.

Newborn Assessment
Dr Mohd Maghayreh
PRTH
 General Survey
Appearance
• Symmetry, any
obvious deformities,
size, smell, muscle
tone, sex, posture
Behavior
• Crying, lethargic,
responsive, reflexes,
jittery
 Measurements
• Normal Weight
• 2500-4000gms
• 5 ½lbs. – 8lbs, 13 oz.
• (AGA-appropriate for
gestational age)
• Below normal (SGA- small
for gestational age)- <10%
• Above normal (LGA-large
for gestational age)- >90%
• Normal Length- 18-22” or 48-52 cm.
• Head circumference- 13-14” or 32-36 cm.
(measure right above eyebrows)
• Chest circumference- 12-13” or 30-34cm
(measure at nipple line)
Vital Signs
• Temperature- first is usually
taken axillary, but may be taken
rectally to assure anal patency
(36.5-37.5C or 97.5-99.5F)
• Pulse- 110-160 bpm, unless
sleeping (100) or crying (180)
• Respirations- 30-60 with
periodic breathing
• B/P- only if suspected heart
problem or premature infant
 Skin
• Color-
• Pink
• Pink with blue hands and feet (Acrocyanosis)
• Jaundiced (yellow)
• Blue/cyanotic
• Mottled (lacy appearance)
• Pale (white)
• Harlequin (pink on one side, pale or blue on other)
Acrocyanosis

Mottling

Jaundice
 Skin Appearance
• Vernix- white cheesy substance
• Lanugo- fine hair (usually on shoulders,
ears and back)
• Milia- plugged oil glands (usually on chin
or nose)
Vernix

Milia
 Rashes/Marks
- Erythema Toxicum (Newborn Rash)
- Forcep marks
- Mongolian spots
- Birthmarks:
• Port wine stain
• Stork bite/Nevi
• Strawberry mark
• Café au lait
- Petechiae
 Erythema Toxicum

Mongolian spot

Forcep mark
 Port wine stain

Stork bite/ Nevi

Strawberry hemangioma
Cafe au lait birthmark

Petechiae
 Head
• Size- 1” larger than chest ( > 1” may be
indicative of hydrocephalus)
• Shape:
• Round
• Moulding (suture lines overlap and
head elongates)
• Caput Succedaneum (head elongates
and there is also edema of the soft
tissue)
• Cephalohematoma (hemorrhage into
the cranial bone, swelling and bluish
color on one side of the head- does not
cross suture line)
 Caput
Moulding
Cephalohematoma
• Fontanels/Sutures- 2 fontanels
• anterior one is diamond shaped- closes at
about 18 months old
• posterior one is triangular shaped- closes
by 2-3 months
• Facial Symmetry

• Eyes- shape, Asymmetry

slanted,
hemorrhages,
edema, strabismus

Strabismus
hemorrhages Slanted eyes
•Nose- √ patency of
each nares to r/o
“Choanal Atresia”
• Mouth- √ for cleft lip and palate, √ for
neonatal teeth, Epstein’s pearls, Thrush

Cleft lip
Cleft palate
Epstein’s Pearls Thrush

Neonatal teeth
• Hair- fine with consistent hair pattern
(abnormal hair patterns indicated genetic
abnormalities)
•Ears-
•normal shape
•patent
•even with eyes (low set ears indicate
congenital abnormalities)
•Pits or tags
 Major birth defects of the Head
• 1. Anencephaly- a neural tube defect where only
the brain stem grows and there is no brain tissue

• 2. Encephalocele- another
neural tube defect where the
cranium does not close and
the meninges protrude out of the
head
• Neck and Clavicles- is the neck thick or
webbed, do the clavicles feel intact, no
crepitus.
 Chest
- Size- 1” smaller than head
- Shape- cylinder shape is normal.
Asymmetry can be caused by
Pneumothorax or Diaphragmatic Hernia
- Nipples- location, distance apart, any
accessory nipples
Pneumothorax
 Lung Sounds
- clear or moist, equal, bowel
sounds in chest?
- S/S of respiratory distress
- (tachypnea, grunting, retractions,
nasal flaring, cyanosis)
- Rate (listen for 1 full minute)
 Heart Sounds
• - auscultate for rate & rhythm
• - presence of murmurs (murmurs are
common in the newborn period- 90% are
transient and considered normal)
• Listen for 1 full minute
• Report any abnormal rate, rhythms or
sounds to pediatrician
• If suspected heart problem- take B/P on all
four extremities
• Abdomen:
- Size- same or smaller than chest
- Shape- rounded, no distention
- Any obvious deformities (Gastrochesis,
Omphalocele)
- Bowel sounds- present, hypo, hyper
- Cord- color, # of vessels, clamp on tight (no
skin attached), no bleeding noted
Omphalocele

