High Risk Newborn Exam Study Guide

term newborn - 37-42 weeks late preterm infant - An infant born between 34 0/7 and 36 6/7 weeks of gestation. moderately preterm - 32-34 weeks very preterm - 28-32 weeks extremely preterm/micro premature - less than 28 weeks Physical differences preterm infant - Less plantar creases, soft ear cartilage, lax posture and poor tone, breast and nipple barely visible, male genitalia has minimum rugae on scrotum, female prominent labia and clitoris SGA (small for gestational age) - Defined as a newborn whose birth weight is at or below the 10th percentile IUGR (intrauterine growth restriction) - Fail to grow at normal rate in utero Occurs with fetal malnutrition SGA Small for gestational age Birth wts less than 10% tile for the population Constitutionally small and IUGR LGA (large for gestational age) - Defined as a newborn who's weight is above the 90th percentile risks for SGA newborns - Asphyxia & increased mortality Meconium aspiration Heat loss Hypoglycemia, hypocalcemia Polycthemia Risks for LGA newborns - Trauma Cephalohematoma, fractures, palsy Hypoglycemia & hypocalcemia Hyperbilirubinemia Respiratory distress Asymmetric SGA happens to an infant when: - Later in pregnancy (3rd trimester): Normal amount, small sized cells, brain & heart smaller r/t body, usually can catch up Symmetric SGA happens when: - Chronic issues, earlier in pregnancy (2nd trimester): Happens during rapid cell proliferation so cells are fewer in number but normal size, symmetric head and body, poorer prognosis Symmetric SGA risks - Anemia, smoking, chronic HTN, drug us Assymetric SGA risks - Pre-eclampsia, poor weight gain, partial abruption, gestational diabetes Intraventricular hemorrhage/periventricular hemorrhage - bleeding that occurs from vessels along the ventricles and either into or around ventricles from fragile capillaries. Graded scale of 1-4 Nursing interventions IVH - Minimalize handling, limit stimulation, decrease stress, elevate HOB, avoid lifting extremities above midline or too much oxygen cause can make worse Neonatal Abstinence Syndrome (NAS) - a condition in which a child, at birth, goes through withdrawal as a consequence of maternal drug use neonatal abstinence syndrome symptoms - W-wakefulness I-irritability T-tremors H-hyperactive, hypertonia, high pitched cry, hypersensitive to stimulation D-diarrhea, diaphoresis, disorganized R-runny nose, rub marks A-apnea, abdominal dysfunction W-weight loss, failure to gain weight A-anxious appearance, altered sleep L-lacrimation, or discharge from eyes NAS interventions - Gavage or IV feeds Social services Sympathy Elevate HOB Pacifier Swaddling Minimum stimulation Sheep skin or soft linen Retinopathy of Prematurity (ROP) - A condition resulting from administration of an excessive concentration of oxygen at birth; causes scar tissue to form behind the lens of the eye in the retina--fibrous tissue growth/hardening respiratory distress syndrome (RDS) - respiratory complication in the newborn, especially in premature infants: Inadequate surfactant production As GA decreases, risk increases Every exhale alveoli collapse & lungs become stiff and non compliant RDS manifestations - Usually in first hours of life* Tachypnea Nasal flaring Grunting Retractions Cyanosis Junky/wet lung sounds CXR-ground glass* Bronchopulmonary Dysplasia (BPD) - chronic pulmonary disease that develops in premature infants who were treated with mechanical ventilation