CB6

How to identify for newborn at risk?

• dysmaturity

• Immaturity

• Physical disorders

• Antepartem conditions

• Complications during and after birth

Wha are some predictable risk factors?

• Mother’s low socioeconomic level

• Limited access of healthcare

• Environmental issue Exposure

• Maternal conditions (health conditions, age, pariety)

• Pregnancy complications

What is considered preterm?

Less than 36 weeks 6 days

What is considered late preterm?

34-36 weeks 6 days

What is considered early term?

37-38 weeks 6 days

What is considered full term?

39-40 weeks

What is considered late term?

41- 41 weeks 6 days

What is considered post term?

42 weeks and beyond

What groups are considered at risk newborns?

• SGA

• LGA

• IUGR

• IDM

Define SGA

Any infant who is less than 10% for birth weight

Define LGA

Any infant who is at or above 90% for birth weight

Define IUGR

Fetus with limited growth potential during pregnancy due to variety of factors

Define IDM

Any infant of a mother who had diabetes previously or gestational diabetes

What maternal factors lead to SGA or IUGR

• multiple babies

• Smoking, substance abuse

• PIH or CHTN

• Maternal age (<16 or >40)

• Grand multipariety

• Malnutrition

• Heart disease

• Diabetes

• Sickle cell

Environmental factors leading to IUGR?

• living at high altitude

• x-ray exposure

• Toxin exposure

• Maternal use of meds like anticonvulsants, opioids

Placental factors leading to IUGR?

• small placenta

• Infected placenta

• Placenta previa, thrombosis

• Abnormal cord insertion

• Single umbilical artery (instead of 2)

Fetal factors for IUGR?

Congenital viral factors:

• Toxoplasmosis

• Other

• Rubella

• Cytomegalovirus

• Herpes

Congenital malformations

Metabolic issues

Chromosomal issues

What are the two types of IUGR?

Asymmetric

Symmetric

Define symmetric IUGR

Baby is small overall including

• Organs

• Length

• Weight

• Head circumference

When can one find out they have symmetric IUGR?

2nd trimester via sonogram

Reason for symmetric IUGR

• bc of long term maternal conditions

• Chronic growth restriction throughout pregnancy

cause of asymmetric IUGR?

acute compromise of uteroplacental blood flow

when do we find out pt has asymmetric IUGR?

3rd trimester

Asymmetric IUGR characteristics?

baby is disproportionate:

• head circumference and length WNL

• abd circumference and weight decreased

Factors leading to LGA?

genetic predisposition

• large parents = large babies

• male infants > female infants

multipariety - more common after 1st baby

erythroblastosis fetalis

beckwith weidmann syndrome

transposition of great vessels

poorly controlled maternal diabetes

what is erythroblastosis fetalis?

hemolytic disease of newborn can occur when Rh - mother carries Rh + baby

what is beckwith weidmann syndrome

genetic condition with macroglossia, omphalocele, newborn hyperglycemia, hyperinsulemia

what is the transposition of the great vessels?

• congenital heart defect - abnormal arrangement of vena cava, pulmonary artery, pulmonary veins or aorta

What are issues that can happen to newborns with postmaturity syndrome?

• placenta degrades after 41 weeks

  • poor blood flow, low nutrients, low o2 to baby

  • baby may not tolerate labor well

Characteristics of post mature baby

• dry, cracked, peely skin

• long fingernails/hair

• no vernix

• no lanugo

• body long, thin, wasting

• head circumference and length - WNL
  meconium staining

What are two blood related problems that can occur with at risk newborns?

• Rh incompatibilities

• ABO incompatibilities

What are common complications for at risk newborns?

• hypoglycemia

• Jaundice

• Cold stress

Define cold stress

Occurs when newborns lose more body heat than their own bodies can produce

What can cold stress result in?

• Hypoxemia

• Metabolic acidosis

• Hypoglycemia

• Hyperbilirubinemia

• Worsening respiratory distress

What are some signs of cold stress?

• increased movements

• Increased respirations

• Decreased skin temp

• Decreased peripheral perfusion

• Hypoglycemia

• Metabolic acidosis

What are nursing interventions for cold stress?

• prevention

• Warm baby slowly- isolette, radiant warmer

• Warm iv fluids

• Warm o2

What kind of patients do we routinely screen for hypoglycemia?

• newborns of diabetic mothers

• LGA/SGA babies

• Newborns with IUGR

• Other risks

When is intervention considered necessary for hypoglycemia babies?

Less than 45-47 OR if symptomatic

If hypoglycemia is left untreated what can happen?

developmental delays: seizures, cerebral palsy, learning disabilities

Symptoms of hypoglycemia?

• lethargy

• Tiredness

• Poor feeding/ Vomitting

• Poor sucking/swallowing

• Temp instability

• Apnea/dyspnea/cyanosis

• Lumpiness

• Tremors/ jitters

• High pitched cry

• Exaggerated Moro

Nursing interventions for hypoglycemia

• prevent early

• Promote early, regular feeds

• Heel stick for BS

• IV dextrose if needed

When does jaundice occur?

Elevated bilirubin levels

How does elevated bilirubin levels occur?

End product of red blood cell production breakdown

Describe physiological jaundice

It appears after first 24 hours of birth, resolves in 1 week

Describe breast-feeding jaundice

Can occur in the first few days of life related to inadequate fluid intake

Describe hyperbilorubinemia

Caused by ABO, Rh incompatibility

INTERVENTION NEEDED IF : >13-15

What levels does jaundice typically have?

>4-6

Interventions for jaundice

• adequate feeding/fluid intake

• Phototherapy

• Exchange transfusion