High-Risk Newborns: Classification and Nursing Care

High-Risk Newborn

Infants who are born considerably before term and survive are particularly susceptible to the development of sequelae related to preterm birth.

An accurate assessment of gestational age is critical in helping the nurse to identify the potential health issues that the newborn is likely to experience.

Late preterm infant

Infants born between 34 and 36 6/7 weeks of gestation.

Often experience morbidities similar to those of preterm infants, including respiratory distress, hypoglycemia requiring treatment, temperature instability, poor feeding, jaundice, and discharge delays as a result of illness

associated with speech, behavioural, and cognitive challenges at follow-up in children 6 years of age

Term infant

Infants born between 37 & 42 completed weeks of gestation.

Post-term/Postmature infant

Infants born at > 42 completed weeks of gestation.

Live birth

Birth in which the newborn manifests any heartbeat, breathes, or displays voluntary movement, regardless of gestational age.

Fetal death

Death of the fetus, at any gestational age, before birth, with absence of any signs of life after birth.

Neonatal death

Death of a newborn less than 28 days of life; early neonatal death occurs in the first week of life; late neonatal death occurs at 7 to 28 days.

Perinatal mortality

Total number of fetal and early neonatal deaths per 1,000 live births.

The Preterm Infant

Born before completion of 37 weeks of gestation.

At increased risk for health issues because their organ systems are immature and they lack adequate physiological reserves to function in the extrauterine environment.

Issues Affecting the respiratory system of the preterm infant

•Decreased number of functional alveoli

• Deficient surfactant levels

• Smaller airway lumen

• Decreased tracheal cartilage

• Obstruction of respiratory passages

• Insufficient calcification of the bony thorax

• Circulating hormones (prostaglandins) that may affect cardiovascular

function

• Immature and fragile pulmonary vasculature

• Greater distance between functional alveoli and capillary bed, especially

in ELBW infants

Early Signs of Respiratory distress

Tachypnea

Nasal Flaring

Expiratory grunting

Central Cyanosis

Indicates poor oxygenation

Periodic Breathing

Respiratory pattern commonly seen in preterm newborns and is manifested by 5- to 10-second respiratory pauses followed by 10 to 15 seconds of compensatory rapid respirations.

Apnea

A cessation of respirations for 20 seconds or more, associated with hypoxia, bradycardia, or both.

Current guidelines for Rescuscitation

Current resuscitation guidelines advocate the use of room air, as the initial gas, for infants greater than 35 weeks’ gestation and judicious use of oxygen when resuscitating preterm infants.

Preterm infants, particularly ELBW infants, lack a sufficiently developed antioxidant defense system

Respiratory distress

A condition common in late preterm infants due to immature lung development.

Thermoregulation

The process of maintaining body temperature, which can be a problem for late preterm infants.

Neutral Thermal Environment

An environment that permits newborn to maintain a normal core temperature with minimum oxygen consumption and calorie expenditure.

Jaundice

A condition characterized by yellowing of the skin and eyes, common in late preterm infants.

Neurodevelopmental problems

Potential cognitive and developmental issues that can arise in late preterm infants.

Gestational age assessment

The process of determining the age of the fetus or infant, often using the New Ballard scale.

Continuous distending pressure (CPAP)

A form of respiratory support used for infants to keep their airways open.

Mechanical ventilation

A method of providing respiratory support for infants who cannot breathe adequately on their own.

Gavage feeding

A method of feeding infants through a tube inserted into the stomach (nasogastric/orogastric).

Gastrostomy feeding

A method of providing nutrition directly to the stomach via a surgically placed opening.

Non-nutritive sucking

A practice where infants suck on a pacifier or finger without feeding, which can promote oral development.

Sudden infant death syndrome (SIDS)

The sudden and unexplained death of an infant, often during sleep.

Complications of Prematurity

Conditions such as respiratory distress syndrome (RDS), patent ductus arteriosus, and necrotizing enterocolitis that can affect preterm infants.

The Post-term Infant

An infant born after 42 weeks of gestation, regardless of birth weight.

Meconium aspiration syndrome (MAS)

A condition in newborns caused by inhalation of meconium-stained amniotic fluid.

Gentle oropharyngeal suctioning

A technique used to clear the airway of a newborn, especially in cases of meconium aspiration.

Intubation if thick meconium

The procedure of placing a tube in the airway if the meconium is thick and obstructive.

Persistent pulmonary hypertension of the newborn (PPHN)

A serious condition where a newborn's circulation system does not adapt to breathing outside the womb.

Treatment of the underlying cause

Addressing the root issues contributing to PPHN.

Ventilation support

Assistance provided to help a newborn breathe adequately.

Sedation & muscle relaxation

Medications used to calm the newborn and reduce muscle tension during treatment.

Pulmonary vasodilators (iNO)

Medications that help widen blood vessels in the lungs to improve oxygenation.

ECMO

Extracorporeal membrane oxygenation, a life-support technique used for newborns with severe respiratory failure.

Small for gestational age (SGA)

Infants whose weight is below the 10th percentile for their gestational age.

Large for gestational age (LGA)

Infants whose weight is above the 90th percentile for their gestational age.