🖼️ Feeding the newborn.Swipe it sideways if it is cut off, or tap to open it full size.
In suspected NEC, stop all feeds immediately and report. Feeding a hypoxic gut makes it worse.
Antenatal steroids given to a mother in preterm labor accelerate surfactant production
— that single intervention is why RDS is far less lethal than it was.
💉 The infant of a diabetic mother
Large baby, low sugar. Maternal glucose crossed the placenta; the baby’s pancreas
ramped up insulin. At birth the sugar supply stops but the high insulin does not.
Check the glucose within the first hour and feed early. Also watch
for birth injury from size, hypocalcemia and polycythemia.
🏁 Course-wide priorities to revise from
Situation
First action
Membranes rupture
Check the fetal heart rate
Late decelerations
Turn to the left side
Cord prolapse
Lift the presenting part off the cord
Boggy uterus
Massage the fundus
Uterus displaced right
Empty the bladder
Newborn just delivered
Dry and warm
Preeclampsia + epigastric pain
Notify — seizure is imminent
Magnesium running
Check deep tendon reflexes
Suspected previa
No vaginal exam
Cover the right column and say it out loud. If you can produce all nine, you have the
spine of maternity nursing.
⭐ High-yield — what the exam actually asks
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RDS from surfactant deficiency: nasal flaring, grunting, retractions, tachypnea → surfactant and respiratory support.
Prevent jaundice with early frequent feeding; phototherapy for a rising bilirubin.
SIDS risk reduction: back to sleep, no smoke exposure, firm flat surface, no co-sleeping.
Gestational diabetes: carbohydrate-controlled diet, exercise, frequent monitoring, glyburide/metformin or insulin. Insulin requirements climb through pregnancy as hPL rises, then fall abruptly after delivery. Fetal risks: macrosomia, shoulder dystocia, neonatal hypoglycemia.
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Cardiac disease in pregnancy: left lateral recumbent rest. The highest-risk window is immediately postpartum, as fluid shifts back. Report dyspnea, orthopnea, persistent cough, crackles, edema, fatigue.
The newborn is at hypothermia risk after a cesarean because the OR is cold — dry, cap, skin-to-skin, radiant warmer.
📕 From your ATI review book
Covered by ch. 27.
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Classification: SGA below the 10th percentile · AGA 10th–90th · LGA above the 90th or over 4,000 g · low birth weight ≤2,500 g. Late preterm is 34 0/7–36 6/7.
NAS care is the opposite of stimulation: cluster care, dim lights, low noise, swaddle, non-nutritive sucking, small frequent high-calorie feeds, head elevated during and after feeds, suction available. Morphine, methadone, phenobarbital, sometimes clonidine.
Fetal alcohol syndrome: small palpebral fissures, flat midface, smooth philtrum, thin upper lip, plus growth restriction. No safe amount.
RDS: tachypnea over 60, nasal flaring, expiratory grunting, retractions, fine crackles, cyanosis. Worsening looks like flaccidity, apnea and unresponsiveness. Birth weight alone does not predict lung maturity.
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After surfactant, do NOT suction the ET tube for 1–4 hours. Suction before, not after.
Before any nipple or breast feeding the newborn needs an intact gag and a coordinated suck-swallow; under 34 weeks generally means IV or gavage.
Shoulder dystocia: McRoberts position and SUPRAPUBIC pressure — never fundal pressure.
Postmature: wasted look, loose peeling leathery skin, long nails and hair, meconium staining, alert like a 2-week-old, hypoglycemia from depleted glycogen. Highest risks are meconium aspiration and persistent pulmonary hypertension.
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Jaundice is a TIMING question: after 24 h = physiologic. Before 24 h = pathologic, usually blood-group incompatibility or infection. ABO incompatibility = parent type O, newborn A or B; a positive direct Coombs confirms.
Phototherapy: eye mask on, undressed except for a diaper, reposition every 2–3 h so every surface gets treated, unmask q4h to check for injury, temp q4h. Turn the lights OFF before drawing bilirubin. Bronze discoloration and a maculopapular rash are expected — not a reason to stop. No lotion or oil on the skin (burns under the lights) and no water or glucose water — it displaces milk, so fewer stools and a higher bilirubin. Feed 8–12 times a day to move bilirubin out in the stool; levels should fall in 4–6 h.
Kernicterus is irreversible. Acute bilirubin encephalopathy — lethargy, hypotonia, arching, high-pitched cry — is the reversible stage before it.
Neonatal sepsis is subtle: temperature INSTABILITY rather than fever, poor feeding, lethargy, glucose swings, apnea, color change, hypotonia.
TEF/esophageal atresia: excessive oral secretions, drooling, choking and cyanosis with feeding, often preceded by polyhydramnios. Withhold feedings, head up, orogastric tube to low continuous suction.
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Positioning by anomaly: myelomeningocele prone with a sterile moist dressing · tetralogy knee-chest during a spell · cleft lip/palate upright with frequent burping.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 26 (high-risk newborn) · ch. 27 (physical or developmental difference).
Corticosteroids in preterm labor are for the fetal lungs, not for the labor. They accelerate surfactant formation and reduce respiratory distress syndrome.
⚠️ Exam traps
For a cardiac client the dangerous part is after delivery, not labor.
Postpartum insulin needs drop off a cliff. Yesterday's correct dose causes hypoglycemia today.
🧠 Mind maps 1
One per disorder, built from the structure of your ATI chapter.
Complications of the Newborn
🎯 Who gets it
Maternal diabetes raises risk for newborn hypoglycemia, RDS, and being large for gestational age.
