High Risk Newborn: Altered Gestational Age or Birth Weight

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18 Questions

What is the term used to describe infants who fall between the 10th and 90th percentile of weight for their gestational age?

Appropriate for Gestational Age (AGA)

What is one of the most common problems for Small for Gestational Age (SGA) infants?

Hypoglycemia (decreased blood glucose)

What is a common problem for Small for Gestational Age (SGA) infants due to their underdeveloped chest muscles and risk of meconium aspiration syndrome?

Birth asphyxia

What physical characteristic of Small for Gestational Age (SGA) infants may indicate their lack of normal bone growth?

Widely separated skull sutures

What is the term used to describe infants who are above the 90th percentile of weight for their gestational age?

Large for Gestational Age (LGA)

What is a potential consequence of being Small for Gestational Age (SGA) that may have occurred due to lack of oxygen and nourishment in utero?

Cognitive development impairment

What is the most likely cause of respiratory difficulties in some LGA infants at birth?

Increased intracranial pressure from the larger-than-usual head

Which of the following is NOT a common finding in a small-for-gestational-age (SGA) infant?

Enlarged abdomen

What is the most serious type of ABO incompatibility in newborns?

Type B

What is the primary cause of hyperbilirubinemia in newborns?

Abnormal destruction of red blood cells

What is the purpose of using phototherapy in the management of hyperbilirubinemia in newborns?

To convert bilirubin to a more water-soluble form for excretion

What is the purpose of performing an exchange transfusion in the management of hyperbilirubinemia?

To decrease bilirubin levels

Which of the following conditions is associated with large for gestational age (LGA) infants?

Transposition of the great vessels

What is a common characteristic of small for gestational age (SGA) infants?

Wasted appearance

Which of the following is a potential problem for large for gestational age (LGA) infants?

Jaundice

What condition is characterized by overgrowth and associated with large for gestational age (LGA) infants?

Beckwith syndrome

Which of the following is a potential problem for small for gestational age (SGA) infants?

Hypoglycemia

What is a potential birth injury associated with large for gestational age (LGA) infants?

Cephalohematoma

Study Notes

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.

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