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71 Cards in this Set
- Front
- Back
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Gestational age
-premature -full term -post mature |
-premature-37 weeks
-full term-38-42 -post mature-42 weeks |
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Low birth weight (LBW)
very low birth weight (VLBW) extremely low birth weight (ELBW) |
-LBW-<2500g
-VLBW-<1500g -ELBW-<1000g |
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AGA-appropriate for gestational age
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-when the birth weight falls between 10th-90th% intrauterine growth curves
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Small for gestational age (SGA)
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-birth weight below 10%
-rate of intrauterine growth restricted -also called small for date (SFD) |
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Intrauterine growth restriction (IUGR)
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-does not grow as expected in utero
-symmetric IUGR-infant's weight, length, and head circumference are all affected -asymmetrical IUGR-birth wt below 10%; head circ is normal |
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Large for gestational age (LGA)
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-birth weight falls above 90%
-infant of diabetic mom |
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Ballards exam (gestational age) has two components
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-physical maturity
-neurologic and or neuromuscular development evaluations -score given in each area -added up=gestational age -also needed weight, length, head circ. |
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Preterm infants risks include
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-immature organs
-lack physical ability to live outside of mom -wide range of birth wts and problems -lower the weight and gestational age, the less chance of survival |
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Incidence of preterm births are highest among?
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-low socioeconomic groups
-lack prenatal care |
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causes of preterm births
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-age
-smoking -poor nutrition -placental problems -preeclampsia/eclampsia -incompetent cervix -multiple babies -infections -exposure to harful substances |
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Severity of problems can be related to?
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-baby's age
-greater chance of complication the earlier infant is born |
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Respiratory complications in preterm baby's
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-decreased/immature # of alveoli
-develop in utero at 26-28 -decreased surfactant -smaller lumen in resp system -immature/fragile capillaries in lungs -skeletal muscles weak-difficulty positioning head/neck, problems maintaining patent airway |
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Surfactant does what
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-lines the lung tissue
-acts like a detergent -when present helps alveoli open easily -when not present difficult to expand lungs -infant must exert great effort with each breath -eventually becomes exhaused-atelectasis |
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All resp problems can lead to
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-respiratory distress
-expiratory grunting -retractions -tachypnea -skin color pale/cyanotic |
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Retraction types
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-subcostal -low bottom of ribs
-substernal -intercostal -suprasternal-high by clavicals |
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Apnea
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-no breathing for at least 20 seconds
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periodic breathing
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-common in preterm infants
-5-10 sec resp pauses followed by 10-15 seconds of compensatory rapid respirations |
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Interventions/Treatment for resp distress
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-assess resp status q 1-2 hrs
-cont pulse ox -arterial blood gases -HR, BP, RR-monitored continuously -admin of O2 |
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Goal of administration of O2
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-provide adequate oxygen
-avoid negative effects of O2 administration |
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Surfactant replacement therapy
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-Adj to O2 and ventilation therapy
-infants <29 wks with resp distress syndrome (RDS) -given via ET |
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Betamethasone for mom does what
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-enhances fetal lung development
-needs to be within 24 hrs of birth |
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Potential long term effects with preterm respiratory problems
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-respiratory distress syndrome
-chronic lung disease (bronchopulmonary dysphasia) -retinopathy of prematurity (ROP)-damage to retinea cause of O2 |
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S/S of cardiovascular function problems that you would report
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-hypotension
-cap refill >3 sec -tachycardia (initially, than bradycardia) -cont. resp. distress |
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Why are preterm infants at risk for poor themperature regulation?
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-poor muscle tone
-immature terperature-regulating center in brain -less fat -cold stress can lead to man problems |
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Sources of external heat
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-radiant warmer
-incubator or isolette -kangaroo care |
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Meathods to help maintain a neutral thermal environment (NTE)
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-minimize drafts
-prewarm all surface -bathing-keep covered, warm water -knitted caps and booties -warm moist O2 |
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CNS is well developed by?
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24 weeks
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Preterm babies are susceptible to injury due to?