Gastrochesis
 Genitalia:
- Female- labia may be swollen and red from
delivery, hymenal tag, pseudomenses, whitish
drainage
- Male- testes should be descended at term, rugae on
scrotum, check where urinary meatus comes out
- Hypospadias- urethral opening is on the underside
- Epispadias- urethral opening is on the upperside
Hypospadius with repair
 Extremities
• Arms & Hands
• Symmetry
• 10 fingers
• Simian crease
• Polydactyly- extra digits
• Syndactyly- webbing of digits
• Brachial pulse
 Syndactyly
Polydactly

Simian Crease
Hips- check for congenital hip dysplasia

Normal Hip Hip Dysplasia

S/S of Hip Dysplasia:
Hip click
+Ortalani’s test
One leg shorter
Gluteal creases assymetrical
 Legs and Feet

• Symmetry
• 10 toes
• Femoral pulse
• no club feet
• Creases on bottom of feet
 Back and Buttocks
- Straight spine
- Spina Bifida Occulta- dimple or tuft of hair
- Meningocele (sac with fluid only)
- Meningomyelocele (sac with fluid and
spinal cord)
 Neurologic
• Reflexes (see page 533)
• Babinski, Plantar, Moro, Rooting, Sucking,
Stepping, Tonic neck
• Sensory assessments
• (do eyes track, does infant respond to
sound?)
 Gestational Exam
• EDD is not always correct (only accurate 75-85%
of the time)
• Performing a gestational exam helps the nurse
evaluate for potential age-related problems. Should
be done in the first 4 hours of life.
• Gestational age tools have 2 components: physical
maturity and neuromuscular maturity
• Most common tool is the “Ballard”
• (see pages 538-545 in text)
Lab Assessments
• Blood Glucose (>40 mg/dl
is normal)
• Bilirubin Level- < 12 is
normal. Peaks on 3rd day of
life
• Newborn Screening Test
(NBS)- State required test
-Phenylketonuria (PKU)
-Hypothyroidism
-Galactosemia
-Hemoglobinopathies
IV. Adaptation of the Newborn
Infant
 Initiation and Maintenance of
Respirations
• 1) Lung Development- as
a baby nears birth, fluid
begins to move to
interstitial space.
Production of Surfactant
by 34-36 weeks. Keeps
alveoli of lungs from
collapsing when
exhalation occurs.
 Factors that initiate Respirations
• 1) Chemical Factors- ↓in O2 and ↑ in CO2
causes impulses to stimulate the respiratory
center in the medulla of the brain.
• 2) Thermal Factors- abrupt temperature
change sends impulses to brain
• 3) Mechanical Factors- fetal chest is
compressed during birth, forcing fluid out.
• 4) Factors that maintain respirations-
surfactant, functional residual capacity
 Cardiovascular Adaptation: Transition from
fetal to neonatal circulation
• What is fetal circulation?
• A combination of structures/vessels that are
present only during the fetal period, which
help shunt the highest oxygenated blood to
the head, brain and heart.
• 1) Ductus Arteriosus
• 2) Foramen Ovale
• 3) Ductus Venosus
 At birth, after the first few breaths, the
following cardiovascular changes occur:
• 1) Ductus Arteriosus closes in
response to ↑O2 and ↓
resistance in lungs
• 2) Pulmonary blood vessels
dilate in response to demand
in lungs
• 3) Foramen Ovale is forced to
close because of increased
pressure in left side of heart
• 4) Ductus Venosis constricts
when umbilical cord is
clamped
 Neurologic Adaptation:
Thermoregulation
• The maintenance of body temperature is a major task
for the NB infant (normal temperature is 97.7-98.6)
• 1) their skin is thin and blood vessels are close to the
surface
• 2) they have little SQ fat to serve as a barrier to heat
loss
• 3) they have 3x the surface to body mass as an adult
• 4) Preterm infants are especially susceptible to heat
loss because their tone is poor and they have even
less fat and thinner skin than full term babies.
 Methods of Heat Loss
• 1) Evaporation-occurs when wet surfaces
are exposed to air.
• 2) Conduction- occurs when the NB comes
in direct contact with objects that are cooler
than their skin.
• 3) Convection- occurs when heat is
transferred to air that surrounds the NB.
• 4) Radiation- occurs when there is a
transfer of heat to cooler objects that are not
in direct contact with the infant.
 Effects of Cold Stress
• 1) ↑Metabolic Rate: leads to ↑ use of glucose and ↓
production of Surfactant. This can lead to
hypoglycemia and respiratory distress.
• 2) Non-Shivering Thermogenesis-metabolism of
Brown fat. This leads to increased production of free
fatty acids, which leads to metabolic acidosis and
jaundice.
• 3) Vasoconstriction: leads to pale, mottled skin and
shut down of pulmonary vessels, which leads to fetal
circulation patterns.
Brown Fat
“Neutral Thermal Environment”
• NTE helps prevent heat
loss in newborns.
• Maintains stable temp
without an increase in
oxygen or metabolic rate.
• In healthy unclothed NB’s,
89.6° to 92.3°.
 Hematologic Adaptation

