Family Centered Care of

the Newborn
Erin Bailey, RN
Ch 8, 9, 10, 11
Adjustments to Extrauterine Life
Immediate changes
Respiratory system-chemical factors in the
blood (low pH, low oxygen, high CO2) &
thermal stimuli (sudden change in ambient
temp & warming) help initiate respiration
Adjustments to Extrauterine Life
cont.
Circulatory system-change from fetal to postnatal
circulation
• Lungs expand and O2 dialates pulmonary vessels
• Decreases pulmonary vascular resistance & increases
pulmonary blood flow
• As lungs receive blood, pressure in right atrium & ventricle &
pulmonary arteries decrease
• At same time there is a rise in systemic vascular resistance and
increases blood volume due to cord clamping which increases
pressure in left side of heart
• Since blood flow from areas high pressure to low pressure,
circulation through fetal shunts is reversed
Change in circulation cont.
Increased oxygen, decreased endogenous
prostaglandins, & acidosis are main factors
directing ductal closures
Foramen ovale- closes at or soon after
birthfrom compression of 2 parts of atrial
septum
Ductus arteriosus-closed by 4th day
Thermoregulation
Factors that predispose to heat loss
Large surface area
Thin subcutaneous fat layer
Nonshivering thermogenesis-newborn cannot
shiver like child; uses brown adipose tissue
which uses increased metabolic activity to
produce heat, BAT found around nape of neck,
axilla, between scapula, behind sternum,
around kidneys, trachea, esophagus, adrenals
Status of Systems
Hemopoietic-blood volume depends on
placental transfer of blood

Fluid & electrolytes-term infant 73% fluid; rate

of fluid exchange 7 times adult + rate of
metabolism twice as great in relation to weight
+ kidneys cannot concentrate urine to conserve
water
Gastrointestinal
Only able to use simple carbohydrates and proteins
Deficient pancreatic lipase limits fat usage
immature liver and reduced activity of glycuronyl
transferase affect conjugaton of bilirubin which
contributes to physiological jaundice
No saliva till 2-3months
In esophagus, rapid peristalsis and simultaneous
nonperistalsis along with immature lower esophageal
sphincter cause frequent spitting-up
Renal System-
cannot concentrate urine;
should first void within 24 hours of birth;
24 hour urinary output should be 200-300ml by
the first week of life
Integument
Epidermis and dermis thin and loosely bound together;
slight friction (ex. Tape removed) can cause blisters
Sebaceous glands-very active producing vernix on face
scalp, & genitalia, plugged glands are milia
Eccrine (sweat) glands functional at birth (palms) but
apocrine glands nonfunctional till puberty
Hair follicles-growth and loss asynchronous during first
months
Melanin low at birth ie. Lighter skin color than as adults
Musculoskeletal
More cartilage that bone; calcification rapid in
1st year(nose, skull, sinuses)
Muscular system complete at birth; growth by
hypertrophy not hyperplasia
Immune System
Defense-skin & mucous membranes- primarily
Secondary-cellular elements
Third line of defense-antibodies; unable to
make own immunoglobulins (Ig) till 2nd month
but use passive immunity (IgG) from mother
circulation and milk for about 3 months
Endocrine-
Limited ADH (normally inhibits diuresis)-
prone to dehydration
Increased maternal sex hormones-engorged
breast, enlarged labia, pseudomenstration
Neurological system
Incompleterly integrated
Primitive reflexes
Myelination is cephalocaudal-proximodistal
Sensory function
Vision-eye structure incomplete
Hearing
Smell
Taste
Touch
Assessment
Apgar-Initial Assassment
Scored at 1 & 5 minutes after birth and until
stabile
Score heart rate, respiratory effort, muscle tone,
reflex, color
Transitional Assessment
First period of reactivity.
6-8 hours after birth;
During 1st 30 min.Very alert, cries, sucks.
Second stage-last 2-4 hrs.; Heart rate, respirations,
temperature, mucous production decrease and
stool/urine not passed; Infant calm & asleep.
Second period of reactivity.
o Begins when wakes & last 2-5 hrs.
o Alert and active.
o Ends when respiratory mucous has decreased.
Behavioral Assessment
Brazelton Neonatal Behavioral Assessment
Attachment & Bonding
Bonding-development of emotional ties
from parent to infant
Attachment-ties from infant to parent
Important and difficult to assess
Support systems
Ideal v.fantasy
drugs
Assessment of Gestational Age
Dubowits Scale
Ballard Scale
Correlation with weight ,length, head
LGA, SGA, AGA
Physical Assessment of Newborn
Measurements-head, length, weight, chest
Vital Signs-temperature, respiratory rate,
heart rate, BP
General-posture
Skin-hair, red areas, discolored areas,
edema, tags
Head-fontanels, caputs, hematomas,
craniotabes
cont
Eyes
Ears
Nose
Mouth &Throat
Neck
Chest
Lungs
Heart
Abdomen
Cont.

