Ch.25:High Risk Infants

what should be assessed when an infant is receiving phototherapy?

temperature, serum bilirubin, hydration, and exposure time

AIDS

defined as a Cd4 t cell count less than 200 associated with many infections that are "AIDs defining"

Polydactyly

extra digits

spina bifida myelomeningocele

Herniation of meninges and nerve roots through defect, associated with neurological deficits; MOST COMMON?

HBV vaccine

given 12 hours after birth

what is the treatment for gonorrhea neonatorum?

erythromycin eye ointment

how often should an infant be assessed for jaundice after birth?

every 8 to 12 hours

true or false: All congenital heart defects are discovered during routine newborn screening done by pulse oximetry.

false

how long does it take for bronchopulmonary dysplasia to improve?

2 to 4 months

total serum bilirubin (TSB)

a measurement used to confirm transcutaneous bilirubin measurements

what is the normal fetal respiratory rate?

30-60 breaths/min

neonatal infections

infections that are acquired in utero, during, or after birth that can be caused by a viral, fungal, or bacterial agent and are often due to the immaturity of the newborn immune system

when is an HIV positive mother most likely to transmit HIV to their infant?

intrapartum period

breastfeeding failure jaundice

jaundice that appears in the first week of life due to the small volume of feeds and resulting slow passage of stool and bilirubin via the digestive system

pathologic jaundice

jaundice that is left unnoticed or untreated that can cause cerebral palsy or hearing loss; indicated by lethargy, fever, irritability, jitteriness, hypotonia, poor feeding, apnea, seizures, and high pitched cry. develops soon after birth.

physiologic jaundice

jaundice that occurs from hyperbilirubinemia due to the unconjugation and reabsorption of bilirubin from an immature and sterile intestinal system

mild symptoms

neonatal encephalopathy that consists of absent seizures, normal muscle tone, hyperexcitability, and hyper alert; infant has a high probabilty for normal function

moderate neonatal encephalopathy

neonatal encephalopathy that consists of seizure activity, hypotonia, and decreased muscle tone

severe neontal encephalopathy

neonatal encephalopathy that consists of seizures, primitive reflexes, flaccid muscles, and stuporous

neonatal toxoplasmosis

neonatal infection caused by a protozoan found in cat feces, contaminated soil, and undercooked meat that can cause anemia, seizure activity, calcifications in the brain, thrombocytopenia, or jaundice

candidiasis

neonatal infection that is a common cause of late onset neonatal sepsis due to invasive colonization; treated through antifungals and the removal of invasive devices. Further divided into four categories: mucocutaneous candidiasis, which includes diaper dermatitis and oral thrush ; systemic candidiasis that progresses from a localized infection to a disseminated infection; catheter-related infections that do not disseminate to multiple organs; and invasive focal infections such as meningitis, peritonitis, and infections of the urinary tract

neonatal varicella

neonatal infection that is dangerous if it occurs within the first 5 days of life, varicella is a member of the herpes family; may cause skin lesions, ocular defections, limb abnormalities, and CNS abnormalities that include intellectual disability and seizures. The signs of neonatal varicella may be mild as with chickenpox, with lesions that resolve within 10 days. Alternatively, the more dangerous disseminated form of the infection can include pneumonia, hepatitis, and meningoencephalitis.

congenital rubella syndrome

neonatal infection that is rare in countries with high immunization rates but includes symptoms of hearing loss, cataracts, and jaundice; also could include growth restriction, large anterior fontanelle, hearing loss, cataracts, glaucoma, retinopathy, pneumonia, cardiac defects, jaundice, hepatitis, hepatosplenomegaly, bone lesions, petechiae (blueberry muffin rash; Fig. 25.7), hemolytic anemia, and thrombocytopenia.

Late onset sepsis (LOS)

neonatal sepsis that occurs after the first week; may also be from vertical transmission (from mother to infant) or may result from an exposure to an environmental source or care provider, as can occur with the placement of an IV or other invasive procedure.

