Common Blood Diseases in Newborns

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NICU guide

- Bleeding in Newborns

Bleeding in newborns results from platelet disorders, clotting factor deficiencies, and vascular disorders.

Causes:

• Vitamin K deficiency and immature liver development leading to impaired clotting factor production, as seen in hemorrhagic disease of the newborn.
• Low platelet count or platelet dysfunction.
• Disseminated intravascular coagulation (DIC), which consumes clotting factors and causes bleeding.
• Congenital or hereditary clotting factor deficiencies, such as hemophilia.

Hemorrhagic Disease of the Newborn

Hemorrhagic disease of the newborn is a bleeding disorder occurring in the first few days after birth due to vitamin K deficiency, leading to impaired production of clotting factors by the liver.

Symptoms:

• Persistent bleeding from the umbilical cord.
• Continuous bleeding from the circumcision site in male infants.
• Blood in urine and stool.
• Subcutaneous blood collections (bruises) on the baby’s body.

Prevention:

• Administering vitamin K (0.5 – 1 mg intramuscularly) within 1–2 hours after birth.

Treatment:

• Administering 5 mg of vitamin K intramuscularly or intravenously (slowly).
• Fresh plasma transfusion or packed red blood cell transfusion in severe bleeding cases, as per the doctor's instructions.

- Anemia in Newborns

Anemia in newborns is defined as a decrease in hemoglobin levels below 13 mg/100 ml, reducing the blood’s oxygen-carrying capacity. There are two types:

Physiological Anemia:

• Occurs in the first few weeks after birth, especially in preterm infants.
• Considered normal and often goes unnoticed without symptoms.

Pathological Anemia:

• Results from red blood cell breakdown or blood loss.

Causes of Pathological Anemia:

• Blood group incompatibility between the mother and baby (e.g., Rh incompatibility).
• Neonatal sepsis.
• Bleeding during birth (e.g., placental abruption) or postnatally (e.g., intracranial or scalp hemorrhage).
• Frequent blood sampling for laboratory tests in newborns receiving intensive care.

Symptoms:

• Decreased newborn activity and lack of interest in feeding.
• Pallor.
• Yellowing of the skin and sclera (in hemolytic anemia).
• Increased heart rate and weak pulse.
• Frequent episodes of apnea in severe cases.
• Symptoms of neonatal shock in cases of significant blood loss.

Nursing Care:

• Maintaining circulatory stability.
• Monitoring vital signs, including heart rate, blood pressure, and oxygen saturation, using a cardiac and respiratory monitor.

In Cases of Bleeding:

• Informing the doctor immediately.
• Applying pressure with a dry cotton pad on external bleeding sites.
• Administering vitamin K (5 mg intramuscularly or intravenously, slowly) as per medical instructions.
• Administering intravenous fluids or blood transfusions as needed.
• Monitoring hemoglobin levels and reporting any changes.

In Cases of Blood Group Incompatibility:

• Placing the baby under phototherapy or performing an exchange transfusion as directed by the doctor.

In Severe Anemia Cases:

• Administering packed red blood cells as per medical instructions.

In Cases of Neonatal Sepsis:

• Administering appropriate antibiotics based on microbial culture results.

- Neonatal Sepsis

Neonatal sepsis is the presence of pathogenic microbes and their toxins in the bloodstream. It is a serious condition that can be life-threatening, especially in preterm infants admitted to the neonatal intensive care unit (NICU), due to multiple invasive procedures and inadequate infection control practices.

Risk Factors:

Maternal Factors:

• Maternal fever during pregnancy.
• Preterm birth.
• Prolonged rupture of membranes (≥ 18 hours before delivery).
• Maternal urinary tract infections during pregnancy.

Neonatal Factors:

• Immature immune system, especially in preterm infants.
• Invasive procedures such as intubation, cannulation, or central catheter insertion.
• Formula feeding.

Hospital-Related Factors:

• Poor infection control practices, particularly inadequate hand hygiene.
• Overcrowding and understaffing in the NICU.
• Insufficient handwashing facilities.
• Presence of asymptomatic carrier newborns.

Nurse’s Assessment:

Medical History:

• Gestational age.
• Maternal infections during pregnancy (e.g., Group B Streptococcus infection).
• Prolonged rupture of membranes.
• Low Apgar score.
• History of neonatal sepsis in a previous sibling.

Newborn Examination:

Sepsis presents with varied symptoms requiring a comprehensive examination:

• General lethargy and reduced activity.
• Weak sucking reflex and poor feeding.
• Gastrointestinal symptoms such as vomiting, feeding intolerance, abdominal distension, or diarrhea.
• Temperature instability (hypothermia or hyperthermia).
• Respiratory distress signs (e.g., tachypnea, apnea, increased respiratory secretions).
• Umbilical stump infection signs (e.g., purulent discharge, foul odor).
• Hypoglycemia symptoms.

Critical Symptoms Requiring Immediate Medical Attention:

• Hypotension.
• Severe abdominal distension.
• Seizures.
• Signs of neonatal shock.

Laboratory Tests:

• Complete blood count (CBC).
• C-reactive protein (CRP).
• Blood culture.
• Urine culture.
• Cerebrospinal fluid analysis and culture.
• If respiratory distress is present:
• Chest X-ray.
• Blood gas analysis.
• Sputum culture.

Nursing Care:

Infection Control Measures:

• Maintaining NICU hygiene.
• Wearing hospital scrubs in the NICU and following proper handwashing protocols.
• Ensuring an adequate nurse-to-patient ratio for optimal care.
• Adhering to infection control practices during preparation of intravenous fluids, medication administration, blood sampling, and catheter insertion.
• Cleaning and disinfecting equipment such as incubators and ventilators before use on another infant.
• Assigning dedicated tools (e.g., stethoscope, thermometer) for each infant.
• Using protective equipment (e.g., masks, gowns, gloves) when handling infected infants.
• Reducing waterborne infections by:
• Using sterile water in nebulizers and humidifiers.
• Regularly draining condensation from ventilator circuits.

Care for an Infected Newborn:

• Continuous cardiac and respiratory monitoring until stabilization.
• Checking vital signs hourly until stabilization.
• Monitoring blood glucose levels as per medical instructions.
• Observing respiratory distress symptoms and suctioning secretions if needed.
• Providing oxygen therapy or mechanical ventilation as required.
• Monitoring for seizures and reporting any occurrences.
• Following the doctor’s instructions regarding feeding and intravenous fluids.
• Maintaining fluid balance records.
• Measuring abdominal circumference in cases of feeding intolerance or abdominal distension.
• Administering antibiotics as prescribed.