PED Exam 2: Prematurity and Complications

obstruction

A few of the problems that affect the preterm newborn's breathing ability and adjustment to extrauterine life include: -Unstable chest wall, leading to atelectasis -Immature respiratory control centers, leading to apnea -Smaller respiratory passages, leading to an increased risk for __________ -Inability to clear fluid from passages, leading to transient tachypnea

TTN (transient tachypnea of the newborn)

An infant born by cesarean birth is at risk of having excessive pulmonary fluid as a result of not having experienced all the stages of labor. Passage through the birth canal during a vaginal birth compresses the thorax, which helps remove the majority of this fluid. Pulmonary circulation and the lymphatic drainage remove the remaining fluid shortly after birth. ______________occurs when the liquid in the lung is removed slowly or incompletely.

20

Apnea is defined as absence of breathing for longer than ______seconds; it might be accompanied by bradycardia. Sometimes apnea presents in the form of an acute life-threatening event (ALTE), an event in which the infant or child exhibits some combination of apnea, color change, muscle tone alteration, coughing, or gagging.

Periventricular-Intraventricular hemorrhage:

Bleeding around and into the ventricles of the brain. occurs in up to 45% of infants with birth weight less than 1,500 g and/or born at less than 35 weeks' gestation. It is uncommon in term neonates, but may occur with birth trauma or asphyxia The earlier the newborn is, the greater the likelihood for brain damage. While all areas of the brain can be injured, this area is the most vulnerable

asphyxia

By 1 minute of age, most newborns are breathing well. A newborn who fails to establish adequate, sustained respiration after birth is said to have _________________(perinatal acidosis), which is the deprivation of oxygen during the birth process, resulting in fetal hypoxia that can lead to organ damage and brain injury

tactile stimulation

C-A-Bs of Newborn Resuscitation Breathing Give rescue breathing in an apneic infant with a pulse. Initiate breathing first by using ___________. Follow stimulation with positive pressure ventilation (PPV) with a bag-mask device. ETT insertion if newborn remains apneic or PPV doesn't achieve effective ventilation. Listen for audible breath sounds.Look for slight chest movement with each breath.

30

C-A-Bs of Newborn Resuscitation • Compressions Place two fingers on the sternum just below the nipple lin.. After ______compressions, administer two sequential breaths. • Airway Place infant's head in slightly extended sniffing position. Suction mouth, then nose if secretions are blocking the airway. Head tilt/chin lift to open airway

Preterm Birth

Causes of ______________- •Infections/inflammation such as GBS •Maternal or fetal distress such as from Placenta previa, oligo or polyhydramnios •Bleeding: Placenta previa, abruption, trauma, •Substance use disorder

bronchopulmonary dysplasia

Chronic lung disease formerly termed ________________ is often diagnosed in infants who have experienced RDS and continue to require oxygen at 28 days of age. It is a chronic respiratory condition seen most commonly in premature infants. It results from a variety of factors, including pulmonary immaturity, acute lung injury, barotrauma, inflammatory mediators, and volutrauma.

kidney, ureter, bladder (KUB)

Common laboratory and diagnostic tests ordered for assessment of NEC include: ____________________ of the abdomen x-ray: confirms the presence of pneumatosis intestinalis (air in the bowel wall) and persistently dilated loops of bowel -An abdominal x-ray to demonstrate dilated bowel loops, abnormal gas patterns, air bubbles that occur from bacteria, and thickened bowel walls

meconium

Determine the need for resuscitation by performing a rapid assessment using the following questions: What is the newborn's heart rate? What is the gestational age of this newborn? Was the amniotic fluid clear of _________? Is the newborn breathing or crying now? Does the newborn have good muscle tone?

hemorrhage

Developmental care principles for babies with IVH include avoiding lifting the lower extremities above the midline with diaper changes, giving rapid fluid boluses, and high oxygen and ventilation, as these can increase the chance of more ______________ •Complications •Long term neurological impact •Learning, vision, hearing, motor function

positive end-expiratory pressure (PEEP)

Effective therapies for established RDS include conventional mechanical ventilation, continuous positive airway pressure (CPAP), or_______________ to prevent volume loss during expiration, and surfactant therapy. Surfactant replacement therapy is crucial in the management of RDS, but the best preparation, optimal dose and timing of administration at different gestations has not been scientifically established.

