CH 24 The High Risk Newborn: Complications Associated with Gestational Age & Development

Late preterm infants

- Infants born betwen 34 weeks and 36.6 (36 6/7) weeks of gestation.

- Risks, appearance, and behavior.

Preterm infant's appearance

- Appearance frail and weak

- Poor tone

- Head appears large

- Fat-lacking

- Skin is thin, translucent

- No plantar creases less than 32 weeks.

Preterm infant's behavior

- Tire easily

- No energy because body is overworking.

PAIN & FLUID IMBALANCE

- Signs of Dehydration in Infant

- Signs of pain in infant

Signs of Dehydration in Infant

- Output is less than

Signs of Pain in Infant

- Tachycardia or bradycardia

- Hypertension

- Decreased O2 saturation

- High pitched cry

- Eyes squeezed shut

- Grimace

- Tense muscles

- Rigid extremities

Common complications of preterm infants

- Intraventricular hemorrhage (IVH)

- Bronchopulmonary dysplasia (BPD)

- Retinopathy of prematurity (ROP)

- Necrotizing enterocolitis (NEC)

- Respiratory distress syndrome

Postterm infants

- Born after the 42 week of gestation.

- Scope less than 10% of all intrauterine pregnancies.

Small-for-Gestational Age infants

- Can be either born preterm, term, or postterm.

What are the causes for Small-for-Gestational Age infants?

- Genetic factors

- Chromosomal issues

- Fetal infections

- Multifetal gestations

- Poor placental function

- Small size of placenta

- Separation can interfere

Small-for-Gestational Age Infants vs IUGR

- Not just small, they look malnourished

- Symmetric vs. Asymmetric

Symmetrical IUGR

- Early onset and seen in 20% cases.

- etiology by genetic disease or infection, intrinsic to fetus.

Symmetrical IUGR total cell number and cell size?

- Total cell number: Less

- Cell size is normal

Symmetrical IUGR USG

All parameters such as HC, BPD, AC, FL smaller than expected.

Symmetrical IUGR neonatal course

Complicated with poor prognosis (Px).

Asymmetrical IUGR

- Late onset, seen in 80% cases.

- Etiology by chronic placental insufficiency, extrinsic to fetus.

Asymmetrical IUGR total cell number. Cell size?

- Total cell number is Normal

- Cell size is Smaller

Asymmetrical IUGR USG:

Head sparing effect but the abdomen is small.

Asymmetrical IUGR neonatal course

Usually uncomplicated having good prognosis (Px).

Large-for-Gestational Age infants

- Above 90%

- Macrosomia may or may not be present more than 4,000g and 8 lbs and 13 oz.

What are the causes for Large-for-Gestational Age infants?

- Diabetes in mother

- Multipara

- Large parents

- Obesity in mom

- Certain ethic groups such as Asian, Black, and Hispanic.

What are the risks for Large-for-Gestational Age infants?

- Difficult labor

- Injury in birth

- Cesarean section

- Can lead to shoulder dystocia