• 1) Blood Values-
• RBC’s- Newborns have a higher # of RBC’s
than adults, and their RBC’s are larger in
order to receive adequate O2 to cells.
“Polycythemia” =a high RBC count.
Increases risk of jaundice and brain infarct.
• Hematocrit- higher than in the adult. 48%-
69% is normal (heel stick) 65% venous blood
• WBC’s- Elevation is normal, because the stress of
birth increases production.
• Infection can cause either decreased or increased
WBC’s with large # of immature WBC’s (Bands or
Stabs).

• 2) Risk of Clotting deficiencies- the NB is at risk

because they lack Vitamin K, which activates
several clotting factors in the body- factors 2, 7 and
10.
• To decrease this risk, NB’s are given an injection of
Vitamin K at birth.
 Gastrointestinal System Adaptation
• 1) Stomach- capacity is low at birth, but expands to
about 90ml within a few days. The cardiac sphincter is
relaxed, which causes a tendency to regurgitate.
• 2) Intestines- sterile at birth, once the infant takes in
food, bacteria enters the GI tract.
• 3) Digestive enzymes- deficient in amylase and lipase
until 3-6 months of age. Breast milk has these two
enzymes.
• 4) Stools- 1st stool is meconium, which has accumulated
in the intestines throughout gestation. Usually the 1st
Meconium stool is passed within first 24 hrs of live.
Passage during labor is a sign of fetal stress.
 Hepatic System Adaptation
• 1) Blood Glucose Maintenance- glucose is
stored in the liver during the last 4-8 weeks
of pregnancy. This is used for the energy of
birth, heat production and stores until the
first feedings are taken.
• Normal blood glucose for infants is 40-60.
< 40 is considered hypoglycemia.
• Infants at risk for hypoglycemia:
• SGA, LGA, stressful deliveries, infection,
cold stress.
 2) Conjugation of Bilirubin
• “Bilirubin” is a byproduct of the breakdown of
RBC’s.
• It is released in the unconjugated form.
• Unconjugated bilirubin is fat-soluble and is
absorbed by the SQ fat, causing a yellowish
discoloration of the skin, called jaundice.
• The liver must conjugate the bilirubin (change it
into a water-soluble form) in order for the body to
excrete it through the urine and the stool.
The conjugation of Bilirubin by the Liver:
 Hyperbilirubinemia
• Definition: excessive levels of bilirubin in
the blood >12 mg/dl.
• Extremely high levels >25 mg/dl can lead to
brain damage because the brain tissues are
stained (“Kernicterus”)
• Two types:
• 1) Physiologic Jaundice
• 2) Pathologic Jaundice
 1) Physiologic Jaundice:
Timing: Occurs after 24 hrs
Peaks on 3rd day of life
Incidence: Occurs in 60-80% of NB’s
Etiology: Caused by breakdown of excessive RBC’s
after birth. The immature liver can’t handle them all,
so build up of unconjugated bilirubin occurs, and skin
becomes yellow.
Bruising, cephalohematoma, or poor feeding
(dehydration) worsens this normal occurrence
Breast Milk Jaundice- sleepy infants who have a poor
suck do not receive enough colostrum (laxative effect
clears bilirubin rich meconium)
• Treatment: If level goes > 12mg/dl;
• 1. Phototherapy lights are started- high intensity
flourescent lights that convert the bilirubin under
the skin so that it can be excreted in the stool.
• *The eyes and the genitals of the infant must be
protected.
• 2. Feedings are increased to promote stooling and
urination (with breast milk jaundice- formula is
given for 24-48 hours)
• 3. IV fluids may be needed if infant not feeding
well.
Phototherapy Bed
Phototherapy Blanket

