Care of Client Across the Life ___ with
Maternal Age
Mother, Child and Family at _____ or with
Problem
NURSING CARE OF HIGH RISK NEWBORN
- are infants who are “Predicted” to have illness or
may be prone to have complications at birth and
in the first days of life.
FACTORS THAT MAY LEAD NEWBORN TO
BECOME HIGH RISKS
1. Maternal Age
2. Concurrent Disease Condition of mother
3. Complications of Pregnancy
4. Unhealthy Maternal Lifestyle
5. Dysmature Newborn
HIGH RISK NEWBORN WITH ALTERED BIRTH
WEIGHT AND GESTATIONAL AGE
-TERM INFANTS
- 38th weeks & before 42 weeks
-PRETERM INFANTS
- before term (37weeks & less)
-POST-TERM INFANTS
- after the onset of 43 weeks
GESTATIONAL AGE
- is the number of weeks fetes remained in
utero
APPROPRIATE FOR GESTATIONAL AGE (AGA)
- weight falls between 10th to 90th percentile
for their age.
LARGE FOR GESTATIONAL AGE (LGA)
- above the 90th percentile
SMALL FOR GESTATIONAL AGE (SGA)
- below the 10th percentile
LOW BIRTH WEIGHT INFANT
- 1,500 to 2,500 grams
VERY LOW BIRTH WEIGHT INFANT
- 1,000 to 1,500 grams
EXTREMELY VERY LOW BIRTH WEIGHT INFANT
- 500 to 1,000 grams
SMALL FOR GESTATIONAL AGE (SGA)
- infants are small for their age because they have
experienced intrauterine growth restriction (IUGR)
or failure to grow at the expected rate in utero.
CAUSES OF SGA INFANTS:
A. MATERNAL CONDITIONS
1. Mother’s poor nutrition during pregnancy
2.
3. Placental Anomaly
4. Placental Damage
5. Multiple Gestation
6. Mothers with systemic diseases
7. Mothers who smoke heavily or use narcotics.
B. FETAL CONDITIONS
1. Infants with intrauterine infections
2. Chromosomal abnormalities
3. Congenital malformations
ASSESSMENT OF SGA NEWBORNS
1. Prenatal- fundal height is less than expected
(<28 cms) the height of the fungus in
centimetres from the symphysis pubis to the
highest point in the midline at the top of the
uterus.
Ultrasound (sonogram)- will provide additional
biophysical & placental information of the fetus.
2. Appearance
- decrease in weight and height
- Head circumference is large
- Skull is firm but sutures are widely separated due
to lack of normal bone growth.
- Hair is dull and lusterless
- Abdomen is sunken
- Cord is dry and yellow stained
3. Laboratory Findings
- hematocrits is high due to lack of fluid in utero
- Haemoglobin (RBCs) are high due to anoxia (lack
of O2 supply)
- Glycogen storage in the blood is low due to
hypoglycemia
COMMON PROBLEMS ASSOCIATED WITH SGA
1. Birth Asphysia - stoppage of breathing due to
airway obstruction
4. Impaired Mental Development- due to lack of
oxygen and nourishment while in utero
5. Below Normal Level of Growth and Development
6. Delayed Growth and Development
NURSING MANAGEMENT FOR SGA:
1. Provide Adequate fluid, electrolytes and
nutrition- promote weight gain to 12-30 gms/day
by increasing calories (20 cal/ounce)
7. Decrease Metabolic Demands when Possible -
provide savage feeding if the infant does not
have a steady weight gain
8. Prevent Hypoglycemia - provide early & frequent
feeding (q 2-3 hrs)
9. Maintain a Neutral Thermal Environment
10. Monitor Serum Hematocrit - (by capillary heel
prick sample); for early detection of anaemia and
or polycythemia.
11. Provide Parental Education & Emotional Support
- inform parents the possible effect of intrauterine
growth retardation
- Explain parents the infant’s goal on weight gain
- Teach parents how to prepare high calorie
formula or breastfeeding
LARGE FOR GESTATIONAL AGE (LGA)
CAUSES:
1. Overproduction of growth hormone
12. Multiparous women in their succeeding
13. Transposition of the great vessels
14. “Beckwick” Syndrome
15. Congenital Anomalies
ASSESSMENT PROCEDURES FOR LGA:
1. Non- Stress Test and Ultrasound
16. Lung maturity may be assessed by
amniocentesis
17. Cephalopelvic Disproportion (CPD)
18. Appearance
- infants show immature reflexes and low score on
gestational age exams.
- EYES- there’s an evidence of unresponsiveness
or dilated pupils.
- HEAD- prominent holding or caput succedaneum;
or cephalhematoma.
- SKIN COLOR- with ecchymosis
- EXTREMITY- motion of extremities on
spontaneous movement in response to moro
reflex can detect fracture of the clavicle; or may
have extensive bruising or birth injury.
- CHEST- there is asymmetry of the anterior chest
or unilateral lack of movement due to
diaphragmatic paralysis from edema of the
phrenic nurve.
*Shows signs of seizure activities - like bitterness,
lethargy and uncoordinated eye movements.
*Shows signs of increased intracranial pressure - like
bulging fontanelle, vomiting & high pitched cry.
5. Cardiovascular Dysfunction - increase signs of
hyperbilirubinemia resulting from absorption of blood
from bruising and polycythemia.
*hypoglycemia - infants uses up nutritional stores
readily to sustain his/her weight.
BIRTH INJURIES DUE TO DISPROPORTIONATE
SIZE OF NEWBORN TO BIRTH PASSAGE WAY
1. Fractured Clavicle
19. Erb- Duchenne palsy or (brachial plexus
paralysis)
20. Klumpke Paralysis (hand appears claw shaped)
21. Phrenic nerve palsy
22. Facial nerve palsy
23. Skull fracture
NURSING MANAGEMENT FOR LGA:
1. Monitor and manage birth injuries and its
complications
a. Clavicle Fracture
- assess for clavicle deformity
- Decreased movement of the arm or its affected
side
- Manage the pain through immobilisation of
affected side
b. Facial nerve injury
- assess for asymmetry of mouth while crying
- If eyes is affected, protect it with patches.
*Erb-Duchenne Palsy
- more reflex is absent on the affected side
- Grasp reflex is intact
*Klumpke Paralysis
-absent grasp reflex on the affected side
*Phrenic Nerve Palsy
- assess for respiratory distress with diminished
breath sounds
*Skull Fracture
- assess for soft tissue swelling over fracture site
- Visible indentation in the scalp
- Observe for intracranial hemmorhage signs
(lethargy, seizure, apnea, hypotonia)
2. Confirm the injury through X-Ray- on the affected
part of the body
3. Provide splints for immobilisation if necessary.
_________________________________________
PRETERM NEWBORN
- Preterm Infants -infants born before term (37
weeks and less) of pregnancy
- Approximately 7-19% of all births are preterm
infants
- Mostly has a weight of less than 2500

