ASSIGNMENT

ON
IDENTIFICATION, CLASSIFICATION
&
NURSING MANAGEMENT OF HIGH
RISK NEWBORN

Submitted to Submitted by
Dr.(Mrs.)Sukhwinder Kaur Jeena James
Lecturer M.Sc. Nursing 1 st year
INTRODUCTION
The high-risk neonate can be defined as a newborn, regardless of gestational age or birth weight, who
has a greater than average chance of morbidity or mortality because of conditions or circumstances
that are superimposed on the normal course of events associated with birth and adjustment to
extrauterine existence. The high-risk period encompasses human growth and development from the
time of viability up to 28 days following birth and includes threat to life and health that occur during
the prenatal, perinatal and postnatal periods.

IDENTIFICATION OF HIGH-RISK NEWBORNS

High-risk newborns are associated with certain conditions; when one or more of these are present,
nursery staff should be aware and prepared for possible difficulties. The cord blood and placenta
should be saved after delivery in all cases of high-risk delivery, including cases that involve transfer
from the birth hospital, since an elusive diagnosis such as toxoplasmosis may be made on the basis of
placental pathology.
The following factors are associated with high-risk newborns:
A. Maternal characteristics and associated risk for fetus or neonate
1. Age at delivery
a. Over 40 years. Chromosomal abnormalities, macrosomia, intrauterine growth
restriction (IUGR), blood loss (abruption, previa).
b. Under 16 years. IUGR, prematurity, child abuse/neglect (mother herself may be
abused).
2. Personal factors
a. Poverty. Prematurity, infection, IUGR.
b. Smoking. IUGR, increased perinatal mortality.
c. Drug/alcohol use. IUGR, fetal alcohol syndrome, withdrawal syndrome, sudden
infant death syndrome, child abuse/neglect.
d. Poor diet. Mild IUGR to fetal demise in severe malnutrition.
e. Trauma (acute, chronic). Abruptio placentae, fetal demise, prematurity.
3. Maternal medical conditions and associated risk for fetus or neonate
 a. Diabetes mellitus. Congenital anomalies, stillbirth, respiratory distress. syndrome
(RDS), hypoglycemia, macrosomia/birth injury
b. Thyroid disease. Goiter, hypothyroidism, hyperthyroidism (see Chap. 2B).
c. Renal disease. IUGR, stillbirth, prematurity.
d. Urinary tract infection. Prematurity, sepsis.
e. Heart, lung disease. IUGR, stillbirth, prematurity.
f. Hypertension (chronic or pregnancy-related). IUGR, stillbirth, asphyxia, prematurity.
g. Anemia. IUGR, stillbirth, asphyxia, prematurity, hydrops.
h. Isoimmunization (red cell antigens). Stillbirth, anemia, jaundice, hydrops.
i. Isoimmunization (platelet antigens). Stillbirth, bleeding.
j. Thrombocytopenia. Stillbirth, bleeding.
4. Obstetric history and associated risk for fetus or neonate
a. Past history of infant with prematurity, jaundice, RDS, or anomalies. Same with
current pregnancy.
b. Maternal medications.
c. Bleeding in early pregnancy. Stillbirth, prematurity.
d. Hyperthermia. Fetal demise, fetal anomalies.
e. Bleeding in third trimester. Stillbirth, anemia.
f. Premature rupture of membranes. Infection/sepsis.
g. TORCH infections.
h. Trauma. Fetal demise, prematurity.
B. Fetal conditions and associated risk for fetus or neonate
1. Multiple gestation. Prematurity, twin-twin transfusion syndrome, IUGR, asphyxia, birth
trauma.
2. IUGR. fetal demise, congenital anomalies, asphyxia, hypoglycemia, polycythemia.
3. Macrosomia. Congenital anomalies, birth trauma, hypoglycemia.
4. Abnormal fetal position/presentation. Congenital anomalies, birth trauma, hemorrhage.
5. Abnormality of fetal heart rate or rhythm. Hydrops, asphyxia, congestive heart failure, heart
block.
 6. Decreased activity. Fetal demise, asphyxia.
7. Polyhydramnios. Anencephaly, other central nervous system (CNS) disorders,
neuromuscular disorders, problems with swallowing (e.g., agnathia, esophageal atresia),
chylothorax, diaphragmatic hernia, omphalocele, gastroschisis, trisomy, tumors, hydrops,
isoimmunization, anemia, cardiac failure, intrauterine infection, inability to concentrate
urine, maternal diabetes. (May also be associated with large but otherwise well infant.)
8. Oligohydramnios. IUGR, placental insufficiency, postmaturity, fetal demise, intrapartum
distress, renal agenesis, pulmonary hypoplasia, deformations.
C. Conditions of labor and delivery and associated risk for fetus or neonate
1. Premature labor. RDS, other issues of prematurity.
2. Post-term labor (occurring more than 2 weeks after term). Stillbirth, asphyxia, meconium
aspiration.
3. Maternal fever. Infection/sepsis.
4. Maternal hypotension. Stillbirth, asphyxia.
5. Rapid labor. Birth trauma, intracranial hemorrhage (ICH), retained fetal lung fluid/transient
tachypnea.
6. Prolonged labor. Stillbirth, asphyxia, birth trauma.
7. Abnormal presentation. Birth trauma, asphyxia.
8. Uterine tetany
9. Meconium-stained amniotic fluid. Stillbirth, asphyxia, meconium aspiration syndrome,
persistent pulmonary hypertension.
10. Prolapsed cord
11. Cesarean section. RDS, retained fetal lung fluid/transient tachypnea, blood loss.
12. Obstetric analgesia and anesthesia. Respiratory depression, hypotension, hypothermia.
13. Placental anomalies.
a. Small placenta. IUGR.
b. Large placenta. Hydrops, maternal diabetes, large infant.
c. Torn placenta and/or umbilical vessels. Blood loss.
d. Abnormal attachment of vessels to placenta. Blood loss.
D. Immediately evident neonatal conditions and associated risk for fetus or neonate
1. Prematurity. RDS, other sequelae of prematurity.
2. Low 5-minute Apgar score. Prolonged transition (especially respiratory).
3. Low 15-minute Apgar score. Cardiac failure, renal failure, severe neurologic damage.
4. Pallor or shock. Blood loss.
5. Foul smell of amniotic fluid or membranes. Infection.
6. Small size for gestational age (GA).
7. Postmaturity.

