Newborn Complications 2

Variations in Birth Weight & Gestational Age

• Variations in either can increase neonatal risk factors

• Nurses must know how to identify newborns at risk, based on these variations

• Classification Methods:

  • Birth weight

  • Gestational age

Birth Weight & Gestational Age Variations

• By Birth Weight & Gestational Age:

  • AGA (Appropriate for Gestational Age)

  • SGA (Small for Gestational Age)

  • LGA (Large for Gestational Age)

• By birth weight:

  • Low birth weight

  • Very low birth weight

  • Extremely low birth weight

• Measured in the NICU

AGA (Appropriate for Gestational Age) Overview

• Weight is within 10th to 90th percentile for gestational age

  • Growth charts

• Lower morbidity & mortality rates

SGA (Small for Gestational Age) Overview

• Weight is < 10th percentile for gestational age

  • Growth charts

• < 2500g (5lbs 8 oz) at term

LGA (Large for Gestational Age) Overview

• Weight is > 90th percentile for gestational age

  • Growth charts

• > 4000g (8 lbs 13 oz) at oz

Factors Contributing to the Birth of SGA Newborns

• Maternal

• Placental

• Fetal

Maternal Factors Contributing to the Birth of SGA Newborns

• Chronic HTN or preeclampsia

• Smoking/ substance abuse

• Infections or malnutrition

Placental Factors Contributing to the Birth of SGA Newborns

• Placental insufficiency

• Abnormal cord insertion

• Placenta previa

Fetal Factors Contributing to the Birth of SGA Newborns

• Genetic abnormalities

• Chronic fetal infections

• Congenital malformations

SGA (Small For Gestational Age)

• < 10th percentile on growth chart for age

• Can be preterm, term, or post-term

• Intrauterine Growth Restriction (IUGR)

  • Rate of growth does NOT meet the expected growth pattern

  • Symmetrical growth restriction (early)

  • Asymmetric growth restriction (third trimester)

SGA (Small For Gestational Age) Symmetric Growth Restriction (Early)

• Weight, length, head circumference < 10th percentile

• Body is proportionate & normally developed for size

• Cause:

  • Congenital anomalies

  • Genetic disorders

  • Drugs/ infection during pregnancy

SGA (Small For Gestational Age) Asymmetric Growth Restriction (Third trimester)

• Disproportionately large head for body size

• Normal length, weight < 10th percentile

• Cause:

  • Placental insufficiency

SGA (Small For Gestational Age) Assessment Findings

• Thin extremities & trunk

• Reduced subcutaneous fat stores

• Scaphoid abdomen

• Thin umbilical cord

• Loose, dry skin

• Elderly facial appearance

SGA (Small For Gestational Age) Nursing Mngmnt.

• SGA babies are at risk for:

  • Perinatal asphyxia

  • Meconium aspiration

  • Difficulty w/ thermoregulation

  • Hypoglycemia

  • Polycythemia → Hyperbilirubinemia

LGA (Large for Gestational Age)

• Weight is > 90th percentile

• May have macrosomia

• Can be preterm, term, or post-term

LGA (Large for Gestational Age) Risk Factors

• Maternal diabetes

• Multiparity

• Previous LGA baby

• Maternal obesity

• Male fetus

• Genetics

LGA (Large for Gestational Age) Assessment Findings

• Large body, appears plump, full faced

• Head circumference/ body length at upper limits

• Proportional increase in body size

LGA (Large for Gestational Age) Nursing Mngmnt.

• LGA babies are at risk for:

  • Traumatic birth injuries

  • Hypoglycemia

  • Polycythemia

  • Perinatal asphyxia

  • Hyperbilirubinemia

• Might have to use vacuum/ forceps

  • R/F bruising, trauma

Infants of Diabetic Mothers (IDM)

• Babies of mom’s who are:

  • T1DM, T2DM, or Gestational DM

• Can be preterm, term, or post-term

• Can be SGA, AGA, or LGA

• Macrosomia (LGA):

  • Due to hyperinsulinemia which acts as a growth hormone

Infants of Diabetic Mothers (IDM) Risk for

• Hypoglycemia

• Hypocalcemia

• Birth trauma

  • Big baby

• Perinatal asphyxia

• Respiratory Distress Syndrome (RDS)

  • Cause: Lack of surfactant, lung immaturity

• Polycythemia & hyperbilirubinemia

Infants of Diabetic Mothers (IDM) Assessment Findings

• Round face

• Puffy, rosy cheeks

• Obese body

• Distended abdomen

• Wide shoulders

• Ruddy skin color

• Poor muscle tone at rest

Gestational Age Variations

• Mean duration of preg. is calculated from the first day of the last normal menstrual period and is approximately 280 days or 40 weeks

• Preterm:

  • Born before 38 weeks of gestation

• Late preterm:

