High risk neonates can experience various medical issues including respiratory distress syndrome, meconium aspiration syndrome, sepsis, and more. Nursing interventions focus on stabilizing vital functions like respiration and thermoregulation. Additional priorities include maintaining hydration and nutrition, facilitating development, and supporting the neonate-family bond. Risk factors span prematurity, growth abnormalities, and maternal health conditions that can endanger the fetus.

1. High Risk Neonate

2. Respiratory Distress Syndrome Most frequently affects premature births Deficiency of surfactant which leads to atelectasis Leads to collapsed alveoli Goal is to prevent preterm birth

3. Silverman Anderson Index

4. Continuous Positive Airway Pressure (CPAP)

5. Broncopulmonary Dysplasia Compilcation of RDS Long term lung disease Damage to alveolar secondary to ventilation

6. Meconium Aspiration Syndrome Meconium enters the lungs Airway obstruction Air gets in but cannot get out Overdistended alveoli leads to rupture

7. Cold Stress Excessive heat loss resulting in use of compensatory mechanisms S&S: tachypnea decreased temperature tremors irritable

8. Birth trauma Injury sustained during labor and delivery Assess neonate: symmetry mobility bulging fontanells

9. Fractured Clavicle

10. Erb Duchane Paralysis

11. Cephalhematoma

12. Talipes Equinovarus Heel turned inward Sole is flexed Achilles tendon shortened Unilateral or bilateral

14. Congenital Hip Dysplasia Imperfect development of the hip Can affect the femoral head, the acetabulum or both Preluxation, subluxation, dislocation Allis sign Ortalani manuever

15. Impeforated Anus Congenital defect Absence of meconium Requires surgical intervention

16. Retinopathy of Prematurity Due to immaturity of developing blood vessels Associated with excessive oxygen treatment Weekly optho exams Laser abnormal vessels

17. Diaphragmatic Hernia Failure of the pleuroperitoneal folds to fuse Lungs cannot expand Stomach contents in chest cavity Diagnosed by x-ray

19. Sepsis Neonatorum Systemic infection of the bloodstream Immature immune system Fewer antibodies Blood brain-barrier less effective in keeping organisms out thus CNS infections may result Causes: GBS, E-Coli are the most common

20. Necrotizing Enterocolitis Acute inflammatory bowel disorder Ischemia and necrosis LBW S&S: abd distention, vomiting, decreased bowel sounds, stool occult blood, gastric residule, poor color

21. Small for Gestational Age Below the 10 th percentile on growth chart May be preterm, full term, or postterm SGA and IUGR Symmetrical – caused by long term maternal problem or fetal genetic anomaly Asymmetrical – problem after 28 weeks gestation

22. Preterm Neonate Appearance frail, limp, extended position, lack subcutaneous fat, translucent skin, nipples barely visible, plantar creases absent, abundant vernix and lanugo, flat pinna Associated problems: ROP,RDS,BPD,NEC,cold stress, hyperbilirubemia, apnea,

23. Nursing Interventions Respiratory status – CPAP, oxygen , suction, position changes to drain secretions Maintain hydration, fluid electrolyte balance Maintain thermoregulation Skin integrity Pain assessment Promote rest, motor development Readiness for feeding Facilitate interactions

24. Large for Gestational Age Above 90 th percentile on growth chart General appearance – fat, puffy, cherub like Associated problems – birth trauma, hypoglycemia, polycythemia

25. Postterm Beyond 42 weeks about 7% of all pregnancies Characteristics: dry skin, no vernix or lanugo, long nails, increased sole creases Weights vary

26. Postmature Beyond 42 weeks and placental insuffiency Not all postterm are postmature Associated problems: MAS, polycthemia, hypoglycemia

27. Rh Isoimmunization RH – woman carries an Rh + fetus Mother can produce antibodies (become sensitized) to Rh+ blood These antibodies would cross the placenta and destroy the fetus’ RBC

30. Fetal Amenia Erythroblastosis fetalis Hydrops fetalis

31. Prevention Screen all women at first PNV Indirect coombs – determines if the RH- woman has been sensitized to the Rh antigen If sensitized then titers every 2 weeks will be done

32. If not sensitized the we want to keep it that way RhoGam at 28 weeks Postpartum again if needed

33. RhoGam IM deltoid Pain at site Kleihauer- Bletke test if needed to determine amt of RhoGam to be given

34. ABO Incomatibility Common Rarely causes problems Mostly type O mom with an A or B fetus No relationship between # of pregnancies and degree of the disease No antepartum treatment Neonate may require bili lights and rarely exchange transfusion

35. Domestic Violence 1:4 women have been raped or abused by a partner Control and Power Cycle of Violence

36. Effects of abuse on pregnancy Start PNC late or no PNC STD’s Missed appointments Low weight gain

37. Nursing Responsibilities Empower women!!! Make it clear she owns her own body!!! She decides how she wants to be treated!! Ask the question of all your patients?????