Genitalia
Back/rectum
Extremities
Neuromuscular
 Reflexes

Babisnki

Tonic neck

Moro
Reflexes

Dance and Crawl Reflex

Care

Maintain airway patency

Bulb syringe
Supine
Monitor signs closely
Maintain body temperature
Cover and bundle
Dry
Use warm instruments
Cont.
Protect from injury
HANDWASHING!!!!!!!
Identification
Eye care-opthalmia neonatorum
Hep B
Vitamin K
Newborn & Hearing Screening
Bathing & standard precautions
Umbilical care
Circumcision care
Nutrition
Breast Feeding
Protective
Types
Positioning
Twins
Problems
Bottle Feeding
Formula
preparation
Breast milk
Schedules
Cues and
behavior
Fathers and Siblings
Discharge to Home
Instructions!!!
Health Problems of the
Newborn
Chapter 9
Types of Injuries
Birth injuries
Dermatological problems
Physiologic factors
Inborn errors of metabolism
Problems caused by perinatal
environmental factors
Birth Injuries
Occur during birth process
Most likely when infant is large, breech, delivery
is precipitous, forceful extraction is used, or
practitioner is inexperienced
Types-
Soft tissue
Head trauma
Fractures
Paralysis
Soft tissue injuries
Generally bruises or
abrasions secondary to
dystocia
Nursing care- directed
at preventing skin
breakdown and
infection
Head Trauma
Caput Succedaneum-
most common;
edematous area over scalp
where presented in vertex
delivery;
serum and blood accumulate
between bone and skin;
Swelling subsides in days
 Head Trauma cont.

Subgaleal Hemmorrhage-
Bleeding into subgaleal
compartment (space
containing connective tissue
that connects frontal and
occipital muscles an forms
inner scalp;
Signs-boggy scalp,pallor,
tachycardia, increasing head
circumference
Care-CT/MRI, replace lost
blood, monitor LOC & H&H,
watch bili
Head Trauma cont.

Cephalhematoma-
bleeding between bone &
periostium
Minimal swelling at birth &
increases on 2nd/3rd day
No treatment; absorbs in 2
weeks-3 months
Monitor bili and for infection
Head Trauma
Care directed to assessment and observation
of injury and for possible infection and skin
breakdown
Reassure parent that resolves spontaneously
Fractures
Clavicle most common- noted by crepitus &
edema/hematome; verified by Xray;suspect if
limited use of armof cries when moves arm
Long bones-infants with these fractures should be
assessed for osteogenesis and other congenital
orders
Skull-uncommon; follow prolonged,difficult labor
or forceps; Most fractures are linear; craniotabes-
cranial bones move freely (prematurity, rickets,
hydrocephalus);
Paralysis
Facial-primary cranial nerve VII with loss
of movement on affected side
Brachial Palsy
Phrenic Nerve
Dermatological Problems
Erythema Toxicum Neonatorum
Candidiasis
Bullous Impetigo
Birthmarks
Erythema Toxicum Neonatorum
newborn rash;
appear within 2-3 days as 1-3mm lesions
that are firm with yellow/white pustules on
erythematous base;
multiple or single;
anywhere but palms and soles;
etiology unknown
Candidiasis (aka moniliasis)
Candida albicans-yeast like fungus
acquired from maternal vaginal delivery, person-to-person from
poor hand washing, contaminated hands, nipples, bottles, …
Often confined to oral (thrush) and diaper regions
Thrush-white adherent patches on tongue, palate, inner cheeks
(difficult to distinguish from milk);
can cause decrease suck from pain
Acute in newborns but chronic in older infants/children
Appears from altered flora from antibiotics/poor hand washing
Generally spontaneously resolves, but may take as long as 2
months; Can spread to larynx, trachea, bronchi, and lungs
Bullous Impetigo (impetigo neonatoum)
Superficial by Staph aureus
Vesicular lesions and intact skin on any body surface
Vary in size, contain turbid fluid, and easily ruptured
Treat with oral antibiotics and Bactroban
Isolate to prevent spread to other infants
HANDWASHING and standard precautions
Prevent scratching in older infants
Birthmarks
Problems Related to
Physiological Factors
Hyperbilirubinemia
Hemolytic Disease of Newborn
Hypoglycemia
Hyperglycemia
Hypocalcemia
Hemmorrhagic Disease of Newborn
Hyperbilirubinemia

