HIGH RISK INFANTInfants at riskWhat is a high-risk infant?DefinitionNeonatal mortality riskRisk factors for high risk infants?1) Maternal conditions2) Placental conditions3) Fetal conditions4) Environmental conditionsDEFINITIONSPreterm or prematurePowerPoint PresentationSlide 14PosttermSGASlide 17LGAAGASlide 20REASONRESTACTIVITYELIMINATIONSlide 25ACCEPTANCE AND BELONGINGSlide 27Slide 28Slide 29Slide 30Slide 31SAFETYSlide 33Slide 34Slide 35Nursing CareCOLD STRESSSlide 38Slide 39OXYGENATIONSlide 41LGA (continued)Slide 43Pre-termPost-termNursingRDS versus transient tachypneaTake a guess?RDSSlide 50Slide 51Slide 52APNEASlide 54Nursing care for asphyxiaOxygenation sourcesSlide 57Slide 58Slide 59Drugs used for resuscitationSlide 61NutritionSlide 63Inborn Errors of MetabolismPKU (Phenylketonurea)Slide 66GalactosemiaCretinismSlide 69Slide 70Ambiguous GenitaliaMale or Female?Slide 73Aquired disordersFractured clavicleHyperbilirubinemiaPhysiological jaundicePathological jaundiceSlide 79BILIRUBIN LEVELSCOOMBs testPhototherapy (“sun”)Exchange transfusionSlide 84Drug AbuseComplications For the Drug Dependent InfantSlide 87Slide 88“STREET” DRUGSHEROINSlide 91METHADONECOCAINE (CRACK)Warning Signs During PregnancyNEWBORN WITHDRAWALNewborn WithdrawalSlide 97Slide 98BIRTH COMPLICATIONSMECONIUM ASPIRATIONCOLD STRESS: Refer to previousSlide 102NECROTIZING ENTEROCOLITIS (NEC)NECSlide 105SEPSISSlide 107Slide 108Slide 109Slide 110BRONCHOPULMONARY DYSPLASIA (BPD)BPD or BOOPSlide 113TRISOMY 21Slide 115SEXUALLY TRANSMITTED DISEASESHERPES SIMPLEX VIRUSSlide 118HerpesSlide 120Slide 121HSV Type IHSV Type IIVAGINITISCandida AlbicansSlide 126Slide 127Slide 128Bacterial VaginosisTrichomoniasisSlide 131ChlamydiaSlide 133Slide 134Slide 135SyphilisSlide 137Slide 138Slide 139Slide 140Slide 141Slide 142Slide 143GonorrheaSlide 145Human Papilloma Virus (HPV)Slide 147Slide 148HIV and AIDSMaternal Implications:Maternal Implications continuedNursing DiagnosesFetal Implications:NURSING/TREATMENT for Pregnant Mother and fetusNURSING/TREATMENT for Pregnant Mother and fetusImplications for Newborns born to HIV+ momsInfants and Children with HIVCDC Clinical CategoriesClinical manifestationsTreatment for childTreatment for childSlide 162Slide 163Tips for dealing with HIV+ childrenKaposi’s SarcomaSlide 166Slide 167Remember!!! Be non-judgmental! The nurse’s attitude of acceptance and “matter of fact” conveys to the woman that she is still an acceptable person who just happens to have an infection (???????????)Slide 169THE END!HIGH RISK INFANTStudy Guide # 9By Unn HidleUpdated Spring 2010Infants at riskWhat is a high-risk infant?DefinitionOne who is susceptible to illness (morbidity) or even death due to one or more of the following conditions at birth:Dysmaturity (low birth weight a/t gestational age)Immaturity Physical disordersComplicationsNeonatal mortality risk= the chance of death within the first 28 days of lifeThe neonatal mortality risk decreases as BOTH gestational age and birth weight increasesInfants who are preterm and SGA have the highest neonatal mortality riskRisk factors for high risk infants?Let’s review!1) Maternal conditionsMedical conditionsSubstance abuseNutritional deficitsAgeGenetic problems2) Placental conditionsSmall placentaImpairment of the placenta3) Fetal conditionsGestational diabetes Premature infantsMaternal hyperthyroidism4) Environmental conditionsX-rayTerratogensHigh altitude (?????)DEFINITIONSPreterm or prematureInfant born < 37 weeks gestationPosttermInfant born > 42 weeks gestationSGASmall for gestational ageInfant who at birth is at or below the 10th percentile for weight (a/t intrauterine growth curves) on the newborn classification chartLGALarge for gestational ageInfant whose birth weight is at or above the 90th percentile on the intrauterine growth curve (at any week of gestation)AGAAppropriate for gestational ageREASONRESTPre-term: Increased sleep in order to decrease oxygen demandACTIVITYPre-term: Key to remember = ThermoregulationBrown fat versus white fat: What is the difference?Large surface areaELIMINATIONBOWEL: Pre-term and SGA: NEC (Necrotizing enterocolitis) secondary to chronic hypoxia. The result is bowel ischemia and risk for NECPost-term: Aging placenta may result in bowel hypoxia. Increased risk of meconium aspirateRENAL:Premature: Decreased ability to concentrate urine (immature kidneys). Insensible losses (excessive respirations through mouth and nose; RDS). Increased risk for dehydrationACCEPTANCE AND BELONGINGPre-term and SGA: Delayed bonding (NICU) – “Kangeroo care”IntubationFear Monitors Feeding (NG vs OG) – TPNSAFETYLGA:Characteristics: Phlethoric (ruddy); increased amount of subcutaneous fatAt risk for birth trauma secondary to CPD (cephalopelvic disproportion)Etiology may be unclear (diabetic, genetic disposition, multiparity, gender)Associated with erythroblastosis fetalis (isoimmune hemolytic disease) = Rh incompatibilityAssociated with Beckwith Wiedemann syndrome (genetic condition) = hypoglycemia and hyperinsulinemiaTransposition of the Great VesselsSGA:Etiology: Congenital malformationsCharacteristics:Decreased subcutaneous fat = poor insulationDecreased breast tissue = lack of adipose tissueHigh surface-to-mass ratioRed, loose dry skinRisk for continued growth difficultiesLearning difficultiesPre-term:Etiology: Multiple causesCharacteristics:Skin is transparent and thinAbundant vernix and lanugo (depends on how premature)Lack of subcutaneous tissueHigh risk for hypothermiaLarge surface-to-mass ratioLack immunity IgG antibodiesPost-term:Etiology: Physical conditions such as DMCharacteristics:Decreased subcutaneous fat (“loosing baby fat”)Dry, cracked skinDecreased or absent vernix caseosa and lanugoYellow stained nails, skin and cordAbundant scalp hair (but no lanugo)At risk for congenital anomalies of unknown etiologyRisk for seizures secondary to hypoxiaNursing CareMonitor temperature: Risk for cold stress ***Prevent heat loss - Evaporation - Conduction - Condensation - RadiationCOLD STRESSAt risk: Premature and SGA babies due to:Decreased adipose tissueDecreased brown fat storesDecreased glycogen available for metabolismExcessive