Early Onset Sepsis (EOS)

neonatal sepsis that occurs in the first 7 days after birth; usually due to exposure to bacteria from contaminated amniotic fluid or from the mother's lower genital tract during the birth. Chorioamnionitis is an important risk factor for early-onset sepsis, as is group B streptococcus (GBS) colonization

intestinal atresia

obstruction of the lumen of the intestine caused by a congenital defect. It can occur at any point in the gastrointestinal tract, but the small intestine is affected most commonly. vomiting and abdominal distension are common and due to stopped transit of meconium, hyperbilirubinemia is common

encephalocele

a neurologic abnormality that consists of the brain or meninges protruding through a skull defect called a cranium bifidum

hydrocephalus

accumulation of CSF in the ventricles of the brain and the subarachnoid space that leads to dilation of the ventricles.

what is neonatal varicella treated with?

acyclovir

how are infants experiencing neonatal abstinence syndrome treated?

eat, sleep, and console

permanent fetal disability can occur with which type of transmission of CMV?

in utero transmission

what is often the first sign of neonatal sepsis?

low temperature

Opiods

medications give to infants experiencing severe neonatal abstinence syndrome that are then weaned after the infant has been stable for 24 hours

what is the treatment for neonatal syphilis?

penicillin G

how is MAS diagnosed?

radiography

syndactyly

webbed fingers or toes

when does surgical treatment of cleft lip take place?

3 months

when does surgical treatment of cleft palate take place?

6 months

where is the pulse ox placed on an infant?

right hand and either foot

Jaundice that lasts longer than ______ days is considered pathologic

Clinical jaundice that persists for more than 10 days is indicative of pathologic jaundice.

HBsAG

a treatment given to newborns of hepatitis B positive mothers to reduce the chance of transmission

conjugated bilirubin

bilirubin that is excreted in bile into the digestive tract that cannot be reabsorbed by the intestine

what is the leading cause of intellectual disability in the United States?

fetal alcohol spectrum disorder (FASD)

communicating hydrocephalus

hydrocephalus caused by a problem with the normal uptake (absorption) of CSF through the arachnoid granulations; whole CSF system would have increased pressure

incomplete syndactyly

webbing partial length of digit

A woman at 15 weeks' gestation who works at a daycare center thinks she may have just been exposed to rubella at work. The client asks how this may affect her fetus. What is the best response the nurse can give?

"By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed."

After teaching the parents of a newborn with retinopathy of prematurity (ROP) about the disorder and treatment, which statement by the parents indicates that the teaching was successful?

"Can we schedule follow-up vision screenings with the pediatric ophthalmologist now?" Parents of a newborn with suspected retinopathy of prematurity (ROP) should schedule follow-up vision screenings with a pediatric ophthalmologist every 2 to 3 weeks, depending on the severity of the findings at the initial examination.

A newborn has ambiguous genitalia. The parents are quite emotional and do not know what to do, or if they should raise the child as a boy or girl. What is the best advice for the nurse to offer at this time?

"Research shows that it is best for anatomical structure to determine the sex of rearing."

Serum bilirubin greater than ______ mg/dl (171.04 µmol/l) in the preterm newborn or greater than _____ mg/dl (256.56 µmol/l) in the term newborn is indicative of pathologic jaundice.

10,15

within how long after birth do infants of hepatitis B positive mothers recieve the first dose of the hepatitis B vaccine to reduce transmission?

12 hours

Cord blood bilirubin concentration of ______ mg/dl (42.76 µmol/l) is indicative of physiologic jaundice

2.5

infants with a serum bilirubin > _________ need to be monitored continously but below that should be removed for feeding

20

infants who become jaundice before ______ after birth are at a higher risk for severe hyperbilirubinemia due to ABO or Rh(D) incompatability

24 hours

infants born before ______ weeks are at a higher risk for pathologic jaundice and are often screened and treated based on weight and gestational age at birth

35

when is hip dysplasia treatment generally initiated to allow time for spontaneous resolution?

4 weeks; treatment begins immediately

when does the risk of ROP end?

45-50 weeks gestational age

how long does respiratory distress syndrome usually progress?

