Newborn with Special Considerations
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
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