NB at risk 2

Question 1

preterm NB resp prob

Answer 1

1. not enough surfectant

2. pulm vesseles not dev/can’t constrict -> L to R shunt of blood through ductus arteriosus, may remain open

Question 2

preterm NB resp complications-4

Answer 2

pulm congestion, increased resp effort, CO2 retention, bounding femoral pulse

Question 3

preterm NB thermoregulation-6

Answer 3

1. high ratio of body surface to body wt decreases ability to produce heat
2. little subcut fat
3. thin skin raises insensible heat loss
4. less flex of extremities (extend at 28 wks)
5. low vasoconstriction ability
6. low brown fat and glycogen in liver

Question 4

preterm NB GI-7

Answer 4

1. high risk aspiration- poor gag, undeveloped sphincters, poor suck/swallow
2. unmet nutrition sm stomach
3. limited conversion to nonessential amino acids
4. undev kidneys
5. lactose/sat fat absorption limited
6. deficient in Ca and phos-ricketts
7. high basal metab rate increase O2 needs

Question 5

preterm NB renal-4

Answer 5

1. low GFR before 34 wks
2. gradual decline in UOP r/t decline in BP
3. limited response to ADH- fl imbalance
4. affects drug excretion

Question 6

preterm NB immune-3

Answer 6

1. passive immunity in 3T (IgG)
2. IgA in breast milk
3. bacterial sepsis- sudden onset of apnea and bradycardia

Question 7

preterm NB neuro-3

Answer 7

1. rapid brain development in 3T
2. period of reactivity delayed
3. sleep-wake disorganized

Question 8

preterm NB nutrition-4

Answer 8

1. early feed- 95-130 cal/kg/day
2. need wt gain 20-30g day
3. oral feed ready- hands to mouth, alert, suck, root
4. BF ready- suck/swallow, consistent wt gain, control temp

Question 9

gavage-5

Answer 9

lack suck/swallow, vent, orogastric preferred over nasal

• check residual in stomach first
• after feed on rt side or belly

Question 10

preterm NB complications-7

Answer 10

1. apnea of prematurity-20 sec + or w cyanosis, pallor, brady (day 2-7)
2. patent ductus arteriosus
3. respiratory distress syn (surfectant)
4. intraventricular hem (less 34 wks, longterm comp)
5. retinopathy of prematurity
6. bronchopulmonary dysplasia
7. speech/ neuro/ auditory defects

Question 11

developmental progress

Answer 11

evaluated based on expected DOB not actual DOB

Question 12

preterm NB ass 1-5

Answer 12

1. color- pink, ruddy, cyanotic
2. skin- red, translucent, see veins, no subcut fat
3. lanugo plentiful
4. head size large in relation to body
5. skull bones pliable w flat fontanelles

Question 13

preterm NB ass 6-11

Answer 13

6. ears pliable fold over
7. genitals non ruggated, prominent clitoris and minora
8. posture flaccid, frog-like
9. weak feeble cry
10. reflex- poor suck/swallow/gag, incomplete moro
11. activity jerky low tone