48-72 hours

within how long does transient tachypnea of the newborn typically resolve?

72 hours

how long should women wait atleast ___________ weeks before attempting conception after zika exposure and men ________ months

8 weeks, 6 months

fetal red blood cells have a life span of _____________ days as compared to ___________ days in an adult and a hematocrit of _______% compared to ______% in an adult

85,120,50-60,36-54

the target blood oxygen saturation level for a preterm infant to meet the metabolic needs while minimizing the risk for ROP and lung injury is _______%

90

what should the O2 sat be above when treating transient tachypnea of the newborn?

90%

a SpO2 below _____ in either location, SpO2 below ______ in both locations in ____ different readings each separated by ________ hour, or a difference in SpO2 of more than _______ between extremities in _____ different readings separated by _____ hour each is positive diagnostic criteria for a congenital heart defect

90%, 95%, 3, 1, 3%, 3, 1

club foot

A birth defect in which the foot is twisted out of shape or position; the exact cause is unknown

obstructive hydrocephalus

A condition in which all or some of the brain's ventricles are enlarged; caused by an obstruction that impedes the normal flow of CSF.

maternal diabetes

A condition in which fetuses recieve maternal glucose but not insulin thus they must produce an excessive amount of insulin to compensate for the excess maternal glucose, which, in turn, leads to increased oxygen consumption and possible hypoxia. Other adverse affects include macrosomia, prematurity, respiratory distress, LGA --> shoulder dystocia fetal lung immaturity, and hyperbilirubinemia. Other potential complications include perinatal asphyxia, hypoglycemia, hypocalcemia, polycythemia, low iron stores, and cardiomyopathy

complex syndactyly

Also includes fusion of the bones and nails

Positive combs test

An abnormal (positive) direct Coombs test means you have antibodies that act against your red blood cells. This may be due to: Autoimmune hemolytic anemia. Chronic lymphocytic leukemia or similar disorder. Blood disease in newborns called erythroblastosis fetalis

What increase in serum bilirubin every 4 to 8 hours and what cord blood bilirubin concentration is indicative of pathologic jaundice?

An increase in the serum bilirubin at the rate of 0.5 mg/dl (8.55 µmol/l) every 4 to 8 hours is indicative of pathologic jaundice in term newborns. Cord blood bilirubin concentration greater than 4 mg/dl (68.42 µmol/) is indicative of pathologic jaundice.

ambiguous genitalia

a genitourinary abnormality that consists of genitalia that is not easily categorized as male or female due to genetic, hormonal, embryonic abnormalities, or adrenal hyperplasia (life-threatening adrenal crisis)

epispadias

a genitourinary abnormality that consists of the malplacement of the urethra on the dorsal aspect of the penis

hypospadias

a genitourinary abnormality that consists of the malplacement of the urethra on the ventral aspect of the penis

hyperbilirubinemia (physiologic jaundice)

a greater than normal bilirubin in the blood

hip dysplasia

a musculoskeletal abnormality that may be evident at birth or become evident during infancy or childhood and can be a part of a syndrome or an isolated occurrence --> not connected hip and acetabulum meaning the hip cannot abduct; not corrected in childhood may result in pain, osteoarthritis, and functional disability later on.

gonorrhea neonatorum

a neonatal infection caused by Neisseria gonorrhoeae that consists of newborn conjunctivitis that is treated with antibiotic eye ointment containing tetracycline or erythromycin at the time of birth.

neonatal chlamydia

a neonatal infection that can cause either conjunctivitis or pneumonia that is often transmitted through a vaginal birth but may pass the membranes of the placenta

congenital cytomegalovirus

a neonatal infection that is the leading cause of nonhereditary hearing loss and other long term neurodevelopmental disabilities; most common congenital and perinatal viral infection in the world

neonatal herpes

a neonatal infection that is the most commonly transmitted through vaginal birth by a mother experiencng a herpes outbreak that can cause sepsis

Kernicterus

Bilirubin encephalopathy, a form of brain damage resulting from unconjugated bilirubin entering the brain. Characterized by lethargy, poor feeding, vomiting, irregular respiration, perhaps death and is diagnosed with a serum bilirubin >35. The goal of phototherapy is to avoid this.