Preterm birth risk factors: gestational hypertension, PPROM, cervical insufficiency, placenta previa, and a prior preterm delivery.
SGA risk factors: maternal malnutrition or infection, smoking or substance use, placental insufficiency, or fetal congenital infection like rubella.
Jittery plus a mother with diabetes equals a glucose check. Feed her first; IV dextrose only if she cannot suck or stays low. — tap it to open full size.
Sepsis: unstable temperature, poor feeding, apnea, skin color changes, irritability, and low muscle tone.
Birth injury clues: a hoarse cry suggests laryngeal nerve palsy; an absent Moro reflex with an inward-turned arm suggests Erb-Duchenne palsy.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
NAS is confirmed by testing urine, meconium, hair, or umbilical cord tissue for drug exposure.
Confirm hypoglycemia with a lab glucose sample after a bedside reading under 45 mg/dL.
RDS labs: ABGs, CBC with differential, and blood or CSF cultures.
Preterm labs often show low Hgb/Hct and prolonged PT/aPTT, raising bleeding risk.
LGA newborns often show polycythemia on CBC, with Hct above 65%, from chronic hypoxia.
Diagnostic Procedures
Chest x-ray screens for RDS, meconium aspiration, and (in FAS) congenital heart defects.
Preterm newborns get head ultrasound, echocardiography, and eye exams to catch complications early.
TEF may show on prenatal ultrasound; confirm after birth with a chest x-ray and NG tube study.
Birth injuries are diagnosed with CT, targeted x-ray, or a neurologic exam.
Transcutaneous bilirubin testing estimates bilirubin level without a blood draw.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Feed a stable, hypoglycemic newborn within an hour of birth, then recheck glucose and feed roughly every 2 to 3 hr across the first 24 hr.
Confirm an intact gag, suck, and swallow reflex before oral feeding a preterm newborn to avoid aspiration.
Use a radiant warmer or isolette and cluster care to limit handling in preterm, SGA, or postmature newborns.
Encourage kangaroo (skin-to-skin) care to lower preterm infant stress and support temperature control.
TEF: keep the head of bed raised, maintain low continuous orogastric suction, and withhold feeds until a provider evaluates secretions or distress.
Avoid endotracheal suctioning for 1 to 4 hr after giving surfactant.
During phototherapy, shield the eyes, remove the mask every 4 hr to inspect them, change the newborn's position every 2 to 3 hr, and turn off lights before blood draws. No lotions or oils on the skin, and no supplemental water or glucose water.
During phototherapy, feed early and often, about 8 to 12 times a day, to help clear bilirubin through the stool.
Give an exchange transfusion for newborns at risk of kernicterus from severe hyperbilirubinemia.
Medications
Morphine sulfate, a short-acting opioid analgesic, treats neonatal withdrawal symptoms.
Methadone, a long-acting synthetic opioid, is used for neonatal opioid withdrawal.
Phenobarbital (anticonvulsant) lowers CNS irritability and controls seizures from alcohol or opioid withdrawal; clonidine may be added.
Surfactant replacement (beractant, calfactant, or lucinactant) restores lung surfactant in preterm RDS.
Antireflux drugs and antacids help manage TEF-related reflux.
Preterm RDS involves reduced alveolar surfactant regardless of the newborn's birth weight.
Bronchopulmonary dysplasia: ventilator/oxygen therapy overinflates and damages immature lungs over time.
Apnea of prematurity comes from immature neurologic and chemical breathing control.
Intraventricular hemorrhage is bleeding in or around the brain's ventricles.
Retinopathy of prematurity involves abnormal retinal vessel growth and can impair vision.
Patent ductus arteriosus is a noncyanotic defect where the ductus stays open after birth.
Necrotizing enterocolitis is ischemic bowel injury that can progress to necrosis or perforation.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Classification: SGA below the 10th percentile · AGA 10th–90th · LGA above the 90th or over 4,000 g · low birth weight ≤2,500 g. Late preterm is 34 0/7–36 6/7.
RDS: tachypnea over 60, nasal flaring, expiratory grunting, retractions, fine crackles, cyanosis. Worsening looks like flaccidity, apnea and unresponsiveness. Birth weight alone does not predict lung maturity.
After surfactant, do NOT suction the ET tube for 1–4 hours. Suction before, not after.
Before any nipple or breast feeding the newborn needs an intact gag and a coordinated suck-swallow; under 34 weeks generally means IV or gavage.
Shoulder dystocia: McRoberts position and SUPRAPUBIC pressure — never fundal pressure.
Postmature: wasted look, loose peeling leathery skin, long nails and hair, meconium staining, alert like a 2-week-old, hypoglycemia from depleted glycogen. Highest risks are meconium aspiration and persistent pulmonary hypertension.
Jaundice is a TIMING question: after 24 h = physiologic. Before 24 h = pathologic, usually blood-group incompatibility or infection. ABO incompatibility = parent type O, newborn A or B; a positive direct Coombs confirms.
Phototherapy: eye mask on, undressed except for a diaper, reposition every 2–3 h so every surface gets treated, unmask q4h to check for injury, temp q4h. Turn the lights OFF before drawing bilirubin. Bronze discoloration and a maculopapular rash are expected — not a reason to stop. No lotion or oil on the skin (burns under the lights) and no water or glucose water — it displaces milk, so fewer stools and a higher bilirubin. Feed 8–12 times a day to move bilirubin out in the stool; levels should fall in 4–6 h.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