3rd

Failure To Thrive is frequently identified by plotting a child on the growth chart and noting they are falling off their curve or if they plot below the ________ percentile. Typically, when a child fails to grow physically, they may also fail to meet developmental milestones, lag in social development, and have a delay in the development of secondary sex characteristics.

blindness

If ROP continues to progress, laser surgery may be necessary to prevent ___________. Complications of ROP include myopia, glaucoma, and blindness. Strabismus may occur even in cases of regressed (resolved) ROP. Nursing management of infants with ROP mainly focuses on ensuring that the family is compliant with the ophthalmologist's follow-up recommendations.

lung infections

In BPD the bronchi are damaged, causing tissue destruction (dysplasia) in the alveoli. These infants are at risk for pulmonary hypertension and in severe cases heart failure can occur. Many also have feeding difficulty and delayed development. Babies with BPD have a higher risk of ______________ _____________than other babies and BPD sometimes leads to lung damage.

Pelvic pressure

Like regular labor, signs of early labor include: Contractions (the abdomen tightens like a fist) every 10 minutes or more often Change in vaginal discharge (a significant increase in the amount of discharge or leaking fluid or bleeding from the vagina) _________________—the feeling that the baby is pushing down Low, dull backache Abdominal cramps with or without diarrhea

head circumference

Management of IVH Correct anemia, acidosis, and hypotension with fluids and medications. Avoid rapid volume expansion to minimize changes in cerebral blood flow. Keep the newborn in a flexed, contained position with the head elevated to prevent or minimize fluctuations in intracranial pressure. Continuously monitor the newborn for signs of hemorrhage, such as changes in the level of consciousness, bulging fontanel, seizures, apnea, and reduced activity level. Also, measuring _________ daily to assess for expansion in size is essential in identifying complications early.

preeclampsia

Maternal risk factors associated with preterm birth include a previous preterm delivery, low socioeconomic status, _________________, hypertension, poor maternal nutrition, smoking, multiple gestation, infection, advanced maternal age, and substance abuse.

lethargy

Monitor laboratory studies such as hemoglobin and hematocrit for signs of polycythemia. Screen for hypoglycemia upon admission and then hourly, always observing for nonspecific signs of hypoglycemia such as _______________-, poor feeding, and seizures.

proximal enterostomy

Necrotizing Enterocolitis: Nursing Management •Maintenance of fluid and nutritional status •Bowel rest and antibiotic therapy; IV fluids •Ongoing assessment and close monitoring •Girth measurements, shiny bowel Surgery with ___________

distention

Necrotizing enterocolitis: observe the newborn for common signs and symptoms, which may include: Cardiorespiratory baseline changes Feeding intolerance Abdominal ____________and tenderness Bloody or hemoccult-positive stools Diarrhea and vomiting Delayed gastric emptying Respiratory distress Metabolic acidosis Temperature instability Decreased or absent bowel sounds Signs of sepsis Lethargy

failure to thrive

Perform a detailed dietary history and instruct the parents to complete a 3-day food diary to identify what the child actually eats and drinks. Assess the parent-child interaction, with particular attention to the parent's ability to read and respond to the infant's or child's cues. Observe feeding, noting the child's oral interest or aversion, oral-motor coordination, and swallowing ability, as well as parent-child interactions before, during, and after the feeding Significant ______________may require hospitalization for evaluation and management. Sometimes, enteral tube feedings are necessary in order for children with ______________or feeding disorders to demonstrate adequate growth

Thin transparent

Premature babies often have a •Weight <5.5 lb •Scrawny appearance •Poor muscle tone •Minimal subcutaneous fat and brown fat •Undescended testes •Soft spongy skull bones •____,_____ skin •Plentiful lanugo (soft, downy hair), especially over the face and back •Poorly formed ear pinna, with soft, pliable cartilage

34

Premies may have problems feeding because the suck/swallow reflex is not fully developed until _____ weeks. May not have enough body fat to regulate temperature until _______ weeks

Infection

Preterm Newborns: Nursing Management •Oxygenation •Thermal regulation •Nutrition and fluid balance •___________ prevention •Stimulation •Pain management •Growth and development •Parental support

Hemolytic disease of the newborn (ABO)

Preterm babies are at risk for problems with 1. Thermoregulation: Hypothermia 2. Hypoglycemia is seen in babies both SGA and LGA and higher amount in mother with GDM and Hypertension 3. Hyperbilirubinemia seen in babies whos mothers have GDM, babies LGA and due to _______________________