Refers to excessive level of accumulated

bilirubin in blood; causes Jaundice (icterus)
May result in increased unconjugated or
conjugated bilirubin; Common in newborns
=unconjugated
Uncongugated bili is highly toxic to neurons (at
risk for bilirubin encephalopathy)
Kernicterus- yellow staining of brain cells
Signs of bilirubin encephalopathy-CNS
depression or excitation
Phototherapy
Frequent bili levels checked (6-12hours)
Eye shields and diaper in place
Check eyes every 4 hrs for discharge or signs of
pressure and remove during feedings for stimulation
Monitor ambient and body temp
Side effects-loose stools, rashes, hyperthermia,
increased metabolism, dehydration, electrolyte
disturbances
No lotions or oil
Family support and discharge planning
Phototherapy
Hemolytic Disease of Newborn
Abnormally rapid rate of RBC destruction often
causing hyperbilirubinemia
Blood incompatibility-read patho pg. 310-312
Rh incompatibility (Alloimmunization)-difficulty arises
when mother is Rh + and and infant is Rh-;
Can cause fetal hypoxia, cardiac failure, asascara,
effusions, and still born
Prevention-RhoGAM
Intrauterine transfusions
Exchange transfusion
Hypoglycemia
Plasma glucose<45mg/dl(2.5mmol/L) requires
intervention
At risk-maternal illness (diabetes, HTN,
terbutaline administration) or newborn factors
(hypoxia, infection, hypothermia, polycythemia,
congenital malformations, hyperinsulinism, SGA,
fetal hydrops)
Interventions-breast/bottle feed, oral D5W, IV
dextrose
Hyperglycemia
Glucose>125 in full term or >150 in preterm
infant
At risk-SGA, with decreased insulin sensitivity
(transient DM), receiving methylxanthines, infants
that are stressed (respiratory, surgery)
Usually asymptomatic
Treat by reducing glucose intake or insulin in very
SGA
Hypocalcemia
Normal range7.0-8.5 mg/dl
Early-onset hypocalcemia-
Late-onset hypocalcemia (cow’smilk-induced
hypocalcemia/neonatal tetany)
Treat with early feedings, correction of
hypoparathyroidism, and sometimes calcium
supplements, IV calcium gluconate 10%
Monitor for signs of hypercalcemia-vomiting,
bradycardia
Hemorragic disease of Newborn
Bleeding disorder due to vit K deficiency
Signs-bleeding from umbilicus or circ site,
bloody/black stools, hematuria, ecchymosis,
epistaxis, or bleeding from punctures
Check PT, OTT, platelets, fibrinogen level
Prophylactic Vitamin K at birth!
Inborn Errors of Metabolism
Congenital Hypothyroidism
Phenylketonuria (PKU)
Galactosemia
Congenital Hypothyroidism
“cretinism”
Deficient thyroid hormones at birth
Permanent CH
Transient hypothyroidism
Signs are subtle (Typical thyroid signs usually
appear 6 wks after life)
Treatment-lifelong thyroid replacement
Most important-early id to reverse and prevent
lasting effects
Phenylketonuria (PKU)

