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THE HIGH RISK NEWBORN

THE PRETERM NEWBORN

PRETERM
Live born infant born before the end of
the 37th week of gestation
Birth weight of less than 2500g (5lbs,8oz)
Low birth weight
Very low birth weight
Extremely very low birth weight

Exact cause: rarely known

ASSESSMENT:
Often an apparently normal prenatal hx
Appears small and underdeveloped
Disproportionately large head
Ruddy skin
Easily noticeable veins; acrocyanosis
Little vernix; extensive lanugo
Both fontanelles small
Very few or NO creases on sole of the feet

COMPLICATIONS ARRISING
FROM PREMATURITY
ANEMIA bone marrow has difficulty with
production and maturation of new erythrocytes;
immature hematopoietic system
KERNICTERUS - concentration of indirect
bilirubin; acidosis;
PERSISTENT PDA surfactant
HEMORRHAGE periventricular and
intraventricular

PROBLEMS IN PREMATURITY
RESPIRATORY FUNCTION
lung surfactant- 34-35 wk
irreversible acidosis
difficulty maintaining respirations
FLUID VOLUME DEFICIT
insensible water loss

NUTRITION
feeding problems
gag reflex - 32 wks
sucking and swallowing coordination
32-34 wks AOG
nutritional requirement than term
calories 115-140 cal/kg/day
CHON 3-3.5 g/kgBW
frequency
caloric concentration of formula 24cal/oz

MAINTAINING
BODY HEAT
large surface area per
pound BW
does not flex well, remains
in extended position
limited amount of brown fat
unable to shiver

Radiant warmer

Kangaroo care and touch therapy

HIGH RISK FOR


INFECTION
tissues are extremely
sensitive

DIVERSIONAL
ACTIVITY
DEFICIT
PARENT
BONDING

CHECK FOR THE


NEUROLOGIC FUNCTION

Surfactant Rescue

POST MATURE
An infant who stays in utero past 42 weeks of
gestation
COMPLICATION:
\placenta loses ability to function
Postterm syndrome
Death
DX EXAM:
Sonogram
Nonstress test
amniocentesis

ASSESSMENT:
Dry, cracked, almost leather-like skin
Absence of vernix
Low weight
Long fingernails
Alert
May be meconium stained
Less amniotic fluid than normal

PROBLEMS IN POST MATURE


INFANTS
1.
2.
3.
4.
5.
6.

Maintaining respiration
Meconium aspiration
Hypoglycemia
Temperature regulation
Polycythemia
Elevated hematocrit

The Small-for-Gestational-Age Infant


May be a preterm, term or post-term infant
CAUSES:
Mothers nutrition
Placental anomaly
Systemic diseases
Intrauterine infections

Sx:
Fundal height
Sonogram
Nonstress test
Dx:
Blood studies

APPEARANCE:
Below average weight, length and head
circumference early in pregnancy
Weight only late in pregnancy
Over-all wasted
Small liver glucose,protein,bilirubin
Poor skin turgor, big head, dull hair
Skull sutures widely separated
Sunken abdomen, dry yellowish umbilicus

PROBLEMS
Respiratory function birth asphyxia
Ineffective thermoregulation
Parent bonding

The Large-for-Gestational-Age Infant


Also termed as
Macrosomia
CAUSES:
Overproduction of
growth hormone in utero
Multiparous mothers

ASSESSMENT:
Unusual large for age
APPEARANCE:
Immature reflexes in relation to size
Extensive bruising
Birth injury / trauma

PROBLEMS:
Respiratory function
Nutrition
Altered parenting

FAS
Fetal Alcohol Syndrome

ETHANOL
CROSSES
THE
PLACENTA
FREELY

ASSESSMENT:
Pre- and Post- natal growth retardation
CNS involvement mental retardation
Microcephaly
CP, Growth deficiencies throughout life
Tremulous, fidgety, irritable, poor suck
Sleep disturbances
Facial features

FACIAL FEATURES

Infant of a
DrugDependent
Mother

ASSESSMENT:

Tend to be SGA
Withdrawal
symptoms
(neonatal
abstinence
syndrome)
Urine test 1st hour
of life
- quickly cleared from
the body
- narcotic metabolites
or quinine

NEONATAL ABSTINENCE
SYNDROME
Appears on the 1st 24hrs of life
7 days heroin; 2 wks - methadone
Irritable, disturbed sleep pattern
Tremors, sneeze
Shrill, high pitched cry
Neuromuscular irritability
Tachypnea alkalosis
Vomiting and diarrhea

