High Risk Newborn Flashcards
Neonatal Birth Weights
normal = 2500-3999 g
SGA = 2500 or less (can be broken further into two categories)
-LBW = 1500-2500g
-VLBW = less than 1500g
(<10% for gestational age (for birth weight)
LGA = great than or equal to 4000g
*important to realize that weight of neonates at birth is an important predictor of future morbidity and mortality rates
IUGR
IUGR growth not consistent with EGA, refers to antepartal issues
Symmetric IUGR: caused by long term conditions in early pregnancy (teratogen, infection, genetic issues). affects general growth > all structures are smaller.
Asymmetric IUGR: “head sparing” caused by more acute compromise in later pregnancy (preeclampsia, malnutrition > uteroplacental deficiency). Disproportional reduction in size of structures/organs (decreased abdominal circumference)
SGA/IUGR Risks
fetal hypoxia (chronically lower O2 levels in utero), labor intolerance, mec aspiration r/t asphyxia during labor, hypothermia (diminished SQ fat), hypoglycemia (heat loss and poor hepatic glycogen stores), polycythemia (chronic intrauterine hypoxic stress), hyperbilirubinemia.
LGA
definition: weight >90% for infants gestational age
Risk for LGA: maternal DM, previous macrosomic infant, prolonged pregnancy, genetic predisposition
Risks related to LGA: c/s delivery, operative vaginal delivery, shoulder dystocia, breech presentation, birth trauma, CPD, hypoglycemia, hypebilirubinemia, polycythemia, temp instability, respiratory distress
Infants of Mothers with Type 1 Diabetes
complications r/t high maternal levels of glucose during pregnancy:
- cardiac anomalies
- neural tube defects
- possible IUGR or SGA
- risk of RDS (delay in surfactant production)
- hypoglycemia
assessment findings:
- macrosomia
- ruddy color
- hyperbilirubinemia
- hypoglycemia
- birth trauma
tx: monitor BG, early and frequent feedings
Postmaturity Syndrome
Post-term pregnancy = delivered >42 wks
Risk factors leading to postterm pregnancies: anencephaly, hx postterm pregnancy, first pregnancy, grand multip
Postmaturity syndrome: fetus begins to use subcutaneous fat and glycemic stores. As placental function decreases there is potential for altered oxygenation and nutrient transport d/t placental aging and compromised blood flow.
Risk r/t postmaturity: mec aspiration, fetal hypoxia, neuro complications r/t placental insufficiency and fetal asphyxia in labor, hypthermia, hypoglycemia, birth trauma, polycythemia, macrosomia if placenta is still working well
Assessment findings: dry peeling skin, lack of vernix, long fingernails, thin, wasted appearance, mec staining, hypoglycemia, poor feeder
Physical Characteristics of Prematurity <37wks
- decreased tone and flexion (hypotonic and extended leading to more heat loss)
- decreased subcutaneous fat
- poor suck, swallow, and breathing
Issues for Preterm Infants
respiratory and cardio physiology
- immature lungs (risk for RDS)
- ductus arteriosis remains open (left to right shunting of blood > pulmonary congestion)
altered thermoregulation d/t lack of glycogen stores in liver, lack of brown fat, less energy reserves to maintain heat balance
GI physiology: indigestion, digestion. and absorption issues
renal physiology: immaturity > inability to concentrate urine
hepatic and hematologic physiology: decreased glycogen stores, impaired conjugation of bilirubin
immunologic: increased susceptibility to infections, decreased IgG transfer
neuro: brain growth and development occurs in 3rd trimester
sleep is disorganized
PDA
patent ductus arteriosus
remains open after birth > left to right shunting
risk factor for PDA: prematurity
PVH/IVH
preventricular/intraventricular hemorrhage
4 grades of IVH: the higher the grade the higher risk of long-term sequelae
RDS
underdeveloped and small alveoli, insufficient levels of pulmonary surfactant causing decreased alveolar surface tension > atelectasis
leads to hypoxemia
RDS decreases with increasing gestational age
(surfactant starts being produced by 24-28wks until term)
L/S ratio >2:1 indicates maturity
Sx: tachypnea, intercostal retractions, expiratory grunting, nasal flaring, skin gray or dusky, lethargic and hypotonic
may be given exogenous surfactant via ET tube
NEC
necrotizing enterocolitis
disease that results in inflammation and necrosis of the bowel
sx 3-10 days after birth, abd distention, bloody stools, vomiting, discoloration of abdomen, visible bowel loops
Substance Abuse Exposure
risks: intrauterine asphyxia, respiratory distress, congenital abnormalities, growth retardation, jaundice, neurobehavioral development problems
neonatal withdrawal is dependent on several factors (timing of exposure, type of substance, half life of substance)
signs of neonatal withdrawal = hyperactivity, jitteriness, high pitched cry, irritability, disrupted sleep patterns, seizures (after birth -> 2wks)
CCHD
critical congenital cardiac disease
cyanosis in the absence of respiratory distress? think cardiac disease
- usually right to left shunt occurring
- do CCHD
Transient Tachypnea of the Newborn
resembles RDS but develops within hours after delivery (6hrs of life)
progressive respiratory distress