Autosomal-recessive trait, caused by absence of

enzyme to metabolize phenylalanine
Common in Caucasian children in USA an Europe
Manifestations- FTT, frequent vomiting, irritability,
hyperactivity, unpredictable erratic behavior
Early prevention and treatment prevents mental
retardation- Guthrie blood test before hospital
discharge and at 2wks of age
Treatment-dietary management
Galactosemia
Autosomal-recessive trait where hepatic enzyme
galactase 1-phosphate uridine transferase is absent
As galactose accumulates in blood, hepatic dysfunction
leads to cirrhosis and jaundice by 2nd week of life;
spleen enlarges from portal HTN; cataracts by 1-
2months; cerebral damageevident after 2 months
Signs-malnutrition, dehydration, decreased muscle
mass and body fat
Treatment-eliminate all milk and lactose containing
foods including breast milk
Problems caused by perinatal
environmental factors
Infectious agents
Chemical agents
Fetal alcohol syndrome
Radiation
Infectious Agents
Caused by maternal infection (especially
viral during early gestation)
T-Toxoplasmosis
T-
O-other
O- (hepatitis, parvovirus,…)
R-Rubella
R-
C-Cytomegalovirus
H-Herpes
H-H simplex virus
Infectious Agents cont.
Standard pecautions
No pregnant women around persons with
suspected TORCH
Chemical Agents
Drugs have little effect on fetal tissue till
day 15; days 15-90 drugs affect tissue that
has affinity for it; 90+days fetal tissue
relatively resistant to tetratogenic drugs
Caution expecting mothers against taking
any medication without checking with
practitioner
Fetal alcohol syndrome (FAS)
Features: box 9-3
Fetal Alcohol Effects-show cognitive,
behavioral, and psycosocial problems
without facial dysmorphia and growth
retardation
Leading cause of mental retardation
Early diagnosis and treatment beneficial
Totally preventable!!!!!!!!!!!
Chapter 10 High Risk
Newborn
General Management of High
Risk Newborn
Identify
Intensive Care facilities
Uterus is ideal place to transport
Nursing Care
InitialAssessment
Systematic Assessment
Monitor Physiological data
Safety Respiratory support
Thermoregulation
Protect from infection-hand washing, no one sick
in room
Hydration
Skin care-careful with tape & soaps
Nursing Care cont.
Nutrition-sucking and swallowing do no
occur till 32-34 wks gestation and gag reflex
till 36wks;
Medications- be meticulous to detail
NO bacteriostatic or hyperosmolar solutions
(preservative is toxic)
Pain
Nursing Care cont
Developmental outcomes vary
Highest risk are those that had respiratory distress
and youngest gestational age
Avoid waking infant for touch or care-disrupts
sleep/wake cycle; use cues to determine when to
interact
Swaddle, slow position changes, massage, gentle
touch, Kangaroo care, co-bed multiples, positioning
and caution to parents on SIDS
Auditory and visual stimulation
Nursing Care cont.
Facilitating parent-infant relationships
Discharge planning and home care
Rooming in
Begin early on instructing parents and increasing their
skill
Immunizations, home health, equipment, referrals??
Car seat safety and car seat test (blankets rolled)
Nutritional info
Nursing care cont.
Neonatal loss
Loss for parents, few memories, loss of part of themselves-let
photograph before and after death and take mementos (lock of
hair, hand/footprints, cards)
