Newborn at Risk Flashcards
What is small for gestational age (SGA)
Any infant who is less than the 10th percentile for birthweight
What is large for gestational and (LGA)
Any infant who is at or above the 90th percentile for birthweight
What is intra-uterine growth restriction (IUGR)?
Fetus with limited growth potential during pregnancy due to a variety of factors
What is IDM?
Infants of diabetic mothers
So any infant of a mother with pre-existing diabetes or gestational diabetes
What are maternal factors leading to SGA or IUGR?
Multiples
Smoking
PIH or CHTN
Maternal age less than 16 or greater than 40
More than six pregnancies
Malnutrition
Heart disease
Substance abuse
Diabetes
Sickle cell
Environmental factors leading to IUGR
Living at high altitudes
Exposure to x-rays
Exposure to toxins
Maternal use of medications such as anti-convulsants
Maternal use of drugs such as opioids
Placental factors leading to IUGR
Small placenta
Infarcted areas
Placenta previa or thrombosis
Abnormal cord insertion
Single umbilical artery rather than the normal pair
Fetal factors contributing to IUGR
Congenital viral infections such as torch infections
Congenital malformations
Metabolic issues
Chromosomal issues
What are torch infections?
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
What are the two types of IUGR?
Symmetric and asymmetric
What is symmetric IUGR?
Caused by long-term maternal conditions
Chronic growth restriction throughout pregnancy
Baby is small all over including: organs, length, bodyweight, head circumference
Discovered as early as second trimester
What is asymmetric IUGR
Caused by acute compromise of utero placenta blood flow
May not be discovered until third trimester
Baby appears disproportionate:
-Head circumference and length may be within normal limits
-abnormal circumference and weight will be decreased
Factors leading to LGA?
Genetic predisposition
-large parents often have large babies and male infants are larger on average and female infants
Multiparity
-Much more common after the first pregnancy
Maternal diabetes that is poorly controlled during pregnancy
-macrosomia may occur in 40 to 50% of diabetic pregnancies due to high levels of glucose crossing the placenta, which is stored as fat by the growing fetus
What is post maturity syndrome?
Newborn delivered after 42 weeks gestation who have problems associated with an extended pregnancy
What kind of problems are associated with an extended pregnancy?
The placenta might begin to deteriorate after about 41 weeks
This can lead to poor blood flow, decrease nutrients and decrease oxygen to baby
What are characteristics of post mature newborn?
Dry, cracked, peeling skin (parchment like)
Long fingernails/hair
No vernix
No lanugo
Body long, thin, wasting
Heads circumference and length typically WNL
Meconium staining
What is jaundice?
Occurs with elevated bilirubin levels, which is the end product of red blood cells breakdown. Many newborns have a mild version that resolves without problems.
What is physiological jaundice?
Appears after the first 24 hours of life and typically resolved within one week
What is breast-feeding jaundice?
Can occur in the first few days of life and is related to inadequate fluid intake
What is hyperbilirubinemia
Is a more serious condition which also causes jaundice, and requires intervention.
Sometimes caused by ABO or RH incompatibility.
Intervention is necessary if bilirubin exceeds 13 to 15 mg/dL
What does RH incompatibilities mean?
RH + infants of Rh negative mothers are at risk for destruction of red blood cells resulting in jaundice or worse
What are the symptoms of jaundice?
Bilirubin level greater than 4-6 mg/dL
Yellow tint to skin when blanched at forehead
What are the interventions for jaundice?
Prevention is best with early and frequent feedings to keep baby hydrated and help eliminate bilirubin via urine and stool
Phototherapy (protect babies eyes)
Exchange transfusion
What is fetal alcohol syndrome?
Physical, behavioral, and cognitive abnormalities caused by exposure to alcohol during pregnancy
What is the nursing management for fetal alcohol syndrome?
Quiet, dim environment
Consistent caregivers
Provide adequate nutrition
Support parents and provide positive reinforcement
What is the nursing management for neonatal opioid withdrawal syndrome?
Provide quiet, dimly lit area
Perform neonatal abstinence scoring
Provide small, frequent feedings
Administer medication as ordered
Swaddle with hands near mouth and provide pacifier
What are complications that occur more frequently in the SGA or IUGR newborn
Fetal hypoxia
Aspiration syndrome
Hypothermia
Hypoglycemia
Polycythemia
What is aspiration syndrome?
In utero hypoxia can cause the fetus to gasp during birth, resulting in aspiration of amniotic fluid into the lower airways
What is polycythemia?
The number of red blood cells is increased in the SGA newborn.
This finding is considered a physiological response to in utero, chronic hypoxic stress.
Polycythemia may contribute to hypoglycemia
What are some common complications of the infant of diabetic mother?
Hypoglycemia
-blood sugar less than 40
Hypocalcemia
- tremors are the obvious clinical sign of hypocalcemia
Hyperbilirubinemia
-Maybe caused by slightly decreased cellular fluid volume, which increases the hematocrit level. This elevation facilitates an increase in red blood cell breakdown, thereby increasing bilirubin levels.
Birth trauma
Polycythemia
Respiratory distress syndrome
What are signs and symptoms of hypoglycemia?
Usually present within one to two hours following delivery, include tremors, cyanosis, apnea, temperature instability, poor feeding, hypotonia
Seizures may occur in severe cases