A newborn is discharged from a healthcare center following treatment for bronchopulmonary dysplasia. Which of the following interventions would be most important for the home care nurse to do when caring for this newborn?A) Administering surfactant on a weekly basisB) Monitoring the arterial blood gas levelC) Monitoring oxygen saturation levels weeklyD) Administering intravenous antibiotics

C) Monitoring oxygen saturation levels weekly Newborns treated and discharged for bronchopulmonary dysplasia require home healthcare. The nurses providing home healthcare must monitor the oxygen saturation level weekly in infants, which should be in the range of 94-95 %. Surfactant therapy is given to preterm infants with respiratory distress syndrome to reduce the lung surface tension. Monitoring of arterial blood gas levels and administering intravenous antibiotics may be necessary but only if additional complications arise.

Nikolsky sign

Diagnostic sign whereby the superficial epithelium separates easily from the basal layer on exertion of firm, sliding manual pressure with the fingers that is

what methods can decrease bilirubin levels?

Hydration, early feedings, and phototherapy are measures that the nurse should take to reduce bilirubin levels in the newborn.

atrioventricular canal defect

Incomplete fusion of the endocardial cushions between the two sides of the heart. Blood flows freely through all four chambers of the heart. As the left side of the heart is more muscular, flow is usually from left to right.

Normal pressure hydrocephalus

Increased CSF due to decreased reabsorption by arachnoid granulations, resulting in dilated ventricles; triad of dementia, incontinence and instability

Ponseti method

Involves the following steps: • Manipulation of foot and serial casting weekly in doctor's office for 6-8 weeks • Small surgical procedure under local anesthesia in doctor's office to lengthen heel cord • Special orthopedic device with a bar separating feet (Dennis Brown Brace) is worn for 2 months, and then only at night time for 2 years

Pneumatosis intestinalis

Pneumatosis intestinalis is the collection of gasses within the wall of the small bowel and is considered the hallmark of NEC.

when does treatment for a club foot begin?

at about 6 months

Pneumoperitoneum

Presence of air in peritoneal cavity

The nurse is conducting a class for pregnant women on problems associated with infections seen in women during gestation. One mother tells the nurse that she has never had chickenpox (varicella) and is worried she will contract it before she delivers. What would the nurse explain to this mother to ease her anxiety?

She can receive her varicella vaccine immediately after delivery, followed by a second dose at her 6-week postpartum visit. This vaccine cannot be given during pregnancy, only the Tdap, covid and flu can be

Breast milk jaundice

Starts around the first week peaks at the second week Due to high levels of beta-glucuronidase activity that deconjugates intestinal bilirubin. Normal infant examination (except for the jaundice). Breast feeding adequately

Classic BPD

This type is associated with airway injury, inflammation, and scarring of the alveoli from oxygen toxicity, barotrauma (injury from increased pressure), and infection. It is rarer today than new BPD. As adults, patients with this condition may have emphysema-like changes as seen in imaging studies

new BPD

This type is associated with impaired alveolar development due to prematurity and low birth weight, fewer, larger alveoli, and abnormalities of pulmonary vasculature.

Neonatal encephalopathy (NE)

a brain injury causing disturbed neurologic function that manifests as seizures or a reduced level of consciousness that is thought to be caused by perinatal asphyxia indicated by frequent late decelerations during labor; presents with symptoms such as diminished reflexes and muscle tone, difficulty maintaining respiratory function, low apgar score, weak cry, and feeding difficulties

bilirubin

a byproduct from the breakdown of red blood cells that binds to albumin and is transported to the liver where it is conjugated

alcohol

a central nervous teratogen in which no amount is considered safe in pregnancy

heart failure

a chronic condition in which the heart is unable to pump out all of the blood that it receives in infants causes poor feeding and activity intolerance.

