PROBLEMS OF NEWBORN: PROBLEMS RELATED TO MATURITY

Preterm Infants

• Immaturity increases newborn risk and adult health problems

• Exact cause unknown

• Risk lower in middle–high socioeconomic groups and higher in low socioeconomic groups

• Good nutrition and prenatal care reduce risk

• Risk factors include multiple pregnancy, gestational hypertension, and placental problems.

Preterm Physical Characteristics

• Very small, thin body

• Minimal/absent subcutaneous fat

• Large head relative to body

• Pink, shiny, smooth skin

• Visible blood vessels

• Abundant lanugo

• Fine head hair

• Soft ear cartilage

• Few palm/sole creases

• Soft skull and ribs

• Eyes fused before 26 weeks

• Males – undescended testes; Females – prominent labia minora and clitoris.

Preterm Behavior and Physiology

• Inactive, listless;

• Limbs extended;

• Poor temperature control;

• Limited urine solute excretion;

• High infection risk;

• Immature breathing with frequent apnea;

• Immature lungs;

• Risk of hyperbilirubinemia, hypoglycemia, and fluid/electrolyte imbalance.

Preterm Management

• NICU alerted

• Team approach

• Heated incubator

• IV therapy as needed

• Oxygen therapy

• Delivery room resuscitation

• Transport to NICU after stabilization

Post-term Infants

• Born after 42 weeks gestation

• Cause unknown

• Appearance of 1–3 week old infant

• No lanugo

• Minimal/absent vernix

• Abundant scalp hair

• Long nails

• Cracked, peeling skin

• Thin, wasted appearance

• Depleted subcutaneous fat

• Yellow/green vernix from meconium

• Meconium-stained fluid common

• High fetal distress risk

• Decreased placental efficiency

• Increased macrosomia and MAS risk

Problems Related to Gestational Weight

• Birth weight + gestational age = better risk prediction

• Measurements plotted on charts

Appropriate for gestational age AGA

normal growth

Large for gestational age LGA

accelerated growth

Small for gestational age SGA

• restricted growth

• decreased birth weight increases mortality risk.

Small-for-Gestational Age (SGA)

• Weight <10th percentile

• May be preterm, term, or post-term

• Associated with IUGR.

SGA Causes

• Poor maternal nutrition

• Adolescent pregnancy

• Placental insufficiency

• Placental infarction/fibrosis

• Placental defects

• Severe diabetes mellitus

• Pregnancy-induced hypertension

• Heavy smoking

• Narcotic use

• Intrauterine infection (rubella, toxoplasmosis)

• Chromosomal abnormalities

SGA Prenatal Detection

• Low fundal height

• Small size on ultrasound

• Biophysical profile for placental function

• Nonstress test for oxygenation

• Risk of labor hypoxia with poor placental function

SGA Physical Features

• Wasted appearance

• Low fat; Small liver

• Poor glucose, protein, bilirubin regulation

• Poor skin turgor

• Large head

• Wide skull sutures

• Dull, dry hair

• Sunken abdomen

• Dry umbilical cord

• Possible yellow staining cord

• Advanced neurologic maturity

• Firm ear cartilage

• Developed sole creases

• Alert behavior

SGA Laboratory Findings

• High hematocrit

• Polycythemia (increased red blood cells)

• Thick blood (high viscosity)

• Increased cardiac workload

• Prolonged acrocyanosis

SGA Common Complication

Hypoglycemia (blood glucose <45 mg/dL).

Large-for-Gestational Age (LGA / Macrosomia)

• Weight >90th percentile

• Healthy appearance at birth

• Immature gestational age exam

• Excess growth hormone in utero

• Common in infants of diabetic or obese mothers

• Severe macrosomia with poor diabetes control

• Larger infants in multiparous women

• Transposition of great vessels association

• Beckwith syndrome association

• Congenital anomalies association

• Omphalocele association

LGA Prenatal Detection

• Uterus large for dates

• Rapid growth on ultrasound

• Nonstress test for placental function

• Amniocentesis for lung maturity

• Labor issues such as failure to descend.

Nonstress test

for placental function

Amniocentesis

for lung maturity

LGA At Birth

• Immature reflexes

• Low gestational age score

• Bruising

• Clavicle fracture

• Erb-Duchenne paralysis

• Caput succedaneum

• Cephalhematoma

• Molding

LGA Care and Risks

• Close monitoring

• Risk of hyperbilirubinemia and polycythemia

• Increased cardiac workload

• Careful heart rate monitoring

• Cyanosis may indicate heart defect

• Risk of hypoglycemia and rebound hypoglycemia

• High insulin levels in first 24 hours