Phototherapy Lights
 2) Pathologic Jaundice
• Timing: Occurs in the first 24 hours of life, some
infants born jaundiced. Level reaches 12 mg/dl by
24 hrs.
• Etiology: anything that causes the destruction of
RBC’s
• 1) Incompatabilities between maternal and fetal
blood
• Rh Incompatability
• ABO Incompatability
• 2) Infection
• 3) Metabolic Disorders
 Rh Incompatability
• This occurs when the expectant mother is
Rh-, the father is Rh+ and the fetus is Rh+.

Rh- Rh+
Rh+
 Pathophysiology
• People who are Rh+ have the Rh antigen on their
RBC’s. People who are Rh- do not.

• If blood that is Rh+ enters the body of a person

who is Rh-, the body reacts as it would to any
foreign substance, and develops antibodies that
destroy the invading antigen (this is called
“sensitization”)
A “sensitized” mother who has built up antibodies
• Theoretically, there is no mixing of fetal and
maternal blood during pregnancy.
• However, small placental accidents can occur
(usually at the time of birth) that allow a drop
or two of fetal blood to enter the maternal
circulation.
• This can also occur during a spontaneous or
elective abortion, or during antepartal
procedures, such as amniocentesis, or with
placental problems, such as abruptio placenta.
•Maternal antibodies cross the placental
barrier and cause massive destruction of the
fetus’ RBC’s.
•To destroy the Rh antigen (which exists as
part of the RBC), the antibody must destroy
the entire RBC.
 Fetal and Neonatal Implications
• 1) Pathophysiology:
• Once the mother is sensitized and has developed
antibodies, the current fetus (if occurs early in
pregnancy) and any subsequent Rh+ fetus will develop a
condition called “Erythroblastosis Fetalis”.
• 2) S/S:
• Infant born severely anemic and jaundiced
• Infant has generalized edema because of the profound
anemia -“Hydrops Fetalis”
• Congestive heart failure
• Ascites
• High risk for death
 Treatment
• Phototherapy
• IV fluids
• Exchange Transfusion
• Cardiac support
(Dopamine)
• Infusion of Albumin
 Maternal Implications
• All pregnant women tested for Blood type and Rh.
• Any Rh- woman also tested for “Coomb’s Test”
(determines presence of Rh antibodies in maternal
blood).
• If unsensitized: A Rh Immunoglobulin (RhoGAM) is
given at 28 weeks.
• If sensitized: Coomb’s test is repeated throughout
pregnancy to determine if the titer is rising. Any
increase means this infant is Rh+ and is in jeopardy.
Amniocentesis is done to determine fetus’ Rh factor.
Fetal diagnostic tests are done weekly to determine
fetus’ well-being. Intrauterine transfusion and/or
early delivery may be needed.
 Postpartum Management
• Infant is tested from cord blood to
determine blood type and Rh, also a
Coomb’s test is done.
• If infant is Rh+, mother must receive
another dose of RhoGAm within 72 hrs of
birth to prevent antibody formation.
• If infant is Rh-, no treatment is needed.
 ABO Incompatability
• 1) Occurs when the mother is type O blood and
the infant is A, B, or AB.
• 2) not as severe as Rh incompatability, but can
lead to jaundice in the NB.
• 3) Pathophysiology: Type A, B, or AB blood has
an antigen that is not present in type O blood.
People with type O develop anti-A or anti-B
antibodies naturally as a result of exposure to
antigens in foods, or to infections by gram-
negative bacteria. IgG or IgM antibodies are
formed. The IgG antibodies cross the placenta and
cause hemolysis in the fetus.
• The first fetus can be affected.
• IgG are the only antibodies that can cross
the placental barrier, and usually most of
the antibodies formed are IgM, so this
condition is usually much milder than the
Rh issue.
• At birth, the coomb’s test will detect
whether antibodies are present. If so, serial
bilirubin level checks are done, and the
infant is watched closely for jaundice.
 Other Liver functions
• 4) Iron Storage- Iron is stored from the mother in
the last weeks of pregnancy. If the infant is full
term, enough iron should be present to last 4-6
months. By then the infant should be started on
foods that have iron, such as infant cereal.
• 5) Metabolism of drugs- NB’s metabolize drugs
slower than older children because their liver is
immature. Any drug taken in labor may take a
while to get out of the baby’s system. Also,
breastfeeding women need to be cautious what
they take.
 Urinary System Adaptation
• Blood flow to the kidneys increases
following birth, because of decreased
resistance in the Renal blood vessels.
• 1st void should occur within 24 hrs.
• Absence of urine could indicate
hypovolemia, absence of kidneys, or
kidney anomalies.
• Usually Oligohydramnios is also present
when there is a kidney dysfunction.
 Psychosocial Adaptation
• Behavioral States:
• 1) Quiet sleep- deep sleep, no eye movement,
resp. quiet and slower
• 2) Active sleep-rapid eye movements, may
move extremities or stretch
• 3) Drowsy- transitional period, yawns, eyes
glazed
• 4) Quiet alert-infant able to focus on objects or
people, tuned into environment
• 5) Active alert-restless, starting to fuss, faster
respirations, more aware of discomfort
• 6) Crying- follows quickly if parent doesn’t
intervene during active alert state.
 V. Care of the Newborn
• 1) Vitamin K- 1 mg. given IM (Vastus
Lateralis) to promote clotting factor
formation.
• 2) Eye treatment- Antibiotic eye ointment
is given to protect against organisms
contracted in the birth canal.
• Gonorrhea and Chlamydia cause “Opthalmia
Neonatorum”, a serious eye infection that
can cause blindness if not caught early.
• 3) Blood glucose
• Checked on all babies who are SGA, LGA, have
low temperatures, are jittery, or who had a
stressful delivery.
• If below 40 mg/dl, start feeding protocol per
hospital.