Retinopathy of Prematurity (ROP)

a condition caused by abnormal vascular growth of the blood vessels of the retina in infants born prematurely that are permeable and leak, leading to edema, hemorrhage, scarring that pulls on the retina, distortion, and detachment; consists of symptoms such as edema, hemorrhage, and scarring of the retina and is linked to low birth weight, prematurity, and excess oxygen after birth

transient tachypnea of the newborn (TTN)

a condition caused by failure to clear fluid from the lungs that is most common in late preterm or postterm infants therefore causing decreased lung compliance due to extra fluids that includes symptoms such as tachypnea, nasal flaring, expiratory grunting, retractions, and cyanosis and involves poor perfusion of alveoli

persistent pulmonary hypertension of the neonate (PPHN)

a condition caused by increased pulmonary vascular resistance that is higher than systemic vascular resistance thereby causing the right side of the heart to pump harder than the left thereby causing a right to left shunting and hypoxia. Caused by underdeveloped or abnormal pulmonary vasculature, or maladaptation to a perinatal condition that leads to pulmonary vasoconstriction. Is indicated by respiratory distress within 24 hours of birth, cyanosis, prominant apical impulses, split S2 heart sound, and systolic murmur. In this condition, deoxygenated blood due to the shunt is able to bypass the lungs, thus causing the hypoxia seen.

fetal alcohol spectrum disorder (FASD)

a condition caused by prenatal alcohol exposure that can cause a wide range of physical, mental, and cognitive issues including thin upper lip, short palpebral fissures (small eyes), and a smooth philtrum must be present for a diagnosis of fetal alcohol syndrome or partial fetal alcohol syndrome but may or may not be present for the diagnosis of neurobehavioral disorder associated with prenatal alcohol exposure; long-term prognosis for individuals diagnosed with FASD is discouraging, with high rates of HIV infection, substance abuse, car accidents, suicide, and homicide. Also may see small head circumphrance; CNS dysfunction such as hyperactive reflexes resulting in exaggerated Babinski and Moro reflexes; hypertonic muscle tone and constant movement (jitteriness); metabolic, vasomotor, and respiratory disturbances with frequent yawning and sneezing; gastrointestinal dysfunction, including poor feeding; and frantic sucking or rooting.

meconium aspiration syndrom (MAS)

a condition caused by the aspiration of meconium in the fetal lungs that can be due to intrauterine stress resulting in passage of meconium, airway obstruction, inflammation and chemical irritation, infection, and inactivation of surfactant that consists of symptoms such as meconium-stained amniotic fluid, respiratory or neurologic depression at birth, post term or SGA infant, respiratory distress (tachypnea), cyanosis, rales and rhonchi, pneumothorax, and PPHN chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis

necrotizing enterocolitis (NEC)

a condition that consists of ischemic necrosis of the intestines and is a gastrointestinal emergency indicated by feeding intolerance, abdominal distension, vomiting, respiratory failure, hypotension, and temperature instability; believed that the mucosa of the intestines of preterm infants may be permeable to bacteria, whereas defenses such as immunoglobulin A and mucosal enzymes are immature and are unable to launch an adequate response, predisposing them to NEC

double outlet right ventricle

a congenital abnormality of the heart in which both the pulmonary artery and the aorta rise from the right ventricle that has several variation and co-occurs with ventricular septal defect

total anomalous pulmonary venous return

a congenital abnormality of the heart that coexists with a patent foramen ovale or another atrial septal defect in which blood returns from the lungs to the right atrium instead of the left atrium. Pulmonary veins are connected to the right side of the heart instead of the left atrium. Oxygenated blood pumped right back to lungs. Requires ASD to survive. Includes cyanpsis, dyspnea and poor feeding. Treatment is surgical repair to connect the pulmonary veins to the left atrium.

