulin
transmitted to the when the mother is (HBIG) within 12 hours of birth to
newborn through positive for the virus decrease the possibility of infection.
Hepatitis B Virus
contact with (HBsAg%).  The infant should be bathed as soon as
Infection
infected vaginal possible after birth to remove HBV-
blood at birth when infected blood and secretions.
the mother is
positive for the
virus (HBsAg%).
A herpes simplex  Contracted  Infants has vesicles  An antiviral drug such as Acyclovir
virus type 2 (HSV- from the covering the skin. (Zovirax), a drug that inhibits viral
2) infection, most vaginal  Neurologic Damage deoxyribonucleic acid synthesis, is effective
prevalent among secretions of a  Loss of appetite, low- in combating this overwhelming infection.
women with mother who grade fever, and  Cesarean Birth
multiple sexual has active lethargy. Stomatitis  Infants with an infection should be
Generalized partners, can be herpetic (ulcers of the mouth) or separated from other infants.
Herpes virus contracted by a vulvovaginitis
Infection
a few vesicles on the  Health care personnel who have herpes
fetus across the at the time of skin appear. (Day 4-7) simplex infections should not care for
placenta if the birth.  Dyspnea newborns until the lesions are crusted.
mother has a  Jaundice  Urge a woman who is separated from her
primary infection  Purpura newborn at birth to view her infant from the
during pregnancy nursery window and participate in planning
 Convulsions
 Shock care to aid bonding.

Human  Caused by
Immunodeficienc placental
y Virus Infection transfer or
direct contact
 with maternal
blood during
birth.

 Macrosomia  Infants of diabetic women are fed early with

 Birth Injury: shoulder formula administered
& Neck Injury  A continuous infusion of glucose.
 Hyperbilirubinemia  Careful monitoring for normal bowel
Diabetes Mellitus  Hyperglycemic movements is important.
 Hypocalcemia
 Caudal regression
syndrome
 Congenital anomaly

An Infant of a Infants of drug-  Irritability  Keep them in an environment free from

Drug-Dependent dependent women • Disturbed sleep pattern excessive stimuli (a small isolation nursery,
Mother tend to be SGA. If • Constant movement, possibly not a large, noisy one).
the woman is leading to abrasions on the  Maintenance of electrolyte
dependent on a elbows, knees, or nose and fluid balance is essential
drug, an infant will • Tremors  IV Administration if infant has vomiting or
show withdrawal • Frequent sneezing diarrhea
symptoms • Shrill, high-pitched cry  drugs used to counteract withdrawal
(neonatal  Possible hyperreflexia symptoms
abstinence and clonus include paregoric, phenobarbital,
syndrome) shortly (neuromuscular methadone, chlorpromazine (Thorazine),
after birth irritability) and diazepam (Valium).
• Convulsions  Avoid breastfeeding
• Tachypnea (rapid
respirations), possibly so
severe that it
leads to hyperventilation and
 alkalosis
• Vomiting and diarrhea,
leading to large fluid losses
and
secondary dehydration
Complications
 Long term neurologic
problems

Alcohol Intake Alcohol crosses the Possible problems at birth  All pregnant women are advised to avoid
placenta in the same  Prenatal and postnatal alcohol intake to prevent any teratogenic
concentration as is growth restriction; effects on their newborn
present in the maternal central nervous system
bloodstream. This involvement such as
results in fetal alcohol cognitive challenge,
exposure and fetal microcephaly, and
alcohol syndrome cerebral palsy; and a
distinctive facial
feature of a short
An Infant With palpebral fissure and
Fetal Alcohol thin upper lip.
Exposure Neonatal Period
 Tremulous, fidgety, and
irritable and may
demonstrate a weak
sucking reflex.
 Sleep disturbances
Long term effect:
 Cognitive challenge

