ACUTE CONDITIONS OF THE

NEWBORN A. Positioning – elevate the

head of the patient and turn to
sides still maintaining comfort to
1. Respiratory Distress Syndrome improve bronchial drainage and
(RDS) ventilation to all lung fields
2. Transient Tachypnea of the B. Oxygen administration –
Newborn (TTN) is necessary to maintain oxygen
3. Meconium Aspiration Syndrome level
4. Hyperbilirubinemia C. Perform chest
5. Sudden Infant Death Syndrome physiotherapy - with the child’s
(SIDS) tolerance level to loosen mucus
6. Fetal Alcohol Syndrome (FAS) secretion.
7. Newborn at Risk because of
Maternal infection

Assessment on Respiratory Distress

Syndrome Techniques of Chest
Physiotherapy :
1.) postural drainage (elevate head,
1. Tachypnea – most common; turn to sides)
universal sign of Respiratory 2.) percussion
Distress (>60 breaths/min) 3.) vibration
2. Nasal flaring – increasing size of D. Suction secretions as
the airways by flaring the nostrils needed
3. Retractions – substernal, E. Ventilation – use of
subcostal, suprasternal, mechanical ventilator which aids
intercostal in breathing by controlling air
4. Grunting – breathing against a getting in & out of the lungs.
closed glottis, low-pitched
5. Seesaw retractions – excessive
use of abdominal muscles 2. Prevent secondary
6. Head Bobbing – head moving up infections
& down motion when breathing A. Maintain aseptic
7. Stress Response – tachycardia, technique & observe
hypertensive, worried look (air- isolation precautions.
hunger), diaphoretic B. Minimize the child’s
8. Respiratory Failure – Cyanosis, contact with infected
late sign persons.

C. Administer antibiotics &

medications as ordered.
Nursing Care Management for
RESPIRATORY DISTRESS SYNDROME:
1. Promote adequate Terbutaline medication
oxygenation & a normal - used to quicken the
breathing pattern formation of lecithin.
 Surfactant replacement -
synthetic surfactant is sprayed APNEA – a pause or absence of
into the lung using a syringe or respiration longer than 20
catheter through an ETT. seconds accompanied with
bradycardia and cyanosis.
3. Promote desired fluid & > More common in preterm
nutritional intake. infants due to fatigue or
A. Ensure adequate hydration immaturity of respiratory
by administering fluids and mechanisms.
monitor the infusion Conditions which triggers babies to
develop APNEA:
* IV fluids should be given via 1. Hypothermia
infusion or via soluset to 2. Hyperbilirubinemia
prevent fluid overload. 3. Hypoglycemia
4. Infection

Nursing Management of Apnea:

1. Stimulate the baby to breathe
1. Rapid rate of respiration that again by shaking or flicking
remains between 80 to 120 the soles of the feet.
breaths per minute. 2. Use apnea monitor to warn
2. It occurs after birth and fades by nurses for the
72 hours of age when the lung succeeding episodes.
fluid is absorbed & respiratory 3. Protect the baby from
activity becomes effective. undergoing the conditions
which triggers them to
cause apnea.
3. It occurs more often in infants
who are born by C/S because 3. Meconium Aspiration Syndrome
lung fluid absorption during labor
& delivery did not normally take
place.
3. Meconium Aspiration Syndrome
2. TRANSIENT TACHYPNEA OF THE
NEWBORN (TTN)
Assessment (TTN)
4. Tiring effect of breathing so 10. MAS is a respiratory distress in a
rapidly newborn caused by the presence
5. Tachypnea – fast, shallow of meconium in the
breathing tracheobronchial airway. An infant
6. Mild retractions but no cyanosis with hypoxia in utero
7. Mild hypoxia and experiences a vagal reflex
hypercapnia/hypercarbia relaxation of the rectal sphincter
w/c releases meconium into the
8. Oral feeding is difficult since child amniotic fluid - baby is under
can’t suck ‘stress’, meaning not receiving
enough oxygen
9. Chest x-ray reveals some fluid 11. If the baby is stressed enough in
in the central lung but aeration utero, the baby will be gasping for
is adequate O2 causing meconium to be
 aspirated or breathed in into the clapping & vibration to help
lungs remove remaining meconium
12. Babies born breech from the lungs.
presentation may expel 5. Give antibiotic therapy to prevent
meconium into the amniotic the development of pneumonia.
fluid from the pressure on the
buttocks. Hyperbilirubinemia
13. An elevated level of bilirubin
in the blood is a result from the
destruction of red blood cells by
either a normal physiologic
process or by the abnormal
Assessment destruction of red blood cells.
(Meconium Aspiration
Syndrome)
Hemolytic Disease of the Newborn
This means destruction (lysis)
of red blood cells caused by Rh
1. Chest retractions with tachypnea Incompatibility and/or ABO
2. Barrel chest – enlargement of the Incompatibility.
antero-posterior diameter of the
chest. Rh Incompatibility
3. Blood gas reveals low PO2 and
high PCO2 due to poor gas
exchange.
4. Chest X ray - The bilateral lung
fields are hyperinflated with non If the mother’s blood type is Rh (D)
symmetrical air space opacities, negative and the fetal blood type
suggestive of meconium is Rh (D) positive (contains the
aspiration. D antigen)