37

Preterm babies are born before completion of _________weeks

Necrotizing enterocolitis

Risk factors for •Underdeveloped immune system, compromised mucosal barrier, slow moving gut Cold stress (poor perfusion) The onset of ____________is heralded by the development of feeding intolerance, abdominal distention, and bloody stools in a preterm infant receiving enteral feedings. As the disease worsens, the infant develops signs and symptoms of septic shock (respiratory distress, temperature instability, lethargy, hypotension, and oliguria).

sudden

Suspect pain if the newborn exhibits the following: ______-high-pitched cry Facial grimace with furrowing of brow and quivering chin Increased muscle tone Oxygen desaturation Increase in heart rate squirming, kicking, arching Limb withdrawal and thrashing movements Increased blood pressure, pulse, and respirations Fussiness and irritability

38

Term babies are Born from the first day of the ___th week through 42 weeks

Group B streptococcal

The clinical manifestations of infection can be nonspecific and subtle: apnea, diminished activity, poor feeding, temperature instability, respiratory distress, seizures, tachycardia, hypotonia, irritability, pallor, jaundice, and hypoglycemia. _________________ infection remains the most common cause of early and late neonatal sepsis Report any of these to the primary care provider immediately so that treatment can be instituted

developmental delay

The comorbidities that ex-preemies exhibit in the form of prior and current medical problems place these infants at high risk for ______________. Even mild ________________ require intervention. screening tools may be used, though they do not always identify children at risk. Parent-report questionnaires demonstrate fairly accurate estimations of developmental problems and are simple to use. Most importantly, assess the child's development based on corrected age until the child is 3 years old

periventricular area

The immaturity of the preterm infant's brain makes it vulnerable to injury. The area most vulnerable is the _______________ which is the rim of brain tissue that lines the outside of the lateral ventricles. The tremendous physiologic stress during the birth process can cause these vessels to rupture and bleed into the _____________________. If the bleeding persists, the expanding volume of blood dissects into the adjacent lateral ventricles leading to an intraventricular hemorrhage

steroids

The introduction of prenatal _____________to accelerate lung maturity and the development of synthetic surfactant can be credited with the dramatic improvements in the outcome of newborns with RDS

fluid retention

The renal system of the preterm newborn is immature, increasing the risk for _____________, with subsequent fluid and electrolyte disturbances. In addition, preterm newborns have an increased risk of drug toxicity. Close monitoring of the preterm newborn's acid-base and electrolyte balance is critical

capillaries

The signs of IVH vary significantly and some infants may display no clinical signs. Approximately 50% of PIVH occurs by 24 hours of age. Usually originates in subependymal germinal matrix region and extends to ventricles. Contributing factors include, fluctuations in blood flow, Immature cerebral vasculature and Thin fragile _________

patent ductus arteriosus (PDA)

This is a heart condition that happens when a blood vessel called the ____________ doesn't close properly. The __________________ helps blood go around a baby's lungs before birth. Once a baby's born and her lungs fill with air, the _______________ isn't needed anymore and usually closes on its own a few days after birth. If it doesn't close properly, too much blood may flow into the lungs.

6

Though breast milk is the preferred form of nutrition for former premature infants, many of them require special diets to foster catch-up growth. Extra calories are needed for increased growth needs. Additional calcium and phosphorus are required for bone mineralization. For these reasons, former preemies should be fed breast milk fortified with additional nutrients or a commercially prepared formula specific for premature infants. When former preemies demonstrate consistent adequate growth, usually by __months corrected age, they may be switched to a "term infant formula" such as Similac or Enfamil, concentrated to a higher caloric density, if needed

retinopathy of prematurity (ROP)

Use of large concentrations of oxygen and sustained oxygen saturations higher than 95% while on supplemental oxygen have been associated with the development of ____________and further respiratory complications in the preterm newborn. For these reasons, oxygen should be used judiciously to prevent the development of further complications. A guiding principle for oxygen therapy is it should be targeted to levels appropriate to the condition, gestational age, and postnatal age of the newborn. Current common practice is to maintain oxygen saturation levels in the high 80s to mid-90s, though a wide variation in practice may still occur

sepsis

With Necrotizing enterocolitis we want to minimize the chance of perforation, which can cause a hole in the intestines And cause life threatening _______. Because of this Perforation is considered a medical emergency

Perinatal hypoxia

_______________causes shunting of blood from the gut to more important organs such as the heart and brain. Subsequently, ischemia and damage to the intestinal wall can occur. This combination of shunting, ischemia, damage to the intestinal wall, and poor sucking ability places the preterm infant at risk for malnutrition and weight loss.

