question

Appropriate for gestational age (AGA)

answer

a newborn weight that falls within the 10th-90th percentile for that particular gestational age -80% of newborns, lowest risk

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Small for gestational age (SGA)

answer

newborns typically weight less than 2500gr (5 lb 8oz) at term due to less growth than expected in utero; at or below 10th percentile as correlated with the number of weeks of gestation

question

Large for gestational age (LGA)

answer

newborns whose birthweight is above the 90th percentile on a growth chart and who weigh more than 4000gr (8 lb 13oz) at term due to accelerated growth for length of gestation; may be preterm, postterm, or full term

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Marginal weights at birth and of any gestational age

answer

Low birth weight: less than 2,500 g (5.5 lb) Very low birth weight: less than 1,500 g (3 lb 5 oz) Extremely low birth weight: less than 1,000 g (2 lb 3 oz)

question

What condition does SGA newborns have?

answer

intrauterine growth restriction (IUGR); intrinsic or environmental causes to SGA

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SGA infants are associated with

answer

-increased neonatal morbidity and mortality -short stature, -cardiovascular disease, -insulin resistance, - diabetes mellitus type 2, -dyslipidemia, -end-stage renal disease in adulthood. -decreased levels of intelligence and cognition

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Potential factors contributing to the birth of SGA newborns

answer

Maternal causes: Chronic hypertension Diabetes mellitus with vascular disease Autoimmune diseases Living at a high altitude (hypoxia) Smoking or exposure to passive smoke Periodontal disease of the mouth Maternal age of >20 or <35 years old Failure to seek any prenatal care Substandard living conditions Low socioeconomic status Abuse and violence Placental factors: Abnormal cord insertion Chronic abruption Decreased surface area, infarction Decreased placental weight Placenta previa Placental insuficiency Fetal factors: Trisomy 13, 18, and 21 Turner's syndrome Chronic fetal infection (cytomegalovirus [CMV], rubella, syphilis, toxoplasmosis) Congenital anomalies (heart, diaphragmatic hernia, tracheoesophageal fistula) Radiation exposure Multiple fetal gestation

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Symmetric IUGR

answer

-fetuses with equally poor growth rates of the brain, the abdomen, and the long bones and is thought to result from an early global insult -occurs at less than 28 weeks -poor prognosis

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Asymmetric IUGR

answer

refers to infants whose brain growth is spared compared to their abdomen and internal organs -occurs at more than 28 weeks -better prognosis

question

Glucose concentration for hypoglycemia

answer

at or below 40 mg/dL

question

Typical characteristics of SGA

answer

head larger than rest of body (asymmetric), wasted appearance of extremities, reduced subcutaneous fat stores, decreased amount of breast tissue, sunken abdomen, wide skull sutures secondary to inadequate bone growth, poor muscle tone over buttocks and cheeks, loose and dry skin that appears oversized, thin umbilical cord

question

Signs of hypoglycemia

answer

lethargy, tachycardia, respiratory distress, jitteriness, drowsiness, poor feeding, feebrl sucking, hypothermia, temperature instability, diaphoresis, weak cry, seizures, hypotonia, blood glucose levels <40 for term newborns, <20 for preterm newborns

question

Who is at risk for polycythemia (elevated RBC count)?

answer

SGA newborns, infants of diabetic mothers, and multiple births; screening should be done at 2, 12, and 24 hrs of age

question

Hyperviscosity

answer

increased resistance to blood flow and decreased oxygen delivery; can cause hypoglycemia, CNS abnormalities, decreased renal function, cardiorespiratory distress, and coagulation disorders

question

Polycythemia

answer

- venous hematocrit above 65%.