Therapeutic Management for MAS The introduction of fetal blood causes

sensitization to occur and the mother
begins to form antibodies against the
D antigen.
(Before Delivery) –
Amniotransfusion may be used
to dilute the amount of meconium Few antibodies form in the mother’s
in amniotic fluid and reduce the blood stream in the first 72 hrs
risk of aspiration. afterbirth because there is an active
(Immediately upon Delivery) exchange of fetal – maternal blood as
1. Do tracheal suctioning immediately placental villi loosen and placenta is
before the baby can start breathing / delivered.
crying
2. Do oxygen administration and By the second pregnancy, there will
assisted ventilation. be a high level of antibody D
3. Maintain a neutral temperature to circulating in the mother’s blood
prevent increased metabolic oxygen stream, which acts to destroy the
demands. fetal red blood cells early in
4. Do chest physiotherapy with pregnancy if the fetus is Rh(+)
 Phototherapy
1. Increase fluid intake to prevent
By the end of the second dehydration.
pregnancy, a fetus can be 2. Cover the eyes to prevent
severely compromised by the damage of the retina and make
action of these antibodies sure it does not cover the nose to
crossing the placenta and prevent suffocation.
destroying RBC’s. 3. Cover also the genitalia to
prevent damage of the
reproductive system.
4. Remove the baby from the
phototherapy during feeding &
Some infants require intrauterine promote mother-child bonding.
transfusion to combat red cells Therapeutic Management
destruction. (Hyperbilirubinemia):

2. Early Feeding – either breast milk

Antibody – a protein produced or formula to stimulate bowel
by the body which reacts peristalsis.
specifically with a foreign
substance in the body.
3. Exchange Transfusion – done if
bilirubin continues to be high in
Antigen – a foreign substance spite of previous procedures
w/c stimulates the body to done.
produce antibodies. > It is a lengthy procedure (1
to 3 hrs) wherein baby’s blood is
Assessment withdrawn in small amount (2 to
1. Progressive jaundice within the 10 ml) & replaced it alternately
first 24 hrs of life (pathologic with equal amount of donor’s
jaundice) blood.
2. Direct Coomb’s Test (DCT) Sudden Infant Death Syndrome (SIDS)
sample taken from the fetal cord
is weakly (+)
3. CBC results:
Hgb – LOW 14. Also known as cot or crib death, is
Hct – LOW the sudden unexplained death of a
MCV – normal child of less than one year of age
Reticulocyte count – High in 15. Death usually occurs during sleep
cases of severe anemia 16. There is usually no noise or evidence
of struggle.
  17. PREVENTION: Putting newborns
Therapeutic Management on their back to sleep,
(Hyperbilirubinemia):

care of the Patient under

Cause >> Unknown - Infants at
 Greatest Risk for SIDS: sputum/vomitus in their mouth or
1. Premature infants bedclothes as a result of
2. Underweight infants death rather than as the cause of
3. Infants with prenatal drug death.
exposure & smoking (narcotic-
dependent mothers) Nursing Management for SIDS:
4. Siblings of infants who have 1. Evaluate family coping and
died of SIDS. grieving patterns.
5. Peak age of incidence: 2-4 2. Allow parents to verbalize.
months (listen & validate feelings)
3. Refer family for counselling, if
needed.
Contributing Factors causing 4. Teach parents how to minimize
SIDS: the risk of SIDS.
5. Monitor infants at risk of apnea.

AAP RECOMMENDATIONS TO
1. Maternal viral respiratory PREVENT SIDS:
infections
2. Pulmonary edema 1. Have baby sleep in supine
3. Distorted familial breathing position
patterns 2. Use firm sleep surface
4. Sleeping in prone position 3. Breastfeeding
rather than supine 4. Room-sharing without bed-
5. Heart rate abnormalities sharing
6. Brain stem abnormalities 5. Routine immunization
7. Neurotransmitter 6. Consider using a pacifier
deficiencies 7. Avoidance of soft bedding
8. Decreased arousal response 8. Exposure to smoke, alcohol, &
9. Possible lack of lung illicit drugs
surfactant
10. Sleeping in a room without Fetal Alcohol Syndrome
moving air
currents (infant tends to
rebreathe expired CO2)
11. Sleeping on a soft mattress 1. A condition associated with an
may increase likelihood of infant born to a
smothering woman who uses alcohol
during pregnancy
2. It is a teratogenic effect of
alcohol to the newborn.
18. An autopsy often reveals
petechiae in the lungs Assessment (Fetal Alcohol
(Pulmonary Petechial Syndrome):
Hemorrhages) and
mild inflammation and
congestion in the 1. Pre & post natal growth
respiratory tract. restriction
19. Infants who die of SIDS usually 2. Central nervous system
has blood-flecked challenge like
 (cognitive challenge –
microcephaly & anencephaly;
behavior problems –
hyperactivity)
3. Distinctive facial feature of a
short palpebral
fissure and thin upper lip,
smooth philtrum
4. Weak sucking reflex
5. Sleep disturbances (always
sleepy or always awake)