●​ Nutrition (feeding ability)

🩺 Detailed Summary - High-Risk Newborns

●​ Waste elimination (urination, meconium passage)
●​ Signs of infection
●​ Bonding with parents
●​ Developmental milestones

1. Important Terms to Know

●​ Small for Gestational Age (SGA):

4. Determining Gestational Age
○​ Baby’s weight is below the 10th percentile for
their age.
●​ Methods:
○​ Causes: Poor nutrition, smoking, drugs, infection
○​ Mother’s menstrual history
during pregnancy.
○​ Ultrasound
○​ Risks: Hypoglycemia, polycythemia, poor
○​ Postnatal physical and neurological exams:
temperature regulation.
■​ Ballard Score (best done within 12
●​ Appropriate for Gestational Age (AGA):
hours)
○​ Normal weight between the 10th and 90th
●​ Ballard Score looks at:
percentiles.
○​ Neuromuscular signs: posture, flexibility (square
●​ Large for Gestational Age (LGA):
window), arm recoil, popliteal angle, scarf sign,
○​ Baby’s weight is above the 90th percentile.
heel-to-ear.
○​ Causes: Maternal diabetes, obesity, multiparity
○​ Physical signs: skin maturity, plantar creases,
(many pregnancies).
ear cartilage, genitalia development.
○​ Risks: Birth injuries (shoulder dystocia),
hypoglycemia, bruising.
●​ Preterm Infant:
○​ Born before 37 weeks.
○​ Risks: Respiratory distress, brain bleeds (IVH), 5. Weight Classifications
feeding problems.
●​ Postterm Infant: Classification Weight
○​ Born after 42 weeks.
○​ Risks: Meconium aspiration, hypoglycemia, Low Birth Weight (LBW) <2500g
stillbirth due to aging placenta.
Very Low Birth Weight (VLBW) 1000–1500g

Extremely Low Birth Weight (ELBW) 500–1000g

2. National Health Goals for High-Risk Newborns

●​ Lower low birth weight rates (goal: <7.8%).

●​ More VLBW babies (very low birth weight) to be born in 6. Newborns at Risk: Weight and Gestation Problems
Level III hospitals.
●​
●​
Reduce SIDS deaths.
Lower perinatal (before and just after birth) death
➡️ SGA (Small for Gestational Age)
rates. ●​ Wasted appearance, low fat stores.
●​ Poor skin turgor, polycythemia, risk for hypoglycemia.
●​ Causes: Poor nutrition, placenta problems, teenage
pregnancy, infections.
3. Transition
Assessment
to Extrauterine Life: Immediate Newborn
➡️ LGA (Large for Gestational Age)
Immediately after birth, check for: ●​ Looks healthy but immature (immature reflexes).
●​ Risk for shoulder dystocia, hypoglycemia, bruising,
●​ Breathing/Respiration (is baby crying? breathing?) polycythemia.
●​ Circulation (heart working independently?) ●​ Associated with maternal diabetes, obesity.
●​ Temperature regulation (keeping warm)
●​ Fluid and electrolyte balance (no dehydration)

Later Assessments:
 Retinopathy Blindness risk from Routine eye screening

➡️ Preterm Infants of Prematurity

(ROP)
high
therapy.
oxygen for preemies.

●​ Small, thin, low muscle tone, weak reflexes (poor sucking, Ophthalmia Eye infection from Erythromycin ointment
Moro reflex). Neonatorum birth canal STD. after birth.
●​ Skin thin and shiny.
●​ Risk for:
○​ Respiratory Distress Syndrome (RDS) (no
surfactant).
8. Management Tips
○​ Anemia (low red cells).
○​ Brain bleeds (IVH).
●​ Keep baby warm (radiant warmer, incubator, skin-to-skin).
○​ Retinopathy of Prematurity (ROP) (blindness
●​ Feed early if possible (watch for hypoglycemia).
risk from oxygen therapy).
●​ Monitor breathing (especially for apnea and respiratory
○​ Necrotizing Enterocolitis (NEC) (intestinal
distress).
infection).
●​ Teach parents to bond early even if baby is in NICU.