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Maternal factors that increase the chance of bearing an LGA

answer

diabetes mellitus or glucose intolerance, multiparity, prior history of a macrosomic infant, postdates gestation, maternal obesity, male fetus, and genetics

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Risk for LGA newborns

answer

shoulder dystocia, clavicular fractures, facial palsies, cesarean birth, asphyxia, hypoglycemia, polycythemia

question

Characteristics of a LGA newborn

answer

large body and appears plump and full-faced, increase in body size is proportional, however, head circumstance and body length are in the upper limits of intrauterine growth; poor motor skills and have difficulty in regulating behavioral states; more difficult to arouse to a quiet alert state

question

What do you assess in an LGA newborn at birth ?

answer

traumatic birth injuries such as fractured clavicles, brachial palsy, facial paralysis, phrenic nerve palsy, skull fractures, or hematomes; neurologic abnormalities such as immobility of the upper arm

question

What are LGA at risk for developing?

answer

hypoglycemia related to early depletion of glycogen stores in their liver

question

Clinical signs of a hypoglycemia newborn

answer

often subtle and include lethargy, apathy, drowsiness, irritability, tachypnea, weak cry, temperature instability, jitteriness, seizures, apnea, bradycardia, cyanosis or pallor, feeble suck and poor feeding, hypotonia, and coma

question

Disorders present in LGA newborns

answer

septicemia, severe respiratory distress, congenital heart disease, polycythemia and hyperbilirubinemia

question

Treatment for hypoglycemic newborns

answer

asymptomatic- supervised breast-feeding or formula; symptomatic- continuous infusion of parental dextrose

question

Nursing interventions for stabilizing the LGA newborn

answer

monitor blood glucose levels within 30 minutes of birth and repeat the screening every hour, recheck levels before feedings; to prevent hypoglycemia, initiate feedings with formula or breast milk, with intravenous glucose supplementation as needed; increase fluid volume to decrease blood viscosity

question

How do you treat hyperbilirubinemia?

answer

hydration, early feedings, and phototherapy

question

Typical complications associated with a postterm newborn

answer

perinatal asphyxia (caused by placental aging or oligohydramnios [decreased amniotic fluid]), hypoglycemia (caused by acute episodes of hypoxia related to cord compression which exhausts carbohydrate reserves), hypothermia (caused by loss of fat), and polycythemia (caused by an increased production of RBCs)

question

What do you monitor in a postterm newborn?

answer

blood glucose levels (IV dextrose 10% and/or early initiaion of feedings), skin temperature, RR characteristics, results of blood studies (ABGs and serum bilirubin levels and neurologic status), hypothermia

question

Clinical findings in postterm newborns - postmature infant

answer

dry, cracked, peeling, wrinkled skin, vernix caseosa and lanugo are absent, long, thin extremities, creases that cover the entire soles of the feet, wide-eyed, alert expression, abundant hair on scalp, thin umbilical cord, limited vernix and lanugo, meconium-stained skin and fingernails, long nails

question

What condition is the leading cause of death within the first month of life and the second leading cause of all infant deaths?

answer

prematurity

question

Common complications in preterm newborns

answer

respiratory distress syndrome, periventricular-intraventricular hemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity, hyperbilirubinemia, anemia, necrotizing, enterocolitis, hypoglycemia, infection or septicema, delayed growth and development, and mental or motor delays

question

Leading cause of preterm births

answer

Infections/inflammation. Maternal or fetal stress. Bleeding. Stretching.

question

Preterm infants at high risk for

answer

-neurodevelopmental disorders cerebral palsy, intellectual disability, intraventricular hemorrhage, congenital anomalies, neurosensory impairment, behavioral problems, high frequency attention problems, psychiatric disorders, and chronic lung disease

question

Cardiovascular problems in preterm newborns

answer

blood flow may bypass the lungs, increased incidence of congenital anomalies associated with continued fetal circulation, impaired regulation of BP may cause fluctuations, intracranial hemorrhage can occur

question

Gastrointestinal problems in preterm newborns

answer

lack the coordination to maintain the suck, swallow, and breathing regimen necessary for sufficient calorie and fluid intake to support growth, hypoxia stops blood from reaching the heart and brain, ischemia and damage to the intestinal wall, small stomach, weak abdominal muscles, limited ability to digest proteins and absorb nutrients

question

Problems that affect the preterm newborn's breathing ability

answer

-surfactant deficiency, leading to the development of respiratory distress syndrome, -unstable chest wall, leading to atelectasis, -apnea, - increased risk for obstruction, -inability to clear fluid from passages, leading to transient tachypnea

