Parents of high-risk neonates may experience grief and difficulty coping as they adjust to their neonate’s condition. They may also feel a sense of loss and have difficulty bonding because their neonate isn’t the perfect, healthy baby they anticipated. The family of a neonate with a chronic illness or congenital anomaly must find ways to cope with long-term grief and develop strategies to provide the special care the condition will require (and perhaps to balance these care needs with those of other children). If the neonate is stillborn or dies within a few hours or days after birth, family members must complete their bonding with the neonate, then detach themselves gradually so they can focus again on the family’s life and needs.

Although the neonate’s condition dictates the specifics of nursing care, the main nursing goals for all high-risk neonates are to:

Pregnant women who use addictive drugs are at higher risk for:

Complications seen in the neonate may include:

The Neonatal Abstinence Scoring System is a scoring tool that can be used for term neonates. It assesses and scores areas of response in neonates with CNS, metabolic, vasomotor, respiratory, and GI disturbances. The current scoring system used is the Finnegan Score. The higher the overall score, the more likely the need for medication administration for withdrawal. Each institution has their medication administration protocol for the initiation of pharmacologic intervention and weaning. The test is repeated at specific intervals based on previous scores.

If the clinical signs and symptoms are consistent with drug withdrawal, obtain specimens of urine and meconium for drug testing. Meconium testing can detect drug use over a 20-week period. Be aware that urine screening may have a high false-negative rate because only neonates with recent exposure test positive. Also, keep in mind that although meconium drug testing isn’t conclusive if results are negative, this method is more reliable than urine testing. Umbilical cords may also be sent for analysis of maternal drug usage and is an accurate assessment.

Preventing maternal drug use is the ideal approach to eradicating the problem of neonatal drug addiction. Patient teaching and
support are essential. To identify a woman and neonate at risk for drug addiction:

To screen for drug exposure, perform maternal and neonatal assessments. Maternal findings that may indicate a need for neonatal drug testing include:

Neonatal characteristics that may be associated with maternal drug use include:

Ongoing neonatal assessment should include monitoring for changes in:

Supportive care of the neonate with a drug addiction includes:

FAS is caused by the exposure of a fetus to alcohol in utero. Although prenatal alcohol exposure doesn’t always result in FAS, the safe level of alcohol consumption during pregnancy isn’t known. Alcohol crosses through the placenta and enters the fetal blood supply, and it can interfere with the healthy development of the fetus. In fact, birth defects associated with prenatal alcohol exposure can occur in the first 3 to 8 weeks of pregnancy, before a woman even knows she’s pregnant. Variables that affect the extent of damage caused to the fetus by alcohol include the amount of alcohol consumed, the timing of consumption, and the pattern of alcohol use.

Affected neonates may display these signs within the first 24 hours of life:

Identifying clinical problems and assessment findings characteristic of FAS leads to diagnosis. Respiratory distress and neurologic dysfunction may be present. Feeding difficulties may also be noted. Radiographic studies may be used to reveal renal or cardiac defects.

Treatment of FAS is supportive and depends on the individual neonate. The initial difficulties may be managed by preventing stimulation that may precipitate seizures, administering sedative or anticonvulsant medications, and providing supportive measures. Because the effects of alcohol in utero vary, care must be individualized to focus on the neonate’s specific abnormalities and deficits.

A fundamental nursing intervention for FAS is helping to prevent it. This can be achieved by:

Variations in gestational size are caused by different factors.

Assessment findings depend on whether the neonate is SGA or LGA.

Neonates of mothers with diabetes should have laboratory work to determine their hematocrit and glucose, calcium, and bilirubin levels. They should also be monitored for hypoglycemia, hyperbilirubinemia, and respiratory distress syndrome (RDS).

Treatment of gestational age size abnormalities varies depending on whether the neonate is SGA or LGA.

Nursing interventions for SGA and LGA neonates include:

HIV can be transmitted to the neonate in one of three ways:

transplacentally during pregnancy

during labor and delivery

through breast milk.

Risk factors for perinatal transmission can be either maternal or neonatal. (See Risk factors for perinatal transmission of HIV.)

Most neonates exposed to HIV are born at term and are of AGA size. Normal physical findings are usually present. Physical findings, such as adenopathy or hepatosplenomegaly, are absent at birth because HIV infection is believed to occur at delivery. These findings may develop later and suggest HIV infection.

The Centers for Disease Control and Prevention (CDC) recommends testing for HIV within 48 hours of birth, at age 1 to 2 months, and again at age 3 to 6 months. Two positive tests at different ages are required to make a positive diagnosis. Diagnostic tests used to detect HIV include HIV DNA polymerase chain reactions (PCR), HIV p24 antigen assay, HIV antibody, HIV culture, and immunologic testing.