Newborns at Risk: Prematurity

• Newborns are considered at risk when maternal factors create hazards.
• Prematurity, birth defects, infection, and prenatal drug exposure are risk factors.

Premature Newborns

• Prematurity is birth before 37 weeks of gestation.
• Premature infants have immature body systems.
• Respiratory distress syndrome (RDS) is common due to immature lungs and surfactant deficiency.
• Preterm infants have fewer alveoli than term infants.
• Retinopathy of prematurity can occur due to high oxygen levels affecting immature retinal vessels.
• Apnea is common due to immature neurological control of breathing.
• Preterm infants have limited nutrient stores.
• They may have difficulty digesting proteins and absorbing fats.
• Preterm infants have limited ability to excrete metabolites and drugs.
• Preterm infants struggle with temperature regulation because of decreased brown fat, heat loss from a large surface area, and immature temperature-regulation mechanisms.
• Preterm infants are more susceptible to infection.
• Immature immune systems offer limited protection.

Post-Term Newborn

• Post-term newborns are born after 42 weeks gestation.
• These infants may experience problems related to placental insufficiency,
• The placenta's ability to provide oxygen and nutrients decreases over time.
• Post-term infants are often larger, increasing the risk of birth trauma.
• Some post-term infants may be thin with loose skin due to depletion of subcutaneous fat.
• Post-maturity syndrome includes characteristics like dry, cracking skin, long nails, and abundant scalp hair.
• There is an increased risk of meconium aspiration.
• There is an increased incidence of birth trauma.

Small for Gestational Age (SGA)

• These infants are below the 10th percentile in weight for their gestational age.
• SGA newborns may be preterm, term, or post-term.
• Factors contributing to SGA include maternal, placental, or fetal issues.
• SGA infants have a higher risk of complications like hypoglycemia and hypothermia.
• SGA infants have a higher risk of polycythemia

Large for Gestational Age (LGA)

• LGA newborns are above the 90th percentile in weight for gestational age.
• Often associated with gestational diabetes in the mother.
• LGA infants are at risk for birth injuries due to their size.
• LGA infants have a higher incidence of cesarean births.
• LGA infants are at risk for hypoglycemia, particularly in the first few hours after birth, due to high insulin levels in response to maternal glucose exposure during gestation

Newborns of Diabetic Mothers

• Infants of diabetic mothers (IDM) face specific risks.
• Maternal hyperglycemia leads to fetal hyperinsulinemia.
• After birth, the newborn's high insulin level can cause hypoglycemia.
• IDMs are often LGA but may have immature organ systems.
• There is an increased risk of birth defects, especially cardiac and neural tube defects.
• Monitor for respiratory distress syndrome, hypocalcemia, and polycythemia.

Newborn Infections

• Newborns are susceptible to infections due to immature immune systems.
• Infections can be acquired in utero, during delivery, or postpartum.
• Common infections include sepsis, pneumonia, and meningitis.
• Group B Streptococcus (GBS) is a common cause of early-onset sepsis.
• Herpes simplex virus (HSV) infection can be devastating in newborns.
• Congenital infections include toxoplasmosis, rubella, cytomegalovirus (CMV), and syphilis (TORCH).
• Infections may present with subtle signs like temperature instability, poor feeding, or lethargy.

Neonatal Abstinence Syndrome (NAS)

• NAS occurs when a newborn is exposed to drugs in utero and experiences withdrawal after birth.
• Opioids, alcohol, and other substances can cause NAS.
• Symptoms include irritability, tremors, high-pitched cry, and feeding difficulties.
• Severity of symptoms varies depending on the drug and duration of exposure.
• Treatment includes supportive care and, in some cases, medication.

Hyperbilirubinemia

• Hyperbilirubinemia is elevated bilirubin levels in the blood.
• It can cause jaundice, a yellowing of the skin and eyes.
• Physiologic jaundice is common and usually resolves without treatment.
• Pathologic jaundice occurs within the first 24 hours of life or if bilirubin levels are very high.
• Untreated hyperbilirubinemia can lead to kernicterus, a form of brain damage.
• Treatment includes phototherapy and, in severe cases, exchange transfusion.

Birth Defects

• Congenital anomalies are structural or functional abnormalities present at birth.
• Genetic factors, environmental factors, or unknown causes can lead to birth defects.
• Common defects include heart defects, neural tube defects, and cleft lip/palate.
• Early detection and intervention are critical to improve outcomes.

Hemolytic Disease

• Hemolytic disease occurs when there is an incompatibility between the mother's and newborn's blood types.
• Rh incompatibility and ABO incompatibility are common causes.
• Maternal antibodies attack the newborn's red blood cells,
• This can lead to anemia and hyperbilirubinemia.
• Rh incompatibility can be prevented with Rh immunoglobulin (RhoGAM) administration to Rh-negative mothers.

Respiratory Distress Syndrome (RDS)

• RDS is primarily a disease of prematurity.
• It is caused by a deficiency of surfactant in the lungs.
• Surfactant reduces surface tension and prevents alveolar collapse.
• Symptoms include rapid breathing, grunting, and nasal flaring.
• Treatment includes surfactant administration, oxygen therapy, and mechanical ventilation.

Meconium Aspiration Syndrome (MAS)

• MAS occurs when the newborn inhales meconium-stained amniotic fluid.
• Meconium can block the airways and cause inflammation of the lungs.
• Symptoms include respiratory distress and cyanosis.
• Treatment includes suctioning, oxygen therapy, and mechanical ventilation.