Chapter 28: newborn at risk: conditions present at birth
Identification of newborn at risk • Risk factors: low socioeconomic level of the mother • Limited access to healthcare or prenatal care • Exposire to environment dangers such as toxic chemicals • Preexisiting maternal conditions: heart disease, diabetes, hypertension, hyperthyroidism, and renal disease • Maternal factors such as age and parity • Medical conditions related to pregnancy and their associated complications • Pregnancy complications such as abruptio placentae, oligohydramnios, preterm labor, premature rupture of membranes, and preeclamsia • EFHM, fetal heart ascultation by Doppler detects stress or distress on fetus • Apgar score is also a helpful tool to identify at risk = indicator • Neonatal mortatlity chart is useful tool to identify at risk • Birth weight and gestational age are criterias used to assess maturity and morbidity • Preterm: < 37 weeks (late preterm 34-37 weeks), term: 37-40 weeks, and postterm: >42 weeks • LGA = above 90th percentile, SGA, between 10th percentile • Assigned depending in birth weight, length, occipital-frontal head circum, gestational age • Neonatal mortatlity risk is the infant’s chance of death within the newborn period—first 28 days • Mortality decreases as age and birth weight increases • Min by min observation changes for at risk infants • Organization of nursing care directed toward: decreasing physiologically stressful situations, constantly observing for subtle signs of change, interpreting lab values, conserving infant’s energy for growth and healing, providing for developmental stimulation and maintenance of sleep cycles, involve family in planning

Care of SGA/IUGR

• SGA = less then 10th percentile and based on local population (preterm, term, or posterm) • IUGR = advanced gestation and limited fetal growth • SGA = mothers who smoke and hypertension ( perinatal asphyxia andn mortality when compared to AGA, polythermia and hypoglycemia

Factors Contributing to IUGR

• Caused by maternal, placental, or fetal factors not apparent antenatally • IUG = linear from 28-38 weeks, after 38 weeks it is variable • Causes of growth restrictions: maternal factors o Maternal factors: primiparity, grand multiparity., lack of prenatal care, low socioeconomic status, nutrional needs before third trimester o Maternal disease: heart disease, substance abuse, sickle cell anemia, PKU, lupus, asymptomatic pyelonephritis with SGA, preeclampsia decreases O2 to fetus o Environmental factors: high altitudes, exposture to xrays, excessive exercise, hyperthermia, nicotine, alcohol, narcotics o Placental factors: small, infracted areas abnormal cord insertions, placenta previa, thrombosis o Fetal factors: congentital infections: TORCH: toxoplasmosis, other, rubella, cytomegalovirus, herpes

Patterns of IUGR

• Occurs by increase in cell number and cell size • Growth failure in later in pregnancy does not effect total number of cells, just size • Symmetric proportional: caused by long term maternal conditions or fetal genetic abnom; it is noted by ultrasound in first half of second trimester, there is chronic prolonged restriction of growth in size of organs, weight, and length • Asymmetric disproportional: acute compromise of uteroplacental blood flow, causes are placental infarcts, preeclampsia, and poor weight gain, growth restriction not evident before third trimester because weight is decreased and head and length are appropriate for gestational age. Early indicator of asymmetric SGA is a decrease in growth rate of abd circumfrince = subnorm liver growth

Common Complications of SGA newborn

• Asphyxia: chronic hypoxia in uterowhich leaves little reserve to withstand the demands of normal labor and birth: c-sec • Aspiration