OB Newborn

Birth Weight Variations

  • Growth Charts
    • Important for assessing fetal growth and categorizing weight.
    • Appropriate for Gestational Age: between the 10th and 90th percentiles.
    • Small for Gestational Age (SGA): less than 10th percentile.
    • Large for Gestational Age (LGA): greater than 90th percentile.

Factors Influencing Fetal Growth

  • Maternal Factors:

    • Maternal nutrition (what and how much the mother eats during pregnancy).
    • Maternal genetics and health (chronic conditions, weight gain, young or advanced maternal age).
    • Environmental factors (exposure to chemicals, smoking, pollution, heavy physical workload).
    • Maternal conditions impacting fetal growth include:
    • Chronic hypertension
    • Preeclampsia
    • Diabetes (gestational, type 1, type 2)
    • Smoking or exposure to smoke (2nd hand)
    • Lack of prenatal care
    • Certain infections (e.g., chlamydia, HIV, trichomonas)

  • Placental Factors:

    • Abnormal cord insertion
    • Chronic abruption
    • Decreased surface area for the baby
    • Infarction of the placenta
    • Placenta previa

  • Fetal Factors:

    • Chromosomal abnormalities (trisomy 13, 18, 21, Turner syndrome)
    • Congenital anomalies
    • Multiple gestation

Characteristics of SGA Babies

  • Physical Features:
    • Head larger relative to the body (disproportionate head size).
    • Wasted appearance of extremities.
    • Reduced subcutaneous fat and muscle mass.
    • Shrunken, wrinkled face and wider cranial sutures.
    • Thin umbilical cord and loose, dry skin.

Management of SGA Babies

  • General Management:

    • Monitor intake and output and daily weight for every baby.
    • Precautions for common problems:
    • Perinatal asphyxia
    • Thermoregulation issues (incubator or warmer may be needed).
    • Hypoglycemia (early feedings every 2-3 hours).
    • Polycythemia (hematocrit >65%, hemoglobin >20).

  • ABC Stabilization Protocols: Monitor airway, breathing, and circulation.

    • Common protocol for SGA includes blood sugar checks right after birth and during the first 24 hours.
    • High-risk infants monitored for blood sugar consistently.
    • Measure labs (bili, hematocrit), especially for signs of respiratory distress.

Characteristics of LGA Babies

  • Definition and Causes:

    • Most commonly attributed to maternal diabetes (gestational or pre-existing).
    • History of large babies in the family impacts size; like father, like son (genetics play a role).
    • Maternal weight gain during pregnancy is another influencing factor.

  • Physical Features:

    • Chunky appearance with large cheeks.
    • Ruddy skin color potentially indicating polycythemia.
    • Round, puffy faces and excessive subcutaneous fat.

  • Risk Concerns with LGA:

    • Increased risk for mechanical trauma during delivery (shoulder dystocia, fractured clavicle, skull fractures).
    • May require C-sections due to size.

  • Common Problems and Management:

    • Monitor for signs of respiratory distress.
    • Daily weights, intake and output checks, polycythemia, hyperbilirubinemia from potential bruising.

Gestational Age Variations

  • Definitions:
    • Full Term: 38-41 weeks gestation.
    • Preterm: Less than 37 weeks.
    • Post-term: After 42 weeks.

Preterm Birth:

  • Major Risk Factors:
    • History of premature birth increases chances in future pregnancies.
    • Smoking and cervical abnormalities can contribute.
    • Preterm infants often face immature body systems and related issues.

Characteristics of Preterm Babies:

  • Lack of body fat increases risk for hypothermia and infection.
  • Common features:
    • Undescended testes or enlarged labia.
    • Sparse lanugo, poorly formed ear pinna.
    • Fever instability is a sign of infection.

Management:

  • Use of saran wrap to maintain temperature.
  • Monitor glucose levels and ensure adequate feeding (may require tube feeding).
  • Cluster care and reduced stimulation to promote rest and development.

Post-term Babies:

  • Occur when gestation extends beyond typical 42 weeks; placentas can lose functionality as they age.
  • Common physical characteristics include:
    • Dry, cracked skin and loss of vernix and lanugo.
  • Potential for respiratory distress and weight management issues.

Hyperbilirubinemia and Jaundice

  • Causes of Jaundice
    • Trauma from delivery that leads to elevated bilirubin from red blood cell breakdown.
    • Prematurity and inadequate breastfeeding impact bilirubin levels.
    • Critical in determining when to initiate phototherapy.

Management Protocols for Hyperbilirubinemia

  • Successful breastfeeding encouraged to promote elimination of bilirubin via stool.
  • All hospitals require protocols to monitor bilirubin levels frequently and manage treatment (phototherapy and follow-ups).

Neonatal Abstinence Syndrome (NAS)

  • Occurs in babies born to mothers reliant on opioids (legal or illegal).
  • Specific scoring tool (Finnegan scoring system) used to monitor withdrawal symptoms.

Management of NAS

  • Depending on withdrawal severity, some babies may receive morphine or methadone as treatment.

  • Supportive care, ensuring proper nutrition and preventing complications.

  • Signs and Symptoms of NAS:

    • Increased tremors, irritability, diarrhea, vomiting, feeding intolerance, and temperature instability.
    • Need for monitoring vital signs and potential for medication adjustment based on scoring.

Respiratory Issues in Newborns

  • Common Respiratory Issues:
    • Transient Tachypnea of the Newborn (TTN)
    • Respiratory Distress Syndrome (RDS)

TTN Management

  • Common in babies born via C-section without the benefit of vaginal squeeze, typically self-resolving in 12-24 hours.
  • Requires monitoring, oxygen support and maintaining warmth.

RDS Management

  • Significant for preterm babies due to lack of pulmonary surfactant.
  • Treatment includes the administration of steroids to the mother prenatally and oxygen support for the baby.

Conclusion

  • This comprehensive overview of neonatal conditions emphasizes the necessity for close monitoring, management, and supportive care in ensuring optimal outcomes for infants during the perinatal period.
  • Ongoing education and resources for parents surround care and signs of distress are essential for at-home management post-discharge.