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• Term infant


  Born at the end of week 37 gestation
• Preterm infant


  Born before the end of week 37 gestation
• Post term infant


  Born after 41st week of pregnancy
• Small-for-gestational-age infant


  Birth weight is below 10th percentile
• Large-for-gestational-age infant


  Birth weight is above the 90th percentile
• Preterm infant


  • Anemia of Prematurity
  • Acute Bilirubin Encephalopathy
  • Periventricular/Intraventricular Hemorrhage
  • Retinopathy of Prematurity (ROP)
• Large for Gestational Age

  • Polycythemia
  • Increase Hematocrit
  • Hypoglycemia
  • Decrease Subcutaneous fat levels
• Small for Gestational Age

  • High hematocrit
  • Increase RBCs (polycythemia)
  • Hyperbilirubinemia
  • Hypoglycemia
• A live born infant born before the end of week 37 gestation
• Late preterm

  • Born between 34 and 37 weeks
• Early preterm

  • Born between 24 and 34 weeks
• Common Factors Associated With Preterm Birth

  • Low socioeconomic level
  • Poor nutritional status
  • Lack of prenatal care
  • Multiple pregnancy
  • Previous early birth
  • Race
  • Cigarette smoking
  • Age of the mother (younger than age 20)
  • Order of birth
  • Closely spaced pregnancies
  • Abnormalities of the mother's reproductive system, such as intrauterine septum
  • Infections (UTI)
  • Obstetric complications, such as premature rupture of membranes or premature separation of the placenta
  • Early induction of labor
  • Elective cesarean birth
• Preterm Infant Appearance

  • Head – disproportionately large (> 3cm greater than chest size)
  • Fontanelles – small
  • Eyes – small, hazy vitreous humor, myopia
  • Ears – large, immature cartilage, pinna falls forward
  • Skin – ruddy; vernix caseosa, lanugo
  • Few or (-) creases on soles of feet
  • Neurologic (-) sucking, swallowing and breathing reflexes, diminished Achilles tendon reflex; less active and rarely cries

  
• Preterm Infant Posture and Reflexes

  • Resting Posture
  • Wrist Flexion
  • Recoil Extremities
  • Scarf Sign
  • Heel to Ear
  • Breast Tissue
• Anemia of prematurity


  Anemia occurs from a combination of immaturity of the hematopoietic system combined with the destruction of RBCs because of low levels of Vitamin E, a substance that normally protects RBCs against oxidation
• Acute bilirubin encephalopathy (ABE)


  The destruction of brain cells by invasion of indirect or unconjugated bilirubin
• Periventricular/Intraventricular Hemorrhage


  • Periventricular hemorrhage - tissue surrounding the ventricles
  • Intraventricular hemorrhage - bleeding into the ventricles
• Retinopathy of Prematurity (ROP)

  An acquired ocular disease that leads to partial or total blindness in children, caused by vasoconstriction of immature retinal blood vessels with high concentration of oxygen as the causative agent
• Therapeutic Management (ROP)


  1. Provide early screening and detection in infants

  2. Decrease exposure to bright, direct lighting

  3. Use supplemental oxygen judiciously and monitor oxygen blood levels carefully

  4. Laser photocoagulation - surgical repair of detached retina

  5. Avastin (bevacizumab) - antivascular endothelial growth factor drug
• Post term infant


  Born after 41st week of a pregnancy
• Post term infant appearance

  • Dry, cracked, almost leather like skin
  • (-) Vernix
  • SGA
  • Less amniotic fluid
  • Meconium stained
  • Fingernails will have grown well
  • Alert like 2 week old baby

  
• Post term infant


  • DOB
  • Polycythemia
  • Increase Hematocrit
  • Hypoglycemia
  • Decrease Subcutaneous fat levels
• Therapeutic management of post term infant

  Sonogram
• Small for gestational age infant

  Birth weight is below 10th percentile
• Common Factors Associated With SGA

  • Nutrition
  • Age of the mother (adolescent)
  • Chromosomal abnormality
  • Intrauterine infection
  • Placental issues
  • Diabetes mellitus
  • Gestational hypertension
  • smoking
• Small for gestational age infant appearance

  • Below average weight, length and head circumference
  • Poor Skin turgor
  • Skull sutures widely separated
  • Dull and lusterless hair
  • Small Liver
  • Sunken abdomen
  • Dry umbilical cord
• Small for gestational age infant lab findings

  • High hematocrit
  • Increase RBCs (polycythemia)
  • Hyperbilirubinemia
  • Hypoglycemia
• Large for gestational age infant

  Birth weight is above the 90th percentile
• Common Factors Associated With LGA

  • Overproduction of nutrients & growth hormones
  • Obesity
  • Diabetes mellitus
  • Multiparity
  • Beckwith-wiedemann syndrome
• Large for gestational age infant appearance

  • Immature reflexes
  • Poor Apgar Score
  • Extensive bruising
  • Birth injury (broken clavicle or Erb-Duchenne paralysis)
  • Caput succedaneum, cephalohematoma, or molding
• Assessment criteria for large for gestational age infant

  1. Skin color for ecchymosis, jaundice, and erythema

  2. Motion of extremities on spontaneous movement and in response to a Moro's reflex to detect clavicle fracture

  3. Asymmetry of the anterior chest or unilateral lack of movement

  4. Eyes for evidence of unresponsive or dilated pupils; vomiting, bulging fontanelles, and a high-pitched cry suggestive of increased intracranial pressure

  5. Activities such as jitteriness, lethargy, and uncoordinated eye movements that suggest seizure activity