atrial septum defect

a congenital abnormality of the heart that consists of a hole in the wall between the atria that occurs most commonly at the foramen ovale that creates a left to right shunt when independent from other congenital defects. split wide fix S2

truncus arteriosus

a congenital abnormality of the heart that consists of a single blood vessel that rises out of the right and left ventricles instead of the pulmonary artery and aorta. Patient will have ventricular septal defect causing mixing of blood --> HF, murmur, cyanosis, poor feeding. Surgical repair in first few mos of life

transposition of great arteries

a congenital abnormality of the heart that consists of a swap of the aorta and the pulmonary artery, resulting in oxygen-poor blood being cycled through the body and oxygen-rich blood to be cycled through the lungs. Survival requires patient ductus arterious or septal defect to allow mixing of blood. Causes HF, SOB, cardiomegaly and cyanosis, hypoxia, murmurs, fatigue, poor growth. Prostaglandins to keep PDA open until child can get surgery (first week of life!)

tricuspid atresia

a congenital abnormality of the heart that consists of the abnormal development or absence of the tricuspid valve between the right atrium and right ventricle that co-occurs with atrial septal defect, ventricular septal defect, and patent ductus arteriosus --> cyanosis, tachychardia, dyspnea, clubbing

teralogy of fallot

a congenital abnormality of the heart that consists of the combination of a stenoic pulomary artery leading to hypertrophy of the right ventricle, ventricular septal defect which with right ventricular hypertrophy causes a right to left shunt and an aorta that overrides both ventricles and carries both oxygenated and deoxygenated blood to systemic circulation. PROVe You know all four. cyanosis due to nothing going to lungs. Knee chest posiyion can help with hypercayaonitic episodes.

coarctation of the aorta

a congenital abnormality of the heart that consists of the narowing of the aorta, usually near the side of the ductus arteriosus. The upper body is perfused but not lower leading to upper body HTN and bounding pulses but poor lower extremity perfusion. Baloon angioplasty or stent can help or surgical removal. Manage HTN.

orofacial cleft

a congenital abnormality that consists of a cleft lip without a cleft palate or a cleft palate without a cleft lip that can be caused by a genetic syndrome, maternal exposure to certain teratogens, smoking, diabetes, and obesity; prevent an infant from feeding without assistance since they are unable to create suction

Hirschsprung disease

a gastrointestinal abnormality that consists of a disorder of the enervation of the colon causing a functional bowel obstruction and occurs between gestational weeks 4 and 7; symptoms include abdominal distension, vomiting of bile, and failure to pass meconium within the first 48 hours of life

Tracheoesophageal fistula (TEF)

a gastrointestinal abnormality that consists of an abnormal passage joining the trachea and esophagus that almost always occurs with esophageal atresia (EA); symptoms manifest shortly after birth and include excess secretions, choking, drooling, and respiratory distress

gastroschisis

a gastrointestinal abnormality that consists of an abnormal wall defect associated with bowel herniation with no containing membrane that is associated with poor maternal nutrition, smoking, maternal immune response, and exposure to agricultural chemicals; the umbilical cord is adjacent but not included

omphalocele

a gastrointestinal abnormality that consists of an opening of the abdominal wall at the level of the umbilical cord that contains abdominal contents in a membrane that occurs during the 11th and 12th week of pregnancy and is often accompanied by other abnormalities such as cardiac, gastrointestinal, or neural tube defects

congenital syphilis

a neonatal infection that is transmitted vertically from mother to fetus and can result in stillbirth, prematurity, or hydrops fetalis; symptoms vary widely and it is identified through blood test or evaluation of cerebrospinal fluid, clinical manifestations can range broadly from enlargement of the liver to rhinitis to sepsis. The umbilical cord may take on a stark "barber pole" appearance with red and blue stripes coupled with white streaks with areas of necrosis. The placenta itself may appear unusually large and pale. The liver of nearly all infants with syphilis will be enlarged, although this may not be immediately obvious clinically

microcephaly

a neurologic abnormality that consists of a head circumference two standard deviations below the mean for gestation, age, and sex that is related to genetic abnormalities, maternal disease, prenatal exposure to teratogens, zika infection, and birth injuries; can cause developmental delays, intellectual diabilities, or epilepsy

anencephaly

a neurologic abnormality that consists of an open defect of the cranial neural tube caused by the anterior neural tube failing to close at day 25 post conception

