Nursing Care for Newborns

Newborn Care

• Risk for deficient fluid volume in newborns is due to insensible water loss at birth and small stomach.
• Monitoring weight, urine output, specific gravity, and serum electrolytes is crucial in newborns.

Premature Newborns

• Premature infants are defined as live-born infants born before the end of week 37 of gestation.
• Premature infants have physiologic and anatomic immaturity of various organs and systems at the time of birth.
• Premature infants have a weight of less than 2,500g (5lb 8 oz) at birth.
• Risk factors for premature birth include low socioeconomic level, poor nutritional status, lack of prenatal care, multiple pregnancy, previous early birth, race, cigarette smoking, age of the mother, and abnormalities of the mother's reproductive system.

Characteristics of Premature Newborns

• Large body surface area relative to total body weight.
• Immature reflexes, poor swallowing and sucking, and small stomach.
• Regurgitate readily due to immature cardiac sphincter.
• Immature digestion and absorption.
• Risk for hypoglycemia due to less nutrients.
• Intracranial hemorrhage and respiratory distress syndrome are common complications.

Management of Premature Newborns

• IVF administration via continuous infusion pump to prevent hypoglycemia.
• Provide glucose and prevent hypoglycemia.
• Monitor weight, urine output, specific gravity, and serum electrolytes.
• Use total parenteral nutrition (TPN) for very preterm infants.
• Monitor for sucking difficulty, and small stomach.
• Provide gavage feeding, and use a softer nipple to prevent exhaustion.

Risk for Imbalanced Nutrition

• Risk for imbalanced nutrition is due to additional nutrients needed for maintenance of rapid growth and small stomach.
• Nutrients may not be supplied, and hypocalcemia and azotemia may develop.
• Feeding schedule should be established, and gavage feeding may be used.
• Breast milk expression or breast pump can be used.

Ineffective Thermoregulation

• Premature newborns have ineffective thermoregulation due to immaturity.
• Large surface area to body weight ratio, extended position, rapid cooling from evaporation, little subcutaneous fat, and poor muscular development contribute to heat loss.
• Keep the baby warm using heat warmers, skin-to-skin contact, incubators, and plastic wrap.

Macrosomia (Large for Gestational Age)

• Macrosomia is also known as large for gestational age.
• The birthweight is above the 10th percentile on an intrauterine growth curve for that age.
• Characteristics of macrosomia include a head that is disproportionately large, and fingernails that have grown well beyond the end of the fingertips.

Small for Gestational Age (SGA)

• SGA is defined as a birthweight below the 10th percentile on an intrauterine growth curve for that age.
• The most common cause of SGA is placental anomaly.
• Risk factors for SGA include cigarette smoking, use of narcotics, and women with severe diabetes mellitus.

Postmaturity

• Postmaturity is defined as a birth after 42 weeks of gestation.
• Characteristics of postmaturity include a large body size, less amniotic fluid, and meconium-stained amniotic fluid.
• Management of postmaturity includes sonogram, non-stress test, and complete biophysical profile.
• Cesarean birth may be necessary if the non-stress test reveals compromised placental functioning.
• Postmature babies may have difficulty establishing respirations, hypoglycemia, and polycythemia.