High Risk Newborn OB Exam 3

High risk time - any time that includes any threat to life or wellbeing - begins at viability and up to 28 days after birth Maturity/gestational age - •Preterm: born before 37 wks.. •Late-preterm: 34wk0d - 36wk6d •Full-term infant: 38 wks.. - 42 wks.. •Post-term infant (postmature): >42 wks. Complications of Newborns with Variations of Birth Weight or Gestational Age - •Perinatal asphyxia •Difficulty maintaining thermoregulation •Hypoglycemia •Polycythemia •Meconium aspiration •Hyperbilirubinemia •Birth trauma •NAS (maternal substance use) •Appropriate for gestational age (AGA) - •Newborns born with normal length, weight, head circumference, and body mass index •Small for gestational age (SGA) newborn - •At or below 10th% according to weeks gestation and, or <2,500 grams (5lb8oz) @ term Complications •Perinatal asphyxia •Meconium aspiration •Hypoglycemia •Polycythemia Temperature instability Risk Factors •Congenital or chromosomal abnormalities •Maternal infections, disease, or malnutrition •Gestational hypertension and/or diabetes •Maternal smoking, drug, or alcohol use •Multiple gestations •Placenta previa, decreased placental perfusion, and/or small placenta •Fetal congenital infections (rubella or toxoplasmosis) •Large for gestational age (LGA) newborn - Above 90% and >4,000 grams (8lb 13oz) @ term At risk for birth injuries •Shoulder dystocia: Clavicle fracture or Erb-Duchenne paralysis •Facial palsies •Cesarean birth •Asphyxia •Hypoglycemia Polycythemia Risk Factors •Transposition of the great vessels •Pulmonary artery and aorta are switched; thus poor oxygenation of blood •Genetic factors •Multiparous woman •Maternal obesity •Postmaturity •Maternal diabetes •Uncontrolled maternal blood sugars stimulate insulin production by fetus •Hyperglycemia leading risk factor for LGA •Congenital heart defects •Tracheoesophageal fistula •CNS anomalies •Marginal weight newborns @ any gestational age - •Low birth weight: < 2500 gram (5.5 lb.) •Very low birth weight: < 1,500 grams (3lb 5oz) •Extremely low birth weight: < 1,000 grams (2 lb. 3oz) assessment of SGA - •Respiratory distress and hypoxia •Wide-eyed and alert, associated with fetal hypoxia •Hypotonia •Meconium aspiration •Hypoglycemia •Acrocyanosis •Umbilical cord thin, dry, yellow, and dull instead of gray, glistening and moist •Weight below 10th percentile •Normal head circumference •Hair, little •Wide skull sutures •Dry, loose skin •Little subcutaneous fat •Decreased muscle mass, especially cheeks and buttocks •Flat abdomen instead of well-rounded assessment of LGA baby - •Weight above 4,000g •Large head •Increase in subcutaneous fat •Chubby cheeks •Respiratory difficulty •Tachypnea, retractions, cyanosis, nasal flaring, and grunting •Birth trauma •Fractures, shoulder dystocia, CNS injury, intracranial hemorrhage •Sluggishness, hypotonic muscles •Tremors •Hypoglycemia •Meconium aspiration Postmature Infant - •>42 weeks gestation •Maybe SGA or LGA, depending on placenta function •Prolonged fetal circulation causes pulmonary hypertension •Increased chance for uteroplacental insufficiency and placental deterioration •Polycythemia, meconium aspiration, and/or neonatal respiratory problems Assessment of postmature - •Long, thin body with a wasted appearance; loss of subcutaneous fat causes loose skin •Peeling, cracked, and dry skin; leathery skin •Meconium staining of fingernails and umbilical cord •Hair and nails long •Alert •Possible respiratory difficulty due to meconium staining •Macrosomia •Hypoglycemia Preterm Newborn - •Born before 37 weeks' gestation •Complications arise from immature organ systems •Infections, maternal or fetal stress, bleeding, overstretched uterus Goals •Meet growth and developmental needs •Stabilization of oral feedings, body temperature, and weight gain physical characteristics of premature infants - •Minimal subcutaneous fat; scrawny appearance •Wrinkled features; abundance of lanugo •Skin: thin, smooth, shiny, and translucent •Skull and rib cage feel soft •Eyes closed if born at 22-24 weeks gestation •Weak grasp reflex •Poor suck and swallow; weak or absent gag, suck or cough reflex, weak swallow •Hypotonic muscles, decreased activity, weak cry •Lethargy, tachycardia, poor weight gain complications of premature newborn - •Respiratory distress syndrome •Bronchopulmonary dysplasia •Aspiration •Apnea •Intraventricular hemorrhage •Retinopathy •Patent ductus arteriosus •Necrotizing enterocolitis Respiratory distress syndrome - Breathing disorder due to lung immaturity or lack of surfactant •Atelectasis, lung collapse, makes breathing difficult, thus respiratory acidosis and hypoxemia occur •Lung maturity is not related to birth weight alone Risk Factors Associated with RDS - •Prematurity • Asphyxia •Meconium staining •Cord prolapse •Nuchal cord •Premature rupture of membranes •Hydrops fetalis (massive edema due to hyperbilirubinemia) •Maternal use of barbiturates or narcotics •Maternal hypotension •Cesarean birth w/o labor •Maternal bleeding during 3rd trimester •Maternal diabetes mellitus Genetics: male gender, Caucasian