Developed by D.

Ann Currie, RN, MSN

High Risk Newborn Nursing
Care
Fetal/Neonatal Risk
Factors for Resuscitation
Nonreassuring fetal heart rate pattern
Difficult birth
Fetal scalp/capillary blood sample-acidosis pH<7.20
Meconium in amniotic fluid
Prematurity
Macrosomia or SGA
Male infant
Significant intrapartum bleeding
Structural lung abnormality or oligohydramnios
Congenital heart disease
Maternal infection
Narcotic use in labor
Fetal/Neonatal Risk Factors
for Resuscitation (continued)
An infant of a diabetic mother
Arrhythmias
Cardiomyopathy
Fetal anemia
 Respiratory Distress
Syndrome (RDS)
Deficiency or absence of surfactant
Atelectasis
Hypoxemia, hypercarbia, academia
May be due to prematurity or surfactant deficiency
 RDS: Nursing Care
Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
Education and support of family
 Transient Tachypnea of
the Newborn (TTN)
Failure to clear lung fluid, mucus, debris
Exhibit signs of distress shortly after birth
Symptoms
Expiratory grunting and nasal flaring
Subcostal retractions
Slight cyanosis
 TTN: Nursing Care
Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
Support and educate family
 Meconium Aspiration
Syndrome (MAS)
Mechanical obstruction of the airways
Chemical pneumonitis
Vasoconstriction of the pulmonary vessels
Inactivation of natural surfactant
 MAS: Nursing Care
Assess for complications related to MAS
Maintain adequate respiratory status
Maintain adequate nutritional status
Maintain adequate hydration
 Persistent Pulmonary
Hypertension (PPHN
Blood shunted away from lungs
Increased pulmonary vascular resistance (PVR)
Primary
Pulmonary vascular changes before birth resulting in
PVR
Secondary
Pulmonary vascular changes after birth resulting in
PVR
 PPHN: Nursing Care
Minimize stimulation
Maintain adequate respiratory status
Observe for signs of pneumothorax
Maintain adequate nutritional status
Maintain adequate hydration status
Support and educate family
 Cold Stress
Increase in oxygen requirements
Increase in utilization of glucose
Acids are released in the bloodstream
Surfactant production decrease
 Cold Stress: Nursing Care
Observe for signs of cold stress
Maintain NTE
Warm baby slowly
Frequent monitoring of skin temperature
Warming IV fluids
Treat accompanying hypoglycemia
 Hypoglycemia Symptoms
Lethargy or jitteriness
Poor feeding and sucking
Vomiting
Hypothermia and pallor
Hypotonia, tremors
Seizure activity, high pitched cry, exaggerated moro
reflex
 Hypoglycemia:
Nursing Care
Routine screening for all at risk infants
Early feedings
D10W infusion
 Physiologic
Hyperbilirubinemia
Appears after first 24 hours of life
Disappears within 14 days
Due to an increase in red cell mass
Pathologic
Hyperbilirubinemia
Appears within first 24 hours of life
Serum bilirubin concentration rises by more than 0.2
mg/dL per hour
Bilirubin concentrations exceed the 95th percentile
Conjugated bilirubin concentrations are greater than
2 mg/dL
Clinical jaundice persists for more than 2 weeks in a
term newborn
 Causes of Pathologic
Hyperbilirubinemia
Hemolytic disease of the newborn
Erythroblastosis fetalis
Hydrops fetalis
ABO incompatibility
 Treatment of Pathologic
Hyperbilirubinemia
Resolving anemia
Removing maternal antibodies and sensitized
erythrocytes
Increasing serum albumin levels
Reducing serum bilirubin levels
Minimizing the consequences of hyperbilirubinemia
 Maternal-Fetal
Blood Incompatibility
Rh incompatibility
Rh-negative mother
Rh-positive fetus
ABO incompatibility
O mother
A or B fetus
 Phototherapy: Nursing Care
Maximize exposure of the skin surface to the light
Periodic assessment of serum bilirubin levels
Protect the newborn’s eyes with patches
Measure irradiance levels with a photometer
Good skin care and reposition infant at least every 2 hours
Maintain an NTE and adequate hydration and nutrition
 Anemia
Hemoglobin of less than 14 mg/dL (term)
Hemoglobin of less than 13 mg/dL (preterm)
Nursing management
Observe for symptoms
Initiate interventions for shock
 Polycythemia
Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit
Monitor for signs of distress
Assist with exchange transfusion
Clinical Manifestations of
Sepsis
Increase in blood volume and hematocrit
Nursing management:
Assessment of hematocrit
Monitor for signs of distress
Assist with exchange transfusion
Temperature instability
Feeding intolerance
Hyperbilirubinemia
Tachycardia followed by apnea/bradycardia
Clinical Manifestations of Syphilis
Rhinitis
Red rash around the mouth and anus
Irritability
Generalized edema and hepatosplenomegaly
Congenital cataracts
SGA and failure to thrive
 Syphilis: Nursing
Management
Initiate isolation
Administer penicillin
Provide emotional support for the family
 Gonorrhea
Clinical Manifestations
Conjunctivitis
Corneal ulcerations
Nursing management
Administration of ophthalmic antibiotic ointment
Referral for follow-up
Clinical Manifestationfs of Herpes
Small cluster vesicular skin lesions over the entire
body
DIC
Pneumonia
Hepatitis
Hepatosplenomegaly
Neurologic abnormalities
 Herpes: Nursing
Management
Careful hand washing and gown and glove isolation
Administration of IV vidarabine or acyclovir
Initiation of follow-up referral
Support and education of parents
 Chlamydia
Clinical Manifestations
Pneumonia
Conjunctivitis
Nursing management
Administration of ophthalmic antibiotic ointment
Referral for follow-up
 Needs of Parents of
At-risk Infants
Realistically perceiving the infant’s medical condition
and needs
Adapting to the infant’s hospital environment
Assuming primary caretaking role
Assuming total responsibility for the infant upon
discharge
Possibly coping with the death of the infant if it
occurs
 Facilitating Parental
Attachment
Facilitating family visits
Allowing the family to hold and touch the baby
Giving the family a picture of the baby
Liberal visiting hours
Encouraging the family to get involved in the care
Cont. to Study other conditions from the Text