Highrisk Newborn and PRETERM (1)

8/2/2019 Highrisk Newborn and PRETERM (1)

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Nursing care of the high-

risk newborn and family


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Identification of high-risk newborns

The high-risk neonate :can be defined as anewborn, regardless of gestational age or birthweight, who has a greater-than-average chanceof morbidity or mortality.because of conditions or circumstances

superimposed on the normal course of eventsassociated with birth and the adjustment toextrauterine existence.The high risk period encompasses human

growth and development from the time ofviability up to 28 days following birth andincludes threats to life and health that occurduring the prenatal, perinatal, and postnatalperiods.


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Classification of high-risk newborns

Classified according to:

1. Birth weight.

Low-birth-weight (LBW): an infant whose birth

weight is less than 2500 g, regardless ofgestational age.

Very low-birth-weight (VLBW) infant :an infant

whose birth weight is less than 1500g. Extremely-low-birth-weight (ELBW) infant: an

infant whose birth-weight is less than1000g.


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Classified according to Birth weight.

Appropriate-for-gestational-age (AGA)INFANT:an infant whose birth-weight is falls between the10th and 90th percentiles on intrauterine growthcurves.

Small-for-date (SFD) or small-for-gestationalage (SGA) infant: an infant whose rate ofintrauterine growth was slowed and whose birthweight falls below the 10th percentile onintrauterine growth curves

Intrauterine growth restriction (IUGR) found ininfants whose intrauterine growth is restricted


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Classified according to Birth weight.

Symmetric IUGR: growth restriction in which theweight, length, and head circumference are allaffected.

asymmetric IUGR: growth restriction in whichthe head circumference remains within normalparameters while the birth weight falls below the10th percentile

Large-for-gestational-age (LGA): an infantwhose birth weight falls above the 90th percentileon intrauterine growth curves.


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Classification according toGestational age

Premature (preterm) infant: an infant born beforecompletion of 37 weeks of gestation, regardlessof birth weight.

Full-term infant: an infant born between thebeginning of the 38 weeks and the completion ofthe 42 weeks of gestation, regardless of birthweight.

Postmature (postterm) infant: an infant born after42 weeks of gestational age ,regardless of birthweight.


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Classification according to mortality

Live birth: birth in which the neonate manifestsany heartbeat, breathes, or displays voluntarymovement, regardless of gestational age.Fetal death: death of the fetus after 20 weeks of

gestation and before delivery, with absence ofany signs of life after birth.Neonatal death: death that occurs in the first 27days of life; early neonatal death occurs in the

first weeks of life ; late neonatal death occurs at7-27 days.Perinatal mortality: total number of fetal andearly neonatal deaths per 1000 live births


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Classification according toPathophysiologic problems

a. Associated with the state of maturity ofthe infant. Chemical disturbances. eg:hypoglycemia, hypocalcemia.

b. Immature organs and systems. eghyperbilirubinemia, respiratory distress,hypothermia.


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Characteristic of premature infant

Small and appear scrawny.

Large head in relation to the body.(cephalocaudal direction of growth)

The skin is bright pink( translucent, edematous).

The fine lanugo hair is abundant over the body

The ear cartilage is soft and pliable .

The sole and palms have minimal creases,smooth appearance.


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The bones of skull and the ribs feel soft, and theeyes maybe closed

Male infants have few scrotal rugae, and the

testes are undescended, the labia and clitorisare prominent in females

Inactive and listless.

Reflex activity is only partially developed:

- Sucking is absent, weak, or ineffective.- Swallow, gag, and cough reflexes are absent or

weak.


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Physiologically immature, unable tomaintain body temperature.

A pliable thorax, immature lung tissueand

regulatory center lead to hypoventilationand periodic of apnea

Have biochemical alterations such as

hyperbilirubinemia and hypoglycemia.Neurologic impairment as intraventricular

Hge, and cerebral palsy.


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Therapeutic management

Infants who do not require resuscitationare immediately transferred in a heatedincubator to the NICU. where:

Respiratory support.

Temperature regulation.

Nutrition.Susceptibility to infection.

Activity intolerance.


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Nursing care plan: the high-risk(preterm) infant

NCP . P: 255 - 259


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Postterm infant

Causes: Unknown.Characteristics:

1. absent of lanugo.2. Little if any vernix caseosa.

3. Abundant scalp hair.4. Long fingernails. There is significant increase in fetal and neonatal

mortality, causes: fetal distress associated with the decreasing

efficiency of the placenta, macrosomia, and meconiumaspiration syndrome.

The greatest risk occurs during the stresses of laborand delivery, particularly in infants of primigravdas.

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Highrisk Newborn and PRETERM (1)