High Risk Newborn: Altered Gestational Age or Birth Weight

Altered Birth Weight

• Infants are assessed after birth to determine weight, height, head circumference, and gestational age to determine immediate needs.
• Birth weight increases for each additional week of age.
• Infants who fall between the 10th and 90th percentile of weight for their gestational age are considered appropriate for gestational age (AGA).

Small-for-Gestational-Age (SGA) Infants

• SGA infants have decreased glycogen stores, making them prone to hypoglycemia (decreased blood glucose, or a level below 45 mg/dL).
• SGA infants are at risk for birth asphyxia, meconium aspiration syndrome, and cognitive development impairment due to lack of oxygen and nourishment in utero.
• Physical characteristics:
  • Below average weight, length, and head circumference
  • Wasted appearance
  • Small liver
  • Poor skin turgor
  • Widely separated skull sutures
  • Dull, lusterless hair
  • Sunken abdomen
  • Cord dry and yellow-stained
• Laboratory results:
  • Elevated hematocrit (Hct)
  • Polycythemia
  • Prolonged acrocyanosis
  • Hypoglycemia (20 mg/dL in term infants, 12 mg/dL in preterm infants)

Management of SGA Infants

• Intrauterine transfusions
• Induced preterm labor
• Phenobarbital
• Rh immunoglobulin for ABO incompatibility

Large-for-Gestational-Age (LGA) Infants

• LGA infants may have difficulty establishing respirations at birth due to birth trauma and increased intracranial pressure.
• Physical characteristics:
  • Large head size
  • Immature reflexes
  • Low scores on gestational age examinations
  • Extensive bruising or birth injury (e.g., broken clavicle or Erb-Duchenne)
  • Prominent caput succedaneum, cephalhematoma, or molding
• Common problems:
  • Hyperbilirubinemia (increased serum bilirubin level)
  • Hypoglycemia in early hours of life
  • Cyanosis (may indicate transposition of the great vessels)

Rh Incompatibility and Hemolytic Disease of the Newborn

• Causes:
  • Destruction of red blood cells (RBCs) by normal physiological process
  • Abnormal destruction of RBCs due to Rh or ABO incompatibility
• Results in severe anemia and hyperbilirubinemia
• Management:
  • Initiation of early feeding
  • Phototherapy (quartz halogen, cool white daylight, blue fluorescent)
  • Exchange transfusion (if level exceeds 5 mg/dL at birth, 10 mg/dL at age 8 hrs, 12 mg/dL at age 16 hrs, or 15 mg/dL at age 24 hrs)

This quiz covers the concept of altered gestational age or birth weight in high risk newborns. Learn about assessing infants after birth to determine weight, height, head circumference, and gestational age, and managing their immediate needs promptly.