question

Renal system problems in preterm newborns

answer

reduces ability to concentrate urine and slows the GFR--> risk for fluid retention, with fluid and electrolyte disturbances, drug toxicity

question

Immune system problems in preterm newborns

answer

deficiency in IgG, impaired ability to manufacture antibodies to fight infection, thin skin and fragile blood vessels provide a limited protective barrier, adding to the increased risk for infection

question

Central nervous system problems in newborns

answer

difficulty in temperature regulation and maintaining stability- inadequate amounts of fat, lack of muscle tone and flexion, inadequate brown fat, limited muscle mass activity, inability to shiver to generate heat, and an immature temperature-regulating center in the brain; especially susceptible to hypoglycemia due to immature glucose control mechanisms, decreased glucose stores, and reduced ketone bodies

question

Maternal risk factors associated with preterm birth

answer

previous preterm delivery, low socioeconomic status, preeclampsia, hypertension, poor maternal nutrition, smoking, multiple gestation, infection, advanced maternal age, and substance abuse

question

Asphyxia (preterm)

answer

a newborn who fails to establish adequate, sustained respiration after birth due to impairment in gas exchange resulting in a decrease in oxygen in the blood (hypoxemia) and an excess of carbon dioxide or hypercapnia that leads to acidosis

question

Common physical characteristics of preterm infants

answer

birthweight <5.5 lbs, scrawny appearance, head larger than chest circumference, poor muscle tone and flexion, minimal subcutaneous fat, undescended testes, plentiful lanugo (soft, downy hair), especially over the face and back, poorly formed ear pinna, with soft, pliable cartilage, fused eyelids, soft and spongy scull bones, few creases in the palms and soles, thin transparent skin with visible veins, vernix caseosa

question

Why do preterms have a limited ability to retain air?

answer

insufficient surfactant; therefore, newborns develop atelectasis quickly without alveoli stabilization; inability to initiate and establish respirations leads to hypoxemia and ultimately hypoxia (decreased oxygen), acidosis (decreased pH), and hypercarbia (increased carbon dioxide)

question

Determine the need for resuscitation by following three questions

answer

what is the gestational age of this newborn and was the amniotic fluid clear of meconium?, is the newborn breathing or crying now?, does the newborn have good muscle tone?,

question

Routine care for newborns who need resuscitation

answer

provide warmth, clear the airway, dry the newborn, and assess the color; resuscitation measures are continued until the newborn has a pulse above 100 bpm, a good cry or good breathing efforts, and a pink tongue (good oxygen to the brain)

question

A for Airway (ABCs of Newborn resuscitation)

answer

place infant's head in "sniffling" position, suction mouth, then nose, suction trachea is meconium-stained and newborn is NOT vigorous (strong respiratory effort, good muscle tone, and heart rate>100 bpm)

question

Sequence of resuscitating actions

answer

1. Stabilization. Dry the newborn thoroughly with a warm towel; position the head in a neutral position to open the airway; clear the airway with a bulb syringe or suction catheter; and stimulate breathing. At times, rubbing the newborn with a dry towel may be all that is needed to stimulate respiration. 2. Ventilation 3. Chest compression 4. Administration of epinephrine and/or volume expansion

question

B for Breathing (ABCs of Newborn resuscitation)

answer

use positive-pressure ventilation (PPV) for apnea, grasping, or pulse <100 bpm, ventilate at rate of 40-60 breaths/minute, listen for raising heart rate, audible breath sounds, look for slight chest movement with each breath, use carbon dioxide detector after intubation

question

C for Circulation (ABCs of Newborn resuscitation)

answer

start compression if heart rate is <60 after 30 seconds of effective PPV, give 3 compressions: 1 breath every 2 seconds, compress one third of the anterior-posterior diameter of the chest

question

What causes respiratory distress?

answer

deficiency of surfactant, retained fluid in the lungs (wet lung syndrome), meconium aspiration, pneumonia, hypothermia, or anemia

question

How do maintain thermal regulation immediately after birth?

