11.01 Babies by Term

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Overview

  1. Babies can be classified by their total gestational age at time of delivery or by their weight at delivery compared to their gestational age

Nursing Points

General

  1. Time-Based
    1. Preterm
      1. Definition:  a baby born before 37 weeks
      2. The earlier the birth, the more complications and risks
      3. Higher risk for an admission to the  neonatal intensive care unit (NICU)
      4. Major concerns for hypothermia, hypoglycemia and
    2. Term
      1. Definition: A baby born between 37-42 weeks
    3. infection (infection prevention is key)
    4. Post-Term
      1. Definition:  A baby born after 42 weeks
      2. After 42 weeks, the placenta starts to age and eventually fails
      3. Some post-term babies may not have below assessment findings
      4. Major concerns include meconium aspiration and birth injuries
  2. Weight-Based
    1. Small for Gestational Age (SGA)
      1. Definition: newborns below 10th percentile for their gestational age
      2. It is NOT the same as low birth weight, very low birth weight, or extremely low birth weight
    2. Large for Gestational Age (LGA)
      1. Also called Macrosomia
      2. Definition:  a newborn at or above the 90th percentile for weight

Assessment

  1. Preterm
    1. Increased risk for infection
    2. Hypothermia
      1. Increased risk for cold stress
    3. Impaired ability to eat
      1. Poor suck/swallow reflexes
    4. Immature genitalia
      1. Undescended testicles, narrow labia
    5. Increased risk for jaundice
    6. Multiple integumentary issues
      1. Lanugo present
      2. Visible vasculature → more transparent skin
      3. Minimal subcutaneous fat
    7. Respiratory issues
      1. Immature lungs
  2. Post-Term
    1. Muscle and fat wasting
    2. Large baby → birth injuries
    3. Meconium passing before delivery
    4. Overgrown nails
    5. Hypoglycemia
    6. Dry and peely skin
    7. More hair on scalp than usual
  3. SGA
    1. Hypoglycemia
    2. Difficulty thermoregulating
  4. LGA
    1. Trauma from a difficult and/or assisted birth
    2. Shoulder dystocia from squeezing through birth canal
    3. Hypoglycemia
    4. Jaundice

Therapeutic Management

  1. Preterm
    1. Maintain airway
    2. Respiratory assistance
    3. Frequent vitals (frequency dependent upon newborn’s stability and orders)
    4. Keep baby warm!
  2. Post-Term
    1. Depends on presenting symptoms
    2. Glucose stores all used up, therefore hypoglycemia results
    3. Assess for respiratory issues related meconium aspiration
  3. SGA
    1. Keep infant warm
    2. Closely monitor blood sugar per protocol
  4. LGA
    1. Care for any birth injury
    2. Monitor and treat hypoglycemia per protocols

Nursing Concepts

  1. Human Development
  2. Glucose Metabolism
  3. Oxygenation

Patient Education

  1. Keeping baby warm
  2. Hypoglycemia
  3. Birth injuries

Reference Links

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Video Transcript

In this lesson I will help you understand the classifications for babies by their term and the risk associated with each.

There are two ways that babies can be classified. The classifications are time-based or weight based. So first let’s talk about the time-based. Preterm is referring to a baby born before 37 weeks. o term is a baby born between 37 to 40 weeks and post-term or post dates is a baby born after 42 weeks. Now looking at weight-based criteria. Large for Gestational Age or LGA are newborns that are at or above the 90th percentile for weight. These babies can also be called Macrosomic. Small for Gestational Age or SGA are newborns below 10th percentile for their gestational age Not this is NOT the same as low birth weight, very low birth weight, or extremely low birth weight. SGA infants are just small for their age. Our preterm, postterm, LGA, and SGA kids are going to be more at risk for certain things that we will be looking for on assessment so let’s take a look at these assessment pieces.

So first our preterm babies. Remember they are early so their body isn’t ready to be born. Keep that in mind and it will help everything click. So they are at an Increased risk for infection because their system is immature, hypothermia because they can’t regulate their temperature well and don’t have excess fat to help provide warmth. They also have difficulty eating because they are so sleepy. This babies also have a poor suck and it takes all their energy so they tire out. Because of these babies having an immature system and not eating as well they have an increased risk for jaundice. The preterm baby will have more lanugo, those fine hairs that will help to provide warmth and they also might have more transparent skin. There will be an increased risk for respiratory issues because those lungs are immature.