 Hyperactivity
 Growth Deficiencies
 Disorders of the Skeletal System
Disorder Description Causes Signs and Symptoms Management
1. Absent or Absence or Congenital skeletal disorders may Absent or malformed upper  Fitted with a prosthesis early in life
 result from reasons such as:  Children will have better function if malformed
 maternal drug ingestion portion is amputated before prosthesis is fitted
malformity of the
 virus invasion during pregnancy  Lower extremity: prostheses are fitted as early as 6
Malformed upper and/or lower and/or lower extremities or
 amniotic band formation in months; gait training
Extremities extremities or fingers fingers or toes
utero  Upper extremity: prostheses are fitted at 6 mos
or toes.
In most instances, the cause of  Encourage positive outlook in life
anomaly cannot be established.  Rehabilitation
 Passive stretching exercises
 Infant holds the head tilted
 Lying the infant on a flat surface & rotating the
to the side of the muscle
head through a full ROM
 Occurs as a congenital anomaly involved; the chin rotates to
 Encourage infant to look in the direction of the
when sternocleidomastoid the opposite side.
affected muscle by:
Torticollis is a term muscle is injured & bleeds  Becomes evident only as the
 Feeding
2. Torticollis (Wry derived from tortus during birth original hemorrhage recedes
 Placing a mobile on child’s crib
Neck) (twisted) and collum  Tends to occur in NBs w/ wide and fibrous contraction
 Speaking to and handing objects to the child
(neck). shoulders when pressure is occurs at 1 to 2 months of
 If it still exists at 1 y/o: surgical correction followed
exerted on the head to deliver age.
by a neck immobilizer
the shoulder  A thick mass over the muscle
 Adults w/ spastic torticollis: botulism (Botox)
can usually be palpated at
injections (not recommended or necessary for
this time.
most infants)
 Surgical Procedures:
 Ravitch: Surgeon removes abnormal cartilage &
ribs, fractures sternum, and places a support
Indentation of the
system in the chest to hold it in the proper
lower portion of the
3. Pectus Children usually are born with this position. Typically used for 14 to 21 y/o.
sternum. As a result,  Depression in the chest (in
Excavatum condition, but they may also  Nuss: More recent, less invasive. Using small
lung volume the sternum area)
(Funnel or develop it after chronic obstructive incisions, surgeon inserts a curved metal bar to
decreases and heart  Lower ribs might flare out
Sunken Chest) lung disease or rickets. push out the sternum & ribs, helping reshape
is displaced to the
them. A stabilizer bar is added to keep it in
left.
place. The chest is permanently reshaped in 3
years and both bars are surgically removed.
Procedure can be used with age 8 and older.
4. Craniosynostosis Premature closure of  May occur in utero or early in  Sagittal suture line closes  Continuous measurement of head circumference
the sutures of the infancy because of rickets or prematurely: child’s head on children age 2 years or younger
skull. The posterior irregularities of calcium or tends to grow anteriorly and  If sagittal suture line: Careful observation
 posteriorly.
phosphate metabolism  Coronal suture line fuses
fontanelle normally  Also occurs as a dominantly early: orbits of eyes become
closes at 2 months of inherited trait misshapen, and the
 If coronal suture line: Surgically open to prevent
age, the anterior  Occurs ore often in boys increased ICP may lead to
brain compression & an abnormally shaped head
fontanelle at 12 to  Premature close of coronal exophthalmos, nystagmus,
18 months. suture line is associated with papilledema, strabismus, and
syndactyly atrophy of optic nerve w/
consequent loss of vision.
 Stunted arms and legs
Failure of bone  Head appears abnormally
growth inherited as a large (because this grows
dominant trait. It normally); prominent
 Children may be prescribed growth hormone to
5. Achondroplasia causes a disorder in forehead & flattened bridge
Epiphyseal bones can’t produce increase their ultimate height or, although
or cartilage prod. in of nose
adequate cartilage for longitudinal controversial, leg lengthening may be possible.
Chondrodystro- utero. Women will  Thoracic kyphosis (outward
bone growth.  Encourage positive outlook in life
phia have difficulty w/ curve) and lumbar lordosis
 Continued guidance or counseling
childbearing because (inward curve) of the spine
of a small pelvis, may develop
necessitating a CS.  Rarely reach a height of
more than 4 ft 6 in (140 cm)
6. Talipes Disorders Latin words talus  Occurs more often in boys  Shoe size may vary as much  Make a habit of straightening all NB feet to the
(ankle) & pes (foot).  Probably inherited as a as two shoe sizes midline as part of initial assessment
These are ankle–foot polygenic pattern  child may have asymmetry of  Cast is applied while the foot is placed in an
disorders, aka  Usually a unilateral problem leg length overcorrected position; cast extends above knee to
clubfoot. 4 types:  Some have a pseudo-talipes  Pseudo-talipes: foot looks ensure firm correction; casts must be changed
a) plantarflexion disorder d/t intrauterine turned in but can be brought almost every 1 or 2 wks; after approx. 6 wks (time
(an equinus or position into a straight position by varies depending on extent of problem), final cast
“horsefoot” manipulation is removed
position;  True talipes: foot cannot be  Change diapers freq. to prevent a wet diaper from
forefoot lower properly aligned without touching the cast and causing it to become soaked
than heel) further intervention w/ urine or meconium
b) dorsiflexion (heel  Review w/ parents how to check infant’s toes for
is lower than coldness/blueness & how to blanch a toenail bed
forefoot or and watch it turn pink to assess for good circulation
 anterior foot is
flexed toward
anterior leg)
c) varus deviation
 Since NB cannot report pain except by crying,
(foot turns in)
crying episodes must be evaluated carefully
d) valgus deviation
 After removal of cast: perform passive foot
(foot turns out)
exercises; infant may have to sleep in Denis Brown
Most children have a
splints (shoes attached to a metal bar to maintain
combination or an
position) or a high-top shoes at night for a few mos
equinovarus or a
 Surgery can also be done
calcaneovalgus
disorder (child walks
on the heel w/ foot
everted)
 Subluxated hip: femur “rides
 Idiopathic up” d/t flat acetabulum
 May be from a polygenic  Dislocated hip: femur rides
inheritance pattern so far up that it actually
 May also occur from a uterine leaves the acetabulum
 Positioning the hip into a flexed, abducted
position that causes less-than-  Sometimes affected leg may
(externally rotated) position to press the femur
usual pressure of the femur appear slightly shorter than
7. Developmental head against the acetabulum and cause it to
Improper formation head on the acetabulum the other bec. femur head
Hip Dysplasia / deepen its contour by the pressure
& function of the hip  Occurs most often in children rides so high in the socket.
Congenital Hip  Splints, halters, or casts may be used
socket of Mediterranean ancestry This is most noticeable when
Dysplasia  Those who do not achieve correction by these
 Found 6x more in girls, possibly child is supine and thighs are
methods will have surgery and a pin inserted to
because hips are more flaring flexed to a 90° angle toward
stabilize the hip
in females & possibly because abd. One knee will appear to
maternal hormone relaxin be lower than the other.
causes pelvic ligaments to be  Subluxated or dislocated hips
more relaxed are best assessed by noting
whether the hips abduct