CLASSIFICATION OF HIGH-RISK NEWBORNS

High-risk infants are most classified according to birth weight, gestational age and predominant
pathophysiologic problems. The more common problems related to physiologic status is closely
associated with the state of maturity of the infant and usually involves chemical disturbances (e.g.,
hypoglycemia, hypocalcaemia) and consequences of immature organs and systems (e.g.,
hyperbilirubinemia, respiratory distress, hypothermia).
Formerly, weight at birth was considered to reflect a reasonably accurate estimation of gestational age.
That is, if infant’s birth weight is exceeded 2500 gm they were considered to be mature. However,
intrauterine growth rates are not the same for all infants, and other factors (e.g. , heredity, placental
insufficiency, and maternal disease) influence intrauterine growth and birth weight. The lowest
perinatal mortality is found in the full-term infant who weighs between 3000 and 4000 gms.
CLASSIFICATION ACCORDING TO SIZE
 Low-birth-weight (LBW) infant: An infant whose birth weight is less than 2500g regardless of
gestational age.
 Very-very-low-birth-weight (VVLBW) or extremely-low-birth-weight (ELBW) infant: An infant
whose birth weight is less than 1000g.
 Very-low-birth-weight (VLBW) infant: An infant whose birth weight is less than 1500g.
 Moderately-low-birth-weight (MLBW) infant: An infant whose birth weight is 1501 to 2500g.
 Appropriate- for-gestational-age (AGA) infant: An infant whose weight falls between the 10 th
and 90th percentiles on intrauterine growth curves.
  Small-for-date (SFD) or small-for-gestational-age (SGA) infant: An infant whose rate of
intrauterine growth was slowed and whose birth weight falls below 10 th percentile on
intrauterine growth curves.
 Intrauterine growth retardation (IUGR): Found in infants whose intrauterine growth is
retarded (sometimes used as a more descriptive term for the SGA infant)
 Large-for-gestational-age (LGA) infant: An infant whose birth weight falls above the 0 th
percentile on intrauterine growth charts.
CLASSIFICATION ACCORDING TO GESTATIONAL AGE
 Premature (preterm) infant: An infant born before completion of 37 weeks of gestation,
regardless of birth weight.
 Full-term infant: An infant born between the beginning of 38 weeks and the completion of the
42 weeks of gestation, regardless of birth weight.
 Post mature (post term) infant: An infant born after 42 weeks of gestational age, regardless of
birth weight.
CLASSIFICATION ACCORDING TO MORTALITY
 Live birth: Birth in which the neonate manifests any heartbeat, breaths or displays voluntary
movement, regardless of gestational age.
 Fetal death: Death of the fetus after 20 weeks of gestation and before delivery, with absence of
any signs of life after birth.
 Neonatal death: Death that occurs in the 27 days of life; early neonatal death occurs in the first
week of life; late neonatal death occurs at 7 to 27 days.
 Perinatal mortality: Describes the total number of fetal and early neonatal deaths per 1000 live
births.
 Postnatal death: Death that occurs at 28 days to 1 year.

