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MATERNAL-CARE FOR AT RISK > High-Risk Newborns > Flashcards

High-Risk Newborns Flashcards

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1
Q

How many days or weeks of life is the neonatal period wherein it is a critical time for adaptation to extrauterine life & monitoring for complications?

A

First 28 days (4 weeks) of life

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2
Q

Someone with increased susceptibility to morbidity and mortality due to prematurity, congenital anomalies, birth complications, maternal health issues or infections.

A

High-risk newborn

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3
Q

Risk factors

A

Maternal
1. Maternal age
2. Diabetes, hypertension, infections
3. Substance abuse, alcohol intake, smoking, malnutrition

Fetal
1. Prematurity, IUGR, multiple gestations
2. Dysmature newborn (SGA, LGA, preterm, post term)

Pregnancy / Birth-Related
1. Asphyxia, meconium aspiration, birth trauma
2. Placenta previa, placental abruption

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4
Q
A
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5
Q

3 categories for classifying high-risk newborns

A
  1. Gestational Age-Based
  2. Weigh-Based
  3. Pathophysiological Conditions
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6
Q

Gestational Age-Based Classification of High Risk Newborn

A
  1. Late Preterm (34-36 weeks)
  2. Preterm (< 37 weeks)
  3. Term (37-41 weeks)
  4. Post-term (> 42 weeks)
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7
Q

Weight-based classification of high-risk newbron

A
  1. LBW: 1,500 - < 2500g
  2. VLBW : 1000 - < 1500g
  3. ELBW : 500 - < 1000g
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8
Q

Pathophysiological Conditions Classification of High-Risk Newborns

A
  1. SGA
  2. LGA
  3. IUGR
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9
Q

Before birth, weight is estimated based on size via what device?

A

UTZ measurements

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10
Q

Refers to newbrons whose birthweight falls between the 10th - 90th percentile for their age.

Baby is neither too small nor too large for gestational age

A

Appropriate for Gestational Age (AGA)

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11
Q

Refers to newborns whose birthweight falls above the 90th percentile for their age.

Baby is larger than most babies of the same gestational age

A

Large for Gestational Age (LGA)

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12
Q

Refers to newborns whose birthweight falls below the 10th percentile for their age

Baby is smaller than most babies of the same gestational age

A

Small for Gestational Age (SGA)

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13
Q

After birth, weight is based on…?

A

Actual birth weight

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14
Q

What happens to the SGA label after birth?

A
  1. If baby’s birth weight is confirmed SGA, continued to be classified as SGA
  2. If postnatal growth is poor = failure to thrive
  3. Some SGA babies experience catch-up growth w/n the first 2 years, and if they reach a normal weight percentile no longer SGA
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15
Q

What happens to a baby who is SGA if postnatal growth is poor?

A

May develop postnatal growth failure or failure to thrive (FTT)

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16
Q

Maternal Causes why newborn is SGA

A
  • Hypertension
  • Preeclampsia
  • Malnutrition
  • Smoking
  • Alcohol/drug use
  • Anemia
  • Multiple gestation
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17
Q

Fetal factors causing SGA in newborns

A
  • Chromosomal abnormalities
  • Genetic conditions
  • TORCH
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18
Q

Placental factors causing SGA in newborns

A
  • Placental insufficiency
  • Placental abruption
  • Umblical cord abnormalities
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19
Q

Why are teenage mothers more prone in having SGA infants?

A
  • Immature uterus & poor placental function
  • Nutritional deficiencies
  • Lower prenatal care
  • Unhealthy lifestyle choices
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20
Q

How can genetic influence play a role in infants becoming SGA

A

Small parents tend to have smaller babies due to inherited genetic traits

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21
Q

All SGA newborns are considered high risk at birth due to?

A
  • Hypoglycemia
  • Feeding difficulties
  • Difficulty maintaining body temperature
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22
Q

An abnormality of the placenta that results to insufficient supply of nutrients to the fetus

A

Placental insufficiency

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23
Q

Why is having multiple gestations become a risk factor for SGA newborns?

A

Twins share the same placental ; risk for preterm birth.

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24
Q

Assessment findings of SGA fetuses during pregnancy.

