Midterms - Week 7

• Newborn


  A high-risk neonate regardless of gestational age or birth, who has a greater-than-average chance of morbidity or mortality, because of conditions beyond the normal events related to birth and the adjustment to extrauterine life

  
• High-risk period


  • Begins at the time of viability as early as 23 wks. of gestation 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 often make the difference between a favorable outcome and a lifetime of disability
• Classification of high-risk newborns

  • Birthweight
  • Gestational age
  • Pathophysiologic problems

  
• 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 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 wks. of gestation, regardless of birth weight

  
• Full-term infant


  An infant born between the beginning of 38 wks. and the completion of 42 wks. of gestation, regardless of birth weight

  
• Post-term (post mature) infant

  An infant born after 42 wks. of gestational age, regardless of birth weight

  
• Late-preterm infant


  An infant born between 34 and 36 wks. of gestation, regardless of birth weight

  
• Classification of high-risk newborns by mortality

  • Live birth
  • Fetal death
  • Neonatal death
  • Perinatal mortality
  • Postnatal death

  
• Assessment of the high-risk newborn

  1. Examination and evaluation of the cardiopulmonary and neurologic functions

  2. Apgar score

  3. Evaluation for any congenital anomalies

  4. Evidence of neonatal distress

  
• Physical assessment of the high-risk newborn

  • General assessment
  • Respiratory assessment
  • Cardiovascular assessment
  • Genitourinary assessment
  • Gastrointestinal assessment
  • Neurologic-musculoskeletal assessment
  • Temperature

  
• Preterm infants


  Immaturity places infants at risk for neonatal complications and predispose the infant to problems that persist into adulthood

  
• Characteristics of preterm infants

  • Very small and appear thin
  • Proportionately large head
  • Bright pink, smooth, and shiny skin
  • Fine lanugo is abundant
  • Soft and pliable ear cartilage
  • Undescended testes in males
  • Prominent labia minora and clitoris in females
  • Maintain an attitude of extension
  • Unable to maintain body temperature
  • Periodic breathing, hypoventilation, and frequent periods of apnea
  • Vulnerable to fluid and electrolyte imbalance

  
• Post term infants


  Infants born after 42 wks. of gestational age, regardless of birth weight

  
• Characteristics of post term infants

  • Absence of lanugo
  • Abundant scalp hair, and long fingernails
  • Cracked, parchmentlike, and peeling skin
  • Thin, elongated appearance
  • Stained deep yellow or green skin
  • Prone to fetal distress, macrosomia, and meconium aspiration syndrome

  
• Appropriate for gestational age (AGA)

  Weight is between the 10th and 90th percentiles, presumed to have grown at a normal rate regardless of the length of gestation

  
• Small for gestational age (SGA)

  Weight is below the 10th percentile on an intrauterine growth curve for that age, born preterm, term, or post term

  
• Causes of intrauterine growth restriction

  • Lack of adequate nutrition
  • Pregnant adolescents
  • Placental anomaly
  • Placental damage
  • Maternal systemic diseases
  • Smoking or use narcotics
  • Intrauterine infection
  • Chromosomal abnormality
• Diagnostic tests for intrauterine growth restriction

  • Fundal height progressively less than expected
  • Sonogram – decreased size
  • Biophysical profile
  • Nonstress test
  • Ultrasound - placental grading, amniotic fluid amount

  
• Fetal implications of intrauterine growth restriction

  • Poor skin turgor
  • Large head, small body
  • Small liver
  • Widely separated skull sutures
  • Dull and lusterless hair
  • Sunken abdomen, dry umbilical cord
  • High hematocrit level
  • Polycythemia
  • Acrocyanosis
  • Hypoglycemia

  
• Large-for-Gestational Age Infant (Macrosomia)

  Weight is above the 90th percentile on an intrauterine growth chart for that gestational age

  
• Causes of macrosomia


  • Diabetes mellitus or obese
  • Multiparous
  • Beckwith Syndrome
  • Congenital anomalies
• Diagnostic tests for macrosomia

  • Sonogram – to confirm the diagnosis
  • Nonstress test – to assess placenta's ability to sustain large fetus
  • Amniocentesis – assessed lung maturity

  
• Fetal implications of macrosomia

  • Immature reflexes and low scores on gestational age exam
  • Extensive bruising or birth injury
  • Caput succedaneum, cephalhematoma or molding
  • Signs of hyperbilirubinemia
  • Polycythemia
  • Cyanosis
  • Hypoglycemia
  • Elevated insulin levels
• Newborn priorities in the first days of life


  • Initiation and maintain ace of respiration
  • Establishment of extrauterine circulation
  • Maintenance of fluid and electrolyte balance
  • Control of body temperature
  • Intake of adequate nutrition
  • Establishment of waste elimination
  • Prevention of infection

  
• Most deaths occurring during the first 48 hours after birth result from the newborn's inability to establish or maintain adequate respirations
• Newborn priorities in the first days of life


  • Initiation and maintain ace of respiration
  • Establishment of extrauterine circulation
  • Maintenance of fluid and electrolyte balance
  • Control of body temperature
  • Intake of adequate nutrition
  • Establishment of waste elimination
  • Prevention of infection

  
• Initiating and Maintaining Respirations

  1. Establish an airway

  2. Expand the lungs

  3. Initiate and maintain effective ventilation
• Establishing Extrauterine Circulation


  1. Closed-chest massage

  2. Lung ventilation

  3. Monitor pulse oximetry and palpate femoral pulse

  4. Administer epinephrine
• Hypoglycemia


  From the effort the newborn expended to begin breathing
• Hypotension


  A vasopressor such as dopamine may be given to increase blood pressure and improve cell perfusion
• Hypovolemia


  Caused by fetal blood loss from a condition placenta previa or twin-to-twin transfusion
• Maintaining Fluid and Electrolyte Balance for Hypovolemia

  1. Administer normal saline or Ringer's lactate to increase blood volume

  2. Control the rate to prevent complications