HIGH RISK NEWBORN Lecture 13.ppt

* * * * * * * * * * * * Meconium Aspiration Syndrome: Present in fetal bowel as early as 10 wks. Infant may aspirate meconium in utero or with 1st breath. Can cause severe respiratory distress, inflammation or blockage of small bronchioles by mechanical plugging Ductus arteriosus may remain open; causes blood to shunt from pulmonary artery to aorta instead of passing thru lungs [^ pulmonary resistance], causing ^ hypoxia. Symptoms Tachypnea [RR60] Retractions SOB and expiratory grunting Nasal flaring Periods of apnea Bluish color of skin and mucus membranes Arms or legs puffy or swollen Prevention Oropharyngeal suctioning of infant delivery Laryngoscopic visualizaiton of vocal cords intubation. Additional suctioning of trachea. Amnioinfusion: dilutes meconium. Thins out particulate meconium. Do sepsis workup; CBC, bl.cx., chest x-ray. AB therapy to prevent pneumonia. SIDS: sudden infant death syndrome. Mainly in adolescent moms, closely spaced pregnancies, underweight, PT infants. 2nd hand smoke. Appear well nourished. ^ African American males. Silent death; poss.laryngospasm. Use of sleep apnea monitor for first few wks.-mos. Peak age: 2-4 mos. Cause unknown. Theories: HR abnormalities, decreased arousal [moro] responses, prone position, low surfactant, brain stem abnorm. In 2000 Amer. Academy of Pediatrics recommended back or side position; not prone. Incidence declined 50% since then. New data: use of pacifier for 2-4 mos. Hyperbilirubinemia ^ levels of unconjugated (indirect) bilirubin in blood. Breakdown of RBC’s Hgb heme Unconjugated bilirubin. Bilirubin binds with plasma protein (albumin) = “bound” goes to liver converts to conjugated or H2O soluble where it ‘s excreted via bile by feces. Immature livers which cannot convert indirect to direct; indirect bilirubin remains in bloodstream. Unbound bilirubin = (indirect) jaundice. If indirect level rises 7, yellow color results. Sclera, nail beds, then skin. Cephalocaudal