high risk newborns

• preterm: 37 and earlier
• post-term: over 42 weeks
• small/large for gestational age
• experienced breathing difficulties at birth
• suffered excessive coldness, or hypothermia
• has infectiom
• born to mothers with high risk parental conditions
• Preterm infant: organ system are immature and lack adequate physiological reserves to function in the extrauterine environment
• Preterm infant: the lower the birth weight and the gestational age, the lower the chances of survival
• Preterm infant: practical and ethical dimensions of resuscitation of extremely low-birth-weight infants
• physical characteristics in newborns:

  • abnormal breathing
  • body hair
  • enlarged clitoris
• physical characteristics in newborns:

  • less body fat
  • lower muscle tone ad less activity than full-term infants
  • problems feeding due to trouble sucking or coordinating swallowing and breathing
• physical characteristics in newborns:

  • small scrotum that is smooth and has no rug and undescended testicles
  • soft, flexible ear cartilage
  • thin, smooth, shiny skin that is often transparent
• Preterm respiratory system: one of the last systems to mature, therefore poses great risk for premature newborn: help increase surfactant
• Cardiovascular system: difficulty making transition from intrauterine to extrauterine life
• gastrointestinal system: small stomach capacity
• renal system: increase risk for fluid/electrolyte imbalance
• immune system: increased susceptibility to infection
• central nervous system: susceptible to injury increasing the potential for long-term disability
• Preterm respiratory system: surfactant deficiency, unstable chest wall, immature respiratory control centers, small respiratory passages and inability to clear from these passages, 30-60 breaths per minute, use abdominal muscles
• preterm cardiovascular system: change from fetal to newborn circulation pattern, impact of low oxygen level circulating blood, increased incidence of congenital anomalies associated with prolonged fetal circulation, impaired regulation of BP
• preterm cardiovascular system: monitor for hypovolemia and shock, hypotension, slow capillary refill, continued respiratory despite 02 and ventilation, murmurs
• Preterm infant GI system: provide adequate nutrition can be challenging as needs are great but ability to take optimal calories is reduced
• Preterm infant GI system: lack neuromuscular coordination required to maintain suck, swallow, and breathing, perinatal hypoxia causes shunting of blood away from gut to other organs, small stomach capacity, comprised metabolic function
• Preterm infant GI system: intervention includes introduction of minimal enteral feeding to prepare newborn gut for future introduction of nutrients
• Preterm infant renal and immune system: inability to concentrate urine and slow glomerular filtration rate
• preterm infant immune system: impaired ability to manufacture antibodies to fight infection if exposed to pathogens during the birth process, thin skin and fragile blood vessels provide limited protective barrier, prevention better than treatment
• preterm infant CNS: premature infants are susceptible to injury due to birth trauma, bleeding from fragile capillaries, impaired coagulation process, recurrent anoxic episodes and predisposition hypoglycemia
• preterm infant CNS: high risk for heat loss, susceptible to hypoglycemia
• nursing assessment of pain: monitoring of facial expressions, body movement and crying
• Late preterm infant: higher risk for problems related to

  • thermoregulation
  • hypoglycemia
  • hyperbilirubinemia
  • respiratory distress
  • poor feeding and discharge delays
• post term infant: cause extended pregnancy not well understood, hower tends to be repetitive, ability of the placenta to provide adequate oxygen and nutrients compromised
• post term infant: as placenta loses ability to nourish the fetus, the fetus uses stored nutrients to stay alive, thus wasting occurs
• Post term infants common physical characteristics:

  • dry, cracked skin
  • long, thin extremities
  • creases that cover entire soles of the feet
• Post term infants common physical characteristics:

  • wide-eyed and alert
  • abundant hair on scalp
  • thin umbilical cord
• Post term infants common physical characteristics:

  • limited vernix and lanugo
  • meconium stained skin
• Newborn post term complications include:

  • LGA or SGA
  • meconium aspiration/perinatal asphyxia
  • infectious morbidity
  • birth trauma
  • low APGAR scores
  • perinatal mortality
  • oligohydramnios
  • hypoglycemia
  • hypothermia
  • polycythemia
• Oligohydramnios: decreased amniotic fluid volume, usually due to a decrease in fetal weight
• Polycythemia: an increase in the absolute red blood cell (RBC) mass in the body
• MAS: meconium aspiration syndrome- happens when a newborn has trouble breathing because meconium got into the lungs