High-Risk Newborn: Complications Associated with Gestational Age and Development

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NURS 1102 - Chapter 29 Foundations of Maternal-Newborn and Women's Health Nursing, 5th Edition. Vocabulary, Check Your Reading & Summary Concepts

apneic spells

Cessation of breathing for more than 20 seconds or accompanied by cyanosis or bradycardia.

bronchopulmonary dysplasia

Chronic pulmonary condition in which damage to the infant's lungs requires prolonged dependence on supplemental oxygen. Also called chronic lung disease.

compliance

Stretchability or elasticity of the lungs and thorax that allows distention without resistance during respirations.

containment

A method of increasing comfort in infants by swaddling or other means to keep the extremities in a flexed position near the body.

corrected age

Gestational age that a preterm infant would be if still in utero; the chronologic age minus the number of weeks the infant was born prematurely. Also may be called developmental age.

enteral feeding

Nutrients supplied to the gastrointestinal tract orally or by feeding tube.

extremely-low-birth-weight infant

An infant weighing 1000 g (2 lb, 3 oz) or less at birth.

intrauterine growth restriction

Failure of a fetus to grow as expected for gestational age.

kangaroo care

A method of providing skin-to-skin contact between infants and their parents.

large-for-gestational-age infant

An infant whose size is above the 90th percentile for gestational age.

late preterm infant

An infant born between 34 0/7 and 36 6/7 weeks of gestation.

low-birth-weight infant

An infant weighing less than 2500 g (5 lb, 8 oz) at birth.

macrosomia

Infant birth weight above the 90th percentile for gestation age. Some sources use more than 4000 g (8 lb, 13 oz) or 4500 g (9 lb, 15 oz).

minimal enteral nutrition

Very small feedings designed to help the gastrointestinal tract mature. Also called trophic feedings.

necrotizing enterocolitis

Serious inflammatory condition of the intestines.

noncompliance

Resistance of the lungs and thorax to distention with air during respirations.

parenteral nutrition

Intravenous infusion of all nutrients known to be needed for metabolism and growth.

periodic breathing

Cessation of breathing lasting 5 to 10 seconds followed by 10 to 15 seconds of rapid respirations without changes in color or heart rate.

periventricular-intraventricular hemorrhage

Bleeding around and into the ventricles of the brain.

postmaturity syndrome

Condition in which a postterm infant shows characteristics indicative of poor placental functioning before birth. Also called dysmaturity syndrome.

postterm infant

An infant born after 42 weeks of gestation.

preterm infant

An infant born before the beginning of the 38th week of gestation. Also called premature infant.

pulse oximetry

Method of determining the level of blood oxygen saturation by sensors attached to the skin.

respiratory distress syndrome

Condition caused by insufficient production of surfactant in the lungs; results in ate-lectasis (collapse of the lung alveoli), hypoxia (decreased oxygen [O2] concentration), and hypercapnia (increased [CO2] concentration).

retinopathy of prematurity

Condition in which damage to blood vessels may cause decreased vision or blindness.

small-for-gestational-age infant

An infant whose size is below the 10th percentile for gestational age.

transcutaneous oxygen monitoring

Method of continuous noninvasive measurement of oxygen in the blood by transducers attached to the skin.

very-low-birth-weight infant

An infant weighing 1500 g (3 lb, 5 oz) or less at birth.

How does the appearance of a preterm infant differ from that of a full-term infant?

Preterm infants appear frail and weak and are small, with limp extremities, poor muscle tone, red skin, and immature ears, nipples, areolae, and genitals.

What factors contribute to respiratory problems in preterm infants?

Factors that increase respiratory problems in preterm infants include lack of surfactant, poor cough reflex, small air passages, and weak muscles.

What nursing responsibilities relate to care of preterm respiratory problems?

Nursing responsibilities include working with respiratory therapists to manage equipment, monitoring the infant's changing oxygen needs, positioning infants to promote drainage, and suctioning.

How do nurses help infants adjust to the cooler environment of an open crib?

Nurses wean infants to the open crib by making gradual changes in the environmental temperature, dressing the infant, and using blankets and a hat when the infant is out of the incubator.

How does the nurse keep track of an infant's intake and output?

To measure intake and output for infants, all fluids (IV and oral), including medications, are measured. Diapers are weighed to calculate urine output, and drainage, regurgitation, and stools are measured.

What special problems related to fluid balance, infections, and pain occur in preterm infants?

Preterm infants' kidneys do not concentrate or dilute urine well, and they have large insensible water losses. They lack passive antibodies from the mother and have an immature immune system. Pain causes physiologic responses such as vital sign changes and decreases in oxygenation.

What nonpharmacologic measures can nurses use to alleviate pain in infants?

Nonpharmacologic methods to reduce pain in infants include positioning, swaddling, facilitated tucking, sucking, and sucrose administration.

What can the nurse do for the infant at risk for stress from overstimulation?