TX:
Touch therapy
Free environment from stimuli
- placed on isolation, dark room
Provide a pacifier
Gavage feeding (methadone and cocaine)
Pharmacologic agents to counter-act withdrawal
symptoms
Avoid breastfeeding
Treat mother
Assure safe environment before discharge
Long-term treatment

PHARMACOLOGIC AGENTS TO
LESSEN WITHDRAWAL
SYMPTOMS
Phenobarbital
Methadone
Chlorpromazine (Thorazine)
Diazepam (Valium)
Paregoric

Infant
of a
Diabetic
Mother

The Fragile
Giant

ASSESSMENT:
longer
Weighs more
(macrosomia)
chances of congenital
anomaly
Caudal regression
syndrome
Cushingoid appearance
Lethargic/limp on the 1st
few days of life
Prone to RDS

COMPLICATIONS:
CS
Hyperglycemic immediately after birth
Hypoglycemic hours after birth
Hyperbilirubinemia
Hypomagnesemia
hypocalcemia

MANAGEMENT:
PREVENT HYPOGLYCEMIA
serum glucose level in newborns
= 40-60 mg/Dl
Early feeding
Small frequent feedings

Arnold-Chiari
Deformity

DEFINITION:
Overgrowth of the
neural tube in wks
16-20 of fetal life
Projection of the
cerebellum, medulla
oblongata and the
fourth ventricle into
the cervical canal

EFFECTS:
Hydrocephalus
Lumbosacral myelomeningocele
Upper motor neuron involvement
gagging and swallowing reflex absent
tracheal aspiration

microcephaly

end

CEREBRAL
PALSY

A group of
nonprogressive
disorders of upper
motor neuron
impairment that
result in motor
dysfunction

Cause is unknown
Associated with a variety of contributory fx
brain anoxia brain cell dysfunction
SGA
short pregnancy interval
delivery
kernicterus (athetoid)
infections
head injury
severe dehydration

TYPES:
Pyramidal or Spastic
Extrapyramidal
Ataxic
Dyskinetic or Athetoid
Mixed

Spastic type

hypertonic muscles
abnormal clonus
deep tendon reflexes
abnormal reflexes
neonatal reflexes present
no parachute reflex
scissors gait
asterognosis hemiplegic
plantar flexion
Pseudobulbar palsy - quadri

Dyskinetic / Athetoid
Abnormal involuntary movements
Limp and flaccid
Slow, writhing motions
Poor tongue and swallowing movements
Stress = irregular and jerking motions
CHOROID
Disordered muscle tone

Ataxic type
Awkward, wide-based gait
Unable to perform finger-to-nose test
Unable to do repetitive movements

Mixed
Child shows symptoms of both spasticity and
athetoid movements
Can be manifested at the same time

History
Physical exam
Delayed motor deveopment
Abnormal HC, posture,
reflexes
Abnormal muscle tone and performance

Neurologic assessment
Cranial Xray / sonogram
Negative CT scan

MANAGEMENT
Instruct parents
Promote functions not affected
Prevent further loss of function
Self-care
Communication
Ambulation
Education
Safety
Nutrition
Self-esteem

SEIZURE
DISORDERS

CONVULSIONS
- involuntary contraction of muscle caused
by abnormal electrical brain discharges
- 50% unexplainable
neonates: 75% known cause
Trauma and anoxia
Metabolic disorders
Neonatal infection
Kernicterus

Cont..

Infants and toddlers: 50% identifiable cause


- Infantile spasms
- Burns itself out by age 2; developmental lag remains

- high doses of anticonvulsant medication


Children 3 y/o: idiopathic
- residual damage from a focal or diffuse brain
injury
- consider brain tumor

CLASSIFICATION OF SEIZURES
Partial (Focal) Seizures
Simple partial with motor/sensory signs
Complex partial (psychomotor)

Generalized Seizures
Tonic-clonic
Absence
Atonic
Myoclonic
Infantile

FEBRILE CONVULSIONS
Seizures associated with high fever (38.940 degrees Celsius)
Preschool/ b/w 5mo-5yrs (3mos-7yrs)
Tonic-clonic
Familial
Subsides once temperature goes down

highly preventable TSB, fluids


acetaminophen
phenobarbital

MANAGEMENT
Remain calm
Keep environment safe
Prevent aspiration
Ensure adequate supply of medication
Status epilepticus - Oxygen

GOODLUCK!!!

II. IDENTIFICATION
1. This is the most commonly associated cause leading
to a neural tube defect.
2. Neural tube defect where there is an absence of the
cerebral hemispheres.
3. Herniation of the meninges through the unformed
vertebra.
4. The most common accompanying defect with
myelomeningocele.
5. Surgical procedure done to deviate the passage of
CSF.
6. A procedure where a bright light is shined through a
body cavity or organ.