• 4) Circumcision
• Pros/Cons
• Techniques (Gomco or Plastibell- page 563)
• Pain Relief
• Nursing Responsibilities
Plastibell method

Gomco method
• 5) Bathing-
• *remember Thermoregulation
• Good time to observe for any
missed abnormalities
• Sponge bath until cord falls
off

• 6) Cord care-
• Alcohol, Betadine, Triple dye
• Teach parents how to care for
cord and when to expect it to
fall off
• 7) Protection of Infant-
Security, ID badges,
observation of any
suspicious looking people

• 8) Teaching Parents
• NB Care
• Feeding
• When to call the Doctor
• Lab tests
• Hearing Screen
VI. Care of the High Risk
Newborn
 Levels of Care
• Level 1 nurseries- Newborn
• Care for minor problems and transitional issues
(TTN, Jaundice, hypothermia)
• Level 2 nurseries- care of preterm infants 32 weeks
or >, conditions that will resolve rapidly (sepsis,
mild RDS)
• Level 3 nurseries- care of severely preterm and
infants with long term problems
• Level 4 nurseries- “Tertiary” centers that do
specialty care, such as heart surgery
Infants at risk because of gestational age
or size
• SGA/IUGR- an infant born at <10% normal
weight for it’s gestational age.
• -Symmetric growth restriction indicates long-term
complications because the total # of cells are
decreased. Caused by congenital anomalies,
exposure to infection or drugs early in pregnancy
• -Asymmetric growth restriction (head looks big in
comparison to body) Brain and heart size are
normal, other organs may be small. Growth
problem starts in the 3rd trimester. These babies
generally “catch up”.
 Etiology of SGA/IUGR
• Maternal factors
• Maternal disease
• Environmental factors
• Placental factors
• Fetal factors
 Nursing considerations

• 1. Assess for hypoglycemia

• Feedings- early and more frequent
• 2. Assess for hypothermia
• Extra clothing and blankets, overhead
warming units, isolettes
 LGA
• Definition: an infant whose birth weight is
at or above the 90th % at any week of
gestation.
• Etiology: Most commonly infants born to
Diabetic mothers
Common complications of the LGA newborn

