Disorders of the neonates with their pharmacologic and nursing management.

2. RESPIRATORY DISTRESS
SYNDROME
MECONIUM ASPIRATION
SYNDROME
SEPSIS
HYPERBILIRUBINEMIA
SUDDEN DEATH SYNDROME

4.  RDS occurs primarily in premature infants;
its incidence is inversely related to gestational
age and birthweight
 The incidence is highest in preterm male
 The most common cause of death of
premature infants

5.  This is a serious lung disorder
characterized by insufficient
surfactant that causes the alveoli to
collapse on expiration that greatly
increases the work of breathing.
 Surfactants:
Lecithin/Sphingomyelin – 2:1
Phosphatidylcholine
Phosphatidylglycerol

6.  PREMATURITY
 MATERNAL DIABETES
 MECONIUM ASPIRATION SYNDROME
 PNEUMONIA – associated with PROM and
prolonged labor
 ASPHYXIA
 TRANSIENT TACHYPNEA
 CNS DEPRESSION – associated with
maternal analgesia and anesthesia

7.  Surfactant deficiency (decreased production
and secretion) is the primary cause of RDS
 The major constituents of surfactant are
dipalmitoyl phosphatidylcholine (lecithin),
phosphatidylglycerol, apoproteins (surfactant
proteins SP-A, -B, -C, -D), and cholesterol
 Synthesized and stored in type II alveolar
cells
 Mature levels of pulmonary surfactant are
usually present after 35 wk

9.  Tachypnea
 prominent (often audible) grunting
on expiration
 chest retractions
 nasal flaring

10.  Generalized cyanosis increases
often relatively unresponsive to
oxygen administration
 pallor
 Decreased breath sounds
 Hypotension and shock

11.  Clinical course
 x-ray of the chest
 blood gases- respiratory acidosis (higher
level of carbon dioxide) and hypoxemia
(decreased oxygen level)
 Pulse oxymetry
 Electrocardiograms
 Silverman-Andersen Index

13. Assess 0 1 2
Chest
movement
Synchronized Lag on
respiration
See-saw
respiration
Intercoastal
Retraction
None Just visible Marked
Xiphoid
Retraction
None Just visible Marked
Nares dilatation None Minimal Marked
Respiratory
grunt
None Audible by
stethoscope
Audible by ear

15.  Avoidance of unnecessary or poorly timed
cesarean section, appropriate management of
high-risk pregnancy and labor, and prediction
and possible in utero acceleration of
pulmonary immaturity
 Administration of betamethasone to women
48 hr before the delivery of fetuses between
24 and 34 wk of gestation significantly
reduces the incidence, mortality, and
morbidity of RDS

16.  Monitor blood gases, auscultate
breath sounds
 Keep in isolette or radiant warmer
to avoid hypothermia and
minimize oxygen consumption
 Maintain core temperature between
36.5 and 37.2°C

17.  CPAP (Continuous positive airway
pressure)
Therapeutic range is 10-12 cm of water
pressure.
- first 72 hours – increase pressure to keep
airway open
- After 72 hours – decrease pressure for
airways are already open
 Glucocorticoid (Celestone) – artificial
surfactant

20.  BT to replace extracted blood used
for tests
 Give milk by gavage (orogastric) if
newborn has mild tachypnea
 Place NB on the back or in a side
lying position with the neck slightly
extended
 Hold BF to conserve energy – maybe
on NPO and given IVF

21.  TEMPERATURE: 36.5-37.5
 Ph: 7.35-7.45
 pCO2: 35-45
 pO2: 80-100
 HCO3: 22-26
 O2 Saturation: 94-100%

22.  Septicemia
 Bronchopulmonary dysplasia (BPD)
 Patent ductus arteriosus (PDA)
 Pulmonary hemorrhage
 Apnea/bradycardia
 Retinopathy of prematurity

25.  Occurs when the meconium stained
amniotic fluid is aspirated by the
fetus before or after delivery
 Meconium-stained amniotic fluid
is found in 10–15% of births and
usually occurs in term or post-term
infants

26.  Relaxation of anal sphincter
 Accelerated intestinal peristalsis and
passage of meconium
 Reflex gasping and aspiration of
meconium mixed in amniotic fluid

27.  Air trapping, mechanical obstruction by
particles of meconium - more often with the
1st breath, thick, particulate meconium is
aspirated into the lungs
 The resulting small airway obstruction may
produce respiratory distress within the 1st
hours, with tachypnea, retractions, grunting,
and cyanosis observed in severely affected
infants

28.  Signs of infection
 Overdistention of the chest may be
prominent
 The condition usually improves within
72 hr, but when its course requires
assisted ventilation, it may be severe
with a high risk for mortality
 Tachypnea may persist for many days or
even several weeks

29.  rapid identification of fetal distress
and initiating prompt delivery in
the presence of fetal acidosis, late
decelerations, or poor beat-to-beat
variability

30.  SUCTIONING AFTER HEAD IS
DELIVERED
 OXYGENATION AND VENTILATION
 ADMINISTER PRESCRIBED:
- ANTIBIOTIC THERAPY
- BICARBONATE FOR ACIDOSIS
 MONITORING OF BLOOD GASES
 WATCH OUT FOR SEIZURE, GIT
BLEEDING, AND RENAL FAILURE

31.  Routine intubation to aspirate the lungs
of vigorous infants born through
meconium-stained fluid is not
recommended
 Depressed infants (those with
hypotonia, bradycardia, fetal acidosis,
or apnea) should undergo endotracheal
intubation, and suction should be
applied directly to the endotracheal
tube to remove meconium from the
airway

