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What does the term dysmaturity mean?
That the level of maturity does not match gestational age
Newborn susceptibility to morbidity (illness) or mortality are due to what?
- physical disorders
- complications during or after birth
What factors are considered NONmodifiable? (15)
- previous preterm birth
- multiple abortions
- race/ethnic group
- uterine/cervical anomaly
- multiple gestation
- pregnancy induced hypertension
- placenta previa (after 22 weeks)
- DES exposure
- short interval between pregnancies
- abruptio placenta
- (parity 0 or >4) PROM
- bBleeding in first trimester
Treatable/modifiable factors (20)
- age at pregnancy <17 0r >34)
- uplanned pregnancy
- low educational level
- poverty, unsafe environment
- domestic violence
- life stress
- number of implanted embryos in assisted reproduction
- low pre-pregnancy weight
- health problems that can be treated ( HTN, diabetes, clotting problems, anemia)
- Incompetent cervix
- GU infections
- periodontal disease
- substance/alcohol use
- cigarette smoking
- long hours of employment/standing
- late or no prenatal care
- air pollution
What is considered low birth weight?
What is considered very low birth weight?
What is considered extremely low birth weight?
What is SGA? LGA?
- SGA: small for gestational age ( <10th percentile
- LGA: Large for gestational age ( >90th percentile)
What is considered "prematurity?" very premature? premature? late preterm? early term? full term? late term? postmaturity?
- "prematurity": between 20 and 37 completed weeks
- Very premature: <32 weeks
- premature: 32 6/7- 33 6/7
- Late preterm: 34 6/7- 36 6/7
- Early term: 37 6/7-38 6/7
- Full term: 39 6/7- 40 6/7
- late term: 41 weeks-41 6/7
- post maturity: 42 weeks and beyond
What is neonatal mortality? How many deaths occur within 1st week? Highest death rate is when? Neonatal mortality decreases with what 2 things? Which has the higher risk, SGA or LGA?
- Death within 28 days of life
- in the 1st 24 hours
- With increased gestational age and weight
- SGA has the highest mortality risk (glucose, O2, Temp); LGA (glucose)
What is the nursing care of the at risk newborn?
- it is anticipated based on gestational age and birth weight
- Decrease physiological stress on newborn (keep them warm)
- Observe for subtle signs of changes ( temp, lethargy, type of cry)
- interpretation of lab values and coordinate interventions
- conserve infants energy to assist healing and growth
- provide for developmental stimulation and maintenance of sleep cycle
- assist family in developing attachment
- and involve family in planning/providing care
What is SGA and when can it occur? Are SGA and IUGR interchangeable terms? What is it commonly associated with?
- Small for gestational age is the infant whose weight is less than the 10th percentile for his gestational age.
- Infant may be preterm;term or post-term
- the infant may have IUGR but not always
- SGA and IUGR are not interchangeable terms
- Commonly associated with smoking and hypertension
What is the difference between IUGR and SGA?
- SGA: is defined as growth at the 10th % or less for weight of all fetuses at that gestational age. Not all fetuses that are SGA are pathologically growth restricted and may be constitutionally small
- IUGR: is a condition in which a fetus is unable to achieve its genetically determined potential size
What are the maternal risk factors for IUGR? Environmental? placental? fetal?
- Maternal factors: primiparity, grand multiparity, multiple gestation, lack of prenatal care and low socioeconomic status, maternal disease ( heart disease, substance abuse, sickle cell, PKU, lupus, asymptomatic pyelonephritis, preeclampsia, chronic hypertensive vascular disease, diabetes
- Environmental: high altitude, x-rays, excessive exercise, exposure to toxins, hyperthermia, teratogenic drugs
- Placenta factors: small placenta, abnormal cord insertion, placenta previa, chronic abruption placenta, placenta hemangiomas
- Fetal factors: TORCH infections, syphilis, congenital malformations, discordant twins, chromosomal abnormalities
What is the difference between symmetric and asymmetric IUGR?
- Symmetric: a proportional reduction in the size of all structures and organs except the heart and brain, is the result of a condition that occurs early in pregnancy; weight, HC, and length are all below the 10th percentile for gestational age; will not catch up
- Asymmetric: reduction in size of structures and organs, results from maternal or placental conditions that occur later in pregnancy and (acutely) impede placental blood flow head growth and length is usually normal; weight is below the 10th percentile; will catch up
In asymmetric IUGR head growth is usually normal but abdominal girth along with liver is small, why is this dangerous?
sunabnormal liver growth leads to decrease glycogen stores and decrease subcutaneous fat (cold stress)
What term is the pathological changes caused by lack of oxygen (tissue or brain death)
What term describes the deficiency of oxygen in the blood?
hypoxia (which in turn leads to asphyxia)
What is meconium aspiration syndrome and what is it caused by?
Hypoxia leads to the baby releasing meconium into the fluid, at birth when the baby takes its first breath, he breathes it into his lungs. It is dangerous because it can lead to obstruction of the lower airways which leads to air trapping and hyperinflation of the airway, and it can also cause chemical pnuemonitis and inhibit surfactant action all then lead to atelectasis
What are the complications of IUGR?
- Asphyxia: due to chronic hypoxia
- Aspiration: due to intrauterine hypoxia
- Hypothermia: Due to decreases sub Q fat
- Polycythemia: physiologic response to hypoxia
What is the care of SGA/IUGR infants?
- Goal is early recognition: symmetrical ( Are proportionate, just small) Asymmetrical (appear long, thin and emaciated)
- hypoglycemia most common metabolic complication (monitor) and active thermoregulation to prevent cold stress
What is LGA? What are the risk factors?
- Above 90% growth
- Diabetes, multiparity
- previous macrosomic newborn, prolonged pregnancy
What are the complications of LGA?
- Birth trauma
- cesarean birth
- Operative vaginal birth (forceps/vacuum)
- Shoulder dystocia
- polycythemia which then leads to hyperbilirubinemia
What are the common complications for infants of diabetic mothers?
- Hypoglycemia: (blood sugar <40mg/dL)
- Hypocalcemia: (serum calcium <7mg/dL)
- DM/GDM mothers ave decreased serum magnesium levels which lead to fetal hypoparathyroidism which leads to hypocalcemia
- Hyperbilirubinemia: 48-72 hours of age; related to polycythemia
- Birth Trauma: due to macrosomia; shoulder dystocia, brachial plexus injuries, subdural hemorrhage, cephalohematoma, asphyxia
- Polycythemia: related to hypoxia
- RDS: high levels of insulin in fetus interferes with production of surfactant; transient tachypnea of newborn (TTN) due to delay in re-absorption of fetal lung fluid
- Congenital malformation: transposition of the great vessels, ventricular wall hypertrophy, small left colon syndrome, intestinal atresia, hydronephrosis and cystic kidneys; sacral agenesis (occurs in PGD, in 1st trimester)
What is post maturity syndrome?
infants born after 41 completed weeks of gestation; related to decreased placental function; mortality rate is 2-3x that of term infant (most death occurs during labor)
What are the common disorders of postmaturity?
- meconium aspiration d/t hypoxia (oligo-> aspiration of thick meconium)
- Polycythemia r/t hypoxia
- Congenital anomalies ( they tend to --> post term)
- Neuro complications such as seizures r/t fetal asphyxia during labor and birth
- hypothermia r/t loss or poor development of sub Q fat
- birth trauma r/t macrosomia
What are the common complications of prematurity?
- Retinopathy of prematurity
- Bronchopulmonary dysplasia
- patent ductus arteriosus
- preventricular- intraventricular hemorrhage
- necrotizing enterocolitis