• 1) Birth trauma & increased incidence of

cesarean births
• 2) Hypoglycemia
• 3) Polycythemia & Hyperviscosity
• 4) Respiratory Distress syndrome
• 5) Congenital birth defects- particularly in
the Infant of a Diabetic mother
 Nursing Considerations
• 1. Assess for birth injuries
• Fractured clavicles, brachial palsy
• 2. Assess for hypoglycemia
• Follow hospital protocol for obtaining
blood glucose by heel stick
• 3. Assess respiratory functioning
• Rate, effort, breath sounds
 Post term Infants
• Definition: an infant born p 42 weeks.
• 12% of all pregnancies
• 5% of these infants exhibit “Postmaturity
syndrome”, caused by decreased placental
functioning which leads to low oxygen levels and
nutrition transport.
• S/S: Hypoxia, malnourished, loose skin, long
nails, wrinkled and cracked, peeling, meconium
stained cord, skin and nails.
Common complications of the post-term
newborn
• 1) Hypoglycemia
• 2) Meconium aspiration
• 3) Polycythemia
• 4) Seizures
• 5) Cold Stress/Hypothermia
 Nursing considerations
• Assess respiratory functioning (especially
if meconium was passed)
• Assess for hypoglycemia- early and more
frequent feedings
• Assess for hypothermia- blankets,
warming units, etc.
• Assess for polycythemia which can
increase the risk for hyperbilirubinemia
Preterm Infants
 Scope of Problem:
In 2004, 12% of all births were preterm. This # has
not decreased, in spite of advances in technology
to save these infants.
• In fact, since 1982, there has been a 27% increase
in premature births
• Some of the reasons for this increase:
∀ ↑ rate of births to women 35+ years old
∀ ↑ rates of multiple births (ART)
∀ ↑ substance abuse in childbearing women
∀ ↑ Stress
 Survival rates of Preterm Infants
 Birth weight of 1000-1500gms: 85-90%
 Birth weight of 500-600gms: 20%
 In terms of medical expense, lost potential and
suffering of infants and their parents, prematurity
is very costly
 # 1 cause of neonatal mortality (1st four weeks)
 # 1 cause of infant mortality (1st year)
 # 1 cause of black infant mortality
 Major cause of childhood disabilities
 Total U.S. hospital charges for infant stays due to
prematurity/LBW: $11.9 Billion
 Etiology and Risk Factors
for Premature Birth
• Etiology: Unknown
• Risk Factors:
• Infection
• Multifetal pregnancy
• Hx of previous preterm delivery
• Maternal disease: PIH, Diabetes, heart disease
• Low socioeconomic status of mother
• Substance abuse
• Maternal age <17 or >35 years old
 Prevention of Premature Birth
• *Adequate prenatal Care
• Identification of high risk mothers/
fFN test
• Identify and treat infections early
• Teach mothers s/s of premature
labor
• Adequate nutritional state of mother
• Early identification of substance
abuse
• March of Dimes (5 year Campaign
to decrease Prematurity)
• Professionals and Researchers:
 Common problems in the Preterm
Infant
• 1) RDS- Respiratory Distress Syndrome (also
called Hyaline Membrane Disease)
• Etiology: Insufficient production of Surfactant
(allows alveoli to remain open with exhalation).
• Pathophysiology: When surfactant is insufficient,
the alveoli collapse each time the infant exhales.
The lungs become “stiff” and resistant to
expansion. Atelectasis and hypoxia eventually
occur, along with respiratory acidosis.
• 20% of Neonatal deaths in the
U.S. are from RDS.
• Signs/Symptoms of RDS:
• 1) *Grunting on expiration
• 2) Tachypnea
• 3) Retractions
• 4) Cyanosis
• 5) Nasal Flaring
• 6) Respiratory Acidosis
• Diagnosis: Made by s/s and Chest X-ray
(ground glass appearance)
 Treatment:
• Supportive (mechanical ventilation,
correction of acidosis, IV fluids)
• Surfactant Replacement (can be repeated
several times)
• *Infants treated with “Survanta” have higher
survival rates and fewer complications of
RDS
 Nursing Care of the Patient with RDS

• Strict I & O
• Watch blood sugar
• Maintain Umbilical catheter
• Draw and interpret blood gases, and work with
respiratory therapist in adjusting ventilator or O2
settings
• Watch for complications: Pneumothorax,
worsening RDS, Intraventricular Hemorrhage
 Other considerations
• Position Infant for Optimal Neurological
Development
Promote Bonding with Parents (Kangaroo Care)
 Other common problems of the
premature infant
• 1) Apnea
• 2) Thermoregulation
• 3) Poor feeding/ GI infections (Necrotizing
Entercolitis)
• 4) Bronchopulmonary Dysplasia (BPD)
• 5) Intraventricular Hemorrhage
• 6) Retinopathy of Prematurity
• 7) Poor parent-infant bonding
Nursing Interventions to promote
bonding
• 1) give photographs
• 2) place infant’s first name on the

 
incubator ASAP
• 3) provide information on
infant’s progress
• 4) involve parents in decision
making
                                                                                                                                       

