CH 24 Newborn at Risk 8th ed

CH 24 Newborn at Risk 8th ed - Newborn at Risk Chapter 24...

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Newborn at Risk Chapter 24
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Definitions Preterm : born before completion of 37 weeks Term: born between beginning of week 38 and end of week 42 Postterm : pregnancy extending beyond completion of 42 weeks See Box 26-1 for classification of high risk infants
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Preterm birth – almost 2/3rds of infant death. At risk due to immature organ systems and lack of adequate reserves of bodily nutrients. Consider ethical concerns and issues
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PREMATURITY Highest among lower socioeconomic groups Most likely due to lack of prenatal care
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Other Social Factors related to prematurity AA race Single Low maternal age Low prepregnancy weight Stress long periods of standing Short statue <12 years education
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Obstetrical Factors related to Prematurity Previous fetal/neonatal death Previous preterm Premature dilation of the cervix Maternal genital abnormality Diethylstilbestrol (DES) Short interval between pregnancies PROM Preeclampsia/eclampsia Hyperemesis Placenta or umbilical cord complications Multifetal pregnancy Fetal congenital anomalies
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Large for gestational age: weight > 90 th percentile for gestational age Appropriate for gestational age: weight between 10 th and 90 th percentile for gestational age Small for gestational age: weight < 10 th percentile for gestational age Low birth weight (LBW): weight of 2500 gm or less Very low birth weight: weight of 1500gm or less IUGR : intrauterine growth restriction. Fetus whose rate of growth doesn’t meet expected growth pattern
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LBW INFANTS Children/Adults more likely to have: Cerebral palsy Mental retardation Sensory and Cognitive disabilities Difficulty in adaptation Socially Psychologically physically
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Common Causes of Weight Deviations LGA – maternal diabetes, overnutrition, heredity SGA – smoking, undernutrition, anemia, high altitude, rubella & other infection, etc. IUGR – preeclampsia, advanced diabetes, cigarette smoking, alcohol, drugs, fetal anomalies, infections, placental factors
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CARE & MANAGEMENT Gestational age assessment by using Ballard Scale. See pages 581,Fig 19-1 pages 561 & 562
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Also look at Assessment of the Preterm Infants’ Behavior (APIB) to determine infant readiness for behavioral intervention and supportive care See Box 26-2 on page 851
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Even little ones may need rescuing Our hero!
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Baby Girl Laura is born at 32 weeks gestation after attempts to suppress her mother’s preterm labor fail. She is admitted to the NICU.
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Concern of health care providers centers on Laura’s compromised respiratory function. Her parents are distraught, wondering what they could have done to cause all of this to happen to their baby. They become highly anxious when they see Laura and all the equipment surrounding her
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What clinical manifestations would indicate that Laura is experiencing respiratory distress?
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