Nursing care of the highhighrisk newborn and family
Identification
of highhigh-risk newborns
The highhigh-risk neonate :can be defined as a newborn, regardless of gestational age or birth weight, who has a greater greater--than 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 Classified
of highhigh-risk newborns
according to:
1. Birth weight.
Low-birth Lowbirth--weight (LBW): an infant whose birth weight is less than 2500 g, regardless of gestational age.
Very lowlow-birth birth--weight (VLBW) infant :an infant whose birth weight is less than 1500g.
Extremely-low Extremelylow--birth birth--weight (ELBW) infant: an infant whose birthbirth -weight is less than1000g.
Classified
according to Birth weight.
Appropriate--for for--gestational gestational--age Appropriate
(AGA)INFANT: an infant whose birthbirth -weight is falls between the 10th and 90th percentiles on intrauterine growth curves. Small Small--for for--date (SFD) or small small--for for--gestational age (SGA) infant: an infant whose rate of intrauterine growth was slowed and whose birth weight falls below the 10 th 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 for--gestational gestational--age Large
(LGA): an infant whose birth weight falls above the 90 th 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 Fullbeginning 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 a. Associated with the state of maturity of the infant. Chemical disturbances. eg: hypoglycemia, hypocalcemia. b.
Immature
organs and systems. eg hyperbilirubinemia, respiratory distress, hypothermia.
High
1. 2.
3.
4.
risk related to dysmaturity preterm infants
Etiology of preterm birth: Unknown Maternal factors: Malnutrition. Chronic disease: heart, renal, diabetes. Factors related to pregnancy Hypertension. Abruptio placenta or placenta previa. Incompetent cervix. Premature rupture of membranes or chorioasmniotis. Polyhydratmnios. Fetal factors: Chromosomal abnormalities. Intrauterine infection. Anatomic abnormalities.
Characteristic Small
of premature infant
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 The
of premature infant
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 Physiologically
of premature infant
immature, unable to maintain body temperature. A pliable thorax, immature lung tissueand 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.
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 highhigh-risk (preterm) infant NCP .
P: 255 - 259
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 meconium aspiration syndrome. The greatest risk occurs during the stresses of labor and delivery, particularly in infants of primigravdas.