NURSING MANAGEMENT OF HIGH-RISK NEWBORN

Delivery of preterm baby must be attended by neonatologist for prompt management. Expert nursing
care is essential for better recovery from various problems due to physiological handicaps.
The needs of small babies require careful management in order to maximize their potential, both in the
present and the future. These needs encompass:
 Respiratory status
 Thermal environment
 Nutrition and growth
 Infection prevention
 Observation and assessment
 Drug administration
 Pain relief
 Skin integrity
 Positioning
 Parental involvement

CARE OF PRETERM BABIES

Efficient resuscitation and prevention of hypothermia are important aspect of care at birth. Delayed
cord clamping may improve the iron stores and reduce the incidence of hyaline membrane disease. It
should be according to baby’s condition. Continuous breathing support may be necessary. Warmth
should be maintained by heat source, vitamin K 0.5 mg should be administered intramuscularly. Then
after stabilization of condition, the baby should be transferred to neonatal intensive care unit (NICU)
for special care with all precautions.

CARE AT NEONATAL INTENSIVE CARE UNIT

Neonatal intensive care unit (NICU) should provide as like as intrauterine environment for the preterm
neonates. The NICU should be warm, free from excessive sound and have smoothing light. Protection
from infections should be ensured by aseptic measures and effective hand washing. Rough handling
and painful procedures should be avoided. Baby should be placed on a soft-comfortable, nestled and
cushioned bed. Continuous monitoring of the baby’s clinical status is vital aspect of management which
depends upon the gestational age of the baby.

Baby can be placed in prone position during care. Prone posture makes the neonates comfortable, less
cry and reduced chance of aspiration. This position relieves abdominal comfort, improves ventilation
and enhances arterial oxygenation. Unsupervised prone position may cause sudden infant death
syndrome (SIDS).

INITIATION AND MAINTENANCE OF RESPIRATION IN THE PREMATURE INFANT

Initiation and maintenance of respiration in the premature infant is of primary concern. The lung
maturity varies in accordance with the degree of prematurity, drugs given before hand, and/or
prolonged stress before delivery. The alveoli began to form at twenty six to twenty eight weeks
gestation. The longer the delivery of the baby can be delayed, the greater will be the ability of the
lungs to sustain extrauterine life.

