CH 23 Flashcards
Factors affecting Fetal Growth - 4
-maternal nutrition
-genetics
-placental function
-environmental factors
SGA (small for gestational age)
-less than 28 wks, they are never going to catch up in size. Something is going on with the placenta
-greater than 28 wks, they can probably catch up
-IUGR = intraunterine growth restriction - something is happening in there that makes the baby not grow. Depending on how bad it is, might have to deliver.
1. asymmetric - head or chest measures normal and legs arent - part of the baby is growing and other parts are not
2. symmetric - measuring skull, arms, humerus, femur, abdominal circumference
Causes of SGA
- maternal factors (smoking, live at high altitude, age, low socioeconomic, abuse) high altitude = low oxygenation
- maternal disease (preeclampsia, hypertension, autoimmune, renal disease) preeclampsia = decrease in circulation to the baby
- environmental factors (occupational hazards, stress, substandard living)
- placental factors (cord insertion, chronic abruption, placenta previa, placenta insufficiency) abruption = not enough oxygen
- fetal factors (trisomy 13, 18, 21, infection, radiation, multiple gestation) - trisomy babies dont grow right, infection in the uterus, twin to twin transfusion (one big, one small - big will have issues bc it gets overlooked)
Characteristics of SGA
-head disproportionately large compared to rest of body
-wasted appearance of extremities; loose dry skin - look scrawny, dry skin due to low nourishment
-reduced subcutaneous fat stores - not growing
-decreased amount of breast tissue
-scaphoid abdomen (sunken appearance)
-wide skull sutures
-poor muscle tone over buttocks and cheeks
-thin umbilical cord - premature 24-26 wks you will see thin cord. 34 wks you can also see thin cord. Not enough going through it.
Common Problems for SGA
- perinatal asphyxia
- difficulty w/ thermoregulation
- hypoglycemia
- polycythemia
- meconium aspiration - poop inside mixed w/ amniotic fluid - ends up in babys lungs.
- hyperbilirubinemia
SGA RN Management
- weight, length, head circumference measurements - probably abdomen too
-serial blood glucose monitoring
-VS monitoring - make sure oxygenating okay
-early/frequent oral feedings; IV infusion of dextrose 10%
-s/s of polycythemia - dont want blood thickened, watch to see how they grow, oxygenation, meeting milestones
Causes of LGA
Risk factors:
- maternal diabetes mellitus or glucose intolerance
- multiparity - multiple births
- prior hx of a macrosomic infant
- postdated gestation - past 42 wks
- maternal obesity
- male fetus
- genetics - some cultures are just big ex somoans
Characteristics of LGA
- large body, plump, full faces
- proportional increase in body size
- poor motor skills
- difficulty regulating behavior states
Common Problems of LGA
- birth trauma - big baby coming out of avg size mom - worried about shoulder dystocia
- hypoglycemia
- polycythemia
- hyperbilirubinemia
LGA RN Management
-VS
-blood glucose level monitoring
-oral feedings w/ IV glucose supplementation as needed – if sugar too low then need to give IV. may not be able to breastfeed bc not enough glucose in it. would do bottle feeding w/ formula.
-check for s/s of polycythemia and hypoglycemia
-hydration
-phototherapy for increased bilirubin levels
Term Baby
born from the first day of the 38th week thru 42 weeks
Preterm Baby
born before 37 weeks
Late Preterm Baby
born between 34 and 36 6/7 weeks
Postterm Baby
born after 42 weeks
Postterm Newborn
- inability of placenta to provide adequate oxygen and nutrients to fetus after 42 wks
- dry, cracked, wrinkled skin; possibly meconium stained - looks like an old person. Can look yellowish greenish
- long thin extremities; long nails; creases cover entire soles of feet – more mature baby = more creases over the feet
- wide eyes, alert expression
- abundant hair on scalp
- thin umbilical cord
- limited vernix and lanugo
