Newborn with Special Considerations

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THE NEWBORN WITH SPECIAL CONSIDERATIONS

A preterm infant is usually defined as a live-born infant born before the end of week 37 of gestation; another criterion is a weight of less than 2,500 grams (5lb 8oz) at birth

I.

INCIDENCE Occurs approximately 7% of live births of white infants, in Afro-American infants the rate is doubled 14% (Thilo & Rosenberg, 2003) CAUSES/FACTORS ASSOCIATED WITH PRETERM BIRTHS 1. Low socio-economic status 2. Poor nutritional status 3. Lack of prenatal care 4. Multiple pregnancy 5. Previous early birth 6. Race (non-whites have higher incidence than whites) 7. Cigarette smoking 8. Age of the mother (highest incidence is in mothers younger than age 20) 9. Order of birth (early termination is highest in first pregnancies and in those beyond 4th pregnancies) 10. Closed spaced pregnancies 11. Abnormalities of mother’s reproductive system, such as intrauterine septum 12. Infections (especially UTI) 13. Obstetric complications (PROM, premature separation of placenta 14. Early induction of labor 15. Elective cesarean birth ASSESSMENT A. History – detailed pregnancy history will reveal reason for the preterm birth; be careful not to convey disapproval of reported pregnancy behaviors such as smoking, etc. Being overburdened with guilt may be detrimental to her attempts to bond with her infant B. Appearance Criteria Posture Premature infant Resting posture – characterized by very little, if any, flexion in upper extremities and only partial flexion of lower extremities Exhibit a 90˚ angle Minimal or absent Will reach near or across midline Full-term infant Flexion in all four extremities

II.

III.

Wrist flexion Recoil of extremities Scarf sign

It is possible to flex the hand onto the arm Return briskly to full flexion Will not reach midline

Heel to ear Sole (plantar creases) Breast tissue Ears Male genitalia Female genitalia

Very little resistance Very few or no creases Has no breast tissue Very flat, relatively shapeless ears Testes very high in the inguinal canal, very few rugae in the scrotum Clitoris very prominent, labia majora are very small and widely separated

Marked resistance Entire sole has creases 5-6 mm of breast tissue Thick cartilage, ear stiff Testes lower in the scrotum and many rugae Labia minora and clitoris are covered by the labia majora

DIFFERENCE BETWEEN SGA AND PRETERM INFANTS
Characteristics Gestational age Birthweight Congenital malformations Pulmonary problems Hyperbilirubinemia Hypoglycemia Intracranial hemorrhage Apnea episodes Feeding problems Weight gain in nursery Future restricted growth SGA infants 24-44 weeks Under 10% percentile Strong possibility Meconium aspiration, pulmonary hemorrhage, pneumothorax Possibility Very strong possibility Strong possibility Possibility Most likely due to accompanying problem such as hypoglycemia Rapid Possibly always under 10% percentile Preterm Infants Younger than 37 weeks Normal for age Possibility Respiratory distress syndrome Very strong possibility Possibility Possibility Very strong possibility Stomach capacity, immature sucking reflex Slow Not likely to be restricted in growth as “catch-up growth occurs

IV.

POTENTIAL COMPLICATIONS 1. Temperature instability - inability to stay warm due to low body fat 2. Respiratory problems such as  Hyaline membrane disease (condition in which the air sacs cannot stay open due to lack of surfactant in the lungs.  Chronic lung disease/bronchopulmonary dysplasia - long-term respiratory problems caused by injury to the lung tissue  Respiratory disease syndrome 3. Cardiovascular problems – persistent Patent Ductus Arteriosus Insufficient surfactant Difficult for the blood to move from pulmonary artery to lungs Pulmonary artery HPN – interferes the closure of ductus arteriosus - To correct this, INDOMETHACIN is administered (closes the blood vessel by vasoconstriction) 4. Blood and Hematologic problems a. Anemia – fragile capillaries and immature cerebral...
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