A
  • Fundal height smaller than expected for GA
  • Poor maternal weight gain
    -** Abnormal FHR ** ( Suggesting fetal distress or placental insuffiency)
  • Low BPP score (breathing movement, fetal movement)
  • Decreased fetal movements
  • Estimated fetal weight below the 10th percentile.
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25
General appearance of SGA newborns at birth.
- Weight, Length and Head circumference is below the 10th percentile (**Symmetrical SGA**) - Normal head circumference with small abdomen & limbs (**Asymmetrical SGA**) - Thin, Wasted Appearance - Loose, Dry or Peeling Skin - Prominent Ribs and Wrinkles - Dull & lusterless hair
26
Why are SGA newbrons prone to temperature instability or hypothermia?
- Limited brown fat (heat production) - Limited subcutaneous fat (insulation & energy storage)
27
SGA newborns are also at increased risk of respiratory distress if newborn is?
Preterm
28
Why are SGA newborns at risk for hypoglycemia?
Low blood glucose due to low glycogen & fat stores.
29
# Neuromuscular and Reflexes Assessment findings of SGA newborns at birth
- **Irritability or Lethargy** : Hyperactive or hypotonic - **Weak Cry and Sucking Reflex** : due to energy depletion - **Diminished Moro Reflex**: in severely affected newborns
30
# Skin and Circulation Assessment findings of SGA newborns at birth
- Polycythemia - Jaundice - Acrocyanosis
31
What causes polycythemia in SGA newborns
Less plasma compared to RBCs making blood thicker **(Increased Hematocrit)** leading to increased workload of the heart because it is difficult to circulate thick blood
32
What causes jaundice in SGA newborns
Due to increased RBC breakdown.
33
Common Problems associated with SGA newborns
- Hypoglycemia - Hypothermia - Polycythemia - Hyperbilirubenemia - RDS - Growth & Developmental Delays - Necrotizing Enterocolitis
34
Effects of Hypoglycemia in SGA newborns
- Weakness - Tremors - Seizures - Poor Feeding
35
Prevention / Management of hypoglycemia in SGA newborns
- Early and frequent feeding - Glucose monitoring - IV glucose infusion
36
How is CBS done in SGA newborns?
via heel prick method
37
Early and frequent feedings for hypoglycemia is important in order to?
maintain adequate glucose levels & promote weight gain
38
Why is IV glucose infusion a management for hypoglycemia in SGA newborns?
To sustain blood sugar until they are able to suck effectively or take in sufficienct oral feedings.
39
Effects of hypothermia in SGA newborns
- decreased body temp - tremors - pale or mottled skin
40
Prevention / Management of hypothermia in SGA newborns
- Skin to skin contact **(KMC)** - Maintain a neutral thermal environment
41
Cause of polycythemia in SGA newborns?
Chronic intrauterine hypoxia leads to overproduction of RBCs **Effects:** Thick blood, poor circulation , risk of blood clots
42
Prevention / Management of Polycythemia in SGA NBs
- Monitoring Hct levels - Hydration - Partial exchange transfusion : done if severe
43
How is partial exchange transfusion done?
1. Small amount of baby's thich RBC-rich blood is removed 2. Equal amount of Normal saline or plasma is infused to thin the blood 3. Helps improve circulation & oxygen delivery w/o removing too much blood at once.
44
Cause of Hyperbilirubenemia in SGA NBs
Increased RBC breakdown + Immature liver
45
Effects of Hyperbilirubenemia in SGA NBs
- Yellowing of skin/eyes - risk of kernicterus (brain damage)
46
Prevention / Management of Hyperbilirubenemia in SGA NBs
- Early feeding - Phototherapy - Hydration
47
Signs of RDS
- Tachypnea - grunting sounds - nasal flaring - chest retractions - cyanosis
48
Prevention of RDS
- Preventing preterm birth (if possible) - **Corticosteroids** to hasten fetal lung maturity
49
Management for RDS
- O2 administration - Early & frequent feeding ; prevent hypogylcemia
50
Cause of Growth & Developmental Delays in SGA NBs
Poor fetal nutrition leading to impaired brain & muscle development
51
Effects of Growth & Developmental Delays in SGA NBs
- Delayed motor skills - Cognitive impairments
52
Prevention of Growth & Developmental Delays in SGA NBs
- Parental education on proper breastfeeding / nutrition - formula supplementation - regular monitoring / check-up
53
Cause of Nectrozing Enterocolotis in SGA NBs
- Poor blood flow to the intestines causes tissue damage & infection
54
Effects of Nectrozing Enterocolotis in SGA NBs
- Feeding intolerance - Bloating - Blood stools
55
