at risk, high risk, and sick newborn Cheat Sheet by Dan_Niel

5th minute (10)

Determine if neonate can adjust to extrau­terine life

4-6

fair: guarded, moderately depressed

Breathing

Use of abdominal muscles & diaphragm. Newborns are nose breathers

Thermal

sudden chilling of moist infant

To maintain a patent airway

Position

Head lower

Late onset

8-28 days after birth

• poor feeding, bloated abdomen. vomiting (yello­wish)

• low blood sugar and seizures

• Sepsis is confirmed with culture test for 7-21 days

• IV fluids to support the infant till infection clears

• Breast­feeding may help prevent sepsis

• Delivery within 24 hrs after water breaks

• Increase in bilirubin by 2nd day of life, declines in 5th

• Total bilirubin increasing by >5mg/dl per day

• appear on breastfed babies after 7 days of life

• Needs to be kept hydrated with breastmilk

• Photot­herapy: blue light

Sole creases, skull firmness, ear cartilage

sonogr­aphic estimation of gestat­ional age

multiple gest., history of preterm, single teen mother

AOG

less than 37 weeks

Digestive

bowel sounds diminished

Reflex

Poor suck, swallow, flexion

Prevention

Prevention of acquiring infection

Provision

tactile stimul­ation for apnea

Nutrition (readi­ness)

respir­ation is <60/m | rooting, sucking and gag reflex

Handle carefully when reposi­tioning

Share caretaking respon­sib­ilities with parents

Aspiration

Meconium, hypoxia

Seizure activity

severe hypoxia

Hypogl­ycemia

use of glucose stores, glycogen

- may require prolonged monitoring

- Early detection of polycy­themia & hyperb­ili­rub­inemia

- Attention to thermo­reg­ulation & feeding

• 2-3 times higher morbidity than term infants

• Aspiration

of meconium in response to hypoxia

• Seizure activity

from severe hypoxia

• Possible fracture of the clavicles

• Caput succed­aneum (normal: disappear 12 018 mons)

• Increased ceasarian sections

• Polycy­themia, hyperv­isc­osity

- Screening for polycy­themia (cbc, h&h)

- Monitor temp, and minimize heat loss

- Support parents and teach

• Bluish skin color of the infant

• Limpness in infant at birth

• ET tube placement and suctioning

• Antibiotic to treat infection

Not enough of substance called surfac­tants that consists of phosph­olipids and protein. begins to be produced at 24-28 wks. by 35 wks most have develop adequate surfac­tant.

• Difficulty of breathing (tachy­pnea, grunting)

• Flaring of the nostrils

• symptoms peak at 3rd day, diuresis dec. need of O2

• Placing an ET tube, mechanical ventil­ation

• Continuous positive airway pressure (CPAP)

Evapor­ation

wet surface exposed to air

Convection

surrou­nding cool air. Drafts

DD

decrease in temper­ature & activity

S

Shallow respir­ations

Prevention

radiant warmer. careful not to burn

I

increased oxygen need

H

hypogy­lcemia (<30 mg/dl)

- may be born preterm, term, post term

- Placental anomaly, poor nutrition

- Severe DM, decreased blood flow to placenta

Perinatal asyphaxia

deficient oxygen­ation

Hypogl­ycemia

Use of glycogen stores

Still birth

loss from death

• Maintain airway and temper­ature

• Monitor glucose level, or signs of hypogl­ycemia

• Provide feeding, touch, support, teaching

• Monitor signs of sepsis, infection, malfor­mations

VLBW

less than or equal to 1500g (3lbs 5oz)

• Seek medical check uo

• Take multiv­itamin containing 400 micg of folic acid

• height­,we­ight, and head do not match growth charts

• growth may have slowed or stop

Supple­ments

talk to HCP first, correct deficiency

• Back pain, blood in urine

• Steroids to treat swelling and allergies

• Medicines to raise blood pressure if drops too low

• Bilitubin test shows high. CBC: damage to RBC

Brain Ab.

portion that controls sleep & breathing doesn't work properly

infection

contri­butes to breathing problems

• Keep the crib as bare as possible. use firm mattress

Baby should sleep alone. baby can be rolled over by parents