High Risk Newborn: Altered Gestational Age or Birth Weight

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What is the normal range for birth weight percentile for an infant considered appropriate for gestational age (AGA)?

Between the 10th and 90th percentile

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 is one of the most common problems for SGA infants due to their decreased glycogen stores?

Hypoglycemia

What physical characteristic may SGA infants display due to lack of normal bone growth?

Widely separated skull sutures

What is a potential consequence of impaired fetal growth and development for SGA infants?

Impaired cognitive development

What physical characteristic may SGA infants display due to their small body size?

Appear to have a large head

What is the most common congenital anomaly associated with LGA infants?

Omphalocele

What is the typical appearance of an SGA infant?

Wasted appearance, small liver, difficulty regulating glucose, protein, and bilirubin levels

What is the most common birth injury seen in LGA infants?

Broken clavicle

What is the most serious heart anomaly associated with macrosomia in LGA infants?

Transposition of the great vessels

What is the most important clinical sign to monitor for in LGA infants in the early hours of life?

Hypoglycemia

What is the most common physical characteristic of an LGA infant at birth?

Large head and prominent caput succedaneum

Which of the following is considered small for gestational age (SGA)?

Infants below the 10th percentile of weight for their age

What is the primary reason for an infant being small for gestational age (SGA)?

Intrauterine growth restriction (IUGR) or failed growth in utero

Which of the following conditions is NOT associated with an increased risk of having a small for gestational age (SGA) infant?

Maternal obesity

What is the term used to describe an infant whose birth weight is above the 90th percentile for their gestational age?

Macrosomia

Which of the following conditions is associated with an increased risk of having a large for gestational age (LGA) infant?

Severe diabetes mellitus in the mother

Which of the following statements about large for gestational age (LGA) infants is TRUE?

They are more likely to be born to multiparous mothers

What is the primary cause of respiratory distress in some LGA infants at birth?

Increased intracranial pressure from the larger-than-usual head

Which of the following is NOT a characteristic of the small-for-gestational-age infant described in the text?

Large head with widely separated sutures

What is the primary cause of hyperbilirubinemia in newborns described in the text?

Abnormal destruction of red blood cells due to Rh or ABO incompatibility

What is the initial therapeutic management for hyperbilirubinemia in newborns?

Initiation of early feeding

What is the purpose of the Coombs test in the management of hyperbilirubinemia?

To diagnose Rh or ABO incompatibility

What is the most serious type of ABO incompatibility described in the text?

Type B

Study Notes

Newborn Assessment

  • Infants need to be assessed after birth to determine weight, height, head circumference, and gestational age to determine immediate needs and manage promptly.
  • 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)

  • SGA infants are small for their age due to intrauterine growth restriction (IUGR) or failed to grow at the expected rate in utero.
  • Common etiologies include lack of adequate nutrition, pregnant adolescents, placental anomaly, and women with systemic diseases that decrease blood flow to the placenta.
  • SGA infants may have poor skin turgor, a large head, widely separated skull sutures, dull and lusterless hair, and a wasted appearance.
  • Common problems include hypoglycemia, birth asphyxia, and cognitive development impairment.

Large for Gestational Age (LGA)

  • LGA infants are above the 90th percentile of weight for their gestational age.
  • Common etiologies include women with diabetes mellitus, obesity, and multiparity.
  • LGA infants may have immature reflexes, low scores on gestational age examinations, extensive bruising, and a prominent caput succedaneum, cephalhematoma, or molding.
  • Common problems include hyperbilirubinemia, hypoglycemia, and transposition of the great vessels.

Assessment and Management

  • Prenatal assessment includes sonogram, non-stress test, and biophysical profile to determine fetal well-being.
  • Labs for SGA infants include hematocrit, polycythemia, and hypoglycemia.
  • Management for SGA infants includes intrauterine transfusions, induced preterm labor, and phenobarbital and Rh immunoglobulin for ABO incompatibility.

Hyperbilirubinemia

  • Elevated level of bilirubin in the blood due to destruction of RBCs by normal physiologic process or abnormal destruction of RBCs due to hemolytic disease of the newborn.
  • Causes include ABO incompatibility and Rh incompatibility.
  • Therapeutic management includes initiation of early feeding, phototherapy, and exchange transfusion.

This quiz covers the assessment and management of altered birth weight in newborn infants. Topics include determining weight, height, head circumference, and gestational age to address immediate needs effectively.

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