CAUSES:
1. Low socio economic level - due to inadequate
nutrition during pregnancy
24. Lack of prenatal care
25. Multiple pregnancy (twins, triplets)
26. Closely spaced pregnancy
27. Age of mother- the younger the age; the higher
the incidence
28. Order of birth - highest on the first born and
beyond the 4th pregnancy
29. Abnormalities on the mother’s reproductive
system
30. Obstetric complications - (PROM or premature
separation of placenta)
31. Infections
32. Cigarette smoking
33. Previous early delivery
34. Early induction of labor
35. Elective cesarian section
COMMON PROBLEMS/POTENTIAL
COMPLICATIONS OF PRETERM NEONATES
1. Anemia of Prematurity
- RBC production is low because the bone does not
increase its production until at the end of 32
weeks age.
- Infants may need blood transfusion to supply
needed RBCs
2. Kernicterus
- the destruction of brain cells by invasion of
indirect bilirubin leading to a high concentration &
excessive breakdown of RBCs
- Phototherapy is started if jaundice occurs &
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(new) ˅
3. Periventricular/ Intraventricular Hemmorrhage
4. Persistent Patent Ductus Arteriosus
- the ductus arteriosus is an accessory fetal structure
that connects the pulmonary artery to the aorta.
NURSING CARE MANAGEMENT FOR PRETERM
NEWBORNS
1. Provide Respiratory Ventilation.
2. Monitor V/S & presence of inadvertent sounds
(like heart murmurs)
3. Provide adequate fluids & electrolytes & nutrition,
4. Maintain a neutral thermal environment.
5. Prevent infection
6. Assess for readiness for selected ______
7. Promote Parent- child bonding.
POST TERM NEWBORN
- POST TERM INFANTS –infants born after the
onset of 43 weeks of pregnancy
- An infant who stays in utero past 42 weeks of
pregnancy is at risk because the placenta
appears to function effectively for only 40
weeks.
- If the placenta continues to function well, the fetus
continues to grow resulting in a Large for
Gestational Age Infant who possibly manifest
problems (like birth trauma and ypoglycemia)
- The fetus who remains in utero with a failing
placenta develops post term syndrome (fetal
dysmaturity syndrome).
CAUSES:
1. Unknown
2. Maternal Factors associated with post
maturity.
STAGES OF FETAL DYSMATURITY SYNDROME
(ASSESSMENT)
STAGE 1: Due to Chronic Placental Insufficiency
- Dry, cracked, peeling, loose and wrinkled skin
- Malnourished appearance
- Open eyed and alert baby
STAGE 2: Due to Acute Placental Insufficiency
- All features of stage 1 except no.3
- Meconium Staining
- Perinatal Depression
STAGE 3: Due to Sub Acute Placental
Insufficiency
- All features of stage 1 and 2 except no. 3
- Green staining of skin ,nails, cord and placental
membrane
- A higher risk for fetal intrapartum or neonatal
death.
CLINICAL MANIFESTATIONS/ASSESSMENT
FINDINGS
1. Appearance
- SKIN- lanugo is absent, dry, cracked, leather-like
skin due to lack of fluids, yellowish-greenish color
skin, cord & nails due to mecronium staining
- NAILS- long, curved finger nails and toenails
- WEIGHT- is lost due to poor placental function
2. Post Term Baby
- Is likely to have difficulty in establishing
respirations due to fetal hypoxia if meconium
aspiration has occurred.
3. Provide Early Feeding to prevent
Hypoglycemia
- If it is not contraindicated by the respiratory state 3. Vibration
4. Maintain Skin Intergrity C. Suction Secretion as Needed
D. Ventilation- the use of ventilator for these are
- Keep the skin clean pressure cycled which controls the force with
which air is delivered.

