High Risk Neonate

If possible, identify before birth then either

transport mom to high risk facility or have emergency staff in delivery room.

 Immediate Care
Suction mouth then nose on perineum always

have deep suctioning available for any delivery Stimulate except for suspected meconium aspiration Keep Warm

 ABCs of CPR
Airway Stimulate Blow-by oxygen hold oxygen to face Oxygen mask Bag and mask if no respirations or ineffective respirations may lead to intubation

-AP if less than 80, do chest compressions To see if compressions are being effective, feel for the femoral pulse

 Drugs in the Delivery Room

Epinephrine stimulates HR can be given down

ET tube Narcan
Na Bicarb give slowly can cause intracranial

hemorrhage Surfactant artificial surfactant give down ET tube

 Volume Expanders especially if mom has

increased bleeding

Premature Infants
Complications RDS lack of surfactant peaks at 3 days so may need repeated doses of surfactant -Classic signs grunting, nasal flaring, cyanosis, and retractions can lead to apnea Hypoglycemia have no sugar reserves

 Intracranial hemorrhage fragile capillary system

too much oxygen can cause a bleed

Infection immature immune system must

stress good handwashing Hyperbilirubenemia immature liver

 Necrotizing Enterocolitis again fragile capillaries

in the intestines can rupture if infant is fed too early must wait until gut is mature or can cause the bowel to necrotize Anemia immature hematopietic system also frequent blood monitoring

SGA (Small for Gestational Age)

Assessment
Prenatally fundal hts. After birth, baby will have a look of malnutrition Lab findings Polycythemia risk for respiratory problems, thrombus, and hyperbilirubinemia Hypoglycemia -

 Complications
Polycythemia

Hypoglycemia

Meconium aspiration

LGA (Large for Gestational Age)

Assessment
Prenatally fundal hts too large, mom with

increased blood sugars After birth risk for birth trauma leading to increased bilirubin
Polycythema
Hypoglycemia RDS

 Complications
Bruising/birth injury Cyanosis

Polycythemia

 Hyperbilirubinemia Hpyoglycemia

RDS

Transient Tachypnea
Assessment no respiratory problems at birth but

within 3 hours develops tachypnea peaks at 36 hours Causes low reabsorption of fetal lung fluid see more often in C/S babies than vaginal deliveries Treatment
Support with nutrients - do not nipple feed with

elevated respirations Oxygen therapy and keep warm

Phenyletonuria
Lack enzyme to break down phenylalanime

Infants screened after birth must wait 24 hours

S/s without treatment Treatment
Diet

Prenatal Drug Exposure

S/S
NAS neonatal abstinence sydrome Irriatbility Altered feeding patterns Diarrhea Lethargy or restless High-pitched cry Hypertonicity Jitteriness, tremors, seizures Difficult to console yawning

 Treatment
No breastfeeding Drug therapy Morphine Methadone Phenobarbital Tincture of opium

 Need follow-up care

Dont be judgmental
Involve mom as much as possible Encourage bonding

Hyperbilirubinema
Jaundice

Can cause kernicterus

Main cause hemolytic disease Treatment
Early recognition Phototherapy Exchange transfusion