The nurse can diminish overstimulation by organizing care to provide for rest periods, reducing environmental stimuli, minimizing pain, and discussing the plan of care with others.

How does the nurse assess feeding tolerance?

Feeding tolerance is assessed by checking gastric residual volume before gavage feedings, measuring abdominal girth, testing stools for reducing substances and blood, and observing for regurgitation. During nipple feedings, the nurse watches for signs of respiratory difficulty, decreased oxygenation, and fatigue.

Why should the nurse allow the infant to set the pace of feedings instead of urging continuous sucking?

When allowed to set the pace of feedings, infants can stop to rest to conserve energy, regulate breathing, and control the flow of milk. Moving the nipple in the infant's mouth may cause fatigue and choking.

How can the nurse help the mother who wants to breastfeed her preterm infant?

The nurse can help breastfeeding mothers of preterm infants by teaching them how to pump and store milk, by teaching breastfeeding techniques adapted to the preterm infant's needs, and by providing support and encouragement.

How can the nurse help parents be comfortable with their preterm infant?

The nurse can help parents feel comfortable with preterm infants by providing warm support, realistic encouragement, and information about the NICU environment, the infant's condition and characteristics, and the equipment and care. Involving the parents in care also helps.

How should the nurse prepare parents for the discharge of their preterm infant?

Beginning early in hospitalization, the nurse should help parents assume gradually increasing responsibility for care of the infant to help them prepare for discharge. Helping them prepare their home for the infant is also important.

What is the typical appearance of the infant with postmaturity syndrome?

Postmature infants may be thin and have loose skin folds, cracked and peeling skin, minimal vernix or lanugo, and meconium staining.

What special problems might a postmature infant have?

Postmature infants may have polycythemia, meconium aspiration, hypoglycemia, and poor temperature regulation.

How are symmetric and asymmetric IUGR different?

In symmetric growth restriction, all body parts are proportionately small. In asymmetric growth restriction, the head is normal in size but seems large for the body. The weight and abdominal circumference are decreased and the length is normal.

What problems may occur in infants who are LGA?

LGA infants may have birth injuries such as fractures, nerve damage, cephalohematoma, hypoglycemia, and polycythemia.

SUMMARY CONCEPTS

Late preterm infants, born between 34 0/7 and 36 6/7 weeks, are at risk for respiratory, thermoregulation, and feeding problems as well as hypoglycemia, hyperbilirubinemia, and sepsis.

SUMMARY CONCEPTS

Preterm infants differ in appearance from full-term infants. Some differences include small size, limp posture, red skin, abundant vernix and lanugo, and immature ears and genitals.

SUMMARY CONCEPTS

The lungs of preterm infants may lack adequate surfactant, which may cause the lungs to be noncompliant, increasing the amount of energy necessary for breathing and leading to atelectasis.

SUMMARY CONCEPTS

Other factors that may increase respiratory problems are poor cough reflex, narrow respiratory passages, and weak muscles.

SUMMARY CONCEPTS

The prone position is used for preterm infants because it decreases breathing effort and increases oxygenation.

SUMMARY CONCEPTS

Preterm infants are subject to cold stress because they have thin skin with blood vessels near the surface, little subcutaneous white fat or brown fat, a large surface area, a limp position, and an immature temperature control center.

SUMMARY CONCEPTS

Maintaining a neutral thermal environment at all times for infants is important. The nurse should prevent drafts, use warmed oxygen, and keep incubator doors and portholes closed. When taken out of heating devices, the infant should be wrapped in warmed blankets and should wear a hat.

SUMMARY CONCEPTS

Preterm infants are subject to increased insensible water losses and have difficulty maintaining fluid balance. Their kidneys do not concentrate or dilute urine as well as those of full-term infants. Intake and output must be carefully measured.

SUMMARY CONCEPTS

The fragile skin of a preterm infant is easily damaged. Adhesives or chemicals that could injure the skin should be avoided. Special products designed to prevent injury to the skin should be used.

SUMMARY CONCEPTS

Preterm infants are subject to infections because they lack passive antibodies from the mother, have an immature immune system, have fragile skin, and are subjected to many invasive procedures.

SUMMARY CONCEPTS

The nurse must watch carefully for signs of pain and use comfort measures, containment, pacifiers, sucrose, and medications to alleviate it.

SUMMARY CONCEPTS

Infants demonstrate that they are receiving too much stimulation by changes in oxygenation and behavior. The nurse should schedule care to allow rest periods, keep noise to a minimum, and teach parents how to interact with the infant appropriately.

SUMMARY CONCEPTS

Preterm infants lack nutrient stores and need more nutrients but do not absorb them well. They lack coordination in sucking and swallowing and fatigue easily.

SUMMARY CONCEPTS

Signs indicating an infant may be ready for nipple feeding include rooting, sucking on a gavage catheter or pacifier, presence of gag reflex, and respiratory rate less than 60 breaths per minute.

