NURS 2866 - The High-Risk Newborn

What increases morbidity or mortality risk in newborns?

Size, gestational age, and medical conditions.

How are newborns classified by size?

By birth weight and gestational age.

What is considered Low Birth Weight (LBW)?

Less than 2,500 grams.

What is considered Very Low Birth Weight (VLBW)?

Less than 1,500 grams.

What is considered Extremely Low Birth Weight (ELBW)?

Less than 1,000 grams.

Are weight classifications based on gestational age?

No, they are based on weight regardless of gestational age.

What is Appropriate for Gestational Age (AGA)?

Birth weight between the 10th–90th percentile.

What is Small for Gestational Age (SGA)?

Birth weight less than the 10th percentile.

What may cause SGA?

Intrauterine growth restriction (IUGR).

What is Large for Gestational Age (LGA)?

Birth weight greater than the 90th percentile.

What is considered preterm?

Less than 37 weeks.

What is considered late preterm?

34 to 36 weeks and 6 days.

What is considered early term?

37 to 38 weeks and 6 days.

What is considered full term?

39 to 40 weeks and 6 days.

What is considered late term?

41 to 41 weeks and 6 days.

What is considered post-term?

More than 42 weeks.

What is the most common skeletal birth injury?

Clavicle fracture.

How is a clavicle fracture managed?

Gentle
handling, limb containment, and parent education; usually no treatment needed.

What causes Erb’s Palsy?

Stretching or pulling of the shoulder during birth.

What are signs of Erb’s Palsy?

Limp arm, internally rotated shoulder, extended elbow, pronated forearm, flexed wrist/fingers, intact grasp reflex.

What causes facial nerve injury in newborns?

Pressure on the facial nerve during birth.

What are signs of facial nerve injury?

Loss of movement on one side, inability to close one eye, drooping mouth corner, no forehead wrinkles.

What is sepsis in newborns?

Presence of microorganisms or toxins in blood/tissues.

What are risk factors for neonatal sepsis?

Poor prenatal care, substance use, PROM, prolonged labor, meconium aspiration, prematurity, LBW.

What are respiratory signs of neonatal sepsis?

Apnea, tachypnea, grunting, nasal flaring.

What are cardiac signs of neonatal sepsis?

Tachycardia or bradycardia, hypotension, arrhythmias.

What are neurologic signs of neonatal sepsis?

Temp instability, irritability, high-pitched cry, bulging fontanelles.

What are GI signs of neonatal sepsis?

Feeding intolerance, vomiting, diarrhea.

How is neonatal sepsis managed?

Assess risk, report findings, educate parents.

What does TORCH stand for?

Toxoplasmosis, Other (HIV, syphilis), Rubella, Cytomegalovirus, Herpes simplex virus.

How are congenital infections managed?

Identify agent, obtain specimens, teach prevention (e.g. no vaginal birth with active HSV).

What causes NAS?

Opioid exposure (e.g., oxycontin, heroin, methadone).

What are signs of NAS?

Irritability, high-pitched cry, tremors, poor feeding, respiratory distress, temp instability.

How is NAS managed?

Collect urine/hair/meconium, use NAS Scoring System (Figure 25.7).

What are alcohol withdrawal signs in newborns?

Jitteriness, increased tone/reflexes, irritability.

What are features of Fetal Alcohol Syndrome?

Small eyes, thin upper lip, flat mid-face, growth restriction, cognitive delay, ADHD, poor motor/speech, no stranger anxiety, poor judgment.

What does cocaine exposure cause in newborns?

Preterm birth, small head circumference, low birth length/weight due to placental vasoconstriction.

What are known effects of methamphetamine exposure?

Placental abruption, preterm birth, IUGR.

What is marijuana exposure linked to in newborns?

Preterm birth, stillbirth, IUGR, later neurodevelopmental issues (e.g. attention problems).

What causes hemolytic disorders in newborns?

Maternal antibodies attacking fetal RBCs → Hemolysis.

When is Rh incompatibility a problem?

Mother is Rh-negative, fetus is Rh-positive.

What is the risk of isoimmunization?

Maternal exposure to Rh+ blood → antibody formation, risk in future pregnancies.

When does ABO incompatibility occur?

Most commonly when mom is type O, and infant is type A or B.

How does ABO incompatibility cause hemolysis?

Maternal anti-A or anti-B antibodies cross the placenta.

What are risks for an IDM?

Congenital anomalies, RDS, prematurity, hypoglycemia.

Why do IDMs get hypoglycemia?

Maternal glucose crosses placenta, insulin doesn't → fetus makes extra insulin → after birth, glucose supply stops but insulin stays high.

What are signs of hypoglycemia in an IDM?

Jitteriness, lethargy.

How is IDM managed?

Screen early, monitor for anomalies/RDS/cardiac issues, maintain temperature, early feeding and glucose checks.

What are common characteristics of an IDM?

LGA, abundant vernix, listlessness, meconium-stained fluid.

What are common congenital anomalies?

Cleft lip/palate, esophageal atresia, omphalocele, gastroschisis, cardiac defects, neural tube defects.

What are appearance features of preterm infants (<37 weeks)?

Small, scrawny, little fat, large head, red translucent skin, visible vessels, lanugo, soft ears, smooth palms/soles, possibly closed eyes.

What is the definition of late preterm?

34 to 36 weeks and 6 days.

What causes Respiratory Distress Syndrome (RDS)?

Low surfactant.

What are signs of RDS?

Tachypnea, retractions, crackles, grunting, nasal flaring, cyanosis, temp instability.

What is Meconium Aspiration Syndrome?

Breathing problem from inhaling meconium.

What is PPHN (Persistent Pulmonary Hypertension of the Newborn)?

Failure of normal circulatory transition.

What is NEC (Necrotizing Enterocolitis)?

Inflammatory bowel disease in newborns.

How is NEC treated?

Stop oral feeds, NG tube decompression, IV fluids, antibiotics.

What are physical features of post-term infants?

Absent lanugo, little/no vernix, long nails, scalp hair, cracked/peeling skin.