a) At the moment of delivery, the newborn must switch from passive reception of oxygen to
establishing and maintaining ventilation by untried lungs. Not infrequently, the premature
infant is incapable of this task, making resuscitation necessary. The respiratory muscles are
poorly developed, the chest wall lacks stability, and production of surfactant is reduced.
Effective resuscitation must be established to prevent the development of irreversible
respiratory acidosis.
b) The infant should be positioned to allow for easy drainage of mucus from his mouth. Very small
infants are placed on their side, whereas, large infants are placed on their abdomen. The
infant's head may be tilted down except when danger of increased intracranial pressure or
increased respiratory distress, which is due to his liver pressing on the diaphragm.
c) The best way to evaluate the baby's oxygen status is through arterial blood gases. Caution must
be applied during the administration of 100% oxygen during resuscitation or to maintain
respirations because it places the immature infant in danger of developing pulmonary edema or
retrolental fibroplasia.
d) The infant needs continuous monitoring/assessment for:
 1. Respiratory rate, depth, and regularity.
2. Periods of apnea greater than 20 seconds.
3. Respiratory rate after apneic episode (same, increased, or decreased).
4. See-saw respirations.
5. Expiratory grunting.
6. Chin tug.
7. Retractions.
8. Nasal flaring.
9. Cry (feeble, whining, and high-pitched).
10. Heart rate (usually increased).
11. Cyanosis (when it occurs, where, relieved by O2, and amount of O2 needed).
12. Reflexes (gag and swallow).
13. Prebirth history.

MAINTENANCE OF BODY TEMPERATURE IN THE PREMATURE INFANT

Immediately after birth, dry the newborn with a warmed towel and then place him/her in a second
warm, dry towel before performing the assessment. This drying prevents rapid heat loss secondary to
evaporation. Newborns who are active, breathing well and crying are stable and can be placed on their
mother’s chest (kangaroo care) to promote warmth and prevent hypothermia. Preterm newborns who
are not considered stable may be placed unsder a radiant warmer or in a warmed isolette after they
are dried with a warmed towel.

Typically newborns use nonshivering thermogenesis for heat production by metabolizing their own
brown adipose tissue. However, the preterm newborns have an inadequate supply of brown fat
because he or she left the uterus before it was adequate. The preterm newborns also have decreased
muscle tone and thus cannot assume the flexed fetal position, which reduces the amount of skin
exposed to a cooler environment. In addition, preterm newborns have large body surface areas
compared to weight. This allows an increased transfer of heat from their bodies to the environment.
Typically, a preterm newborn who is having problems with thermal regulation is cool to cold to the
touch. The hands, feet and tongue may appear cyanotic. Respirations are shallow or slow or signs of
respiratory distress are present. The newborn is lethargic and hypotonic, feeds poorly and has a feeble
cry. Blood glucose levels are probably low, leading to hypoglycemia due to the energy expended to
keep warm.

When promoting thermal regulation for the preterm newborn remember the four mechanisms for
heat transfer and ways to prevent loss

 Convection : heat loss through air currents(avoid drafts near the newborn)
 Conduction: heat loss through direct contact (warm everything the newborn comes in contact
with, such as blankets, mattress, stethoscope)
 Radiation: heat loss without direct contact (keep isolettes away from cold sources and provide
insulation to prevent heat transfer)
 Evaporation : heat loss by conversion of liquids into vapour (keep the newborn dry and delay
the firs bath until the baby’s temperature is stable)
 Frequently assess the temperature of the isolette or radiant warmer, adjusting th temperature
as necessary to prevent hypo – hyperthermia.
 Assess the newborn’s temperature every hour until stable.
 Observe for clinical signs of cold stress auch as respiratory distress, central cyanosis,
hypoglycemia, lethargy, weak cry, abdominal distension, apnea bradcardia and acidosis.
 Remember the complications of hypothermia and frequently assess the newborn for signs:
 Metabolic acidosis secondary to anaerobic metabolism used for heat production, which results
in the production of lactic acid.
 Hypoglycemia due to depleted glycogen stores.
 Pulmonary hypertension secondary to pulmonary vasoconstriction
 Monitor the newborn for signs of hyperthermia such as tachycardia, tachypnea, apnea, warm
to touch, flushed skin, lethargy, weak or absent cry and CNS depression, adjust the
environmental temperature appropriately.
  Explain to the parents the need to maintain newborn’s temperature including the measures
used, demonstrate ways to safeguard warmth and prevent heat loss.

