chapter 34 Flashcards by Cynthia Carrillo

how are high risk infants classified

Birth weight (LBW, HBW)
Gestational age
Predominant pathophysiologic problems

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low birth weight infant definition

weighs less than 2500 g regardless of gestational age

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very low birth weight infant definition

baby that weighs less than 1500 grams

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extremely low birth weight infant definition

a baby who’s birth weight is less than 1000 grams

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appropriate for gestational age definition

birth weight falls between the 10th and 90th percentiles

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Preterm (premature) defintion

An infant born before completion of 37 weeks of gestation.

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late preterm definiton

An infant born from 34 (0/7) through 36 (6/7) weeks of gestation.

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Early term definition

An infant born from 37 (0/7) through 38 (6/7) weeks of gestation.

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full term definition

An infant born from 39 (0/7) weeks through 40 (6/7) weeks of gestation.

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late term definition

An infant born from 41 (0/7) through 41 (6/7) weeks of gestation.

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post term definition

An infant born at 42 (0/7) or more weeks of gestation

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what is the last thing to develop in a fetus

lungs

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what is the age of viability

24 weeks

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what are the ethical consideration with an EBLW infant <1000 grams

Should resuscitation be attempted, and to what extent should it be continued?
Who should decide?
Is the cost of resuscitation justified?
Do the benefits of technology outweigh the burdens in relation to the quality of life?

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respiratory function in preterm infant

lungs last to fully develop
decreased number of functioning alveoli
deficient surfactant levels
smaller airways
immature and friable capillaries in lungs which puts risk for hemorrhage

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what is periodic breathing

pattern where infant will have 5-10 sec of pauses followed by 10-15 sec of compensatory rapid respirations
Periodic breathing should not be confused with apnea, apnea is cessation of breathing for 20 secs or more

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thermal regulation considerations in preterm infants

less body fat
less brown fat
large surface area compared to weight
immature temp regulation in brain

CNS function in preterm infant

immature CNS
increased risk of damage due to birth trauma in neurological structures
fragile capillaries in brain

considerations for maintaining adequate nutrition in preterm infant

Have to have good respiratory status in order to feed baby
IV fluids high in glucose initially , D10
OG or NG tubes if aspiration risk
TPN if needed
If able to take PO feedings, start slow, always look for risk of aspiration
May have inability to digest proteins and absorb nutrients due to immature enzymes

considerations to maintain renal function

fluids , assess urine output, weighing diapers, accurate I&Os, labs , acid-base balance, BUN, Crt
A lot of preterm infants are on iv antibiotics, make sure no kidney impairment

considerations to maintain hematologic status

Capillary fragility in multiple areas so risk of bleeding, slow rbc production from rapid decrease in erythropoiesis after birth, loss of blood from frequent labs

considerations for resisting infection

Shortage of immunoglobulins, impaired ability to make antibodies,
Breastfeeding helps, hand hygiene

care management for maintain body temp

High risk infant susceptible to heat loss
Unable to increase metabolic rate
Transepidermal water loss is greater
Should be transferred from delivery in a prewarmed incubator
Rapid changes in body temperature may cause apnea.

what causes most heat loss in infants

Lose most heat through head, put hat on, keep dry, skin to skin, warmers, swaddling, warming up hands/stethoscope
Can put tiny babies in Ziploc bags to help with heat

what are the complications associated with oxygen therapy

Retinopathy of prematurity (ROP) Bronchopulmonary dysplasia (BPD) Patent ductus arteriosus (PDA)

what is retinopathy of prematurity (ROP)

babies develop abnormal blood vessels in retina, light sensitive layer of retina worse case leads to bleeding and scarring that can pull retina from wall and lead to blindness

what are the risk factors for ROP

LBW <1500 grams babies born at 32 wks or less o2 level too high during neonatal treatment high o2 levels can be toxic to blood vessels sepsis chronic lung disease poor nutrition

what is Bronchopulmonary dysplasia (BPD)

form of chronic lung disease, most often premature infants and need o2 , lungs and airways are damaged, causing dysplasia. Severity varies from infant to infant, the more premature the infant, the more risk of developing BPD

what is patent ductus arteriosus (PDA)

where ductus arteriosus fails to close after birth , allows portion of oxygenated blood to flow back to lungs

What is Germinal matrix hemorrhage–intraventricular hemorrhage (GMH-IVH)

Usually occurs in infants less than 34 weeks History of hypoxia, birth asphyxia primary cause are the fragile thin vessels in germinal matrix and immature cerebral autoregulation mechanism in preterm neonates (Severe brain bleed)

what is necrotizing enterocolitis (NE)

most common serious intestinal disease in premie babies , happens when tissue in small or large intestine is inflamed , leading to necrosis , can cause perforation,

what are the symptoms of Necrotizing enterocolitis

abdominal distention, temp instability, grossly bloody stools

signs of pain in infant

Cry face, eyes squeezed and increase in BP High pitched cry not indication

Complications in late preterm infants

Respiratory distress Thermoregulation Nutrition Hypoglycemia Hyperbilirubinemia Infection

complications in postmaster infants

Meconium aspiration syndrome (MAS) Persistent pulmonary hypertension of the newborn (PPHN)

what is Meconium aspiration syndrome (MAS)

passed meconium in utero and aspirated, only treat as needed if aspirated , not as aggressive

characteristics of postmature infant

dry, cracked skin, not as much vernix, no lanugo ,may be larger

issues for SGA or IUGR infants

Perinatal asphyxia Hypoglycemia Hyperglycemia Polycythemia Heat loss

definition of SGA

<10th percentile

LGA definition

above 90th percentile

IUGR definition

something inside uterus is not allowing them to grow as they should

what is asymmetric IUGR

Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.