Transcript YOUR NOT SO NORMAL NEWBORN Factors influencing

YOUR NOT SO NORMAL
NEWBORN
Factors influencing preterm labor and delivery
PLACENTAL ABRUPTION
Let me out!!!!!!!!!!
Out too early puts me at risk
for…..
Respiratory distress
syndrome
Hypothermia & Cold
Stress
Hypoglycemia
Brain Hemorrhage
Sepsis
Poor Feeding
Necrotizing
Enterocolitis
Renal Failure
Increased congenital
heart problems
Retinopathy
Separation
Pain
Out too late puts me at
risk for…….
Meconium aspiration
Respiratory distress
Hypoglycemia
Neonatal Hypoxia
Birth Injury
Feeding Problems
Learning Disabilities
Fetal Death
Not your healthiest placenta…
IUGR - TWINS
Intrauterine growth retardation due to decreased nourishment.
Which twin got the most nutrition from the placenta?
SGA
Because they have decreased glycogen and fat stores, small for gestational age (SGA)
babies are particularly prone to hypoglycemia after birth; routine glucose measurements
during the first few hours of life are recommended. Polycythemia is also common, and is
related to the increased erythropoetin levels produced by a relatively hypoxic uterine
environment. Fetal growth is ingluenced by many factors, but decreased uteroplacental
function related to pregnancy induced hypertension (PIH) is a fairly common etiology.
This baby was mildly SGA with a birth weight of about 5 1/2 pounds. Relatively thin
extremities and torso give this baby a typical SGA appearance.
Macrosomia
Infants greater than 4000 gm
These infants are at risk for respiratory
distress, hypo or hyperglycemia, polycythemia
and a variety of birth injuries or congenital
anomalies.
Effects of Gestational Diabetes
NEWBORN SCREENING
why???
Over the years several screens or tests are
performed on every newborn.
These tests are mandatory by law and are meant
to prevent, recognize and provide for early
treatment for numerous conditions.
Several medications are also mandated to be
given to newborns for their protection.
GALACTOSEMIA
Galactosemia is an inherited defect of
galactose metabolism caused by an enzyme
deficiency that prevents proper metabolism
and utilization of galactose, or milk sugar. The
main dietary source of galactose is lactose, the
principle carbohydrate found in all forms of
milk.
Although infants with galactosemia may
appear normal at birth, within a few days to
two weeks after initiating milk feedings, the
symptoms of untreated galactosemia can
become very severe. Early signs of the disease
include feeding problems, poor sucking reflex,
jaundice and hepatomegaly. Other symptoms
may include failure to thrive, lethargy,
cataracts, hypoglycemia, coagulation problems
and decreased immunity.
Early diagnosis and treatment of classical
galactosemia is imperative to prevent life threatening
complications of sepsis and liver failure and to
prevent additional developmental delays. Without
early treatment, sepsis due to Escherichia coli may
prove fatal in the neonatal period. When a lactoserestricted diet is provided within the first 10 days of
life, presenting symptoms may be reversed. Infants
with galactosemia are started on milk substitute
formula, most likely a lactose-free soybean protein
formula.
MSUD
At first, you were happy that the feeding
cycle was longer than the typical four
hours, but the baby just does not seem
hungry. Likewise, the baby that once
kicked imaginary soccer goals now lies
quietly in her bassinet. And the odor that
you first put down to that “new baby
smell” has taken on the tang of maple
syrup. Something is wrong…
within the first few days after birth
as the infants go into ketoacidosis.
Unrecognized and untreated, the
disease leads to vomiting, seizures,
coma, and sometimes death.
DOWN SYNDROME
CHROMOSOME ABNORMALITY
PRESENTATIONS & DIAGNOSIS
IN UTERO
AFTER BIRTH
Neural Tube Defects
OPEN
Or
CLOSED?
TREATMENT = PREVENTION
SURGICAL REPAIR
HYDROCEPHALUS
ADDICTED!!!!!!
IRRITABLE,HIGH PITCH CRY,
JITTERS, POOR FEED,
THERMOREGULATION
PROBLEMS
FAS
signs
CLEFT PALATE/LIP
SPECIAL FEEDING TECHNIQUES
Oh my aching heart!
Tetrology of Fallot
CLUBBED FOOT/FEET
HIP DYSPLASIA
PAVLIK HARNESS
Rh INCOMPATIBILITY
Hydrops fetalis. Intrauterine
death from Rh disease
In many cases of blood type incompatibility, the symptoms of
erythroblastosis fetalis are prevented with careful monitoring
and blood type screening. Treatment of minor symptoms is
typically successful and the baby will not suffer long-term
problems.
Nevertheless, erythroblastosis is a very serious condition for
approximately 4,000 babies annually. In about 15% of cases,
the baby is severely affected and dies before birth. Babies who
survive pregnancy may develop kernicterus, which can lead to
deafness, speech problems, cerebral palsy, or mental
retardation. Extended hydrops fetalis can inhibit lung growth
and contribute to heart failure. These serious complications
are life threatening, but with good medical treatment, the
fatality rate is very low.
MECONIUM ASPIRATION
MECONIUM in DIAPER
MECONIUM COATED AVEOLI
MECONIUM ASPIRATION cont.
Some newborns' breathing during the first
hours of life is more rapid and labored than
normal because of a lung condition called
transient tachypnea of the newborn (TTN).
Newborns at higher risk for TTN include those
who are:
delivered by cesarean section (C-section)
born to mothers with diabetes
born to mothers with asthma
small for gestational age (small at birth)
GASTROSCHISIS
NURSING INTERVENTIONS
For families that have a newborn that is “less than the perfect” newborn that
they have been dreaming of they are suddenly overwhelmed with grief and all
of it’s stages. They are faced with fear of the unknown and usually self guilt.
The nursing aspect of care is two-fold. Immediate care of the newborn and
support of life systems and safety are priorities for the newborn. The mother
and/or family will need significant support and guidance. The nurse becomes
the liaison between the medical world and the family. Proper referrals, patient
education and encouragement to take care of “self” are vital.