ACUTE CONDITIONS OF THE NEWBORN 3. PREVENT SECONDARY INFECTION

1. Respiratory Distress Syndrome A. Maintain aseptic technique & observe isolation
2. Transient Tachypnea of the Newborn precaution.
3. Meconium Aspiration Syndrome B. Minimize the child’s contact with infected
4. Hyperbilirubinemia person.
5. Sudden Infant Death Syndrome
6. Fetal Alcohol Syndrome TRANSIENT TACHYPNEA OF THE NEWBORN
(TTN)

REAPIRATORY DISTRESS SYNDROME (RDS)
- also called Hyaline Membrane Disease
- the most common cause of neonatal and infant
mortality due to deficiency of surfactant due to
lack of the development of the lungs.
* Hyaline- is a fibrous membrane formed from the
exudates of infant’s blood lining along the
bronchioles, alveolar ducts and alveoli.
*Surfactant- a lipoprotein secreted by the alveoli
cells to reduce surface tension in alveoli.
ASSESSMENT:
- Nasal Flaring
- Sternal and Subcostal Retraction (seesaw
retraction)
- Rapid rate of respiration that remains between 80
to 120 breaths per minute.
- it occurs at 36 hours of life and fades by 72
hours age when the lung fluid is absorbed&
respiratory activity becomes effective.
- It appears as a result from slow absorption of lung
fluid
- It occurs more often in infants who are born by
C/S & in infants whose mothers received
extensive fluid administration during labor and in
preterm infants.
ASSESSMENT (TTN):
- Tiring effect of breathing so rapidly.
- Mild retractions but no cyanosis.

- Tachypnea (>60RR) - Mild hypoxia and hypercapnia

- Low Body Temperature - Feeding is difficult since child can’t suck.

- Expiratory Grunting - CHEST X-RAY reveals some fluid in the central

NURSING MANAGEMENT: lungs but aeration is adequate.
1. PROMOTE ADEQUATE OXUGENATION & A
NORMAL BREATHING PATTERN APNEA
A. Positioning- elevate the head of the patient - A pause or absence of respiration longer than 20
and turn to sides still maintaining comfort to seconds accompanied with bradycardia and
improve bronchial drainage and ventilation to cyanosis.
all ling fields.
- More common in preterm infants due to fatigue or
B. Oxygen Administration- is necessary to
immaturity of respiratory mechanism.
maintain its PO2 & pH Levels.
CONDITION WHICH TRIGGERS BABIES TO
C. Perform Chest Physiotherapy- with the child’s
DEVELOP APNEA:
tolerance level to loosen mucus expect___ VITAL SIGNS-
1. Hypothermia
D. Administer Antibiotics as Ordered: RESPIRATIONS
2. Hyperbilirubinemia
i. Terbutaline Medication- used to quicken - Common variation:
the formation of lecithin. 3. Hypoglycemia - Transient
ii. Surfactant Replacement- synthetic 4. Infection tachypnea
surfactant is sprayed into the lung using a NURSING MANAGEMENT - Moist breath
syringe or catheter through an ETT. OF APNEA: sounds may be
2. PROMOTE DESIRED FLUID & NUTRITIONAL 1. Stimulate the baby present shortly after
INTAKE To breathe again by birth
A. Ensure adequate hydration by administering - Periodic breathing:
Shaking or flicking
fluids and monitor the infusion. 5-10 seconds
The soles of the feet without color
B. Techniques of Chest Physiotherapy:
2. Use apnea monitor change or
1. Postural Drainage
To warn nurses for bradycardia.
2. Percussion
 The succeeding episodes.
3. Protect the baby from undergoing the
conditions which triggers them to cause
apnea.

MECONIUM ASPIRATION SYNDROME (MAS)

- .An infant with hypoxia in utero experiences a
vagal reflex relaxation of the rectal sphincter
which releases meconium into the amniotic fluid.