High risk infant

RNSG 1327 Lab

High Risk Infant: Objectives
1. Define the many terms used to describe the premature infant, low birthweight
infant, small for gestational age, average for gestational age, and large for gestational
age infants.
2. List several maternal risk factors that may lead to preterm birth.
3. List maternal signs of preterm labor.
4. Discuss some of the complications or prematurity.
5. Discuss other high-risk problems neonates may experience, their causes and
treatments.

High-Risk Infant: Terminology (How confusing can we get?)

Term infant- 37-40 weeks gestation. Neonate- infant from birth to 28 days old.
Preterm infant- less than 37 weeks, Moderate premature- 32 to 37 weeks, very
premature-28-32 weeks. Post-term infant- born after 42 weeks.
Late preterm infant- 34 to 37 weeks gestation
Extremely preterm infant- less than 28 weeks gestation
Intrauterine growth retardation- a fetus whose growth is below 10% for gestational age
Low birth weight infant- an infant weighing less than 2500 grams at birth (LBW). Very
low birth weight- weighing < 1500 grams (VLBW)
Extremely low birth weight- weighing < 1000 grams (ELBW)

Small for gestational age- a newborn whose birth weight is at or below 10% for gestational
age (SGA).
Average for gestational age- a newborn whose birth weight is between 10-90% for
gestational age (AGA).
Large for gestational age- a newborn whose birth weight is above the 90% for gestational
age (LGA).

High Risk Infant: Causes of Preterm Birth (We really don’t know!)
Infection
Cervical insufficiency
Multiple gestation (triplets or more)
Hypertension
Diabetes/ gestational diabetes
Stressful life events
Smoking/substance abuse/alcohol abuse
Placental abruption and many more

High Risk Infant: Maternal risk factors for preterm birth

Low socioeconomic level Age of the mother
 Poor nutritional status First pregnancy or > 4th pregnancy
Lack of prenatal care Closely spaced pregnancies
Multiple pregnancy Abnormalities of the reproductive
system
Previous preterm birth Infections (esp UTI’s)
Race (non-whites with higher incidence) Pregnancy complications (PROM)
Cigarette smoking Early induction of labor/elective C/S

High Risk Infant: Maternal signs of preterm Labor

Pelvic pressure
Spotting or vaginal bleeding
Increased vaginal discharge
Cramping
Lower abdomen or back discomfort

High Risk Infant: Complications of Prematurity

Intracranial hemorrhage/intraventricular hemorrhage
Weakened immune system (infections)
Respiratory distress syndrome (RDS)
Retinopathy of Prematurity
Gastrointestinal immaturity
Anemia/Jaundice
Cerebral palsy
Temperature instability

High Risk Infant: Other Problems

Necrotizing enterocoliis:
Highest in LBW or preterm infants.
Unknown cause.
Ischemia of the gut with resulting
peritonitis, and perforation of gut.
Gut rest (NPO), IV support, antibiotics, and possible surgery.
Can develop short gut if intestine is lost, death can occur.
High Risk Infant: Other Problems
Diaphragmatic Hernia
Congenital defect that occurs at
8 weeks gestation, diaphragm does not
form and intestines &/or stomach
goes up into chest cavity & collapses lung.
Emergency at birth/requires surgery to repair.
Lung development delayed on affected side.

High Risk Infant: Other Problems

Hypospadius
Familial, multifactorial cause.
 Urethral opening not on tip of penis, but on underside (ventral).
No circumcision at birth, requires surgical repair at 12-18 months.
Epispadius
Familial, multifactorial cause, more severe.
Urethral opening not on tip of penis, but top (dorsal).
No circumcision at birth, requires surgical repair at 12-18 months.

Osteogenesis Imperfecta
A connective tissue disorder that results in
multiple fractures. Inherited, autosomal
Dominant (Type 1) or autosomal recessive
(Type 3). Multiple fractures lead to deformities
of extremities & spine. Sclera of eyes are blue.
No cure, needs supportive care for life.

Rh/ABO Incompatibility
Occurs when an Rh-negative mother has a
Rh-positive infant (on 2nd or more pregnancy)and mother
Mother forms antibodies against the fetus.
Anemia occurs and then jaundice in the infant. Intrauterine transfusions or PUBS may be
required multiple times during the pregnancy. ABO incompatibility is less severe, usually
requiring phototherapy or the newborn.

Spina Bifida/Myelomenigocele
Spina bifida (SB) is a collective term that
Involves all spinal cord disorders. SB oculta
Presents as a dimple or tuft of hair at L5-S1 vertebrae of the spine. Menigocele has a protruding
sac with only spinal fluid in it, no deficits are there after surgical repair. Rupture can lead to
infection. Myelomeningocele has spinal fluid and nerves in the sac and requires surgery with
limitations of mobility and bowel/bladder control. Hydrocephalus can occur with this and need a
VP shunt.

Ambiguous Genitalia
Genitalia in the newborn are not seen
as male or female. Congenital etiology of may causes. Hormone replacement and surgery is
required later in life. Chromosomal analysis shows the true sex of the infant (but this takes ~ 48
to get back and cause severe distress for the parents). Nonfunctioning testes and ovaries are
removed to prevent malignancies later in life. This is a life-long problem and difficult for both
the child and parents.

High Risk Infant: Other Problems-GI

Gastroschesis- congenital defect in the abdominal wall, does not involve the umbilical cord.
Requires surgical correction within 48h due to risk of infection.

Omphalocele- usually an inherited defect involving many chromosomal defects, involving

umbilical cord, requires long-term correction & surgery.
High Risk Infant: Other Problems

Phenylketonuria (PKU)
1. Inherited, autosomal recessive, liver enzyme phenylalanine hydroxylase is missing,
phenylalanine is too high in body.
2. Can result in cognitive impairment if untreated
3. Detected on newborn screening
4. Requires special diet for life.

Galactosemia
1. A problem with carbohydrate metabolism, too much galactose in the blood & urine,
destroys body cells.
2. Can result in failure to thrive, cataracts, cirrhosis of liver, sepsis, and cognitive
impairment if not treated.
3. Detected on newborn screening.
4. Requires special diet for life.
High Risk Infant: Other Problems

Microcephaly
Decreased brain growth, 3 standard deviations below normal brain growth. Intellectual
impairment. Can occurs due to maternal infections: rubella, Zika, CMV, or toxoplasmosis or
poor nutrition or fetal anoxia.

Hydrocephalus The accumulation of an excess amount of CSF in the ventricles or

subarachnoid space, usually due to a blockage prior to the 4th ventricle. It can be congenital
or acquired. Preterm infants with IVH are at high risk.May require diuretics, surgery, or
shunt placement depending on the cause.

Acyanotic heart disease

Patent ductus arteriosis (PDA)
Atrial septal defect (ASD)
Ventricular septal defect (VSD)

Cyanotic heart disease

Transposition of the great vessels
Truncus arteriosis
Tetrology of Fallot
Coarctation of Aorta
Hypoplastic L ventricle
Aortic Stenosis