Complications of the Newborn 2022

Classification of Infants Full term = 37-40.6 weeks Late term = 41-41.6 weeks Post term = 42+ weeks Preterm = any infant born before 37 completed weeks Extremely Preterm 28 weeks Very Preterm/Preterm = 28-34 weeks Late Preterm = 34-36 weeks Birth Weight Classifications Small for Gestational Age = weight below 10th percentile -chronic conditions, IUGR caused by gestational diabetes, hypertension Appropriate for Gestational Age = 10-90th percentile Large for Gestational Age = large for gestation, weight above 90th percentile IUGR/FGR = intrauterine growth restriction/fetal growth restriction Macrosomia 4000 grams (8-14) 00:01 01:13 Preterm Infants Infants born 37 weeks gestation; majority are late preterm ~ 75% Contributing Factors: 1. heredity 2. placental insufficiency 3. maternal disease processes -diabetes, preeclampsia, trauma 4. genetics 5. OB history 6. Socioeconomics (access to care) 7. Assistive reproduction Extremely Premature Infants Risks: -the younger the gestational age, the lower the rate of survival -the gestational age is inversely related to rate of morbidities if the infants survive **22 week baby -- 100% rate of morbidity, 98% mortality rate Late Preterm Infants: 34-36.6 -largest portion of preterm infants -related to medically-indicated delivery rates (vaginal and c/s before 39 weeks generally due to maternal or fetal complications of the pregnancy that preclude safe continuation of the pregnancy to term) -"just a little small" "the great imposters" -Increased risk for: 1. respiratory distress syndrome (RDS) 2. temperature instability 3. hypoglycemia 4. apnea 5. feeding difficulties 6. hyperbilirubinemia Key: identify/assess these infants - gestational age assessment (Dubowitz/Ballard Scoring) Common Preterm Infant Complications 1. RDS 2. bronchopulmonary Dysplasia (BPD) 3. hypothermia 4. sepsis 5. nutritional problems and necrotizing enterocolitis (NEC) 6. anemia of prematurity 7. apnea of prematurity 8. hyperbilirubinemia 9. developmental delays 10. retinopathy of prematurity (ROP) 11. Hemorrhage into ventricles of the brain (IVH) Term: 38-40.6 -best outcomes -fewest complications - if occurring, usually short in duration -can be classified as LGA, AGA, SGA, IUGR, macrosomia Post Term Infants ≥ 42 weeks 1. can be SGA, AGA, LGA -wasting of muscle 2. Placenta Insufficiency: IUGR 3. Skin -little to no vernix -absence of lanugo -abundant scalp hair -skin is often cracked, parchment like and peeling -long fingernails -creases cover soles of feet 4. breast buds well formed 5. significant increase in fetal and neonatal mortality -decreased amniotic fluid -perinatal asphyxia 6. Prone to fetal distress -placental insufficiency -macrosomia -- birth trauma -meconium-stained amniotic fluid Term Infant Complications Complications can still occur in term infants: -if optimal transition does not occur -affected by maternal disease or IUGR (hypoglycemia, hypothermia, respiratory), hyperbilirubinemia etc. -affected by maternal infection -traumatic birth -more often seen in LGA, SGA, or IUGR infants Common term complications: -transient tachypnea of the newborn -hyperbilirubinemia Respiratory Problems - Premature Infants -decreased number of functional alveoli -deficient surfactant levels -small airways -greater collapsibility or obstruction of respiratory passages -bones of thorax not calcified -weak or absent gag reflex -immature and friable capillaries in the lungs -greater distance between functional alveoli and the capillary bed Respiratory Complications: meconium aspiration syndrome (MAS) -meconium is the first stools of the fetus/newborn -viscous, sticky, dark greenish-brown to black -no odor -sterile -MAS can result if fetus has meconium-stained amniotic fluid and aspirates before or during birth -largely affects post-term infants but can be seen in term infants What is it? -meconium is aspirated into the airways -- as a result of gasping respirations in utero -- or the initial breaths following birth -can lead to mechanical obstruction of the airways and air trapping -8% of all newborns exposed to meconium develop MAS -Can also cause chemical pneumonitis or pneumonia resulting in: 1. tachypnea and deactivation of surfactant 2. may lead to persistent pulmonary hypertension -rarely occurs before 38 weeks gestation -Nursing care and priorities: 1. minimize work of breathing 2. neutral thermal environment 3. nutrition 4. comfort Respiratory Complications: transient tachypnea of the newborn (TTN) What is TTN? -delated clearance of fetal fluid from the lungs -- more likely to occur in babies delivered via c/s - labor did not occur before birth -respiratory rate 60 breaths/min Signs/Symptoms: grunting, retracting, nasal flaring, cyanosis Nursing Care and Priorities: -monitor respiratory rate -no oral feeding (or very limited) -minimal exertion -supplemental oxygen Contributing Factors: -cesarean delivery without labor -traumatic delivery -39 weeks -SGA/LGA -maternal diabetes *only affects term newborns -unique to term infants, generally time-limited with little respiratory support