Let hold infant before death if possible and be present for
death (important to hold more than once-say hello and
goodbye)
Allow to parent after death
Family room
Talk openly and honestly about funeral and any questions
Allow for Baptism/religious ceremonies before and after death
High risk conditions related to
dysmaturity
Preterm-largest # of admissions to NICU
Postmaturity-beyond 42 weeks
High risk related to disturbed
respiratory function
Apnea of Prematurity (AOP)-periodic
breathers with periods of rapid breathing
and slow breathing; apnea 20+s which may
have color change or bradycardia
Respiratory Distress Syndrome (RDS/
hyaline membrane disease)
RDS cont
Treatment-
Maintain adequate ventilation and oxygenation with
oxy-hood or mechanical ventilations
Maintain acid-base balance
Maintain neutral thermal environment
Maintain adequate tissue perfusion and oxygenation
Prevent hypotension-IV, antibiotics, neuromuscular
blocking agents, dopamine, dobutamine, blood
transfusions
Maintain adequate hydration and electrolyte status
Meconium Aspiration Syndrome
(MAS)
Caused when fetal asphyxia or intrauterine stress causes
relaxation of anal sphincter and passage of meconium
into amniotic fluid
Infants stained green if exposed long before birth;
tachypneic; hypoxic; depressed; grunting; retractions;
nasal flaring; hypothermic; hypoglycemic; hypocalcemic
Quickly leads to respiratory failure
Prevention-suctioning as soon as head is through birth
canal and chest still compressed; tracheal suctioning
based on assessment at birth
Extraneous Air Syndrome (Air
Leaks)
Alveolar rupture and release of air into tissues (usually
causing pneumothorax if in pleural space or pulmonary
interstitial emphysema if in perivascular space)
May occur spontaneously in normal neonates; can
result from congenital renal/pulmonary malformations;
complicates underlying respiratory disease
Suspect with: absence of breath sounds, shift in heart
sounds, hypotension, bradycardia, decrease
oxygenation, cyanosis, chest asymmetry
Treatment-chest tube
Bronchopulmonary Dysplasia
Chronic lung disease primarily in ELBW and VLBW with RDS,
MAS, persistent pulmonary HTN, pneumonia, cyanotic heart
disease
Consist of, mechanical ventilation, O2 dependency, & abnl
pulmonary x-ray at 28d old; or same at 36 weeks gestational age
Treatment-prevention with surfactant & lowest peak inspiratory
pressure and inspiratory O2 needed a,d least amount fluid ; maintain
ABGs; steroids controversial; diuretics; nebs; supplements; prevent
RSV; reduce stimuli
Growth and developmental delays; osteopenia possible
Prognosis-mortality varies, long hospitalizations, home O2 & trach,
long term G/D problems, airway infections and obstruction
problems
High Risk related to Infectious
Process
Sepsis
Necrotizing Enterocolitis (NEC)
Sepsis
Generalized bacterial infection in bloodstream; neonates
susceptible to to non-immunity status
Sources of infection-prenatal TORCH, contact with
maternal GI or GU tracts (e coli.), nosocomial, cross
contamination with infants or personnel/equipment—
HANDWASHING!!
Signs-vague-FTT or “doesn’t look right,” hypothermia;
changes in tone, color, activity, feeding; apnea and
desaturation
Treatment- early recognition, antibiotics, supportive
measures, hand washing, decrease stress
Necrotizing Enterocolitis (NEC)

