W1

• High-risk neonate is a newborn, regardless of gestational age or birth weight, who has a greater-than-average chance of morbidity or mortality because of conditions or circumstances superimposed on the normal course of events associated with birth and the adjustments to extrauterine existence.
• The (at/high)-risk period encompasses human growth & development from the time of viability, the gestational age at which survival outside the uterus is believed to be possible, or as early as 23 weeks of gestation up to 28 weeks following threats to life & health that occur.
• Appropriate for gestational age (AGA) infant refers to the level of growth and development appropriate for the age of fetus.
• An infant whose weight falls between the 10th & 90th percentile on intrauterine growth curves or birth weight expected for the gestational age is considered AGA.
• Very low birth weight - (VLBW) - an infant whose birth weight is 1000 to 1500g born before 30 weeks of pregnancy (3 lbs & 5 oz.)
• Minimum age of viability is 23 weeks gestation.
• Extremely Low Birth Weight infant (ELBW) - an infant whose birth weight is less than 1000g (2 lbs & 3 oz.) born at 27 weeks gestation or even younger
• Moderately Low Birth Weight infant (MLBW) - an infant whose birth weight is 1501 to 2500g
• Small for date (SFD) or small-for-gestational-age (SGA) infant is an infant whose birth weight is below the 10th percentile on intrauterine growth curve for that age or birth weight less than expected for the specific gestational age.
• Causes of SGA include mother’s nutrition during pregnancy, placental anomaly, placental damage, systemic diseases, and intrauterine infections.
• Placental damage such as partial placental separation with bleeding limits placental function.
• Women with systemic diseases that decrease blood flow to the placenta as severe diabetes mellitus or pregnancy-induced hypertension are at risk of having SGA infants.
• Mothers who smoke heavily or use narcotics are also at risk of having SGA infants.
• Placental supply of nutrients is adequate, but the infant can’t use them - intrauterine infections of rubella or toxoplasmosis can cause SGA.
• Prenatal assessment can be detected in the utero by taking the fundal height during pregnancy.
• Sonogram can demonstrate the decreased size, biophysical profile including a non-stress test, placental grading ultrasound examination can provide placental function.
• SGA infants appear below average in weight, length, & head circumference, have dry skin, and a wasted appearance.
• Characteristics of preterm infants include small size, disproportionately large head, ruddy skin, and high degree of acrocyanosis.
• Nursing Diagnosis: Risk for impaired parenting related to high-risk status of large for gestational age infant.
• Early preterm infants are born between 24 & 34 weeks.
• Late preterm infants are born between 34 & 37 weeks.
• Evaluation: Parents hold infant; speak of the child in positive terms; state accurately why infant needs to be observed closely during postnatal period.
• Preterm infants are born before the end of 37 weeks of gestation, regardless of birth weight or born before the 38th week.
• Fetal factors contributing to preterm birth include multiple pregnancy, infection, intrauterine growth retardation (IUGR).
• Post term infants are born after the end of 41 of pregnancy.
• Maternal factors contributing to preterm birth include age, smoking, poor nutrition, placental problems, preeclampsia/eclampsia.
• Neurologic function in preterm infants is difficult to evaluate due to weak sucking & swallowing, diminished deep tendon reflexes, and high-pitched cry.
• Scarf sign in preterm infants is when the elbow passes the midline of the body.
• SGA infants have a small liver, which may cause difficulty regulating glucose, protein, & bilirubin levels.
• Outcome Identification: Parents demonstrate adequate bonding behavior during neonatal period.
• Other factors contributing to preterm birth include low socioeconomic status, early termination of pregnancies, environmental exposure to harmful substances, iatrogenic causes, such as elective cesarean birth & inducement of labor according to dates rather than fetal maturity.
• General activity in preterm infants is feebler and weaker, often assume frog-like position.
• SGA infants have poor skin turgor and generally appear to have a large head because the rest of the body is so small.
• SGA infants may have widely separated skull sutures due to lack of normal bone growth.
• SGA infants have dull & lusterless hair and an abdomen that may be sunken.
• The cord of an SGA infant may appear dry & stained yellow.
• These infants are not responsive to hypercarbia & hypoxemia, & their neurons have fewer dendritic associations than those of more mature infants.
• Apnea of Prematurity reflects the immature & poorly refined neurologic & chemical respiratory control mechanisms in premature infants.
• If tactile stimulation fails to reinstitute respiration, flow-by oxygen & suctioning of nose & throat, if breathing does not begin, the chin is raised gently to open the airway, & resuscitation by mask & bag is used to lift the rib cage.
• Central apnea is an absence of diaphragmatic & other respiratory muscle function that causes a lack of respiratory effort & occurs when CNS does not transmit signals to the respiratory muscle.