CARE FOR THE FAMILY OF A HIGH-RISK NEWBORN

During pregnancy, screening women for risk factors that could lead to illness in a newborn which is essential to identify infants who need greater than usual care at birth such as: Younger or older than maternal age Concurrent disease conditions Pregnancy complications Unhealthy maternal lifestyle

In addition, an infant who is born dysmature (before term or post term, or who is under- or overweight for gestational age) is also at risk for complications at birth and in the first few days of life. Unfortunately, not all instances of high risk can be predicted.

NURSING PROCESS OVERVIEW

ASSESSMENTAssess for: Obvious congenital anomalies Gestational Age

NURSING DIAGNOSIS Ineffective airway clearance r/t presence of mucus or amniotic fluid in airway Ineffective cardiovascular tissue perfusion r/t breathing difficulty Risk for deficient fluid volume r/t insensible water loss Ineffective thermoregulation r/t newborn status & stress from birthweight variation Risk for imbalance of nutrition, less than body requirements r/t lack of energy for sucking Risk for infection r/t lowered immune response in newborn Risk for parenting r/t illness in newborn at birth Deficit diversional activity (lack of stimulation) r/t to illness at birth

OUTCOME IDENTIFICATION/PLANNINGPlan care that is individualized considering a newborns developmental as well as physiologic strengths, weaknesses, and needs.

IMPLEMENTATION Focus on conserving the babys energy and providing a thermoneutral environment Painful procedures should be kept to a minimum Assisting parents with participation in care ( e.g.bathing/feeding)

OUTCOME EVALUATION Infant maintains a patent airway. Infant tolerates all procedures without accompanying apnea. Infant demonstrates growth and development Infant maintains body temperature Parents visit at least once and make three telephone calls Parents demonstrate positive coping skills and behaviors

NEWBORN PRIORITIES IN FIRST DAY OF LIFE

A. Initiation and maintenance of respirationB. Establishment of extrauterine circulationC. Control of body temperatureD. Intake of adequate nourishmentE. Establishment of waste eliminationF. Prevention of infectionG. Establishment of an infant-parent relationshipH. Developmental care or care that balances physiologic needs and stimulation for best development

THE NEWBORN AT RISK BECAUSE OF ALTERED GESTATIONAL AGE OR BIRTHWEIGHT

Infants are evaluated as soon as possible after birth to determine: Weight Gestational age

Birth-weight is normally plotted on a Growth Chart such as: Colorado Intrauterine Growth Chart ( LUBCHENCO CHART)

a) Pre term born before term (less than the full 37th week of pregnancy)

b) Full term born after the beginning of 38 weeks and before 42 weeks

c) Post term born after the onset of week 43

Birthweight varies for each gestational week of age:

Appropriate Gestational Age (AGA) BW within 10-90th percentile Small Gestational Age (SGA) BW is < 10th percentile Large Gestational Age (LGA) BW > 90th percentile Low Birthweight (LBW) BW < 2,500 grams Very Low Birthweight (VLBW) BW 1000-1,500 grams Extremely-VLBW 500-1000grams

THE SMALL-FOR-GESTATIONAL-AGE INFANT

SGA infants are small for their age because they have experienced intrauterine growth restriction (IUGR) or failed to grow at the expected rate in utero.

CAUSES: Lack of adequate nutrition Placental anomaly Systemic diseases (e.g. severe DM; PIH) Smoke heavily Use of narcotics Intrauterine infection (e.g. rubella; toxoplasmosis) Chromosomal abnormality

ASSESSMENT: PRENATAL ASSESSMENT: Fundal height Sonogram Biophysical profilea) NSTb) Placental gradingc) Amniotic fluid amount

APPEARANCEInfant who suffers nutritional deprivation EARLY IN PREGNANCY Increase in number of body cells below average in weight, length and head circumference LATE IN PREGNANCY Increase in cell size reduction in weight Regardless of when deprivation occurs, an infant has:(1) Overall wasted appearance(2) Small liver(3) Poor skin turgor(4) Large head(5) Skull suture widely separated lack of normal bone growth(6) Dull and lusterless hair(7) Sunken abdomen(8) dry & stained yellow cord

LABORATORY FINDINGS1. Blood studies High Hematocrit level Increase RBC (polycythemia)2. Blood glucose Hypoglycemia