Exam 2 - High Risk Infants

Question 1

1. Define:
   a. Healthy birth weight
   b. Low birth weight
   c. Very low birth weight
   d. High birth weight
   e. Small for gestational age
   f. Large for gestational age

Answer 1

Healthy birth weight: greater than 5.5-9lbs
Low birth weight: less than 5.5lbs usually takes 2 years to catch up
Very low birth weight less than 3.3 lbs
High birth weight above 9 lbs
Small for gestational age less than 10th percentile
Large for gestational age larger than 90th percentile; greater than 10lbs

Question 2

What is the difference between preterm and small for gestational age?

Answer 2

Small for gestational age occurs in babies who have reached full gestation

Question 3

80% of preterm infants are born within the range of _____________weeks gestation.

Answer 3

34-36 weeks gestation

Question 4

Why has the US seen an increase in preterm births in the past 25 years?

Answer 4

mothers are older, multiple fetal births, fertility drugs, most preterm births within 34-36 weeks gestation

Question 5

What is the average length of gestation for a full–term pregnancy? At how many weeks gestation is a newborn considered to be preterm? At how many weeks gestation is a newborn considered to be post term?

Answer 5

Full term: 40 weeks

Pre term:

Question 6

What are some of the causes associated with low birth weight?

Answer 6

mutliple pregnancies, cesarean section, chronic disease, advancing of age, or very young age for first time moms, hypertension, preeclampsia, eeclampsia, poor maternal nutrition, substance abuse

Question 7

What are the chances of survival for an infant born before 25 weeks compared to an infant born after 27 weeks gestation?

Answer 7

27 weeks: 90%

after 27 weeks: 70% or below

Question 8

How long does it generally take for a preterm infant born at a VLBW (28 – 31 weeks gestation) to catch up in growth to a full term infant?

Answer 8

2 years

Question 9

Why are fluid needs so high in preterm infants?

Answer 9

They lose fluid through their skin

Question 10

10. Describe the risks/conditions associated with prematurity (see below):
    a. Heart
    i. Patent Ductus Anteriosis
    b. Gastrointestinal
    i. Necrotising Enterocolitis
    ii. Gastroesophageal Reflux

c. Lung
i. Respiratory Distress
d. Central Nervous System
i. Cerebral Palsy
ii. Mental retardation
iii. Learning disabilities
e. Eyes
i. Poor vision
f. Bones
i. Osteopenia

Answer 10

Describe the risks/conditions associated with prematurity (see below):

a. Heart
i. Patent Ductus Anteriosis: congential disorder in the heart where the duct fails to close after birth. early symptoms are uncommon, but in 1st year of life increased breathing and poor weight gain, high caloric needs

b. Gastrointestinal: 26-38 weeks gestation develope sucrase, poor motility in GI tract
i. Necrotising Enterocolitis: early sign is inflammation of intestine and results in damage/death of cell in the intestine. blood loss from intestines is a major sign. occurs in premature infants who get infections
ii. Gastroesophageal Reflux
sphincter valve on the top of stomach does not work properly and acidic contents of stomach lead baack to esophagus causing burning heartburn sensation

c. Lung
i. Respiratory Distress: mucus membranes around lung have not yet formed so infant cant breathe normally on its own. symptoms=bluish of skin (cyanosis), breief apnea, grunting/flaring of nostrils, rapd breathing, shallow breathing, decreased urine output

d. Central Nervous System
i. Cerebral Palsy
umbrella term that can apply to a group of disorders that can involve brain adn nervous system function (learning, seeing, hearing, thinking) sometimes hard to determine cause
ii. Mental retardation
iii. Learning disabilities

e. Eyes
i. Poor vision

f. Bones
i. Osteopenia: bone mineral density is lower than normal

Question 11

All preterm infants have Respiratory Distress Syndrome. Why?

Answer 11

Lungs are the last organ to develop and preterm babies dont stay in the womb long enough to develop lungs properly

Question 12

Hyperbilirubinemia results from an immaturity of what organ system? What is a physical sign of hyperbilirubinemia?

Answer 12

immature liver, skin and eyes turn yellow (jaundice)

too high can cause mental retardation

Question 13

Why would a preterm infant younger than 26 weeks be fed a formula that is lactose-free?

Answer 13

GI system is immature and cant digest lactose no lactase enzyme has been produced yet in sufficient amounts to break down lactose

Question 14

At what gestational age does the sucking reflex develop?

Answer 14

32 weeks

Question 15

Under what conditions would a preterm infant be fed by the following feeding modalities?

a. Parenteral
i. Peripheral
ii. TPN
b. Enteral
i. Gavage
ii. Gastrostomy (G tube)
iii. Transpyloric feeding
c. Bottle feeding / breast feeding

Answer 15

Under what conditions would a preterm infant be fed by the following feeding modalities?

a. Parenteral (IV)
i. Peripheral: used for hydration and is short term
ii. TPN: central line and used long term but don’t want to use if you can’t

b. Enteral (24-72 hrs after birth)
i. Gavage: delivering nutrients through tube to stomach
ii. Gastrostomy (G tube): G tube is permanently put in stomach
iii. Transpyloric feeding: if child is not tolerating gavage, put tube all way to intestine; use hydrolized nutrients

c. Bottle feeding / breast feeding

Question 16

What are the benefits of enteral feeding compared to parenteral feeding?

Answer 16

improved nutrient intake, decreased jaundice, improved gastrointestinal maturation, full volume feedings tolerated earlier

Question 17

What are the risks associated with enteral feedings?

Answer 17

feeding intolerance; aspiration: when formula goes into lungs so you have to put tube down transplyorically if baby is aspirating and instead of down esophagus, which can lead to pneumonia; necrotizing enterocolitis: aggressively feeding heavily concentrated formula and digestive tract is immature so sometimes overpowering, leading to complications (formula fed and very early premature kids)

Question 18

What are the energy /protein recommendations for premature infants (per kilogram (kg) body weight compared to healthy full-term infants?

Answer 18

3-4 g/kg for premature infants and 1.5 g/kg for full term infants

Question 19

Risks for nutrient deficiencies are high in preterm infants. Why?

Answer 19

premature babies have decreased glycogen stores, decreased fat and thin skin; thin skin makes premature infants lose lots of fluids; decreased stomach size; decreased digestive enzymes so put on preterm formula because they can’t break down lactose; cannot process bilirubin in liver; renal problems in kidneys make it hard to eliminate waste or too much waste is put out too fast; bones in last part of pregnancy have mother transfer calcium to baby for bone mineralization premature babies can be osteopenic [low bone density]

Question 20

What are the criteria used to determine if a preterm infant is ready to go home from the hospital?

Answer 20

when baby reaches 4 lbs and regulates body temp., breathes independently, enteral/oral feedings tolerated, adequate kilocalories and nutrients, gaining weight