SUMMARY CONCEPTS

The nurse should teach mothers who wish to breastfeed their preterm infants how to use a breast pump and store breast milk. Nurses provide privacy, give support and encouragement, explain the infant's behavior, and answer questions about breastfeeding.

SUMMARY CONCEPTS

Nurses can increase parents' comfort with their preterm infant by providing information about the infant's condition and characteristics, the NICU, equipment, and infant care. Spending time with parents during visits, offering therapeutic communication and realistic encouragement, and involving parents in care of the infant also help with bonding.

SUMMARY CONCEPTS

Preparation for discharge should be started early in the infant's hospital stay. This allows parents to gradually learn and assume increasing responsibility in the care of the infant until they are comfortable with complete care.

SUMMARY CONCEPTS

Common complications of preterm birth are respiratory distress syndrome, bronchopulmonary dysplasia, periventricular-intraventricular hemorrhage, retinopathy of prematurity, and necrotizing enterocolitis.

SUMMARY CONCEPTS

Infants with postmaturity syndrome may appear thin with loose skin folds, cracked and peeling skin, and meconium staining. They may have respiratory difficulties at birth and suffer from hypoglycemia and inadequate temperature regulation.

SUMMARY CONCEPTS

Infants with intrauterine growth restriction may be small for gestational age at birth. In symmetric growth restriction, the infant is proportionately small; in asymmetric growth restriction, the head and length are normal and the body is thin.

SUMMARY CONCEPTS

Large-for-gestational-age infants may have birth injuries such as fractures, nerve damage, or bruising as a result of their size. They may have hypoglycemia or polycythemia.

Signs of Inadequate Thermoregulation

Axillary temperature <36.3° C or >36.9° C (<97.3° or >98.4° F)
Abdominal skin temperature <36° C or >36.5° C (<96.8° or >97.7° F)
Poor feeding or feeding intolerance
Lethargy
Irritability
Weak cry or suck
Decreased muscle tone
Cool skin temperature
Mottled, pale, or acrocyanotic skin
Signs of hypoglycemia
Signs of respiratory difficulty
Poor weight gain

Signs of Fluid Imbalance in the Newborn
Dehydration

Urine output <1 mL/kg/hr
Urine specific gravity >1.02
Weight loss greater than expected
Dry skin and mucous membranes
Sunken anterior fontanel
Poor tissue turgor
Blood: elevated sodium, protein, and hematocrit levels
Hypotension

Signs of Fluid Imbalance in the Newborn
Overhydration

Urine output >3 mL/kg/hr
Urine specific gravity <1.001
Edema
Weight gain greater than expected
Bulging fontanels
Blood: decreased sodium, protein, and hematocrit levels
Moist breath sounds
Difficulty breathing

Common Signs of Pain in Infants

High-pitched, intense, harsh cry
Whimpering, moaning
"Cry face"
Eyes squeezed shut
Mouth open
Grimacing
Furrowing or bulging of the brow
Tense, rigid muscles or flaccid muscle tone
Rigidity or flailing of extremities
Color changes: red, dusky, pale
Increased or decreased heart and respiratory rates, apnea
Increased blood pressure
Decreased oxygen saturation
Sleep-wake pattern changes

Signs of Overstimulation in Preterm Infants
Oxygenation Changes

Blood pressure, pulse, and respiratory instability
Cyanosis, pallor, or mottling
Flaring nares
Decreased oxygen saturation levels
Sneezing, coughing, hiccupping

Signs of Overstimulation in Preterm Infants
Behavior Changes

Stiff, extended arms and legs
Fisting of the hands or splaying (spreading wide apart) of the fingers
Arching
Alert, worried expression
Turning away from eye contact (gaze aversion)
Regurgitation, gagging
Yawning
Fatigue signs

Signs of Readiness for Nipple Feedings

Rooting
Sucking on gavage tube, finger, or pacifier
Ability to tolerate holding
Respiratory rate <60 breaths per minute
Presence of gag reflex

Signs of Nonreadiness for Nipple Feedings

Respiratory rate >60 breaths per minute
No rooting or sucking
Absence of gag reflex
Excessive gastric residuals

Adverse Signs during Nipple Feedings

Tachycardia
Bradycardia
Increased respiratory rate
Nasal flaring
Markedly decreased oxygen saturation level
Cyanosis, pallor
Apnea
Choking, coughing
Gagging, regurgitation
Falling asleep early in the feeding
Feeding time longer than 20 to 30 minutes

Signs that Bonding May Be Delayed

Using negative terms to describe the infant
Discussing the infant in impersonal or technical terms
Failing to give the infant a name or to use the name
Visiting or calling infrequently or not at all
Decreasing the number and length of visits
Showing interest in other infants equal to that in their own infant
Refusing offers to hold and learn to care for the infant
Showing a decrease in or lack of eye contact
Spending less time talking to or smiling at the infant

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