Nursing care of the high-risk newborn and family

Identification of high-risk newborns The high-risk neonate :can be defined as a newborn, regardless of gestational age or birth weight, who has a greater-than-average chance of morbidity or mortality. because of conditions or circumstances superimposed on the normal course of events associated with birth and the adjustment to extrauterine existence. The high risk period encompasses human growth and development from the time of viability up to 28 days following birth and includes threats to life and health that occur during the prenatal, perinatal, and postnatal periods.

Classification of high-risk newborns Classified according to: Birth weight. Low-birth-weight (LBW): an infant whose birth weight is less than 2500 g, regardless of gestational 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.

Classified according to Birth weight. Appropriate-for-gestational-age (AGA)INFANT: an infant whose birth-weight is falls between the 10th and 90th percentiles on intrauterine growth curves. Small-for-date (SFD) or small-for-gestational age (SGA) infant: an infant whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves Intrauterine growth restriction (IUGR) found in infants whose intrauterine growth is restricted

Classified according to Birth weight. Symmetric IUGR: growth restriction in which the weight, length, and head circumference are all affected. asymmetric IUGR: growth restriction in which the head circumference remains within normal parameters while the birth weight falls below the 10th percentile Large-for-gestational-age (LGA): an infant whose birth weight falls above the 90th percentile on intrauterine growth curves.

Classification according to Gestational age Premature (preterm) infant: an infant born before completion of 37 weeks of gestation, regardless of birth weight. Full-term infant: an infant born between the beginning of the 38 weeks and the completion of the 42 weeks of gestation, regardless of birth weight. Postmature (postterm) infant: an infant born after 42 weeks of gestational age ,regardless of birth weight.

Classification according to mortality Live birth: birth in which the neonate manifests any heartbeat, breathes, or displays voluntary movement, regardless of gestational age. Fetal death: death of the fetus after 20 weeks of gestation and before delivery, with absence of any signs of life after birth. Neonatal death: death that occurs in the first 27 days of life; early neonatal death occurs in the first weeks of life ; late neonatal death occurs at 7-27 days. Perinatal mortality: total number of fetal and early neonatal deaths per 1000 live births

Classification according to Pathophysiologic problems Associated with the state of maturity of the infant. Chemical disturbances. eg: hypoglycemia, hypocalcemia. Immature organs and systems. eg hyperbilirubinemia, respiratory distress, hypothermia.

High risk related to dysmaturity preterm infants Etiology of preterm birth: 1. Unknown 2. Maternal factors: Malnutrition. Chronic disease: heart, renal, diabetes. 3. Factors related to pregnancy Hypertension. Abruptio placenta or placenta previa. Incompetent cervix.

Etiology of preterm birth Premature rupture of membranes. Polyhydratmnios. 4. Fetal factors: Chromosomal abnormalities. Intrauterine infection. Anatomic abnormalities.

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.

Characteristic of premature infant The bones of skull and the ribs feel soft, and the eyes maybe closed Male infants have few scrotal rugae, and the testes are undescended, the labia and clitoris are 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.

Characteristic of premature infant Physiologically immature, unable to maintain body temperature. A pliable thorax, immature lung tissue and regulatory center lead to hypoventilation and periodic of apnea Have biochemical alterations such as hyperbilirubinemia and hypoglycemia. Neurologic impairment as intraventricular Hge, and cerebral palsy.

Posture

Ear

Sole

Scarf sign

Grasp reflex

Heal to ear maneuver

Therapeutic management Infants who do not require resuscitation are immediately transferred in a heated incubator to the NICU. where: Respiratory support. Temperature regulation. Nutrition. Susceptibility to infection. Activity intolerance.

Nursing care plan: the high-risk (preterm) infant NCP . P: 255 - 259 Ineffective breathing pattern r/to pulmonary and neuromuscular immaturity, decrease energy, and fatigue. Ineffective thermoregulation r/to immature temp control and decrease SQ body fat

Postterm infant Causes: Unknown. Characteristics: absent of lanugo. Little if any vernix caseosa. Abundant scalp hair. Long fingernails. There is significant increase in fetal and neonatal mortality, causes: fetal distress associated with the decreasing efficiency of the placenta, and meconium aspiration syndrome. The greatest risk occurs during the stresses of labor and delivery, particularly in infants of primigravdas.