Premature Infant Classification Quiz

Premature Infant

• Delivered after 42 weeks of gestation
• Abundant scalp hair
• Visible creases on palms and soles of feet with minimal fat deposits
• Absence of lanugo

Intrauterine Growth Restriction (IUGR) and Small for Gestational Age (SGA) Infants

• Infants whose rate of intrauterine growth was slowed
• Birth weight falls below the 10th percentile on the intrauterine growth chart
• Causes:
  • Poor nutrition during pregnancy
  • Placental defects and complications
  • Teenage pregnancies
  • Hypertensive mother
  • Age: under 18 or over 35 years old
  • Poor nutrition during pregnancy
  • Maternal condition (HPN, anemia, DM)

Priority Nursing Care in the First Few Days

• Initiation and maintenance of respirations
• Maintenance of hydration and normal glucose
• Thermoregulation
• Correct IVF rate
• Breastfeeding (q 3-4 hrs)
• Control of body temperature
• Maintain neutral thermal environment
• Monitor vital signs
• Keep the newborn hydrated
• Assess integrity of the skin

Large for Gestational Age (LGA) Infants

• Birth weight falls above the 90th percentile on the intrauterine charts
• Weighs more than 4000g
• Have been subjected to an overproduction of growth hormone in utero
• Clinical manifestations:
  • Large (> 9 lbs)
  • Plump full face
  • Body size is proportionate
  • Poor motor skills
  • Difficulty regulating behavioral state
• Complications:
  • Fetal (stillbirth, anomalies, shoulder dystocia)
  • Neonatal (low APGAR score, hypoglycemia, birth injury, hypocalcemia, polycythemia, jaundice, feeding difficulties)
  • Long-term (obesity, type 2 diabetes, neurologic or behavioral problems)

Nursing Care for LGA Infants

• Observe for potential complications
• Monitor blood glucose

Respiratory Distress Syndrome (RDS)

• Condition of surfactant deficiency and physiologic immunity of the thorax
• Diagnostic exams:
  • X-ray
  • Blood glucose
  • Arterial Blood Gas Analysis (ABG)
  • Fetal Lung Maturity Assay
• Diagnostic findings:
  • Diffuse granular pattern like broken glass appearance on chest x-ray
  • Hypoxemia
  • Increased carbon dioxide
  • Respiratory acidosis on ABG
• Medications:
  • Artificial surfactant
  • Nitric oxide
• Clinical manifestations:
  • Tachypnea (> 60)
  • Flaring nares
  • Expiratory grunting, dyspnea
  • Chest retractions (sternal and subcostal)
  • Seesaw respirations

Meconium Aspiration Syndrome (MAS)

• Aspiration of amniotic fluid containing meconium into fetal or newborn trachea in utero at first breath
• Occurs primarily in full-term and post-term infants
• Assessment:
  • Widened anteroposterior diameter of the chest (barrel-chest)
  • Greenish stains on the skin, umbilical cord, and nail
• Priority nursing care:
  • Assist in tracheal suctioning
• Nursing care:
  • Suctioning (oropharyngeal and tracheal)
  • O2 support
  • Severe: Extracorporeal Membrane Oxygenation
  • Exogenous surfactant administration
  • IV fluid administration
  • Administer systemic antibiotics as prescribed

Sudden Infant Death Syndrome (SIDS)

• Sudden unexpected death of any infant younger than 1 year of age
• Death usually occurs during sleep – “crib death”
• Most common cause of death in children ages 1 month to 1 year
• Peak: 2-4 months, 90% before 6th month
• Nursing management:
  • Teach parents how to minimize the risk of SIDS
  • Avoid smoking during and after pregnancy
  • Encourage sleep on the back or side