Inflammatory disease of bowel resulting

from intestinal ischemia, pathogenic
bacteria, and formula in intestines
Bacteria forms gas in intestine (seen on x-
ray) and causes distension, gastric
distension, blood in stools and other septic
signs
Onset 4-10 days (but as late as 30) after
initial feeding
NEC
Treatment-hold feedings on compromises
Breast milk
Minimal enteric feedings
Abd decompression, antibiotics, correct
extracellular volume depletion and lytes,
serial abd x-ray for progression
Surgical resection/ostomies=fat
malabsorption, FTT
High risk related to cardiovascular/
hematological complications
Patent Ductus Arteriosus-
usually closes in 3-4 days;
signs-recurrent apnea, bounding periph pulses, wide
pulse press, cardiomegally, continuous murmur;
usually spontaneous closure in 12 wks but sever left-to-
right shunt of blood leads to life threatening pulmonary
insufficiency
Treatment-careful fluid regulation, support, diuretics,
surgery
Persistent Pulmonary HTN-persistent fetal circulation
Primarily with near term, term, or post term infants &
associated with aspiration, congenital diaphragmatic
hernia, cold stress, respiratory distress, septicemia
Treatment-fluid regulation, O2, assist ventilations,
vasodilators, treat condition causing hypoxia &
pulmonary HTN
Anemia-result of hemorrhage during pregnancy, labor,
delivery, neonatal period; from lab draws or blood disorders
Treat with transfusions, GI iron, monitor amount of lab
draws
Polycythemia-venous hematocrit of 65+% causing blood
to become sluggish and resulting in hypoperfusion of organs
Signs-plethora, periph cyanosis, resp distress, lethargy,
seizures, hypoglycemia, hyperbilirubinemia
Management-lower viscosity by partial plasma exchange
Retinopathy of Prematurity-worsens with decrease in
gest age
Management-prevent fluctuating arterial O2
concentrations, decrease constant bright environmental
lights, laser therapy
High Risk related to Neurological
Disturbance
Perinatal Hypoxic-Ischemic Brain Injury-most common
cause of neurological impairment in infants
Signs-bilateral cerebral dysfunction, comatose, seizures
begin @6-12hrs and increase in 12-24hrs, between 24-
72hrs, decreased LOC abnl tone,disturbances of suck and
swallow, muscle weakness, apnea
Improvement difficult to predict
Germinal Matrix-Intraventricular Hemmorhage- table
Management-prevention with adequate O2, fluid and lytes,
support, consider ICP with positions an suctioning,
monitor glucose, analgesics
Intracranial Hemorrhage-same as previously learned
Subdural-lifethreatening
Subarahnoid-most common as result of trauma
Intracerebllar-skull compression
Neonatal Seizures-most commonly caused by hypoxic
ischemia encephalapathy secondary to perinatal asphyxia
May be subtle
Types table 10-9
Treatment-prevent cerebral damage, correct metabolic
changes, support, suppress SZ activity (phenobarbital,
dilantin, valium), & treat underlying cause
High Risk related to Maternal
Conditions
Diabetic Mothers-severity of affects on infant affected by
severity of disease
Drug exposed-narcotics readily cross placenta;
Cocaine exposure
Causes-hypoxemia, altered cardiac function, suppressed
immune system
Signs
Usually no withdrawal
Mothers who Smoke
 Chapter 11
Conditions Cause by
Defects in Physical
Development
Defects in Physical Development
Prenatal Development-every organ/system
goes through a period of rapid cell division where
it is more susceptible to injury
Birth-Parents have fantasies about birth and infant
& defects shatter fantasies; phases of shock,
disbelief, denial, withdrawal, guilt
Use honesty and simple language on 1st encounter with
parents; then used repeated encounters to teach
Accept anger
Nursing care of Surgical Neonate
Preop-thorough assessment for comparison,
support systems, IV, stay with parents
Postop-increased stress on infant; maintain
physiological stability and monitor anesthesia
& pain
Malformations of the CNS
Defects of Neural Tube Closure
Anecephaly
Spina Bifida/Myelodysplasia
Myelomeningeocele
Hydrocephalus
Neural Tube Defects

Constitutes largest congenital anomalies

Reoccurrence rate reduced by B vitamin folic acid
before conception; other causes included maternal
heat exposure, valproic acid, familial tendencies
Folic acid should be taken at least 1 month before
planning pregnancy through first trimester because
neural tube closes about 1 month after conception
Two common types:
Ancephaly
Spina Bifida/ Myelodysplasia-any malformation of spinal canal & cord

• Spina Bifida occulta

• Occult spinal dysraphism
• Spina bifida cystica-visible defect with external saclike protrusion
 Memingeocele
 Myelomeningocele
Myelomeningocele