MAINTENANCE OF ADEQUATE NUTRITION IN THE PREMATURE INFANT

Providing nutrition is challenging for preterm newborns because their needs are great but their ability
to take in optimal amounts of energies/ calories is reduced due to their compromised health status.
Individual nutritional needs are highly variable.

Depending on their gestational age, preterm newborns receive nutrition orally, enterally or parentrally
via infusion. Several different methods can be used to provide nutrition: parental feedings
administered through a percutaneous central venous catheter for long term venous access with
delivery of total parenteral nutrition (TPN) or enteral feedings, which can include oral
feedings( formula or breast milk), continuous nasogastric tube feedings or intermittent Gavage tube
feedings. Gavage feedings are commonly used for compromised newborns to allow them to rest during
the feeding process. Many have a weak suck and thus cannot consume enough calories to meet their
needs.

Most newborns born after 34 weeks gestation without significant complication can feed orally. Those
born before 34 weeks gestation typically start with parenteral nutrition within the first 24 hours of life.
Then enteral nutrition is introduced and advanced based on the degree of maturity and clinical
condition. Ultimately, enteral nutrition methods replace parenteral nutrition methods.

To promote nutrition and fluid balance in the preterm newborn:

 Monitor daily weight and plot it on a growth curve.

 Monitor intake, calculate fluid and calorie intake daily.
 Assess fluid status by monitoring weight, urinary output, urine specific gravity, laboratory test
results such as serum electrolyte levels, blood urea nitrogen, Creatinine and hematocrit, skin
turgor and fontanel’s. Be alert for signs of dehydration such as decrease in urinary output,
sunken fontanels, temperature elevation, lethargy and tachypnea.
  Continually assess for enteral feeding intolerance, measure abdominal girth, auscultate bowel
sounds and measure gastric residuals before the next tube feedings.
 Encourage and support breast feeding by facilitating maternal breast pumping.
 Encourage nuzzling at the breast in conjunction with kangaroo care if the newborn is stable.

PREVENTION OF INFECTION IN THE PREMATURE INFANT

Preventing infection is critical when caring for preterm newborns. Infections are the most common
cause of mortality and morbidity in the NICU population. Nursing assessment and early identification of
problems are imperative to improve outcomes.

Preterm newborns are at risk for infection because their early birth deprived them of maternal
antibodies needed for passive protection. The baby also has a lower resistance to infection because of
a white blood cell count that is lower than the term infant. Preterm newborns are susceptible to
infection because of their limited ability to produce antibodies, asphyxia at birth and thin, friable skin
that is easily traumatized, providing an entry portal for micro organisms.

Early detection is crucial. The clinical manifestations can be nonspecific and subtle: apnea, diminished
activity, poor feeding, temperature instability, respiratory distress, seizures, tachycardia, hypotonia,
irritability, pallor, jaundice and hypoglycemia. Report any of these to the primary care provider
immediately so that treatment can be instituted.

Include the following interventions when caring for a preterm or post term newborn to prevent
infection.

 Assess for risk factors in maternal history that place the newborn at increased risk.
 Monitor for changes in vital signs such as temperature instability. Tachycardia or tachypnea.
 Assess oxygen saturation levels and initiate oxygen therapy as ordered if oxygen saturation
levels fall below acceptable parameters.
 Assess feeding intolerance, typically an early sign of infection.
 Monitor laboratory test results for changes.
  Avoid using tape on the newborn’s skin to prevent tearing.
 Use equipment that can be thrown away after use.
 Adhere to standard precautions, use clean gloves to handle dirty diapers and dispose of them
properly.
 Use sterile gloves when assisting with any invasive procedures, attempt to minimize the use of
invasive procedures.
 Remove all jewellery on your hands prior to washing hands, wash hand upon entering the
nursery and in between caring for newborns.
 Avoid coming to work when ill, and screen all visitors for contagious infection.

