1 NEWBORN COMPLICATIONS Diana Barrios, RN, MSN Merritt College ADN Program Nursing 3A: Perinatal Nursing CLASSIFICATION OF INFANTS BY GA & WEIGHT By gestational age Preterm/premature: < 37 weeks gestation Term: 38-42 weeks Postterm/postdate: >42 weeks By birth weight SGA: below 10 th percentile on intrauterine growth curves AGA: between 10 th and 90 th percentile LGA: above 90 th percentile LBW: 2500 g or less VLBW: 1500 g or less ELBW: <1000 g Gestational age and birth weight affect maturity of infant’s body systems and likelihood to experience health problems THE PRETERM INFANT The preterm infant has immature body systems and inadequate physiological reserves, making it difficult to adjust to extrauterine life Degree of maturity depends on length of gestation and birth weight Prematurity results in immediate and/or lifelong negative sequelae Preterm birth causes 2/3 of all infant deaths
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NEWBORN COMPLICATIONS
Diana Barrios, RN, MSN
Merritt College ADN Program
Nursing 3A: Perinatal Nursing
CLASSIFICATION OF INFANTS
BY GA & WEIGHT
� By gestational age�Preterm/premature: < 37 weeks gestation�Term: 38-42 weeks
�Postterm/postdate: >42 weeks
� By birth weight�SGA: below 10th percentile on intrauterine growth curves
�AGA: between 10th and 90th percentile�LGA: above 90th percentile
�LBW: 2500 g or less
�VLBW: 1500 g or less
�ELBW: <1000 g
� Gestational age and birth weight affect maturity of infant’s body systems and likelihood to experience health problems
THE PRETERM INFANT
� The preterm infant has immature body systems and inadequate physiological reserves, making it
difficult to adjust to extrauterine life
� Degree of maturity depends on length of
gestation and birth weight
� Prematurity results in immediate and/or lifelong
negative sequelae
� Preterm birth causes 2/3 of all infant deaths
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RESPIRATORY & CARDIOVASCULAR
SYSTEMS: THE PRETERM INFANT
� Respiratory�Immature lungs
�Inadequate amount of surfactant
�Fewer functional alveolar sacs
�Respiratory passages collapse or become obstructed
�Immature or fragile capillaries in the lungs
�Infant may experience respiratory distress or apnea; oxygen and/or artificial ventilation may be necessary
� Cardiovascular�Issues with heart rate & rhythm, color, blood pressure,
perfusion, pulses, O2 sat, acid-base balance
THERMOREGULATION:
THE PRETERM INFANT
� High ratio of body surface to body weight � Poor muscle tone, less flexed posture� Little subcutaneous fat
� Decreased stores of brown fat� Decreased ability to constrict superficial blood
vessels� Thinner, more permeable skin
� Immature temperature regulation center in brain� Inadequate glycogen stores� Radiant warmer, incubator, or kangaroo care
may help establish a neutral thermal environment.
CENTRAL NERVOUS SYSTEM:
THE PRETERM INFANT
� Most rapid brain growth occurs in 3rd trimester
� CNS vulnerable to injury related to:�Birth trauma with damage to immature structures
�Bleeding from fragile capillaries
�Impaired coagulation
�Recurrent anoxic or hyperoxic episodes
�Hypoglycemia
�Fluctuating BP
� Evaluate infant for signs of neuro dysfunction: seizures, hyperirritability, CNS depression, increased ICP, decorticate positioning
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DIGESTIVE SYSTEM:
THE PRETERM INFANT
� Ingestion, digestion, and absorption
problems
�Weak/absent suck and swallow reflex
�Poorly developed gag reflex increases risk
for aspiration
� Immature digestive enzymes
�Small stomach capacity
�Oral feedings may not be possible – may need gavage or IV feedings
GENITOURINARY & HEPATIC SYSTEMS:
THE PRETERM INFANT
� Immature kidneys lead to issues:
�Maintaining fluid & electrolyte balance
�Excreting metabolites and drugs
�Concentrating urine
�Monitor I&O, specific gravity, serum levels of meds
� Hepatic system
�Fewer glycogen deposits & increased risk for cold stress
� hypoglycemia
�Low iron stores � anemia
�Increased risk for hyperbilirubinemia & jaundice
IMMUNE SYSTEM:
THE PRETERM INFANT
Greater risk for infection:
�Deficient antibodies (less passive acquired
immunity) b/c less time spent in utero
�Decreased ability to make antibodies
� Inability to suck or difficulty sucking affects
breastfeeding and transfer of IgAantibodies
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Problems of
Prematurity
Can be LBW, SGA, IUGR, or AGA –
but all organs/systems are immature
RDS:
↓Surfactant
↓ Vascularity/neuro
↓ Lung compliance
↓pO2→ PDA
Anaerobic metabolism →metabolic acidosis, lack of
available albumin-binding
sites adds to
hyperbilirubinemia
Lack of body fat, brown fat,
posturing → hypothermia
Cold stress
Hypoglycemia
Hypoxemia → RDS
Absence of suck reflex/↑
energy expenditure > calories
for metabolic needs
Increased risk of
hyperbilirubinemiaHigh risk of infection
NECIatrogenic risks
Risks of maladaptive attachment
PARENT-INFANT ATTACHMENT:
THE PRETERM INFANT
� Preterm infants may be separated from mom and family for an extended period of time
� Nurse should foster parent-infant bonding
�Photographs of baby showing growth over time
�Baby’s name on incubator
�Weekly card with footprints, weight & length
� Involve parents in infant care
� Provide discharge teaching
THE NEWBORN AT RISK:
HEALTH PROBLEMS
�Respiratory distress syndrome (RDS)
�Necrotizing enterocolitis (NEC)
�Hypoglycemia
�Physiologic and pathologic jaundice
�Hemolytic disease of the newborn
�Sepsis
� Infants affected by maternal drug use
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RESPIRATORY DISTRESS SYNDROME
� Immature lungs lack or are unable to produce surfactant
�Without adequate surfactant, alveoli collapse and gas exchange inhibited �hypoxia and acidosis
� Presence of microorganisms or their toxins in the infant’s blood or other tissues
� Early-onset sepsis occurs within 48 hours of life. Caused by microorganisms from normal flora of maternal vaginal tract (GBS, E. coli, H. influenzae, S. pneumoniae)
� Late-onset sepsis occurs 2 weeks after birth. Caused by bacteria from birth canal or environment (S. aureus, S. epidermidis, Pseudomonas, GBS)
� Measures to prevent infection: STD screening, sterile technique with vag exams during labor, intrapartal use of IV antibx in GBS+ moms, erythromycin eye ointment
� Signs & symptoms of infection� Lab studies if infection suspected
CLINCAL PICTURE OF SEPSIS
Although infrequently seen, an exaggerated arched position of the
head and neck, termed opisthotonos, can be indicative of meningitis.
�O: other – gonorrhea, syphilis, varicella, hep B, HIV
�R: rubella
�C: cytomegalovirus
�H: herpes simplex virus
� GBS infection - page 899� 1 out of 4 women are GBS positive – not harmful to mom, but
can be very harmful to baby (leads to meningitis and sepsis)
�Early GBS screening (@ 35-37 weeks GA) and administration of antibiotics to GBS + moms during labor has decreased incidence of neonatal morbidity and mortality r/t GBS disease.