  • Born between 34 weeks & 37.6 weeks

  • 37.6 weeks = 37 weeks & 6 days

• Full-term:

  • 38 through 41 completed weeks

• Post-term:

  • 42 weeks or more

Term Newborns

• 38-41 completed weeks

• Less morbidity & mortality

• Best outcomes

• Best ability to deal w/ stressors

• Still require much education

• Adaptation of family

Post-Term Newborns

• 42 weeks or more

• Postmature infant

• Can be AGA, SGA, or LGA

• May have macrosomia

• Risk Factor:

  • Prior Post-Term infant

• Risk for placental insufficiency:

  • Postmaturity syndrome

  • Decreased oxygen & nutrient supply

  • Wasting of fetus due to using stored nutrients

  • Oligohydramnios

  • SGA

Post-Term Newborns Assessment Findings

• Dry, cracked, peeling, wrinkled skin

  • Possibly meconium stained

• Absent or limited vernix & lanugo

• Long, thin extremities

• Minimal fat

• Creases that cover entire soles of feet

• Wide-eyed, alert expression

• Abundant hair on scalp

• Loose skin around thighs & buttocks

• Thin umbilical cord

• Long overgrown fingernails

Post-Term Newborns Nursing Management

• Post-term newborns are at risk for the following:

  • Perinatal asphyxia

  • Difficulty w/ thermoregulation

  • Meconium aspiration

  • Hypoglycemia

  • Polycythemia

  • Hyperbilirubinemia

Late Preterm Newborns

• Born between 34 weeks & 37.6 weeks

• Often look like full-term infant

  • Often overlooked

  • Vulnerable because of physiological & structural immaturity

Late Preterm Newborns Therapeutic Mngmnt.

• Thermoregulation

• Feedings

  • Feeding issues

• Resp. issues

• Discharge

Preterm Newborns

• Born before 38 weeks

• Prematurity is the leading cause of newborn death

Effects of Prematurity on Body Systems

• Body system immaturity affecting transition to extrauterine life

  • Increasing risk for complications

• Resp. system

• Cardiovascular system

• GI system

• Renal system

• Immune system

• Central nervous system

Effects of Prematurity on Body Systems (Resp. System)

• Surfactant deficiency → respiratory distress syndrome

• Apneic spells

Effects of Prematurity on Body Systems (Cardiovascular System)

• Perinatal asphyxia → possible persistent fetal circulation

Effects of Prematurity on Body Systems (GI System)

• Uncoordinated suck & swallow

• Shunting of blood to vital organs

• Necrotizing enterocolitis (NEC)

Effects of Prematurity on Body Systems (Renal System)

• Decreased GFR

Effects of Prematurity on Body Systems (Immune System)

• IgG deficiency

• Possible infection

• Septicemia

Effects of Prematurity on Body Systems (CNS)

• Mental/ motor developmental delays

• Intraventricular hemorrhage

Preterm Newborn Assessment

• Characteristics vary by gestational age

Physical characteristics:

• Scrawny, frail appearance

• Head disproportionately larger than body

• Poor muscle tone & flexion → extended position

• Skin red & transparent, minimal subcutaneous fat, visible blood vessels

• Plentiful vernix caseosa & lanugo

• Eyelids fused, poorly formed ear pinna

• Genitals:

  • Prominent clitoris & labia minora in females

  • Undescended testes in males & minimal scrotal rugae

• Few to absent plantar creases

• Breast tissue:

  • Not developed

Routine NICU Care

• Continuous cardiac & resp. monitoring

• Maintaining thermoregulation

• Promoting nutrition & fluid balance

• Preventing infection

• Providing appropriate stimulation

• Managing pain

• Promoting growth & development

• Promoting parental coping

• Preparing for discharge

Preterm Nursing Management (Risk For)

• Preterm newborns are at risk for the following:

  • Perinatal asphyxia

  • Resp. distress syndrome

  • Difficulty w/ thermoregulation

  • Hypoglycemia

  • Hyperbilirubinemia

  • Sepsis

Skin-To-Skin (Kangaroo Care) in NICU

• Benefits:

  • Maintaining physiological stability

  • Increasing immunity

  • Optimizing breastfeeding

  • Facilitating parent-infant bonding

Preterm Nursing Management (Prepare for Discharge)

• Prepare for discharge:

  • Provide parental education

  • Teach infant CPR & emergency care

  • Develop appropriate home care environment

  • Establish a medical home & referrals

  • Initiate primary care routine

  • Car seat trial

  • Celebrate progress & milestones

Dealing w/ Perinatal Loss

• Assisting parents to cope

• Convey concern & acknowledge parental loss

• Use active listening

• Give parents a sense of control

• Provide privacy as needed

• Assist parents to make memories

• Respect & incorporate cultural interventions

• Help family w/ grieving process

• Supporting the family afterwards

Perinatal Loss

• Memory/ bereavement boxes

• CuddleCot cooling cot