HEALTHY / HIGH-RISK
[Link] PRIORITIES
IN FIRST DAY OF LIFE
• A.1. Initiation and maintenance of
respiration.
A.1.i. Resuscitation
a.1 Establish and maintain
an airway
a.2 Expand the lungs
a.3 Initiate and Maintain
effective ventilation
Factors Predisposing Infants To
Respiratory Difficulty in The First Few
Days of Life
• Low birthweight
• Maternal History of diabetes
• Premature rupture of
membranes
• Maternal use of barbiturates or
narcotics close to birth
• Meconium staining
• Irregularities defected by fetal heart
monitor during labor
• cord prolapse
• Lowered Apgar score (under 7) at 1 or 5
min.
• Postmaturity
• SGA
• Breech birth
• Multiple birth
• Chest, heart, or respiratory tract
anomalies
Airway
Naloxene (Narcan)
Classification: Naloxene
is a pure narcotic
antagonist
Action : Administered
parentally to reverse
the effects, such as
respiratory depression,
that may occur with
opiod narcotic agents
Surfactant (Survanta)
Action: Surfactant
restores
naturally
occurring lung
surfactant to
improve lung
compliance
• A.2 Establishing Extrauterine
Circulation
Although establishing respirations
is the usual priority at a high-risk
newborn’s birth, lack of cardiac function
may be present if respiratory function
cannot be quickly initiated and
maintained.
Epinephrine
Action:
Strengthens or
initiates cardiac
contractions;
increases heart
rate and blood
pressure
Maintaining Fluid and
Electrolyte Balance
• Dehydration may result from
increased insensible water loss from
rapid respirations.
• Fluid’s such as Ringer’s Lactate or
5% dextrose are commonly used to
maintain fluid and electrolyte levels.
A.3 Control of Body Temperature
• To prevent a newborn from becoming
chilled after birth, wiped the infant
dry, cover the head with a cap, and
placed him immediately under a
prewarmed radiant warmer or in a
warmed incubator or skin-to-skin
against mother
Radiant Heat Sources
Radiant Heat Warmer Incubator
Photo Theraphy
Kangaroo Care
A.4 Intake of Adequate
Nourishment
• Neonatology
Nasogastric
feeding of Pts–
eg, premature
infants with
weak sucking
reflexes or
nasogastric
hyperalimentati
on
A.5 Establishing Waste Elimination
A.6 Prevention of infection
Common Viruses
Megalovirus
Toxoplasmosis
Prevalent Perinatal Infections
Streptococcal septicemia
Candida Infection
Herpes Infection
A.7 Establishing Parent-Infant
Bonding
• Continue
Support,
Encouragement,
and Health
Teaching the
Mother or Family
A.8 Developmental Care
• Follow-Up of High-Risk Infants
at Home
• High-Risk Infants and Child
Abuse
B. THE NEWBORN AT
RISK BECAUSE OF
ALTERED
GESTATIONAL AGE OR
BIRTHWEIGHT
Term Infants – born after the
beginning of week 38 and
before week 42 of pregnancy.
Preterm Infants – born before
term or less than the full 37th
week of pregnancy.
Post-term Infants – born after the
onset of week 43 of pregnancy.
Appropriate for Gestational Age
(AGA) – infants who fall
between the 10th and 90th
percentiles of weight regardless
of gestational age.
Small for Gestational Age (SGA) –
infants who fall below the 10th
percentile of weight for their
age.
Large for Gestational Age (LGA) –
infants who fall above the 90th
percentile in weight.
Infants Weighing
under 2500g – low-birthweight
infants
1,000 to 1,500g – very-low-birth
weight infants
500 to 1000g – extremely- very
low-birthweight infants
• Preterm Infants may be:
SGA
LGA
AGA
Low birthweight
Very low
Extremely very low birth
weight
B.1 The Small-for-Gestational-Age
Infant
• Causes
Lack of adequate nutrition during fetal
growth
Placental anomaly
Placental damage
Severe diabetes mellitus
Pregnancy-induced hypertension
Mothers who smoke heavily
Use of narcotics
B.2 The Large-for-Gestational-Age
Infant (MACROSOMIA)
• Causes:
overproduction of growth
hormone in utero
High glucose levels of diabetic
mother
Multiparous women
Transposition of great vessels
Beckwith Syndrome
Congenital anomalies such as
omphalocele
B.3 Preterm Infant
• Causes:
the exact cause of
premature labor and early
birth is rarely known
Low socioeconomic level
Poor nutritional status
Lack of prenatal care
Multiple pregnancy
Previous early birth
Race
Cigarette Smoking
Age of the mother
Order of birth
Closely spaced pregnancies
Abnormalities of the mother’s
reproductive system
Infections
OB complications
Early induction of labor
Elective cesarean birth