Our post-term babies have been overcooked. They have been in that oven past 40 weeks so they are more then done. That placenta is an awesome organ but it is not permanent so it has worked hard this whole pregnancy and it starts to not work as well for the post-term baby. This will cause some problems. So they can experience weight loss because the placenta isn’t providing nutrients as well for the fetus. These babies are typically going to be larger so they are at risk for birth injuries. They are also at risk for meconium aspiration because remember that baby was supposed to already be born and would be passing stool already. Instead the baby is in uterus and passes meconium prior to delivery, which can be a big problem. Refer to the lesson on meconium aspiration for more on that. They will have overgrown nails and dry peely skin. Think about when you’ve been in water too long your hands and feet get all pruny, well these babies have been in water too long and get more wrinkling skin and it peels. They are at risk for hypoglycemia because they are bigger and have used up their extra sugar stores.

Our SGA babies are going to be at risk for hypoglycemia and thermoregulating. They are small and don’t have excess sugar stores and they will have trouble thermoregulating. It becomes a bigger problem because as they try to thermoregulate they will burn up sugar that they have to get warm so it becomes a spiral effect for these little ones. LGA infants are at risk for trauma from a delivery because they are big and trying to fit. Think about if you try to fit a tennis ball into a golf ball hole. It’s not going to go well right? Injury will happen to that tennis ball so our big babies could end up with bruising and shoulder injuries. These babies are also at risk for hypoglycemia and also jaundice and that is because they might have more bruising that has occurred which causes a higher bilirubin.

Our management will depend on the infant’s gestation, size, and hospital protocols but I’m going to tell you some basic management pieces. For our preterm baby we want to give respiratory assistance if needed and frequent vitals and one of the most important is to keep baby warm! Post-Term will be to monitor symptoms of hypoglycemia. Their glucose stores are all used up so they can present with hypoglycemia symptoms. At delivery we want to assess for meconium aspiration that would present with respiratory problems. For our SGA baby we need to keep them warm because they are small and also monitor blood sugars. The LGA infant will also have blood sugars checked and treated for any hypoglycemia. Birth injuries will also be card for if they are present.

We want to provide education to these parents so first they need to understand the importance of keeping their baby warm. So help them understand the importance of skin to skin, swaddling, and hats. We want to prevent hypoglycemia so educate them on feeding that baby to prevent hypoglycemia. If there are any birth injuries then we will need to provide education for them for this. So the most common is a broken clavicle. These babies need to keep them arm still so we will safety pin the arm of their shirt to the abdomen part of the shirt so that the arm rests across their abdomen. Let me draw that so you can better visualize this.
Human Development, glucose Metabolism, and oxygenation are our concepts because this all deals with the development and we are very concerned with blood sugar and oxygenation on these kiddos.
Ok so what are our important facts? The preterm baby is prior to 37 weeks and we are most concerned with respiratory, hypoglycemia and thermoregulation. Term is 37-42 weeks. Post term is 42 weeks or more and we are worried about hypoglycemia. SGA is a weight under the 10th percentile and we are concerned with thermoregulation and hypoglycemia. Our large for gestational age is over the 90th percentile and for these babies we are concerned with hypoglycemia and birth injury. Term is 37 to 42 weeks and these are our babies that are born when they are supposed to be so no added concern for them. Post-term is over 42 weeks and we are most concerned with hypoglycemia and meconium aspiration.

Make sure you check out the resources attached to this lesson and review the different ranges and the concerns that we have for each range. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 5

A newborn nursery nurse has just received shift report. Which baby should be seen first?

  • Question 2 of 5

A nurse is performing a newborn assessment on a baby born at 28 weeks. Which assessment findings should the nurse expect? Select all that apply.

  • Question 3 of 5

A nurse is caring for a newborn that weighs 4,500 g. The nurse knows that this baby is at increased risk for which of the following?

  • Question 4 of 5

A nurse is caring for a newborn diagnosed as “Large for Gestational Age (LGA)”. Which of the following babies would meet this criteria?

  • Question 5 of 5

A nurse is educating a nursing student on the best ways to keep a preterm infant warm immediately after birth. A preterm infant is born stable and the nurse knows that the teaching has been understood if the student identifies which of the following as appropriate? Select all that apply.

Module 0 – OB Course Introduction

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