spina bifida

a neurologic abnormality that consists of incomplete closure of the vertebra surrounding the spinal cord that results from the spinal neural tube failing to close by 28 days after conception; prevented with folic acid supplementation prior to conception

congenital diaphragmatic hernia

a respiratory abnormality that consists of a condition in which the abdominal contents herniate through the diaphragm into the chest and include symptoms of respiratory distress consistent with the degree of herniation, development of persistent pulmonary hypertension, diminished or absent breath sounds, and displaced heart sounds

respiratory distress syndrome (RDS)

a respiratory condition that is caused by a surfactant insufficiency, immature lugns, and prematurity that causes symotoms of tachypnea, nasal flaring, expiratory grunting, retractions, cyanosis, and pallor

GBS

a significant cause of neonatal sepsis that is transmitted from mother to fetus during delviery

cranium bifidum

a skill defect that allows for encephalocele

neonatal abstinence syndrome (NAS)

a term used to describe withdrawal symptoms that occur as a result of in utero exposure to opioids that is recognized by irritability, high-pitched cry, disorganized feeding, sleep/wake disturbances, hypertonia, hyperactive reflexes (babinski), tremors, sweating, sneezing, and yawning

antiretroviral therapy (ART)

a therapy given to infants born to HIV positive mothers that is beguna 6-12 hours after delivery

bronchopulmonary dysplasia (BPD)

a treatment complication of artificial respiratory support caused by damage that consists of symptoms such as tachypnea, retractions, rales, and wheezing; a form of chronic lung disease that affects newborns, most often those who are born prematurely and need oxygen therapy. In BPD the lungs and the airways (bronchi) are damaged, causing tissue destruction (dysplasia) in the tiny air sacs of the lung (alveoli).

exchange transfusion

a treatment for hyperbilirubinemia that effectively removes bilirubin from circulation through the systemic removal and replacement of blood volume, removes maternal antibodies destroying RBC in the case of ABO or rH incompatibility, and receives albumin prior to the procedure to draw out more bilirubin ; Is very effective but expensive, requires clinical expertise, and is rarely used

phototherapy

a treatment for hyperbilirubinemia that is used in the hospital or at home in which the infant's skin is exposed to a particular wave length of light that converts bilirubin into a more soluble form that does not need to be conjugated and can be directly excreted into bile; a larger surface area exposed makes it more effective, can cause dehydration, interrupted breastfeeding,hyperthermia and an erythematic rash that resolves on it's own

Pavlik Harness

a treatment intervention for hip dysplasia that limits adduction and extension while stabilizing the hip

therapeutic hypothermia

a treatment that is used as a neuroprotective therapy for neonatal encephalopathy that is begun within 6 hours of birth and lasts for 72 hours for infants at least 36 weeks gestation in which the neonates temperature is kept at 33-35 degrees celcius

transcutaneous bilirubin (TcB)

a universal screeing tool for bilirubin measurements

zika

a virus that is transmitted sexually or by mosquito bite that can be transmitted prenatally to a fetus and is associated with microcephaly, craniofacial disproportion, and hearing loss

early-onset GBS disease

an infection that may manifest as sepsis, pneumonia, or meningitis in which symptoms often present within 24 hours after birth; risk factors include delivery less than 37 weeks, premature rupture of membranes 18 or more hours prior to delivery, chorioamnionitis, and GBS urine in current pregnancy

late-onset GBS disease

an infection that usually presents 4-5 weeks after birth, is less likely to exhibit signs of shock, but may include symptoms such as fever, cellulitis, irritability, lethargy with poor feeding, grunting, tachypnea, apnea, nunchal rigidity, and seizures

ventricular septal defect

an opening in the septum separating the ventricles; a congenital abnormality in which there is a large hole between two ventricles lets venous blood pass from the left to right ventricle; cause dyspnea with feeding and poor growth during infancy. A loud, harsh, holosystolic murmur at the lower left sternal border is common.

what is the treatment for neonatal herpes?