Lesion located at any point along spinal column (usually lumbar or

sacral area) encased in fine membrane that is prone to tears CSF
leaks (can be covered by any number of skin layers)
Most frequently associated with hydrocephalus (requires constant
monitoring of head circumferences and fontanels
Manifestations-visible upon inspection
Management- 1st surgery within 1st 24hr, rehab, PT, OT; initial care-
prevent infacetion, neuro assessment, blsdder evaluation and
treatments p428-430
Care of sac-place prone in warmer without clothes/covers with
moisten, sterile changed every 2hr dressing if overhead warmer used
Latex allergy prone
Hydrocephalus-results from disturbance of dynamics
in CSF caused from SB, intrauterine infection,
neoplasm, hemorrhage
Manifestations affected by acuity, time of onset, presence
of structural malformations
• Head enlargement primary sign before closures of head sutures
• Bulging nonpulsating fontanels, frontal protuberance with
depressed eyes in sun setting sign, pupils sluggish and unequal in
response to light, irritable, poor feeding, LOC changes, cries
when held or rocked, high shrill cry
Management- relief of hydrocephalus (surgical shunt),
treat complications, mange psychomotor problems
Cranial deformities
Microcephaly-small brain from a variety of insults with varying
degrees of mental retardation
Craniosynostosis-premature closure of one or more cranial
sutures; signs depend on which suture closes; brain atrophy
and underlying motor delay; surgery before 6 months for best
results
Craniofacial abnormalities-psychologically devastating;
requires many surgeries
Plagiocephaly-rhomboid-shaped deformity by brain
malformation or unilateral suture stenosis; use of helmet to
treat worn 23 hrs a day for about 3months
Skeletal Defects
Developmental Dysplasia of Hip-abnl
development of hip during any part of fetal
development
Manifestations-Ortolani test=click; shorter
limb; limp; lordosis, waddling gait
Management-splinting hip joint (newborn to
6months) in Pavlik harness, skin traction,
traction, surgical; still nurture in devices,
prevent skin breakdown
Congenital Clubfoot-deformity that includes
forefoot adduction, midfoot supination,
hindfoot varus, ankle equinus (fig11-12)
Metatarsus Adductus-from intrauterine positioning;
pigeon toe; treat with passive stretching or
casting
Skeletal Limb Deficiency-underdevelopment of
skeletal elements of extremities; absence or
partial absence of limb to severe abnormalities;
fit with prosthetic devices at earliest time
Disorders of GI tract
Cleft lip/cleft palate-degree varies
Management-surgical- of CL within 1st week of
life; speech therapy, dental problems, hearing
loss, mouth care
Feeding-infant head upright with special
nipples, good seal, careful
Post op care-protect site, positioning to prevent
airway obstruction, allow feedings by cup or
bottle/breast
Esophageal Atresia & Tracheoesophageal
fistula
Failure of esophagus to develop as a continuous
passage to stomach & to separate from trachea
Manifestations-frothy saliva, drooling, coughing,
chocking, cyanotic and apneic with feedings that
return through nose and mouth, unable to apss NGT
Management-maintain patent airway, prevent
pneumonia, surgical repair, IV, suction secretions,
antibiotics for pneumonia, elevate head; post-op
feedings begin with sterile water than frequent
small feedings of formula, nonnutritive sucking
Anorectal Malformations
Rectal atresia and stenosis
Persistent cloaca
Imperforated anus
Management- surgical, npo, IV, colostomy
care, anal dilation, bowel management
program, Monitor UTI, prevent constipation
Biliary Atresia-inflammatory process that causes intra
& extrahepatic bile duct fibrosis
Manifestation-jaundice last beyond 2 weeks, dark urine,
gray stools, hepatomegaly, serum aminotransferase, alkaline
phosphatase, and gamma glutymyl transpeptidase are
elevated
Management-orthotopic liver transplant, hepatic
portoenterostomy (improves prognosis but not a cure), fat
soluble vitamins, nutritional support, immunosuppressive
drugs with transplant, stoma care
Abdominal Wall Defects
Omphalacele-herniation of abdominal
contents through hernia of umbilical cord
Management-loosely cover with bowel bag or
saline soaked pads and plastic drape to prevent
fluid loss, drying, temp instability; gastric
decompression; surgery
Gastroschisis-herniation of intestine is
lateral to umbilical ring; no peritoneal sac
present
Hernias
Umbilical Hernia
Congenital Diaphragmatic Hernia
Inguinal Hernia
Femoral Hernia
Defects of Genitourinary Tract
Phimosis-narrowing of foreskin; normal
Occasionally obstructs flow of urine
Circumcision or proper hygeine
Hydrocele-similar to inguinal hernia but fluid
collects
Cryptorchidism-failure of 1+ testes to descend
Hypospadias-urethral opening below glans penis
Episadias/Exstrophy Complex-externalization of
bladder, splaying of urethra, diastasis of pelvic bones
Obstructive Uropathy-structural or
functional abnormalities
Ambiguous genitalia-potential lifetime
social tragedy for parents and infant
Needs examination by geneticist, pedi
urologist, endocrinologist, pediatrician, pedi
surgeon
Need lots of emotional support