2500 grams

a baby is considered low birth weight if they are below ______

1000

considered very low birth weight (VLBW) if below 1500 grams and ELBW or extremely low birth weight if they are less than __________ grams

retinopathy of prematurity

is a disorder characterized by rapid growth of retinal blood vessels in the premature infant. In the fetus, retinal vascularization begins at 4 months and progresses until completion at 9 months or shortly after birth. The premature infant is born with incomplete retinal vascularization, yet new vessels continue to grow between the vascularized and nonvascularized retina

Transient Tachypnea of the Newborn (TTN)

is a self-limiting condition characterized by inadequate or delayed clearance of lung fluid leading to transient pulmonary edema. The newborn experiences a mild degree of respiratory distress that requires minimal intervention. It usually occurs within a few hours of birth and resolves by 72 hours of age

failure to thrive

is a term used to describe inadequate growth in infants and children. The child fails to demonstrate appropriate weight gain over a prolonged period of time. Length or height velocity and head circumference growth may also be affected. Typical children may experience ________________, but it is much more common in the child with special needs. Adequate nutrition is critical for appropriate brain growth in the first 2 years of life and obviously for growth in general throughout childhood and adolescence

Necrotizing enterocolitis

is an inflammatory disease of the bowel which can cause ischemic and necrotic injury in the gastrointestinal tract. It is the most common and most serious acquired gastrointestinal disorder among hospitalized preterm neonates and is associated with significant acute and chronic morbidity and mortality. NEC occurs in approximately 10% of infants who weigh less than 1,500 g, with mortality rates up to 50%

Necrotizing Enterocolitis (NEC)

minimal enteral feeding is used to prepare the preterm newborn's gut. It involves the introduction of small amounts, of breast milk or enteral feeding to induce surges in gut hormones that enhance maturation of the intestine. All of the expert committees recommend the use of human milk, which reduces the risk of _______________

RDS

•Antibiotics for positive cultures •Fluids and gavage feedings •Blood glucose level monitoring •Clustering of care •Decubitus (bed sore) prevention: Turn and position, tube stabilization, IV assessments complications of ____________ •Air leak syndrome, bronchopulmonary dysplasia (chronic lung disease), patent ductus arteriosus, congestive heart failure, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, complications resulting from intravenous catheter use (infection, thrombus formation), and developmental delay or disability

36 6/7

•Late preterm babies are Born between 34 0/7 and ___________ weeks

72

•Nursing assessment for TTN •Maternal sedation or birth by cesarean; tachypnea, expiratory grunting, retractions, labored breathing, nasal flaring and mild cyanosis; respiratory rates possibly 100 to 140; barrel-shaped chest; slightly low breath sounds •Babies with RR over 60 breaths per minute will be NPO, Given IV fluids and potentially TPN if not resolved by _________hr •Chest x-ray: mild symmetric lung overaeration; prominent perihilar interstitial marks and streaks

Indomethacin

•Pay attention to ICP •Sx, PPV, oxygen, acid base balance, thermoregulation, BP, HR •Fluid replacement rates and amounts •Minimal Stimulating Environment - Cluster Care • Midline positioning •Monitor Head Circumference •Anemia •___________before 6 hours of life •Supportive Care

42

•Postterm babies are born beyond _______completed weeks. •Most will not make it that long, might get c-section to reduce risk of complications

RDS (respiratory distress syndrome)

•Problems related to immaturity of body systems 1. Respiratory system: __________due to lack of Surfactant. 2. Cardiovascular system: Congenital defects such as patent ductus arteriosus and patent foramen ovale 3. GI system: NEC, nutrition, congenital defects, GERD, suck, coordination, fatigue 4. Renal system: Renal Immaturity 5. Immune System is not strong and can increase risk of sepsis 6. Central nervous system: intraventricular hemorrhage (IVH) hydrocephalus, anemia, long term neurological complications

Respiratory Distress Syndrome

•Risk factors •Preterm, C section, male, cold stress, GDM •Chest x-ray: hypoaeration, underexpansion, and ground glass pattern

caffeine (methylxanthine)

•common medication used for apnea of prematurity is_______________