CLOSE OBSERVATION

The physician examines the premature baby on a regular basis and writes specific orders concerning
treatment and nursing care. The physician also relies on the assessment done by the NICU nurses and
must be notified of any significant changes in the baby’s condition. The experienced NICU nurses
observe and charts care and treatment with general accuracy. Sudden changes require interventions
and should be reported immediately.

NURSING OBSERVATIONS IN CARE OF PRETERM INFANTS

Characteristics Observations
Color Paleness, cyanosis, jaundice

Respirations Regularity, apnea, sterna retractions, labored

breathing, grunting

Pulse Rate and regularity

Abdomen Distention

Stools Frequency, color, consistency

Skin Rashes, irritation, pustules, edema, birthmarks

Cord Discharge, color, redness

Eyes Discharge
Feeding Sucking ability, vomiting or regurgitation,
degree of satisfaction

Mucous membranes Dryness of lips and mouth, signs of thrush

Voiding Initial, frequency (1- 2ml/kg/hour is normal)

Fontanels Sunken or bulging

General activity Increase or decrease in movements, lethargy,

twitching, frequency and quality of cry,
hyperactivity

GENTLE RHYTHMIC STIMULATION

Sensory stimulation to be provided to the preterm babies by talking, singing, cuddling and gentle
touching during care. Visual and auditory stimulation also can be provided. Kissing the baby should be
avoided.

ADMINISTRATION OF MEDICATIONS
Nurses must be particularly alert when computing and administering drugs to infants and children.
Administering the correct dosage of a drug is a shared responsibility between the practioners who
orders the drug and the nurse who carries out that order. When a dose is ordered that is outside the
usual range or if there is some question regarding the preparation or the route of administration, the
nurse should always check with the prescribing practitioner before proceeding with the administration,
since the nurse is legally liable for the drug administered.
Before the administration of any medications, the child must be correctly identified, since the children
are not totally reliable in giving correct names o request. Infants are unable to give their names, a
toddler or preschooler may admit any name, and school-age children may deny their identity in an
attempt to avoid the medication. Children sometimes exchange beds during play. Parents may be
present to identify their child, but the only safe method for identifying children is to check their
hospital identification band with the labeled medication or medication card.
MANAGEMENT OF PAIN
Physiological responses in neonates to painful stimuli have been well documented by numerous
studies. This response is evidenced by cardio respiratory changes, palmar sweating, increased intra
cranial pressure, hormonal and metabolic changes. Pain control during procedure can shorten periods
of oxygen desaturation. Neonatal assessment for evidence of pain is done by observation of
movement, facial expression, cry, vital signs and state of arousal.
Nonpharmacologic measurements used to alleviate pain include repositioning, swaddling,
containment, cuddling, rocking, music, reducing environmental stimulation, tactile comfort measures
and nonnutritive sucking.
Continuous intravenous infusion of opioids such morphine and fentanyl provide effective and safe pain
control. To avoid withdrawal the dosage should be gradually reduced over a period of several days.

POSITIONING AND SKIN CARE

The premature baby should not be left I one position for a long period because it is uncomfortable and
may be harmful to the lungs. Positioning on the side, for example, allows drainage of secretions and
prevention of aspiration. Positioning on the right side facilitates digestion. It is always important to
gently change the positions of preterm and high – risk neonates. This is to prevent any positional
deformities. Changing the baby’s position also prevents pressure breakdowns on the delicate skin. The
supine position requires support of the head, trunk and extremities. Positioning aids or blankets are
used to maintain positioning. The prone position may also need positioning aids to keep babies
properly aligned. The prone position is used when the infant is awake. Kangaroo care or skin to skin
contact also has been advocated for fostering intimacy and attachment between premature infants
and their mothers and fathers. In this situation, the infant wears only diaper while the parent holds the
infant semiupright, against his or her skin. The parent covers the infant with his or her own clothing so
as to facilitate temperature stability. Monitoring temperature remains important.
The delicate skin of the preterm infant also requires close monitoring. The skin is easily excoriated.
Caution must be used with any products in the skin, adhesives can adhere to the skin surface so well
that damage can occur when these are removed off. If such a breakdown should occur, the area is
exposed to the air and treatment is done as prescribed.