answer

dry the newborn with a warmed towel and then place him or her in a second warm, dry towel before performing the assessment; "kangaroo care"- stable newborns placed on mother's chest

question

D is for Drugs

answer

Give epinephrine if heart rate is ,60 after 30 seconds of compressions and ventilation. -Caution: Epinephrine dosage is different for endotracheal and IV routes!

question

What prevents a newborn from attaining good thermal regulation?

answer

inadequate supply of brown fat because he or she left the uterus before it was adequate, decreased muscle tone, which reduces the amount of skin exposed to a cooler environment, large body surface areas compared to weight, which allows an increased transfer of heat from their bodies to the environment

question

Retinopathy of prematurity (ROP)

answer

- Major cause of blindness in preterm newborns in the past - Use O2 cautiously

question

Characteristics of a newborn that is having problems with thermal regulation

answer

cool to cold to the touch, hands, feet, and tongue may appear cyanotic, respirations are shallow or slow, or signs of respiratory distress are present, lethargic and hypotonic, feeds poorly, and has a feeble cry, blood glucose levels are low, leading to hypoglycemia, due to the energy expended to keep warm

question

Signs of hyperthermia

answer

tachycardia, tachypnea, apnea, warm to touch, flushed skin, lethargy, weak or absent cry, and CNS depression

question

Signs of dehydration

answer

decrease in urinary output, sunken fontanels, temperature elevation, lethargy, and tachypnea

question

Signs of cold stress

answer

-respiratory distress, -central cyanosis, -hypoglycemia, -lethargy, -weak cry, -abdominal distention, - -apnea, -bradycardia, -acidosis.

question

Clinical manifestations of a infection in a preterm newborn

answer

apnea, diminished activity, poor feeding, temperature instability, respiratory distress, seizures, tachycardia, hypotonia, irritability, pallor, jaundice, and hypoglycemia

question

Signs of pain in a preterm newborn

answer

sudden high-pitched cry, facial grimace with furrowing of brown and quivering chin, increased muscle tone, oxygen desaturation, body posturing, such as squirming, kicking, arching, limb withdrawal and thrashing movements, increase in heart rate, blood pressure, pulse, and respirations, fussiness and irritability

question

Goals of pain management

answer

preventing, limiting, or avoiding noxious stimuli

question

Nonpharmacologic techniques to reduce pain the preterm newborn

answer

gentle handling, rocking, caressing, cuddling, and massaging; rest periods before and after painful procedures; kangaroo care (skin-to-skin contact) during procedure; breastfeeding, if able, to reduce pain from minor procedures; use of a facilitated tuck (holding arms and legs in a flexed position); nonnutritive sucking (pacifier dipped in sucrose) prior to procedure; minimal use of tape, with gentle removal to avoid skin tears; warm blankets; reduce stimuli such as noise and bright lights; distraction, such as with colored objects or mobiles

question

What is a perinatal loss?

answer

any pregnancy loss and/or neonatal death up to 1 month of age

question

Promoting growth and development for preterm newborns

answer

promote rest and conserve the infant's energy, flexed positioning to stimulate in utero positioning, reduce noise and visual stimulation, kangaroo care to promote skin-to-skin sensation, placement of twin in the same isolette or open crib to reduce stress, parent-infant bonding,

question

Activities to promote self-regulation and state regulation

answer

surrounding the newborn with nesting rolls/devices, swaddling with a blanket to maintain the flexed position, providing sheepskin or a waterbed to stimulate the uterine environment, providing nonnutritive sucking, providing objects to grasp (comforts the newborn)

question

Health risks for the late preterm infant

answer

Respiratory system dysfunction—due to surfactant deficiency leading to distress Glycemic instability—due to increased energy demands needed for temperature regulation and increased respiratory effort, which cause the blood glucose to remain low for prolonged periods of time Jaundice—due to feeding dificulties and inability of liver to conjugate bilirubin Inadequate oral intake—due to a decreased ability to suck and swallow Susceptibility to infection—due to immaturity of the immune system Neurologic immaturity—due to reduced cortical development, which occurs during the 34th and 40th week of gestation

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