UNIT II: Nursing Care of the High-

Risk Newborn to Maturity

Chapter I. Problems Related to Maturity

A. Prematurity
B. Postmaturity
*A live-born infant born before the end of
week 37 of gestation
*Another criterion used is a weight of less
than 2500 g (5 lb 8 oz) at birth.
*Specific problems of prematurity:
*respiratory distress syndrome
*hypoglycemia,
*intracranial hemorrhage.
*All preterm infants need intensive care from the
moment of birth to give them their best chance of
survival without neurologic after-effects.
*The maturity of a newborn is determined by:
*physical findings such as:
*sole creases
*skull firmness
*ear cartilage
*neurologic findings that reveal gestational age
*mother’s report of the date of her last menstrual
period
*sonographic estimations of gestational age.
Common Factors Associated With Preterm Birth:

• Low socioeconomic level

• Poor nutritional status
• Lack of prenatal care
• Multiple pregnancy
• Previous early birth
• Race (nonwhites have a higher incidence of
prematurity than whites)
• Cigarette smoking
• Age of the mother (highest incidence is in
mothers younger than age 20)
• Orderof birth (early termination is highest in first
pregnancies and in those beyond the fourth
pregnancy)
• Closely spaced pregnancies
• Abnormalities of the mother’s reproductive system,
such as intrauterine septum
• Infections (especially urinary tract infection)
• Obstetric complications, such as premature
rupture of membranes or premature separation of
the placenta
• Early induction of labor
• Elective cesarean birth
*A detailed pregnancy history may sometimes reveal the
reason for a preterm birth.
*When interviewing parents of a preterm infant, be
careful not to convey disapproval of reported
pregnancy behaviors
*A good answer to her direct inquiries about causes is,
“No one really knows what causes prematurity.”
*Teaching about better pregnancy practices can wait
until she is ready for a second pregnancy.
*In many instances, preterm labor might have been halted
had a woman been able to recognize she was in true labor
and not having Braxton Hicks contractions. In a first labor,
this can easily occur because a woman does not know how
true labor feels.
*Often a woman reports that she thought she was
having intestinal cramps.
*On gross inspection, a preterm infant appears small
and underdeveloped
*The head is disproportionately large (3 cm greater
than chest size).
*The skin is generally unusually ruddy because there
is little subcutaneous fat beneath it
*Veins are easily noticeable
*A high degree of acrocyanosis may be present.
*Covered with vernix caseosa
*Very preterm newborns (less than 25
weeks’ gestation)
*Vernix is absent because it is not formed
this early in pregnancy Lanugo is usually
extensive, covering the back, forearms,
forehead, and sides of the face
*Both anterior and posterior fontanelles
are small
*There are few or no creases on the soles
of the feet.
*Physical findings and reflex testing are used to
differentiate between term and preterm newborns.
*The eyes of most preterm infants appear small
*Pupillary reaction is present
*Ophthalmoscopic examination is extremely difficult
and often uninformative because the vitreous humor
may be hazy.
*Has varying degrees of myopia (nearsightedness)
because of lack of eye globe depth
*The ears appear large in relation to the head
*The cartilage of the ear is immature and allows the pinna
to fall forward
*The level of the ears should be carefully inspected to rule
out chromosomal abnormalities
*Neurologic function in the preterm infant is
often difficult to evaluate as the neurologic
system is still so immature.
*Reflexes such as sucking and swallowing will
be absent if an infant’s age is below 33
weeks
*Deep tendon reflexes such as the Achilles
tendon reflex are also markedly diminished
*During an examination, a preterm infant is
much less active than a mature infant and
rarely cries
*If the infant does cry, the cry is weak and
high-pitched.
*Anemia of Prematurity
*Kernicterus
*Persistent Patent Ductus Arteriosus
*Periventricular/Intraventricular
Hemorrhage
*Other Potential Complications
*Respiratory distress syndrome
*Apnea
*Retinopathy of prematurity
*Necrotizing Enterocolitis
*An infant born after the 42nd week
of a pregnancy
*Most nurse-midwives and
obstetricians recommend inducing
labor at 2 weeks postterm to avoid
postmature births.
*An infant who stays in utero past week 42 of pregnancy
is at special risk because:
*A placenta appears to function effectively for only 40
weeks.After
*A fetus who remains in utero with a failing placenta
may die or develop postterm syndrome.
*They may be lightweight from a recent weight loss that
occurred because of the poor placental function.
*The amount of amniotic fluid may be less at birth than
normal, and it may be meconium stained.
*Fingernails will have grown well beyond the end of the
fingertips
*Such infants may demonstrate an alertness much more like
a 2-week-old baby than a newborn.
*A sonogram is usually obtained to
measure the biparietal diameter of the
fetus.
*A nonstress test or complete
biophysical profile may be done to
establish whether the placenta is still
functioning adequately
*Cesarean birth may be indicated if a
nonstress test reveals that compromised
placental functioning may occur during
labor.
At birth, the postterm baby is likely to have:
*difficultyestablishing respirations, especially if
meconium aspiration occurred
*Hypoglycemia may develop because the fetus had to
use stores of glycogen for nourishment in the last
weeks of intrauterine life
*Subcutaneous fat levels may also be low, having been
used in utero
*Polycythemia may have developed from decreased
oxygenation in the final weeks
*The hematocrit may be elevated because the
polycythemia and dehydration have lowered the
circulating plasma level.
*Make sure a woman spends enough time with
her newborn to assure herself that although
birth did not occur at the predicted time,
the baby should do well with appropriate
interventions to control possible
hypoglycemia or meconium aspiration.
*All postterm infants need follow-up care
until at least school age to track their
developmental abilities.
*The lack of nutrients and oxygen in utero may
have left them with neurologic symptoms
that will not become apparent until they
attempt fine-motor tasks.