33.  The systemic inflammatory response
syndrome (SIRS) is an inflammatory
cascade that is initiated by the host in
response to infection with bacteria,
rickettsiae, fungi, viruses, and protozoa
 This inflammatory cascade occurs when
the host defense system does not
adequately recognize or clear the
infection

34.  Type of neonatal infection and
specifically refers to the presence of
bacterial blood stream infection (BSIS) in
newborn.
EARLY ONSET:
- Within 24-72 hours
- Onset is most rapid in premature
neonates
- Associated with acquisition of m.o. from
the mother:

35.  Etiologic Agents:
- Grp B streptococcus
- E. coli
- Haemophilus influenzae
- Lysteria monocytogenes
Ex. Pneumonia

36. LATE ONSET
- 4-90 days of life from the caregiving
environment
Etiologic agent:
1. E. coli
2. Staphylococcus aureus
3. Pseudomonas
4. candida
- Ex. Meningitis
- bacteremia

37. Early Onset:
 Prematurity
 ROM longer than 18 hours before birth
 Infection of the placenta and amniotic
fluid
Late Onset:
 Presence of IV cannula for a long time
 Prolonged hospitalization

38.  SEPSIS
 SEVERE SEPSIS – organ dysfunction
-decreased urine output
- Altered mental status
- -abdominal pain
- Decreased platelet count
 SEPTIC SHOCK –sepsis-induced
hypotension

39. DEATH

40.  Body temperature changes
 Breathing problems
 Diarrhea or decreased bowel movement
 Low blood sugar
 Reduced movements
 Reduced sucking
 Tachycardia/bradycardia
 Vomiting
 jaundice

41.  Blood Culture
 CBC
 Lumbar puncture
 Chest X-ray

42.  Antibiotic – IV
 IVF – prevent dehydration and kidney
failure
 Oxygen administration
 Vasopressors to increase BP
Ex. Dobutamine
Blood transfusion: PRBCs, platelets, Fresh
Frozen Plasma (FFP )

44. A CONDITION IN
WHICH THERE IS TOO
MUCH BILIRUBIN IN
THE BLOOD

45.  Bilirubin is the yellow breakdown
product of normal haeme catabolism.
Haeme is found in haemoglobin, a
principal component of red blood cells.
Bilirubin is excreted in bile and urine,
and elevated levels may indicate certain
diseases.
 Formula: C33H36N4O6
 Molar mass: 584.66 g/mol
 Soluble in: Water

46. Normal level: 1mg/dl of blood
@ 2-3 mg/dl = jaundice
4-6 = very pathological
12-20 = KERNICTERUS

47.  Occurs around the second to the third
day of life
 More than 50% of all FT babies and as
many as 80% or premature infants
 Occurs first in the face, then the chest,
stomach and legs
 Lasts for a week to 10 days in FT
 Lasts for 2 weeks in premature and
breastfed babies

48.  Breast Milk – has component that blocks
action of GLUCORONYL
TRANSFERASE converts INDIRECTS to
DIRECT BILIRUBIN to be excreted by
the body.
 MGT: SUNLIGHT – promotes oxidation
of indirect bilirubin
 Expose baby only until 7:30am

49.  Occurs as a result of a disease or
abnormal condition
 Major danger: KERNICTERUS
 May lead to brain damage, deafness,
severe developmental disabilities and an
unusual form of cerebral palsy

50. 1. Present at birth or during the first 24 hours
 Prematurity – immature liver
 Hemolytic disease – Rh or ABO
incompatibility
 Birth trauma with subsequent bleeding
(Cephalhematoma)
 Infection
 Breastmilk hormone pregnanediol
 Hypothermia
 Medications

51. 2. Develop during or that lasts past the
second week of life:
 Liver malfunction
 Severe infection
 Enzyme deficiency
 Abnormality of infant’s RBCs

52.  Appears early, up to 24 hours after birth
 Unusual pattern of progression is from
head to feet
 Yellow to bronze coloration of the skin,
sclera and mucous membranes
 Dark concentrated urine (often
dehydrated)
 Behavior changes (irritability, lethargy)
 Poor muscle tone
 Increased serum bilirubin

53.  Prevent conditions that contribute to
development of hyperbilirubinemia (cold
stress, hypoxia, hypoglycemia,
dehydration and infection).
 Carefully asses NB at risk for
hyperbilirubinemia for early recognition
and treatment
 More frequent feedings

54.  Using formula milk
 Implement phototherapy if ordered
 Color of light = bluish to purple
 Distance (baby and lamp) = 12-18 inches
CONSIDERATIONS:
 Unclothe infant for maximum skin
exposure to light, diaper minimally
 Cover eyes to prevent retinal damage
 Cover genitalia

55.  Frequent position change – every 2 hours
 Frequently check TEMPERATURE
 Inform mother that stool will be dark in
color
 Remove from phototherapy for feeding
 Observe skin for signs of irritation
 Record phototherapy time
 Provide extra fluids to excrete bilirubin

60.  Sudden unexplained death in
infancy
 Peak age of incidence – 2 to 4 mos
 Cause is unknown

61.  Apnea
 Viral respiratory
 Pulmonary edema
 Brain stem abnormalities
 Neurotransmitter deficiencies
 Heart rate abnormalities
 Distorted familial breathing patterns
 Decreased arousal responses
 Possible lack of surfactant in alveoli
 Sleeping prone