Lesson 7


  • Mom & baby share nutrition & oxygenation throughout pregnancy, which is crucial for the baby's growth and development.

  • everything we eat & drink will be fed to our baby as well

  • when placenta is not well one of the things above will not be functioning correctly which will affect fetal growth


What affects fetal growth? (failure to grow or failure to thrive)

  • maternal nutrition

  • genetics

  • placental function

  • environmental factors


Variations in Birth Weight:

  • Appropriate for gestational age (AGA)

  • Small for gestational age (SGA) < 2,500 grams, 5lbs 8 oz?

    • full term baby should not be 5lbs 8oz

  • Large for gestational age (LGA) > 4,000 grams 8 lbs 13 oz

    • aka macrosomia

  • Low birth weight (LBW) < 2,500 grams or 5lbs 5oz

    • baby born as a preemie

  • Very low birth weight (VLBW) < 1,500 grams 3lbs 5oz

    • micro preemie

  • Extremely low birth weight (ELBW) < 1,000 grams 2lbs 3oz

    • very micro preemie baby

    • born prematurely


Small for gestational age:

  • < 28 WEEKS GROWTH RESTRICTION

  • >28 WEEKS, INTRAUTERINE MALNUTRITION (aka IUGR-INTRUTERINE GROWTH RESTRICTED)

    • means baby stopped growing and is no longer getting any nutrients

    • it would be better to deliver baby by C-section so it may grow outside of the body

      • Head disproportionately large compared to rest of body

      • Wasted appearance of extremities; loose dry skin

      • Reduced subcutaneous fat stores

      • Decreased amount of breast tissue

      • Sucken appearance (scaphoid abdomen)

      • Wide skull features

      • Poor muscle tone over buttocks & cheeks

      • Thin umbilical cord

        • like as thin as a shoestring


SGA (small for gestational age) common issues:

1. Hypoglycemia

  • may need some IV solution & glucose to bring up sugar levels

2. Polycythemia

  • too many red blood cells in blood

  • will get red/blue-ish skin color around lips

3. Difficulty with thermoregulation

  • no fat storage

4. Perinatal asphyxia

  • serious condition where newborn does not receive enough oxygen at birth

5. Meconium aspiration

  • due to period of stress, which can occur during labor, meconium may be expelled into the amniotic fluid leading to respiratory complications in the newborn

6. Hyperbilirubinemia

  • high bilirubin levels → jaundice → phototherapy

7. Birth trauma

  • trauma from vaginal delivery so possible c-section due to babies being really small


baby will live in NICU for several months

NICU workers will come in to set up for delivery and provide support to the family, ensuring a smooth transition for both the baby and the parents during this critical time.


Large for gestational age (LGA):

  • Mother

    • Was an LGA baby

    • Has diabetes mellitus

    • Increase weight gain

    • Excessive gestational weight gain

  • Infant

    • having a sibling who has LGA and has certain genetic syndromes

  • Features

    • large body, plump full faced

    • proportional increase in body size

    • lots of folds on baby

    • poor muscle skills

    • difficulty regulating behavioral states

      • when baby has trouble transitioning between different states of consciousness

        • like being awake, drowsy, or sleep

      • will have excessive crying

      • irregular sleeping patterns

      • difficulty calming down when irritated/overstimulated → issues with self-regulation

    • eat a lot/often → may need to supplement with formula


Common issues with LGA (large for gestational age):

  1. Birth trauma

  • baby could be stuck, may need assisted delivery, baby could break clavicle or dislocate shoulder

  1. Hypoglycemia

  • blood sugar test within 30 minutes post birth, then check blood sugar hourly through heel prick

  1. Polycythemia

  • too many red blood cells in infants’ blood

  • red/bluish color around lips

  1. Hyperbilirubinemia


Nursing Interventions for LGA (large for gestational age):

  • Monitor vital signs

  • Initiate skin-to-skin

    • will initiate breastfeeding

  • Initiate feedings- hydration

  • Monitor blood glucose levels for hypoglycemia

  • Phototherapy for increased bilirubin levels

  • Monitor for S/S of polycythemia

    • bluish color of lips

    • frequent baby assessments


Gestational variations post term newborn:

  • Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks

  • Nursing assessment: typical characteristics

  • Dry, cracked, wrinkled skin: possibly meconium stained

  • Long, thin extremities; long nails, creases cover entire sole of feet

  • Wide-eyed, alert expression

  • Abundant hair on scalp

  • thin umbilical cord

  • Limited vernix and lanugo

    • vernix is a cheesy-like substance on the baby's skin that provides a protective barrier during gestation. It can be present in varying amounts at birth, influencing skin condition and moisture levels.