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-birth trauma
-bleeding from fragile capillaries -impaired coagulation -episodes of hypoxia -susceptible to hypoglycemia |
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5 areas to look for in preterm infants
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-seizure activity
-hyperirritability -CNS depression -increased intracranial pressure -abnormal movements-reflexes should be present and normal for infant's age |
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Digestive system characteristics of preemies
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-stomach small
-poor muscle tone (cause vomiting) -gag and cough reflexes poor -decreased absorption of fat -limited ability to convet glucose to glycogen -lacks sucking until 32-34 wks -gavage feedings may be necessary until sucking reflex occurs -give baby soft preemie nipple to stimulate sucking as they receive gavage feedings 1-2 cc/hr..always check residual! |
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Liver/Renal issues
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-immature kidneys
-immature liver -cannot conjugate billirubin=jaundice -treat with phototherapy |
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Ways to encourage bonding w/ parent
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-visiting-parents/sibilings
-kangaroo care -twins co-bedding -positioning |
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-Small for gestation age (SGA)
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-less than 10% on the newborn classification chart
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-two types of SGA's
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Symmetric
-infant looks normal but is very small -usually problem happens during first trimester (infection) Asymmetric -later in pregnancy -long arms/legs; looks like a "skinny old man" -usually weight <10%; length hc >10% |
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Maternal Factors contributing to SGA
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-poor nutrition
-adv diabetes -preg induced HTN -moms who are smokers or drug users -age over 35 -placental problems r/t nutritional needs |
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Fetal causes of SGA
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-intrauterine infection
-chromosomal abnormalities and malformations |
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Assessment findings of the skin in SGA
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-loose and dry
-little fat -little muscle mass |
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other assessment findings of SGA
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-small body
-sunken abdomen -thin, dry umbilical cord -little scalp hair -wide scalp sutures -respiratory distress -hypoglycemic -tremors -weak cry -lethargic |
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Large for gestational age )LGA) newborn
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-birth weight >90% on newborn classification chart
-may be preterm, term or post-term |
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Causes of LGA
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-mother with poorly controlled DM
-multiparity -infant w/ trnasposition of the great vessels -genetic predisposition |
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Problems associated with LGA
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-may require c-section
-higher incidence of birth truma w/ vaginal delivery-clavical, skull fx, cephalhematomas -fetal distress -hypoglycemia -polycythemia-hyperbilirubinemia |
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Physical findings in LGA
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-weight > 4000g (8-14.5)
-caput seccedaneum -cephalhematoma -facial nerve damage |
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caput seccedaneum
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-edema on top of head where is pushed against cervix during labor
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cephalhematoma
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-blood collection due to rupturing during birth
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Infant of DM mother major problem
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-hypoglycemia-glucose <40 mg/dl
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Other symptoms R/T DM mother
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-jitteriness/tremors
-lethargy -tachypnea -hyperbilirubineamia->12 -gavage if resp >60 -feeding difficulities |
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Interventions of infant with DM mother
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-monitor glucose at birth
-every 2 hrs for first 8 hrs -every 4 hrs for 24 hrs -offer glucose, breast milk , formula before 4 hrs |
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Group B strep (GBS)
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-major cause of infection in newborns
-natural inhabitant of female genital tract - penumonia 20% die in 24 hrs -meningitis 2-4 wks of age, 50% w/ brain damage |
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TORCH
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-group of maternal infectious diseases
-can lead to serious complications in embryo, fetus and neonate -symptoms often not seen in mom |
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TORCH stands for?
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T-toxoplasmosis
O-other; hep B, HIV, syphilis, gonorrhea, varicella zoster R- rubella C-CMV cytomegalovirus H- herpes simplex virus (HSV) |
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toxoplasmosis
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-from cat box
-raw meat -often spontanously abort -still births, neonatal deaths, severe congenital anomalies, seizures, coma |
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rubella
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-greatest risk is in 1st trimester
-effects congenital heart disease, IUGR, cataracts, mental retardation, hearing impairments, microcephaly, extensive fetal malformations |
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CMV cyomegalovirus
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-member of herpes virus
-transmitted via placenta or cervix -cause of viral infections in the fetus are brain, liver, blood damage -common cause of MRDD -effects hearing SGA infant -Antiviral drugs cannot prevent CMV or treat the neonate |
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Herpes virus type II
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-fetus is exposed from placenta or genitalia during delivery
-may be asymptomatic 2-12 days -can develope jaundice, seizures, fever, vesicular lesions, stomatitis |
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treatment for herpes virus type II
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-c-section
-acyclovir 21 days to infant -health care workers with active lesions cannot care for babies |
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syphillis S/S
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-vesicular lesions on soles, palms; irritabilty
-SGA, failure to thrive, rhinitis, red rash at mpouth and anus, copper rash of face, soles, palms |
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Treatment for syphillis
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-PCN, isolation
-cover baby hands to prevent skin trauma from scratching |
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Hep B
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babies routinely vacc at birth
-babies + moms given immunoglobin to decrease infection possibility |
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Hemolytic disease of the newborn
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--occurs when blood group of mom and baby are different
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Rh incompatibiltiy
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-isoimmunization or Rh sensitization
-10-15% caucasian couples -5% african american couples |
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Rh incompatibility affects who
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-only Rh+ offspring of an Rh- mother is at risk
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Rh incompatibility is
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-some Rh + blood enters mom's blood
-as placenta separates, more enters mom's blood mom becomes sensitized to this Rh + blood and makes antibodies -next pregnancy fetus compenstaes and produces large numbers of immature erythrocytes to replace the destroyed ones -Cont RBC destruction = anemia = jaundice and marked fetal edema = CHF |
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Erythroblastosis fetalis
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red blood cells dying or being destroyed
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Kernicterus
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yellow staining in the brain, nerological damage
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sensitization of the Rh factor can occur during
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-pregnancy
-birth -abortion -amniocentesis |
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Rogam
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-covers the mom's antibodies so they won't find and destroy the babies RBC's
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Indirect Coombs test
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-on mother
-to determine if Rh- mom has developed antibodies to Rh antigen |
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Direct Coombs test
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-on baby's blood
-ID's maternal antibodies attached to fetal RBC's -if + can start getting jaundice |
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How soon does the Rh immune globuline have to be give after birth to prevent sensitization in a mom with fetomaternal transfusion
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72 hours after birth
-also given at 28 weeks |
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Kleihauer-Betke test
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-if large fetomaternal transfusion is suspected this test detects amount of fetal blood in maternal circulation
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ABO incompatibility
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-more common than Rh incompatibility
-causes less severe problems -mom's blood is O and fetus blood is A, B, or AB -first borns can be affected |
