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Abdulmahdi A. Hasan*

*Ph,D, pediatric & psychiatric Mental Health Nursing

Health Problems of the Newborn

Birth Injuries

Occurs in:

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  • Large infants
  • Breach deli vary
  • Forceful extraction
  • Inexperienced hands

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Soft Tissue Injury

  • Usually in cephalopelvic disproportion like: forceps application on side of face.
  • Petechiae or echymosis on the presenting part.
  • Nursing care directed toward assessing the injury and reassure the parents as they usually fades away without treatment.

Head Trauma

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  • Intraventricular hemorrhage
  • Subdural hematoma
  • Skull fracture
  • Caput succedaneum

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  • Most common trauma
  • Edematous tissue of the scapula, the swelling consists of serum or blood or both, extends beyond bone margins, no specific treatment is needed.

Cephalic Hematoma

  • Difficult labor or delivery- bld vessel rupture- blding btw. The bone and periosteum- sharply demarcated boundaries and not beyond the bone.
  • May be in one or 2 parietal bones, less frequent in occipital, rare frontal.
  • Most cases absorbed in 2 to 3 months.
  • No treatment is needed except for severe bld loss.

Fractures

  • Clavicle is the most frequent.
  • May have no symptoms.
  • May have limited use of the affected arm, asymmetric moro reflex, local swelling or tenderness, cracking sound.
  • Fractures of long bones difficult to detect by x-ray.
  • Skull fx: rare

Paralysis

Facial paralysis

  • Pressure during difficult labor- injury- loss of movement of affected side (inability to close eye led drooping of affected angle of mouth)

recovery spontaneous in days to months.

Brachial palsy: results from forces that alter the relationships of the arm, shoulder, and neck.

  • Rx prevent muscle contracture, and maintain correct placement of humeral head.

f the cause is nerve stretching- recovery occurs in about 3 months.

If the cause is nerve a avulsion, a permanent damage results.

  • Phrenic Nerve Paralysis

May occur with brachial pulsy

Unilateral- diaphragmatic paralysis so lung on the affected side does not expand, thoracic breathing, cyanosis occur, pneumonia frequent complications.

Nursing Consideration

  • If facial paralysis aid the infant to suck, use artificial tears, the led is often taped shut.
  • Phrenic nerve paralysis deal with the respiratory difficulty.

Common Problems

  • Erythema toxicum neonatarum (flee bite dermatitis, or newborn rash)
  • Unknown cause
  • Pale yellow or white papules and/or pustules 1-3 mm 1st to 2nd day on face proximal extremities, trunk and buttocks
  • Lasts 5-7 days
  • No treatment is needed.

Candidiasis:caused by candida albicains (yeast like fungus).

Candidal diaper dermatitis:

  • Rx anti candida ointment, may use oral antifungal.

Oral Candidiasis:

  • white patches in tongue , plate, can go to larynx, trachea, and lungs.
  • Rx 1 ml nystatin QID after meals for 7 days.- source of infection mother cleanliness and hand washing

Hypotonia (Floppy Infant Syndrome)

  • Decrease muscle tone, weak response to reflexes.
  • Frog posture, Poor sucking, floppy muscles
  • Causes: cerebral trauma or hypoxia, chromosomal disorder esp.
  • Down Syndrome.

High Risk Newborn

  • New born who has a greater chance than average chance of morbidity or mortality. The high risk period encompasses human growth and develop. From the time of viability up to 28 days.
  • Premature: < 37 wk gestation
  • Term infant: bet. 38 – 42 wks gestation.
  • Post mature: born after 42 wks gestation

Care of High Risk Newborn

  • Respiratory support
  • Provide warmth- neutral thermal environment 36-36.5
  • Protection from infection- hand washing, clean incubator, universal
  • precaution, infected personal should not work unless protective equipment used.
  • Hydration:
  • Sucking and swallowing coordination occur at 34- 35 wks gestation.
  • Gavage feeding: flow with gravity boluses or continuous in a feeding pump.
  • Check residue amt. and color and follow Dr. order.

Hyperbilirubinemia

  • Increased bilirubin in the blood, causing jaundice (icterus).
  • Normal newborn produces 2x as much bilirubin as does an adult while the liver ability to conjugate bilirubin is reduced.
  • Possible causes: interference in the balance btw. Formation and removal
  1. over production of bilirubin
  2. Under excretion of bilirubin
  3. Combined 1&2.
  4. Associated with breast feeding.
  5. Physiologic jaundice (most common, self limited)

** with the 1st 24 hours: hemolytic dz, sepsis, or maternal derived dz.

  • In the 2nd or 3rd day, peak on 4th day, decrease in 5th to 7th day:, physiologic jaundice
  • After the 3rd day within the first week: Sepsis
  • High bilirubin highly toxic to neurons- kernicterus due to deposit in brain cells

Rx: Treatment :-

1- Photo therapy: alter bilirubin to soulable form.

Cover eyes and perform eye care q shift

Cover genital for males.

Change position

Assess for diarrhea

2- Pharmacologic: Phenobarbital stimulates liver maturation & protein synthesis not rapid best if given early to the mother.

3- Exchange transfusion, for hemolytic diseases.

Hemolytic Disease of the Newborn

  • RH incompatibility
  • -ve RH mother carrying +ve RH baby for first time. During delivary will form antibodies and will hurt any future RH +ve babies.
  • In severe forms hydrops fetalis occur.
  • Mothers must receive anti D within fist 72 hours of birth (Rogam).

ABO Incompatibility

  • Maternal blood group Fetal blood group

O A or B

B A or AB

A B or AB

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  • Phototherapy
  • Exchange transfusion:

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IRDS- HMD

  • Responsible for more deaths than any disease.
  • Highest risk of long term neurologic complication.
  • Seen exclusively in preterm infants.
  • Decrease surfactant- inability to keep lungs inflated- atelectasis, hypoxemia, hypercapnia- respiratory and metabolic acidosis- vasoconstriction- decrease puls circulation.

Rx: Treatment :-

Surfactant administration through ETT. single dose may be enough but multiple doses may be needed.

Respiratory support ventilation and oxygenation.

Neonatal Sepsis

  • Premature – immature immune system
  • Sepsis = septicemia common in preterm & after difficult labor
  • Acquired parentally or during birth process from amniotic fluid, across placenta or direct contact in birth canal
  • Postnatally across contamination from infants or staff personal.
  • Blood cultures- umbilicus, nasal, oral, pharyngeal cavity, ear canals, skin, CSF, stool, urine.
  • Rx: respiratory support, circulatory supp., aggressive antibiotics.

NEC

  • Necrotizing Enterocolitis
  • Common below 2 kg, or infants who suffered hypoxia, sepsis, or after exchange transfusion, this reduce bld supply, death of mucosal cells- inability to secrete protective mucus- easy invasion by gas forming bacteria- pnemotosis intestinalis.
  • Hypertonic formula –consistent relationship to NEC.

DX: Diagnosis :-

  • nonspecific signs, lethargy, poor feeding, hypotension, vomiting, apnea, decrease urine output, unstable temp.
  • Specific sy.- distended abd (shiny) bld in stool or gastric content,
  • Rx:NPO, correct fld & elect. Imbalance & hypoxia.
  • Abd decompression.
  • Systemic antibiotic.
  • Surgical resection if deterioration.