    • lanugo is a limited hair substance

  • Perinatal asphyxia

    • condition where baby does not receive enough oxygen at birth

  • Hypoglycemia

  • Hypothermia

  • Polycythemia

  • Meconium aspiration (possible)


Pre-term newborn:

  • Common Causes:

    • Infections/inflammation

    • Maternal or fetal distress

    • Bleeding

    • Stretching

BODY SYSTEM IMMATURE-AFFECTS THE INFANTS TRANSITION FROM IN UTERO TO OUTSIDE THE WOMB.

  • INCREASED RISK FOR: (because their body is not fully developed)

  1. Respiratory issues

  2. Cardiovascular issues

  3. GI issues

  4. Renal issues

  5. Lower immune system

  6. CNS issues

  1. Hypothermia

  2. Hypoglycemia

  3. Hyperbilirubinemia


Appearance of a preemie:

  • Weight < 5.5 lbs

  • Appears scrawny

  • Poor muscle tone

  • Minimal subcutaneous fat

  • Undescended testes

  • Plentiful lanugo

  • Poorly formed ear pinna

  • Fussed eyelids (micro)

  • Soft spongy skull bones

  • Matted scalp hair

  • Absent to few creases in soles & palms

  • Minimal scrotal rugae: prominent labia & clitoris

    • scrotal rugae - creases on a male infant (normal finding) but lack of scrotal rugae is an issue

  • Thin transparent skin

    • can see blueness of baby because you can see the blood circulating their body

  • Abundant vernix

    • cheesy like substance


fetal death → if a baby should die after it is born, it will get a birth certificate & death certificate

  • still give skin to skin care to say goodbye as well as photos & baby footprints & name bracelets into a memory box for the dead baby





Acquired Fetal Disorders:

  • Typically occur at or soon after birth

  • Problems or conditions experienced by the birthing parent during their pregnancy or at birth

  • Possibly no identifiable cause for the disorder

  • Conditions:

    • Neonatal asphyxia

    • Transient Tachypnea of the newborn

    • Respiratory distress syndrome

    • Meconium aspiration

    • Persistent pulmonary hypertension of the newborn

    • Bronchopulmonary dysplasia

    • Retinopathy of prematurity

    • Peri-intraventricular hemorrhage

    • Necrotizing enterocolitis

    • Birth trauma

    • hyperbilirubinemia

    • Newborn infections

    • Infants of diabetic parents



transient tachypnea → fix through skin to skin


Risk factors for getting respiratory distress syndrome^



  • watch babies chest rise & fall

    • is there lag on inspiration

    • retracting means belly goes deep down & back up when breathing (THIS IS NOT NORMAL)

    • is nose flaring (this is not normal sign of respiratory distress)

    • grunting sounds → ehhhhhuh ehhhhuh baby is not singing baby is in respiratory distress


MAS (meconium aspiration syndrome)

  • visualize vocal cords if stained likely has meconium aspiration

  • MAS is verified by chest x-ray


Signs of meconium aspiration:

  • Stained nails, skin, umbilical cord

  • Barrel chest

  • Prolonged tachypnea

  • Increasing respiratory distress

  • Retractions → belly is sunken in

  • Grunting

  • Cyanosis

  • Metabolic acidosis


  • Macro Somy = large baby

  • large babies have trouble regulating blood sugar, bilirubin, calcium, magnesium levels, which can lead to various complications such as hypoglycemia, jaundice, and electrolyte imbalances

    • must check sugar levels within 30 minutes of birth to check for hypoglycemia

  • these babies have trouble eating

  • some babies end up going to ICU


baby withdrawal from opioids or alcohol = NAS (neonatal abstinence syndrome)

  • babies are extremely irritated

  • babies have a high shrill cry

  • babies have tremors & withdrawal symptoms

  • if baby positive - bag baby for first urine or stool sample - if baby is positive mother may not have custody of child

  • CPS & social workers involved




FAS (fetal alcohol syndrome)

  • typical facial features when a baby has FAS

    • no crease under nose (indistinct philtrum)

    • thin upper lip

    • low nasal bridge

    • minor ear abnormalities

    • micrognathia

    • epicanthal folds

    • short palpebral fissures

    • flat midface and short nose

  • CPS & social workers need to be involved when a child has FAS


  • transcutaneous bilirubin monitors tested after 24 hours to test for jaundice

  • less than 8 mg/dl is normal in babies

  • less than 48 hrs., bilirubin levels are normal for anything less than 12 mg/dl


Bilirubin scan - to see bilirubin levels on baby



Phototherapy for babies with hyperbiliruemia


2 types:

  • cover is isolette (left picture)

    • most optimal as babies can get cold

    • this one is sealed

  • baby not in room with mother (right picture)

    • warmer in nursery


bilirubin lights must cover baby’s eyes

  • keep baby warm

  • encourage feeding

    • once feeding done put baby under lights


educate parents on necessity of covering eyes, keeping baby warm, uncovering baby but keeping them warm at the same time to promote optimal thermal regulation and prevent overheating, while also ensuring that the baby's eyes are protected from bright lights.


the more you feed the quicker you get meconium out and bilirubin levels lower (aka go away)