CU8: At-risk/ High-risk Newborn

• High-risk neonate


  - has a greater chance of mortality or morbidity
• High-risk period


  begins at the time of viability up to 28 days after birth
• A. According to Size

  
  

  1. Low-birth-weight (LBW) infant


  less than 2,500 g (5.5 lb.)
• 2. Very-low-birth-weight (VLBW) infant


  less than 1,500 g (3.3 lb.)
• 3. Extremely low-birth-weight (ELBW) infant


  less than 1,000 g (2.2 lb.)
• 4. Appropriate for gestational age (AGA) infant


  weight fall between the 10th and 90th percentiles on intrauterine growth curves
• 5. Small for date (SFD) or small for gestational age (SGA) infant


  birth weight falls below the 10th percentile on curves
• 6. Intrauterine growth restriction (IUGR)


  intrauterine growth is restricted. The baby is not as big as would be expected for the stage of mother's pregnancy
• 7. Large for gestational age (LGA) infant

  birth weight falls above the 90th percentile on curves
• B. According to GA

  1. Late preterm infant


  born between 34 0/7 and 36 6/7 weeks of gestation
• 2. Preterm (premature) infant


  born before completion of 37 weeks
• 3. Full term infant


  born between the beginning of 38 weeks and the completion of 42 weeks
• 4. Postterm (post mature) infant 


  born after 42 weeks of GA
• C. According to Mortality

  1. Live birth


  neonates manifests any heartbeat, breathes, or displays voluntary movement
• 2. Fetal death


  death of the fetus after 20 weeks of gestation and before delivery, with absence of any signs of life after birth
• 3. Neonatal death


  death that occurs in the first 27 days of life
• Early Neonatal Death


  occurs in the first week of life
• Late Neonatal Death


  occurs at 7 to 27 days
• 4. Postnatal death


  death that occurs at 28 days to 1 year after birth
• 5. Perinatal mortality


  describes the total number of fetal and early neonatal deaths per 1000 live births
• Ballard Scoring System


  Scores are given for 6 physical and 6 nerve muscle development (neuromuscular) signs of maturity
• Problems related to Maturity

  1. The Premature Infant

  Primary concerns relates to immaturity of all body systems
• Assessment/s:

  > Irregular RR

  > Body tempt. below normal

  > Poor suck and swallow reflex

  > Very small and appear thin

  > Skin may appear jaundiced

  > Testes are undescended in boy

  > Labia are narrow in girls
• Postmature Nursing Intervention/s:


  > Monitor VS q2-q3 hrs

  > Maintain airway and cardiopulmonary functions

  > Administer oxygen and humification

  > Monitor I and O and electrolyte balance

  > Monitor daily weight

  > Maintain the NB in a warming device

  > Avoid exposure to infections
• 2. The Postmature Infant Assessment/s:

  > Hypoglycemia

  > Parchment like skin (dry and cracked) w/o lanugo

  > Profuse scalp hair

  > Long and thin; old looking

  > Meconium staining possibly present on nails and umbilical cord
• Intervention/s:

  > Provide normal NB care

  > Monitor for hypoglycemia

  > Maintain NB's tempt.

  > Monitor for meconium aspiration
• Clinical Evaluation:

  • Posture

  preterm infant lies in a "relaxed attitude", limbs more extended; the body size is small, and the head may appear somewhat larger
• • Ear

  preterm infant's ear cartilages are poorly developed, and the ear may fold easily; the hair is fine and feathery
• • Sole

  appears more turgid and may have only fine wrinkles
• • Female genitalia

  the clitoris is prominent, and labia majora are poorly developed and gaping
• • Male genitalia

  male infant's scrotum is undeveloped and not pendulous; minimal rugae are present, and the testes may be in the inguinal canals
• • Scarf sign

  preterm infant's elbow may be easily brought across the chest w/ little or no resistance
• • Grasp reflex

  preterm infant's grasp is weak
• • heel to ear maneuver

  preterm infant's heel is easily bought to the ear, meeting w/o resistance