           
• 5) teach parents about unique
behavioral clues of the preterm
infant
• 6) Kangaroo care
• 7) allow to do cares when infant
is stable
 Infants at risk because of
maternal substance abuse
• Identifying drug-exposed infants (Red flags!)
• - lack of prenatal care
• - placental abruption (cocaine or speed)
• - abnormal behavior of mother
 Abnormal s/s of infant
• irritable
• jittery
• restless
• prolonged high-pitched cry
• difficult to console
• poor feeding (uncoordinated suck, frequent vomiting)
• diarrhea
• poor sleep patterns
• yawning
• sneezing & nasal stuffiness
• tachypnea
• seizures
“Narcotic Abstinence Syndrome”
(NAS)
• Seen in infants who have been exposed to
opiates, such as Heroin or Methadone
• Infants experience severe withdrawal
symptoms
• Drug therapy is used to control s/s-
Phenobarbital, oral morphine, paregoric,
tincture of opium, methadone (drug dosage
is tapered over time)
Nursing considerations
• Substance testing when
suspicious- urine or
meconium is obtained
• Scoring on Abstinence
Scale
∀ ↓ stimulation: Swaddling,
lights low, group cares
together, quiet spot in
Nursery
• Medication if needed
Legal and Parental Considerations
• Maternal drug test can only be done with consent
• Infant drug test can be done without consent,
based on suspicions because of mother’s behavior
or infant’s s/s.
• A positive drug test usually results in a CPS
referral. They interview mother, and then
determine placement of child.
• Nurses need to promote bonding and document
mother’s visits and behavior well.
Infants at risk because of Infection
• Bacterial infection of the newborn affects 1-4 in
every 1000 live births.
• NB’s acquire infection in one of two ways:
• 1) Vertical transmission- In utero, either by
passage across the placenta, or during labor, as
organisms ascend the vagina.
• 2) Horizontal transmission- After birth, from
hospital staff or equipment (Nosocomial), or
family members
 Common organisms:
• Group B strep
• E. coli
• Haemophilus influenzae
• Staph Aureaus
• Viral (CMV, herpes,
HIV, Rubella)
• Syphillis, Gonorrhea
• Toxoplasmosis
 Signs/Symptoms

• *Temperature instability (usually with low

temperatures, rather than high)
• Respiratory problems
• Feeding Intolerance
• Lethargy
• Hypoglycemia
• Apnea
 Therapeutic Management

• 1) Testing- blood cultures, urine

samples, CBC, CSF, C-reactive Protein
• 2) Broad–spectrum Antibiotics
(Ampicillin and Gentamicin)
• 3) Supportive Care- fluids, oxygen,
warmth, glucose stabilization
 Infants at risk because of respiratory
problems
1) Transient Tachypnea of the Newborn (TTNB)
• Etiology: Retained lung fluid
• Risk Factors: Cesarean Birth, asphyxia at birth,
maternal analgesia, bleeding, diabetes.
• S/S: Tachypnea (as high as 120/min), retractions,
nasal flaring, may or may not have grunting, mild
cyanosis. Chest X-ray shows streaking and
presence of fluid in the lungs.
• Condition is self-limiting and treatment is
supportive.
Same baby with TTNB, x-rays are 24 hours apart
2) Meconium Aspiration Syndrome (MAS)

• MAS develops when meconium in the amniotic

fluid enters the lungs during fetal life, or at birth.
• Risk Factors: Postterm infants, Intrauterine
asphyxia
• Meconium in the lungs causes obstruction of the
airways and air trapping. This can result in
pneumothorax and/ or respiratory distress.
Therapeutic
Management
• At birth, the airway must be cleared. The
obstetrician suctions the mouth and
pharynx, then the NICU team intubates the
trachea, and deep suctioning is done (prior
to the infant crying/breathing).
• Treatment includes respiratory support
(oxygen, ventilation), Antibiotics, and
possible ECMO.
Please take good care of me!

I’m the Future!