NCMA 219 MIDTERM

• The high-risk neonate is a newborn, regardless of gestational age or birth, who has a greater-than-average chance of morbidity or mortality, usually because of conditions beyond the normal events related to birth and the adjustment to extrauterine life
• The high-risk period begins at the time of viability up to 28 days after birth and includes threats to life and health that occur during the prenatal, perinatal, and postnatal periods
• Assessment and prompt intervention in life-threatening perinatal emergencies often make the difference between a favorable outcome and a lifetime of disability
• The nurse in the neonatal nursery knows the characteristics of neonates and recognizes the significance of serious deviations from expected observations
• When providers anticipate the need for specialized care and plan for it, the probability of successful outcome increases
• Classification of High-risk Newborns

  • According to Size
  • According to Gestational Age
  • According to Mortality
• Low-birthweight (LBW) infant


  An infant whose birth weight is less than 2500grams (5.5 lbs.), regardless of gestational age
• Very low-birthweight (VLBW) infant


  An infant whose birth weight is less than 1500 grams (3.3 lbs.)
• Extremely low-birthweight (ELBW) infant


  An infant whose birth weight is less than 1000 grams (2.2 lbs.)
• Appropriate-for gestational-age (AGA) infant


  An infant whose weight falls between the 10th and 90th percentiles on intrauterine growth curves
• Small-for-date (SFD) or small-for-gestational age (SGA) infant


  An infant whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves
• Intrauterine growth restriction (IUGR)


  Found in infants with whose intrauterine growth is restricted
• Large-for-gestational age (LGA) infant


  An infant whose birth weight falls above the 90th percentile on intrauterine growth charts
• Preterm (premature) infant


  An infant born before completion of 37 weeks of gestation, regardless of birth weight
• Full-term infant


  An infant born between the beginning of 38 weeks and the completion of 42 weeks of gestation, regardless of birth weight
• Post-term (post mature) infant


  An infant born after 42 weeks of gestational age, regardless of birth weight
• Late-preterm infant


  An infant born between 34 and 36 weeks of gestation, regardless of birth weight
• Classification of Mortality


  • Live birth
  • Fetal death
  • Neonatal death
  • Perinatal mortality
  • Postnatal death
• Assessment of the High-risk Newborn

  1. Brief yet thorough assessment at birth to determine any problems and identify conditions that needs immediate attention

  2. Thorough, systematic physical assessment involving general, respiratory, cardiovascular, gastrointestinal, genitourinary, neurologic-musculoskeletal, temperature, and skin assessments

  3. Observational assessments of the high-risk infant according to the infant's seriousness of condition

  
• Preterm infants have distinct characteristics at various stages of development
• Preterm infants are inactive and listless, physiologically immature, and more susceptible to various complications
• When delivery of a preterm infant is anticipated, the neonatal intensive care unit (NICU) is alerted, and a team approach implemented

  
• Post term infants display characteristics of infants who are 1 to 3 weeks of age, and are especially prone to fetal distress, macrosomia, and meconium aspiration syndrome
• Birthweight influences mortality: the lower the birthweight, the higher the mortality
• Small-for-Gestational Age (SGA) infant


  An infant whose birth weight is below the 10th percentile on an intrauterine growth curve for that age
• SGA infants may be born preterm, term, or post term, and have experienced intrauterine growth restriction (IUGR) or failed to grow at the expected rate in utero
• Causes of IUGR include maternal nutrition, placental anomalies, maternal systemic diseases, and maternal smoking/drug use
• SGA infants may be detected in utero and have distinct physical characteristics
• Small-for-Gestational Age (SGA) infant


  Infant whose birth weight is below the 10th percentile on an intrauterine growth chart for that gestational age
• SGA infants


  • Below average in weight, length, and head circumference
  • May have a small liver, poor skin turgor, large head, widely separated skull sutures, dull and lusterless hair, sunken abdomen, dry and yellow-stained umbilical cord
  • May have better-developed neurologic responses, sole creases, and ear cartilage than expected for their weight
• Polycythemia


  Increased total number of red blood cells, caused by anoxia during intrauterine life
• SGA infants have decreased glycogen stores, leading to a common problem of hypoglycemia (decreased blood glucose)
• Large-for-Gestational Age (LGA) infant


  Infant whose birth weight is above the 90th percentile on an intrauterine growth chart for that gestational age
• LGA infants


  • Appear deceptively healthy at birth due to weight, but have immature development
  • Subjected to overproduction of growth hormone in utero, often due to maternal diabetes or obesity
  • May show immature reflexes, low scores on gestational age exams, extensive bruising or birth injuries, prominent caput succedaneum, cephalhematoma, or molding
  • At risk for hyperbilirubinemia, polycythemia, hypoglycemia
• Detecting LGA fetus


  1. Unusually large uterus for date of pregnancy

  2. Sonogram to confirm suspicion

  3. Nonstress test to assess placental ability to sustain large fetus

  4. Amniocentesis to assess lung maturity

  
• Transposition of the great vessels


  Serious heart anomaly associated with macrosomia
• Caput succedaneum


  Swelling of the scalp, caused by pressure during birth
• Cephalhematoma


  Collection of blood between the skull and the periosteum, caused by pressure during birth

  
• Molding


  Temporary deformation of the infant's head, caused by pressure during birth
• LGA infants require the same cautious care as preterm infants