Prevention of Nectrozing Enterocolotis in SGA NBs
- **Breastfeeding** is best - slow careful feeding - stop oral feeding - IV fluids for nutrition - antibiotics - surgery in severe cases if part of the intestines die.
56
Are all LGA babies considered as macrosomic?
No.
57
If mother has gestational or pre-existing diabetes, why is considered a cause for LGA infants?
Hyperinsulinemia converts excess glucose into fat; protein synthesis leads to muscle & organ growth
58
How is obesity or excessive maternal weight gain a cause for LGA infants
Too much disrupts insulin, making it harder for cells to absorb gluocose, leading to high blood sugar (insulin resistances leads to hyperglycemia)
59
How is post-term pregnancy a cause for LGA
Placenta continues to function & nourish the baby
60
Other maternal factors that causes LGA
- Multiparity - Family history of large babies
61
Fetal factors causing LGA
- Genetic or syndromic conditions
62
A LGA babies is considered macrosomic if baby's birth weight is ?
Above 4000 micrograms
63
Prenatal (Fetal) Assessment findings for LGA fetuses
Fundal height is larger than expected for gestational age.
64
Ultrasound findings for LGA fetuses
- **EFW > 90th** percentile for GA - **Increased abdominal circumference** (common in diabetic mothers) - **Fetal macrosomia signs**: disproportionate growth, especially in the shoulders and abdomen
65
General Appearance of LGA Postnatal (Newborn) Assessment findings
- Large, plump body with increased subcutaneous fat - Full, round face - Wide shoulders & ches (risk for shoulder dystocia) - Head size may appear normal compared to the large body.
66
Temporary shaping of the fetal head due to pressure from the birth canal during vaginal delivery. - Occurs because newborn's skull bones are not yet fused and can overlap slightly to allow passage through the birth canal.
Molding
67
Pressure-induced swelling of the scalp causing serosanguinous fluid leakafe from capillaries into the soft tissue above the periosteum (**Crosses suture lines**)
Caput Succedaneum
68
Collection of blood under the periosteum due to rupture of blood vessels from excessive pressure or trauma (**Does not cross suture lines**)
Cephalohematoma
69
Why does ecchymosis happen in LGA newborns?
Due to extravasation of blood into the tissues as a result of trauma.
70
Where is ecchymosis commonly seen?
Areas subjected to pressure or trauma during delivery (ex. face, shoulderts, chest, extremities, buttocks)
71
Skin color assessment findings on LGA newborns
- Ecchymosis - Jaundice
72
How does hypoglycemia happen in LGA newborns
Maternal hyperglycemia leads to fetal hyperinsulinemia - After birth, maternal glucose supply stops, but the newborn's insulin supply remains high for a while. - Insulin brings glucose into the cells, blood glucose drops quickly, leading to hypoglycemia.
73
Why do LGA NBs O2 demand increase?
- Hyperinsulinemia leads to faster growth & metabolsim leading to higher oxygen demand > risk of hypoxia leading to polycythemia as compensation
74
Why does hyperbilirubinemia happen to LGA newborns
- due to breakdown of RBCs from cephalohematoma - due to breakdown of RBCs from polycythemia
75
Birth Related risks associated with LGA newborns
Brachial Plexus Injuries such as: - Erb's palsy - Klumpke's palsy - Clavicle fracture
76
Refers to injury to multiple nerves **(C5-T1)** which orignates in the neck & extends down the arm. - due to excessive lateral traction on the neck or arm during delivery
Brachial plexus injuries
77
**C5-C6** : affects the upper trunk of the brachial plexus - moro reflex is partially absent on affected side - MR involves shoulder abduction, arm extension and hand opening, which depend on the C5-C6 nerve roots.
Erb's Palsy
78
**C8-T1** : affects the lower trunk of the brachial plexus - absent grasp reflex on the affected side
Klumpke's Palsy
79
Occurs when the shoulder gets stuck behind the pubic bone (shoulder dystocia)
Clavicle Fracture
80
Management for LGA NBs
- C-section consideration - Careful monitoring at birth - Earl feeding & blood sugar checks - Physical therapy, pain management, sugery, use of assistive devices - Long term monitoring
81
Management of LGA NBs with clavicle fracture
- Minimal Handling - Pain management - Immobilization - soft arm slin of pinning sleeve to the ches for comfort - Usually heals within 7-10 days - encourage gentle movement

MATERNAL-CARE FOR AT RISK (24 decks)

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