Pediatric Nursing: High risk newborn Part III
High risk newborn baby
High-Risk Newborn: defined as a newborn, regardless of gestational age or birth
weight, who has a greater-than-average chance of morbidity or mortality.
Classification of high-risk newborns: according to:
❖ Birth weight.
1. Low-birth-weight (LBW) infant: an infant whose birth weight is less than 2500
g, regardless of gestational age.
2. Very low-birth-weight (VLBW) infant: an infant whose birth weight is less than
1500g.
3. Extremely-low-birth-weight (ELBW) infant: an infant whose birth-weight is less
than1000g
❖ Gestational age
1. Premature (preterm) infant: an infant born before completion of 37 weeks of
gestation, regardless of birth weight.
2. Full-term infant: an infant born between the beginning of the 38 weeks and
the completion of the 42 weeks of gestation, regardless of birth weight.
3. Postmature (post-term) infant: an infant born after 42 weeks of gestational
age, regardless of birth weight.
❖ According to mortality
1. Live birth: birth in which the neonate manifests any heartbeat, breaths, or
displays voluntary movement, regardless of gestational age.
2. Fetal death: death of the fetus after 20 weeks of gestation and before delivery,
with absence of any signs of life after birth.
3. Neonatal death: death that occurs in the first 27 days of life; early neonatal
death occurs in the first week of life; late neonatal death occurs at 7-27 days.
4. Perinatal mortality—Describes the total number of fetal and early neonatal
deaths per 1000 live births.
5. Postnatal death—Death that occurs at 28 days to 1 year after birth.
Prematurity:
Other terms often used for prematurity are preterm. A baby born before 37 weeks of
pregnancy is considered premature. Many premature babies also weigh less than 2,500
grams.
Causes and risk factors of prematurity?
➢ Etiology of preterm birth:
1. Primary causes Unknown.
2. Maternal factors:
➢ Malnutrition.
➢ Chronic disease: heart, renal, diabetes.
➢ Infection disease.
3. Factors related to pregnancy.
➢ Hypertension.
➢ Placenta problems, e.g. placenta previa.
➢ Incompetent cervix.
➢ Premature rupture of membranes or chorioamnionitis.
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, Pediatric Nursing: High risk newborn Part III
4. Fetal factors:
➢ Chromosomal abnormalities.
➢ Intrauterine infection.
Characteristics of a premature baby?
1. Birth weight of less than 2500g.
2. Scrawny appearance.
3. Head disproportionately larger than chest circumference.
4. Poor muscle tone.
5. Minimal subcutaneous fat.
6. Undescended testes in males.
7. Prominent clitoris and labia minora in females.
8. Plentiful lanugo (soft, downy hair), especially over the face and back.
9. Poorly formed ear pinna, with soft, pliable cartilage.
10. Fused eyelids.
11. Soft and spongy skull bones, especially along suture lines.
12. Matted scalp hair, woolly in appearance.
13. Absent-to-a-few creases in the soles and palms.
14. Minimal scrotal rugae in male infants.
15. Thin, transparent skin with visible veins.
16. Breast and nipples not clearly delineated.
17. Abundant vernix caseosa.
Problems with premature babies:
• Respiratory Problems:
1-Respiratory Distress Syndrome (RDS):
➢ hyaline membrane immature
➢ lung immature
➢ due to lack of surfactant in the lung
2-Apnea: stopping breathing more than 20 seconds.
➢ Incomplete lung development.
➢ Brain immature.
• Cardiovascular problem
o Patent Ductus Arteriosus (PDA): abnormal opening between aorta and
pulmonary artery.
• Temperature instability (hypothermia) due to
➢ Skin immaturity.
➢ Decrease metabolic rate.
➢ Immature brain (hypothalamus).
➢ Minimal subcutaneous fat.
• Fluid and electrolyte imbalances related
➢ Kidney immature.
➢ Sweating gland immature.
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High risk newborn baby
High-Risk Newborn: defined as a newborn, regardless of gestational age or birth
weight, who has a greater-than-average chance of morbidity or mortality.
Classification of high-risk newborns: according to:
❖ Birth weight.
1. Low-birth-weight (LBW) infant: an infant whose birth weight is less than 2500
g, regardless of gestational age.
2. Very low-birth-weight (VLBW) infant: an infant whose birth weight is less than
1500g.
3. Extremely-low-birth-weight (ELBW) infant: an infant whose birth-weight is less
than1000g
❖ Gestational age
1. Premature (preterm) infant: an infant born before completion of 37 weeks of
gestation, regardless of birth weight.
2. Full-term infant: an infant born between the beginning of the 38 weeks and
the completion of the 42 weeks of gestation, regardless of birth weight.
3. Postmature (post-term) infant: an infant born after 42 weeks of gestational
age, regardless of birth weight.
❖ According to mortality
1. Live birth: birth in which the neonate manifests any heartbeat, breaths, or
displays voluntary movement, regardless of gestational age.
2. Fetal death: death of the fetus after 20 weeks of gestation and before delivery,
with absence of any signs of life after birth.
3. Neonatal death: death that occurs in the first 27 days of life; early neonatal
death occurs in the first week of life; late neonatal death occurs at 7-27 days.
4. Perinatal mortality—Describes the total number of fetal and early neonatal
deaths per 1000 live births.
5. Postnatal death—Death that occurs at 28 days to 1 year after birth.
Prematurity:
Other terms often used for prematurity are preterm. A baby born before 37 weeks of
pregnancy is considered premature. Many premature babies also weigh less than 2,500
grams.
Causes and risk factors of prematurity?
➢ Etiology of preterm birth:
1. Primary causes Unknown.
2. Maternal factors:
➢ Malnutrition.
➢ Chronic disease: heart, renal, diabetes.
➢ Infection disease.
3. Factors related to pregnancy.
➢ Hypertension.
➢ Placenta problems, e.g. placenta previa.
➢ Incompetent cervix.
➢ Premature rupture of membranes or chorioamnionitis.
1
, Pediatric Nursing: High risk newborn Part III
4. Fetal factors:
➢ Chromosomal abnormalities.
➢ Intrauterine infection.
Characteristics of a premature baby?
1. Birth weight of less than 2500g.
2. Scrawny appearance.
3. Head disproportionately larger than chest circumference.
4. Poor muscle tone.
5. Minimal subcutaneous fat.
6. Undescended testes in males.
7. Prominent clitoris and labia minora in females.
8. Plentiful lanugo (soft, downy hair), especially over the face and back.
9. Poorly formed ear pinna, with soft, pliable cartilage.
10. Fused eyelids.
11. Soft and spongy skull bones, especially along suture lines.
12. Matted scalp hair, woolly in appearance.
13. Absent-to-a-few creases in the soles and palms.
14. Minimal scrotal rugae in male infants.
15. Thin, transparent skin with visible veins.
16. Breast and nipples not clearly delineated.
17. Abundant vernix caseosa.
Problems with premature babies:
• Respiratory Problems:
1-Respiratory Distress Syndrome (RDS):
➢ hyaline membrane immature
➢ lung immature
➢ due to lack of surfactant in the lung
2-Apnea: stopping breathing more than 20 seconds.
➢ Incomplete lung development.
➢ Brain immature.
• Cardiovascular problem
o Patent Ductus Arteriosus (PDA): abnormal opening between aorta and
pulmonary artery.
• Temperature instability (hypothermia) due to
➢ Skin immaturity.
➢ Decrease metabolic rate.
➢ Immature brain (hypothalamus).
➢ Minimal subcutaneous fat.
• Fluid and electrolyte imbalances related
➢ Kidney immature.
➢ Sweating gland immature.
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