neonatal Flashcards
how to classify GA for preterm?
Preterm = GA < 37 wks at birth
- Extreme- preterm GA<29
- Late-preterm GA 34-37
how to classify birth weight?
- ELBW:< 1000g
- VLBW 1001-1500g
- LBW 1501-2500g
- Normal >2500g
how to classify the growth of the newborn? (size)
SGA
small for gestational age
Less than 10%ile birth wt for GA
AGA
appropriate for gestational age
between 10 to 90%ile for GA
LGA
Large for gestational age
Greater than 90%ile for GA
two types of disproportion of a newborn: classification
IUGR
Symmetric IUGR
Neither wt, length and HC above 10%ile; An indication of chronic malnutrition
asymmetric IUGR
Length and HC are appropriate but only wt is below 10%ile.
IUGR
intrauterine growth restriction
two types of disproportion of a newborn: which one indicates chronic malnutrition? which one is more serious?
Symmetric IUGR
b/c it means neither Wt, Length and HC are under development;
If there is inadequate nutrition, body first will reduce weight, then length and the last HC, since brain is the most important organ.
why to classify the preterm babies
- Fashion of feeding
- Food tolerance level
- Different risk of Comorbidities
I. Fenton Growth curve: why it is the best choice for preterm?
a. Gender specific
b. 22-50 wks GA: easy to follow up the growth even after 40 weeks
c. Equivalent to the WHO growth charts at 50 weeks CGA can help to modify and accommodate the WHO growth curve for preterm babies once CGA of the baby no less than 37 weeks
d. Very accurate:precise to each days
e. based on reliable sample size
Nutritional Goals (5)
- to approximate the rate of growth and composition of weight gain for a normal fetus (mimic the nutrient status in the womb)
- To maintain normal concentrations of blood and tissue nutrients
- To achieve a satisfactory functional outcome similar to an infant born at term
- NUTR adapted to ongoing medical complications
- Establish an adequate follow up in the community
6 Factors affecting preterm infant’s nutritional status
- Gastrointestinal immaturity,
- Thermoregulation and low reservation
- GI and Respiration
- Medical issues
- Decreased Absorption of nutrients
a. APGAR represents
Appearance, pulse, grimace, activity, respiration
what are included the initial consultation? (7 aspects: M, A. M, P,GI, Bi, C)
- maternal Hx
- infant Anthropocentrics
- the medications applied to the baby
- infant’s physical assessment: BWt, length, HC, etc
- infant’s GI (abdomen, meconium (first fece), bowl sounds
- infant’s biochemical records
- infant’s clinical signs, coordination of suck/swallow/breathe
NUTR intervention: what are the variable needs to considers for mode of nutrition? (5+1)
GA, SGA/AGA/IUGR clinical status medications coordination of suck/swollow/breathe (+ feeding fashion)
Who needs PN? 4 points
- Congenital GI anomalies requiring surgical repair
- Impaired GI mobility
- Malabsorption syndromes
- Delayed initiation or advanced of enteral feeds
- Functional immaturity of GI tract or gestational age at birth < 30-32 weeks
- Necrotising enterocolitis (NEC)
when can initiate PN
- Start as soon as the infant is born with at least a starter PN solution to help provide adequate calories and protein
