Summary

Nurses performing initial and ongoing early assessments on newborns need to be aware of and question signs and symptoms of birth trauma. Edema, bruising, immobility, or abnormal movement can be related to both common and life-threatening birth injuries. The neonate can have pain, impaired mobility, or respiratory distress because of these injuries. The more serious consequences of birth trauma can lead to seizures and coma. Treatment is determined by the underlying injury. Parents may find these injuries scary and react with concern and anxiety. Nurses can educate and support the family as they learn to care for their newborn with an injury. Education emphasizes the need to see the primary care provider at all well-child checkups. Closely monitoring child development is vital, as nerve injuries will have the greatest impact on gross and fine motor skills.

Congenital malformations, deformations, and chromosomal abnormalities are important causes of newborn mortality in the United States. Congenital anomalies are also the top cause of death during infancy. Early recognition and treatment can decrease the mortality and morbidity for newborns affected with these disorders. Compassionate nursing care and education can best support families taking on a lifetime of caring and advocating for a child with a global disorder affecting multiple body systems, their ultimate development, and their experience of life.

Effective ventilation is the highest priority for the newborn needing resuscitation. Starting PPV when needed without delay gives the best outcome for the newborn. Monitoring the heart rate and oxygen saturation of the newborn provides the best indication of improved ventilation and oxygenation. The newborn’s inability to maintain and respond to temperature change makes hypothermia a potential need for resuscitation. Multiple treatment modalities are available to support the newborn who has difficulties transitioning to extrauterine life. More than 90 percent of newborns need no medical intervention to successfully transition (AHA, 2020).

Care of the preterm infant is a subspecialty within nursing. Nurses in this subspecialty require both the resolution to care for these very resilient and high-risk patients as well as the critical judgment to quickly identify deadly disease conditions specific to this population and those with potentially few signs and symptoms. Over the past century, the care of high-risk premature infants has improved exponentially, although many continue to have serious health risks through their progression.

Attachment is an important developmental process for the infant. It is affected by hospitalization, acute and critical illness, and the state of the caregiver and their ability to attach with the infant. The family is a changing unit, with new members joining and changing roles. Being open to that change, promoting acceptance, and acknowledging the differences and similarities in parenting experiences make the transition easier for everyone.

Transition to home for the high-risk infant is more complicated than a direct discharge of a healthy newborn. It requires attuned discharge planning and education related to the needs of each individual family and their infant. Multidisciplinary teams must communicate not only with each other but also with the family and the primary care pediatrician who will care for the infant outside the hospital setting. Many support services are available for both the families and the infants to promote functional families and healthy, appropriately developing infants. The family of a terminally ill infant may benefit from hospice care at home.