Neonatal Health Nursing Highlights; do not depend on this content. Read more other materials.

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Wollo University, CMHS,
Department of Pediatrics
and Child health Nursing.
Neonatal Nursing.

2. NEONATOLOGY
Topics
 Neonatal sepsis.
 Neonatal seizures.
 Neonatal injuries.
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3. Neonatal Sepsis:
Definition: Generalized infection in the new-born
 According to the onset:
Early onset : birth—7days.
Late onset : 8--- 28 days.
Nosocomial: 1st.week- discharge.
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4. Classification: according to organism
Early Late Nosocomial
GBS typeI,II,III GBSIII Staph.epidermis
E.coli E.coli Staph.aureus
Kelebsilla Liesteria
monocytogenus
Candida a
Liesteria
monocytogenus
Herps simplex Psudomonas
aerginosa
Non typeable
H.influnza
_____________ E.coli

5. NNS, predisposing factors
 Maternal causes(vertical transmission)
TORCH
PROM
UTI
Colonization(GBS, Herpes)
Complicated delivery, multiple births.
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6. NNS, predisposing factors con…
 Foetal causes:
Prematurity/LBW
Male gender
Resuscitation /ETT , UVC , UAC
Hospitalisation, crowding , inadequate infection
control.
VP shunt , indwelling catheter, alteration in skin &
mm.
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7. NNS: clinical manifestations
 General:
Fever, hypothermia, not doing well, poor feeding ,
sclerema.
 CNS:
Irritability, lethargy, tremors, seizures, hyporeflexia,
irregular respiration , full fontanel, high pitched cry.
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8. NNS: clinical cont.
 CVS:
Pallor, mottling, cold clammy skin, tachycardia,
hypotension, bradycardia.
 Respiratory system:
Apnea, dyspnea, tachypnea, retraction, flaring, grunting,
cyanosis.
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9. NNS: clinical cont.
 GIT:
Vomiting, diarrhoea, abdominal distension, hepatomegaly.
 Renal: oliguria.
 Haematology:
Jaundice, pallor, petichiae, purpura, bleeding tendency,
splenomegaly.
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10. NNS: Investigations
 CBC, differential.
 CRP
, ESR.
 Cultures: blood, CSF, urine, gastric aspirate, ETT aspirate.
 CXR.
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11. NNS: Treatment
1. Ampicillin plus aminoglycoside ( gentamycin, Amikacin).
2. 3rd generation cephalosporin (cefotaxim, ceftazidim).
3. Anti staph (cloxacillin or vancomycin)
NB: duration of therapy is 7-10 days
In meningitis, GBS 14 d/G-ve 21 d.
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12. NNS, Prevention
 Aggressive treatment of maternal chorioamnionitis.
 Control of nosocomial infection by hand washing & avoid
overcrowding.
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13. NEONATAL SEIZURES
Definition:
Paroxysmal involuntary movement due to disturbance of brain
function.
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14. NEONATAL SEIZURES cont.
 Classification:
1. Focal seizures.
2. Multifocal clonic seizures.
3. Tonic seizures.
4. Myoclonic seizures.
5. Subtle seizures “chewing , blinking, nystagmus, paddling,
smacking, fisting”.
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15. NEONATAL SEIZURES cont.
 Aetiology:
 Hypoxia. HIE.
 Metabolic disturbances: (hypoglycemia,
hypocalcemia , hypomagnesmia , hypo &
hypernatremia).
 Inborn errors of Metabolism.
 Infections: congenital & acquired.
 Traumatic.
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16. NEONATAL SEIZURES cont.
 Aetiology: cont.
 Structural abnormalities.
 Hemorrahge.
 Maternal drugs.
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17. NEONATAL SEIZURES cont.
 Investigation:
 Glucose, Ca ,Mg .
 Urea & Electrolytes :Na.
 Lumber puncture : CSF
wbc (bacterial, viral) Rbc’s  Hgb.
 Ammonia level.
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18. NEONATAL SEIZURES cont.
 Investigation:
 ABG-acidosis.
 Lactate/ Pyruvate ratio.
 Drug screening.
 Imaging: US, CT, MRI.
 Karyotyping.
 EEG.
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19. NEONATAL SEIZURES cont.
 Management:
 Primary cause.
 Anticonvulsants:
Phenobarbitone
Phenytoin
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20. NEONATAL SEIZURES cont.
Jitteriness vs. seizures:
1. Simple tremors.
2. Stopped by holding the extremities.
3. Enhanced by sensory stimulation.
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21. III Birth Injuries
 Definition:
Injury to the newborn during the birth
process
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22. III Birth Injuries
 Risk factors:
1. Macrosomia.
2. Prematurity.
3. CPD.
4. Dystocia.
5. Prolonged labour.
6. Breech.
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23. III Birth Injuries
 Cranial injuries:
Cephalohematoma
Subgaleal Hemorrage
Intracranial H.
Subdural H.
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24. III Birth Injuries
 Intracranial Hge (IVH).
Risk factors :
1. BW < 1500 gm (90%).
2. Hypoxic Ischemic injury.
3. Pneumothorax.
4. Hypo/hyper tension.
5. Coagulopathy.
6. Thrombocytopenia.
7. Vit. K deficiency.
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25. III Birth Injuries
 Intracranial Hge (IVH) cont,
CM
-Clinical presentation.
-Diagnosis :U/S Grade I,II,III,IV.
-Management: I, II Recover
grade III, IV hydrocephalus
------>V-P shunt.
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26. III Birth Injuries
Peripheral Nerve Injuries:
- Erb΄s palsy ( C5-6 ).
 Clinically :
loss of abduction, external
rotation , supination , loss of bicep reflex &
abnormal Moro reflex.
 Management: physiotherapy, neurosurgery
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27. III Birth Injuries
Fractures.
# Clavicle:
-asymmetrical Moro.
-crepitus .
-discoloration.
-immobilization
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