Neonatal Intensive Care - Essay Example

Heat may be lost by water evaporation from the skin of the infant, and this is especially likely immediately after delivery. Nursing strategies can address each of these mechanisms. Taking the case of healthy term infants, the most suitable ideal strategy would be to wrap the term infant in warm blankets and to place them into the mothers' arms. The neonate should be dried completely to prevent evaporative heat loss. The neonate can be placed in a preheated radiant warmer immediately after delivery.

A water impervious blanket can prevent evaporative heat loss. Cold oxygen from mask blowing over the neonate's skin should be prevented. Once stabilized, the neonate should be transferred to convection warmed incubator since radiant warmer cannot prevent convection heat loss (Sauer PJJ et al., 1984). Most preterm infants usually present with typical signs and symptoms of respiratory distress. These include retractions of the chest, grunting with breathing, rales, rhonchi, nasal flaring, and tachypnoea.

Additionally, there may be tachycardia, murmurs, and cyanosis. Most preterm babies demonstrate a central cyanosis with cyanosis of the oral mucous membrane. Congenital heart disease may present with differential cyanosis with respiratory distress. There may be associated hypertension or hypotension. There may be hyperpnoea of deep unlaboured breathing or rapid and shallow breathing. There may be disease specific signs and symptoms. Clinically, the onset of massive pulmonary hemorrhage is heralded by sudden deterioration of the infant with hypotension, pallor, cyanosis, bradycardia, or apnea.

Pink or red frothy liquid drains from the mouth. There can be periodic breathing, defined as recurrent sequences of pauses in respiration lasting 5 to 10 seconds followed by 10 to 15 seconds of rapid respiration. Apnoeic episodes are cessation of respiration for 15 to 20 seconds, frequently complicated by cyanosis, pallor, or bradycardia. Small preterm infants exhibit these systemic responses more readily than do more mature infants, even when the apnea is shorter. Bradycardia can be observed during apnoea (Behrman RE et al., 2002). Causes1.

Respiratory distress syndrome (RDS).2. Bacterial pneumonia/sepsis3. Pneumothorax (generally follows initiation of respiratory support, but may occur spontaneously).4. Pulmonary hemorrhage: more common in preterm infants (specially those with those with respiratory distress syndrome)5. Congenital pulmonary hypoplasia.Activity 3: Hypoglycaemia in the NewbornPerturbations in glucose metabolism after birth, caused by failure to adapt to the extrauterine environment as a result of either alterations in maternal metabolism or intrinsic metabolic problems in the neonate, often result in hypoglycaemia.

Although a consensus regarding cutoff values for hypoglycemia has not been reached, most investigators would consider a plasma glucose concentration of lower than 36 mg/dL to be low when it requires intervention, in a full-term neonate 2 to 3 hours after birth. Care should be taken in interpreting glucose values during the transition period of the first 2 to 3 hours after birth, when the plasma glucose concentration may drop to low levels followed by spontaneous improvement. If low glucose levels are observed during this time, frequent glucose determinations