Ophthalmia neonatorum is an eye infection that occurs at birth or during the first month.

Common cause: Neisseria gonorrhoeae(may cause ulceration and destruction) and Chlamydia
trachomatis
- contracted during birth (vaginal secretions)
Assessment: bilateral, eye with pus, edematous, red. Usually on 1-4 days of life.
Prevention: erythromycin(prevents both gonococcal and chlamydial conjunctivitis);
Mgt: if gonococci (penicillin and ceftriaxone); chlamydia (erythromycin); sterile saline solution for irrigation; mother
should also be treated;

Cleft lip
The maxillary and median nasal processes normally fuse between weeks 5 and 8 of intrauterine
life.
Lip more common in boys than girls.
Cause: folic acid deficiency; genetics

Cleft Palate
The palatal process closes at approximately weeks 9 to 12 of intrauterine life
- it is an opening of the palate, is usually on the midline and may involve the anterior hard
palate, the posterior soft palate, or both
- more common in girls than boys
-maybe associated with other congenital anomalies

Assessment: Lip sonogram or upon birth; Palate- depress tongue and shine light on palate.

Mgt: surgery at 2-10weeks; A two-stage palate repair, with soft palate repair at 3 to 6 months of
age and hard palate repair at 15 to 18 months of age, may be recommended.

Nursing Dx: Risk for imbalanced nutrition, less than body requirements, related to feeding
problem caused by cleft lip or palate (post op: After surgery for cleft lip or palate, an infant is
kept NPO for approximately 4 hours. The infant is then introduced to liquids (plain water). Begin
the process with only a small amount to prevent vomiting.); avoiding tension helps keep the
sutures from pulling apart and leaving a large scar. After palate surgery, liquids are generally
continued
for the first 3 or 4 days, and then a soft diet is followed until healing is complete.
After a cleft palate repair, when children begin eating soft food, they should not use a spoon,
because they will invariably push it against the roof of the mouth and possibly disrupt sutures. If
being fed rather than being allowed to use a spoon himself evokes an intense reaction, it is
better to leave a child on a liquid diet until the sutures are removed. Be certain milk is not
included in the first fluids offered because milk curds tend to adhere to the suture line. After a
feeding, offer the child clear water to rinse the suture line and keep it as clean as possible.;
Impaired tissue integrity at incision
line related to cleft lip or cleft palate surgery; Risk for infection related to surgical incision; Risk for
ineffective airway clearance related to oral surgery;

Imperforate anus- stricture of anus

A wink reflex (touching the skin near the rectum should make it contract) will not be present if
sensory nerve endings in the rectum are not intact.; no stool passed
Before surgery, keep the infant
NPO to avoid further bowel distention. A nasogastric tube attached to low intermittent suction for
decompression will be inserted to relieve vomiting and prevent pressure on other abdominal organs or the
diaphragm from the distended intestine. Intravenous
therapy or total parenteral nutrition will be started to maintain fluid and electrolyte balance.
- Mgt: surgery anastomosis

Hydrocephalus is an excess of CSF in the ventricles or the subarachnoid space. Causes:

obstruction of passage (common cause), overproduction of fluid (rare); interference with
absorption of CSF.
Assessment: he infants fontanelles widen and appear tense, the suture lines on the skull
separate, and the head diameter enlarges; scalp becomes shiny and scalp veins become
prominent; increased ICP(decreased respiration and pulse, increased temp and BP, hyperactive
reflexes, strabismus and optic atrophy)

Mgt: if cause is overproduction of fluid, acetazolamide (Diamox), a diuretic; A

ventriculoperitoneal shunt removes excessive cerebrospinal fluid from the ventricles and shunts
it to the peritoneum. A one-way valve is present in the tubing behind the ear; shunting procedure
involves threading a thin polyethylene catheter under the skin from the ventricles
to the peritoneum

Nsg Dx: Risk for ineffective cerebral tissue perfusion related to increased intracranial pressure

After a shunt is inserted, the infants bed is usually left flat or raised only about 30 degrees so the childs
head remains level with the body. This is because if the childs head is raised excessively, CSF may flow
too rapidly and decompression can then occur too rapidly, leading to possible tearing of cerebral arteries

Neural tube disorders: