Chapter 34/35/36 - High Risk Newborn ( Lecture Review )

Question 1

How are high-risk infants classified?

Answer 1

Based on birth weight, gestational age, and predominant pathophysiologic problems.

Question 2

What defines an extremely low birth weight (ELBW) infant?

Answer 2

Weight <1000g.

Question 3

Why do preterm infants have increased risks?

Answer 3

Immature organ systems and limited nutrient reserves.

Question 4

What are the major physiologic challenges for preterm infants?

Answer 4

Respiratory function: Immature lungs, lack of surfactant.
Cardiovascular function: Patent ductus arteriosus (PDA) may remain open.
Thermoregulation: Increased heat loss due to thin skin and lack of fat.
Central nervous system function: Increased risk of intraventricular hemorrhage (IVH).
Nutritional challenges: Immature digestion and metabolism.
Renal function: Impaired ability to regulate fluids/electrolytes.
Hematologic status: Risk for anemia and coagulopathies.
Immunity: Higher risk of infection due to low immunoglobulin levels.

Question 5

What is corrected age in preterm infants?

Answer 5

Gestational age + postnatal age (used until 2½ years old).

Question 6

Why are very low birth weight (VLBW) infants at higher risk?

Answer 6

Increased risk for neurologic and cognitive disabilities.

Question 7

Why do preterm infants require respiratory support?

Answer 7

Lack of surfactant leads to respiratory distress syndrome (RDS).
Management includes CPAP, surfactant therapy, and oxygen support.

Question 8

What are common feeding methods for preterm infants?

Answer 8

Oral feedings, gavage feedings, gastrostomy, and parenteral nutrition.

Question 9

What is nonnutritive sucking, and why is it beneficial?

Answer 9

Sucking on a pacifier to promote oral feeding skills.

Question 10

What are key environmental concerns in preterm infants?

Answer 10

High auditory and visual stimulation may impact neurodevelopment.

Question 11

What is Respiratory Distress Syndrome (RDS)?

Answer 11

Lack of surfactant causes alveolar collapse (atelectasis).

Question 12

What is Retinopathy of Prematurity (ROP)?

Answer 12

Abnormal retinal vessel growth due to oxygen exposure.

Question 13

What is Bronchopulmonary Dysplasia (BPD)?

Answer 13

Chronic lung disease caused by prolonged mechanical ventilation.

Question 14

What is Patent Ductus Arteriosus (PDA)?

Answer 14

Failure of the ductus arteriosus to close after birth.

Question 15

What is Necrotizing Enterocolitis (NEC)?

Answer 15

Acute inflammatory disease of the GI tract, leading to bowel necrosis.

Question 16

What intervention lowers the risk of NEC?

Answer 16

Breastfeeding.

Question 17

What are common issues in late preterm infants (34-36 6/7 weeks)?

Answer 17

Respiratory distress, poor thermoregulation, hypoglycemia, hyperbilirubinemia, infection.

Question 18

What are common complications in postmature infants (>42 weeks)?

Answer 18

Meconium aspiration syndrome (MAS).
Persistent pulmonary hypertension of the newborn (PPHN).
Fetal distress due to placental insufficiency.

Question 19

When should discharge planning begin?

Answer 19

At the time of admission.

Question 20

What are essential discharge teaching topics for parents?

Answer 20

CPR, oxygen therapy, suctioning, nutrition, and developmental care.

Question 21

What is anticipatory grief?

Answer 21

Emotional preparation for the potential loss of an infant.

Question 22

How can healthcare providers support grieving parents?

Answer 22

Involve family in infant care, provide privacy, answer questions, and offer hospice/palliative care resources.

Question 23

What are risk factors for birth trauma?

Answer 23

Maternal age <16 or >35, CPD, macrosomia, preterm/postterm labor, abnormal presentation.

Question 24

What are common soft tissue injuries?

Answer 24

Abrasions, erythema, petechiae, forceps injuries, cephalohematoma, subgaleal hemorrhage.

Question 25

What skeletal injuries are common?

Answer 25

Clavicle fracture is the most common.

Question 26

What are common nervous system injuries?

Answer 26

Brachial plexus injury, facial paralysis, intracranial hemorrhage, spinal cord injury.

Question 27

What are common complications in infants of diabetic mothers?

Answer 27

Macrosomia, birth trauma, hypoglycemia, hyperbilirubinemia, RDS, cardiomyopathy.

Question 28

What is the lower limit for normal plasma glucose in neonates?

Answer 28

40-45 mg/dL.

Question 29

What are signs of neonatal hypoglycemia?

Answer 29

Jitteriness, apnea, tachypnea, cyanosis, decreased activity.

Question 30

What is the most common early-onset neonatal infection?

Answer 30

Group B Streptococcus (GBS) and E. coli.

Question 31

What maternal factors increase the risk of neonatal sepsis?

Answer 31

Prematurity, prolonged ROM, maternal fever, GBS colonization.

Question 32

What substances cause NAS?

Answer 32

Opioids (morphine, heroin, methadone, oxycodone, fentanyl).

Question 33

What drug should be avoided in pregnancy due to the risk of congenital heart defects?

Answer 33

Paroxetine (an SSRI).

Question 34

What are the most common causes of hemolytic disease of the newborn?

Answer 34

ABO incompatibility (most common). Rh incompatibility (second most common).

Question 35

How does Rh incompatibility affect the fetus?

Answer 35

Maternal antibodies destroy fetal RBCs, causing anemia and hydrops fetalis.

Question 36

When is Rh immune globulin (RhoGAM) given?

Answer 36

At 28 weeks, within 72 hours postpartum, and after any potential fetal-maternal hemorrhage.

Question 37

What are the most common major congenital anomalies?

Answer 37

Congenital heart disease, neural tube defects, cleft lip/palate, developmental dysplasia of the hip.

Question 38

What is the most common congenital cardiac defect?

Answer 38

Critical congenital heart disease (CCHD).

Question 39

What is esophageal atresia?

Answer 39

The esophagus does not connect to the stomach.

Question 40

What is the most common congenital anomaly of the nose?

Answer 40

Choanal atresia.