FAMILY SUPPORT DISCHARGE PLANNING, FOLLOW – UP AND HOME CARE

Baby’s condition and progress to be explained to the parents to reduce their anxiety. Treatment plan
to be discussed. Parents should be informed about the care of the baby, after discharge at home. Need
for warmth, breast feeding, general cleanliness, infection and prevention measures, environmental
hygiene, follow- up plan, immunization etc. should be explained to the parents.
Most healthy infants with a birth weight of 1800 gm or more and gestational maturity of 35 weeks or
more can be managed a home. Mother should be mentally prepared and trained to provide essential
care to the preterm baby at home. At the time of discharge the baby should have daily steady weight
gain with good vigour and able to suck and maintain warmth. Ultimate survival of the baby depends
upon continuity of care. The community health nurse should visit the family every week for a month
and provide necessary guidance and support.

PREVENTING COMPLICATIONS

Preterm newborns face a myriad of possible complications as a result of their fragile health status or
the procedures and treatment used. The baby should be observed for respiration, skin temperature,
heart rate, skin color, activity, cry, feeding behavior, passage of meconium or stool and urine, condition
of umbilical cord, eyes and oral cavity, any abnormal signs like edema, bleeding, vomiting etc.
Biochemical and electronic monitoring to be done if needed. Weight recording should be done daily in
sick babies’ otherwise alternate days. Position to be changed frequently at 2 hours interval. Baby
should be placed on right side after feeding to prevent regurgitation and aspiration. Mother should be
allowed to take care of the baby whenever condition permits. Any problem identified should be
managed immediately.

POSTMATURE INFANTS
Infants born of a gestation that extends beyond 42 weeks as calculated from the mother’s last
menstrual period are considered to be post mature or post term regardless of birth weight. This
comprises approximately 12% of all births. The cause of delayed birth is unknown. Some infants are
appropriate for gestational age, but many show the characteristics of progressive placental
dysfunction. The appropriate for gestational age infants are indistinguishable in appearance from term
infants. Others most often called post mature infants display the characteristics of infants who are 1 to
3 weeks of age such as absence of lanugo, little if any vernix caseosa, abundant scalp hair, long finger
nails, and whiter skin than term newborns. Frequently the skin is cracked, parchment like, and
desquamating. A common finding in post mature infants is a wasted physical appearance that reflects
intrauterine impoverishment. There is a depletion of subcutaneous fat that gives them a thin, long
appearance. The little vernix caseosa that remains in the skin folds is usually stained a deep yellow or
green.

There is a significant increase in fetal and neonatal mortality in post term infants compared to those
born at term. They are especially prone to intrauterine hypoxia associated with the decreasing
efficiency of the placenta and to the meconium aspiration syndrome. The greatest risk occurs during
the stressors of labour and delivery, particularly in infants of primigravidas. Caesarian section or
induction of labor is usually recommended when the infant is significantly overdue.

CONCLUSION

Each premature infant & high risk neonate provides the nursery personnel with a unique challenge. His
specific physical needs are met most successfully when the nurse recognized the intensity of care
required and applies expert nursing skills geared to assist with his struggle. When problems are
anticipated, preparations can be made for intensive care during the periods of greatest threat; through
this care the incidence of fetal and neonatal mortality can be significantly reduced. Nurses in a variety
of settings play an important role in detection and intervention where high risk factors are most likely
to occur.

BIBLIOGRAPHY
 Maggi M, Maggie H, elen Y. Nursing the neonate. page 72 - 77
 Susan SR, Terri K. Maternity and pediatric nursing. page 717- 722
 Debra L. P, Julie FG. Pediatric nursing an introductory text. page76 -83
 Wong L. Waley and Wong’s essentials of pediatric nursing. 5th edi; 229 -251.
 Whaley LF, Wong LD. Nursing care of infants and children. 2 nd edi. St. Louis publications.
Toronto 1983; 302-88.
 www.google.com