antiviral therapy for 14-21 days; acyclovir

stage 2 and 3 NEC

confirmed NEC with pneumatosis intestinalis and pneumoperitoneum

A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually transmitted infections and their effect on pregnancy. The nurse determines that the teaching was successful when the group identifies which infection as being responsible for ophthalmia neonatorum?

gonorrhea

Babinski reflex

in response to the sole of the foot being stroked, a baby's big toe moves upward or toward the top surface of the foot and the other toes fan out --> brain injury

skin and soft tissue bacterial infection

infection often caused by S.aureus but can also be caused by Group A streptococcus, L. monocytogenes, Pseudomonas aeruginosa, Treponema pallidum, and Haemophilus influenzae type B, presents as vesiculobullous or pustular lesions. Often nafcillin, oxacillin, or, in areas with a high methicillin-resistant S. aureus prevalence, vancomycin is administered

Hypoplastic Left Heart Syndrome

left side of heart and structures are underdeveloped. Unable to do job effectively (pump blood to body). Will also have PDA and ASD. When oxygenated blood goeds to left atria, will go to right atrium, to ventricle. Right ventricle has to pick up slack and pump to lungs and systemic circulation (able to do due to PDA). Causes cyanosis, HF, cold extremities, lethargy. Admin of prostaglandins to keep PDA open. Surgery done in 3 stages

spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges; small dimple

aortic stenosis

narrowing of the aortic valve (left ventricle to aorta) which keeps the whole body from having enough blood. s/sx of hypotension, dec pulses, tachycardia, poor feeding and exercise intolerance. May do a balloon angiography or valvotomy

pulmonic stenosis

narrowing of the opening and valvular area between the pulmonary artery and right ventricle. Obstructs blood to lungs. Includes systolic ejection murmur, cfyanosis, cardiomegaly and heart failure. Baloon dilation or valvotomy can help

what is the treatment for neonatal chlamydia?

oral antibiotics

patent ductus arteriosus

passageway between the aorta and the pulmonary artery remains open after birth so that the circulation bypasses the lungs. Left to right shunt. Characterized by machine gun murmur and bounding pulses.

The nurse reviews the prenatal record in anticipation of a birth. Which finding would alert the nurse to the possibility of an intestinal obstruction in the infant? Select all that apply.

polyhydramnios sibling with cystic fibrosis

how are newborns screened for heart defects after 24 hours of age?

pulse oximetry

Severe hyperbilirubinemia in a neonate

serum bilirubin >25

cardiogenic shock

shock that occurs due to a heart defect and consists of inadequate tissue perfusion, abnormal heart rate, metabolic acidosis, lethargy, irritability, coma, hypotonia, diminished or absent reflexes, oliguria, apnea, and hypotension

neonatal sepsis

the presence of bacteria, fungi, or viruses in the bloodstream that is confirmed by blood culture and manifested by systemic signs of infection; risk factors include chorioamnionitis, maternal temperature greater than 100.4 during delivery, delivery prior to 37 weeks, or an apgar score of 6 or less

It takes _______ months until the enzyme needed for bilirubin clearance to reach adult levels

three

hypoplastic left colon syndrome

transit of meconium stops in the last third of the colon at or near the splenic flexure; Patients with HLCS do not pass meconium in the first 36 hours after birth. Their abdomens become distended and they may have bilious vomiting. For a small number of infants, the colon will perforate within the first 36 hours of life,

true or false: Opioid withdrawal symptoms in a newborn may not appear until 48 to 72 hours after birth.

true

stage 1 NEC

unconfirmed NEC but often progresses to Stage II and/or III.

enterohepatic circulation of bilirubin

unconjugated bilirubin, unlike conjugated bilirubin, can be absorbed by the epithelium of the gut and deposited back into the circulation, increasing serum levels of bilirubin

spina bifida meningocele

vertebrae don't completely enclose spinal cord, cerebrospinal fluid exits through opening, but no nerves

complete syndactyly

webbing the entire length of digit

what are signs to report of congenital heart disease?

weight loss, poor feeding, cyanosis, breathing difficulties, irritability, increased respiratory rate, and fever.