➡️ Postterm Infants ●​ Prepare parents for possible complications (grief support

for SIDS).

●​ May be large or small depending on placenta function.

●​ Wasted, peeling skin (parchment-like), long fingernails.
●​ Risks:
○​ Meconium Aspiration Syndrome (MAS). 9. Important Nursing Diagnoses
○​ Hypoglycemia (used up fat stores).
○​ Polycythemia (from chronic hypoxia). ●​ Ineffective breathing pattern (manage airway,
oxygenation).
●​ Risk for imbalanced nutrition (assist with feeding
7. Common Illnesses in High-Risk Newborns support).
●​ Risk for impaired parenting (support bonding,
Condition Description Management
education).
●​ Ineffective thermoregulation (keep baby warm).
Transient Fast breathing (>80 Observe, O2 if needed,
Tachypnea breaths/min), lungs resolves by 72 hours.
(TTN) wet.

Apnea Breathing stops >20

sec, slow heart rate.
Stimulate baby, monitor
closely.
🎯 Quiz Hotspots (Must Remember)
Key Point Why It's Important
Respiratory No surfactant → Surfactant therapy,
Distress breathing hard, CPAP, ventilator, Low temp in newborn = Can cause hypoglycemia,
Syndrome grunting, cyanosis. oxygen. emergency acidosis, worsens breathing!
(RDS)

SGA and LGA both → Watch blood sugar and

Meconium Inhaling meconium Suction before
hypoglycemia, polycythemia hematocrit levels.
Aspiration → blocked airways, shoulders deliver, O2,
Syndrome pneumonia. antibiotics, ECMO if
(MAS) severe. Meconium-stained fluid = Prevents MAS (meconium
suction before shoulders born aspiration).
SIDS Sudden death of Sleep baby on back, no
infant (2–4 months smoking, use pacifier. Main cause of RDS = lack of Treat with surfactant and
peak). surfactant breathing support.

ABO Mom (O) attacks Phototherapy, early

SIDS prevention = sleep on Major life-saving advice.
Incompatibilit baby's A, B, or AB feeding, sometimes
back, no pillows, pacifier helps
y blood → jaundice. exchange transfusion.
📋 High-Risk Newborn - Power Cheatsheet ROP Oxygen Eye Eye checks,
overdose problems control O₂ use

📌 BASIC TERMS: Ophthalmi

a
STD at birth Red
eyes
pus Erythromycin
after birth
●​ SGA = <10th percentile → 🥶 Hypoglycemia, Neonatoru
m
Polycythemia

⚡ Hypoglycemia, Injury
●​ AGA = Normal (10–90%)

🫁 RDS, Brain bleed (IVH), NEC

●​ LGA = >90th percentile →
●​
●​
Preterm = <37 weeks →
Postterm = >42 weeks → 💨 Meconium Aspiration, 📌 MUST REMEMBER:
●​ 🌡️ Cold Baby = Emergency! Risk of hypoglycemia +
Hypoglycemia

●​ 🥶 SGA + LGA = Risk for low sugar and thick blood

acidosis.

📌 NEWBORN PRIORITIES: ●​ 🧹 Meconium? SUCTION mouth + nose BEFORE

(polycythemia).

●​ 🫁 RDS = Lack of surfactant → give surfactant +

shoulders deliver!
1.​ Breathing
2.​ Circulation
●​ 🛏️ SIDS prevention = Sleep on back + pacifier.
breathing support.
3.​ Temperature control
4.​ Fluids + Electrolytes
5.​ Feeding ability
6.​ Infection check
7.​ Bonding
📌 NURSING CARE TIPS:
●​ Keep baby warm! (radiant warmer, skin-to-skin).

📌 CONDITIONS QUICK HITS: ●​

●​
Feed early (prevent hypoglycemia).
Monitor breathing (look for apnea, retractions, grunting).
●​ Support parents (grief counseling, bonding
Condition Cause Big Clues Management
encouragement).

TTN Lung fluid left Fast RR > Oxygen PRN,

80, mild observe
cyanosis ✅ Last minute tip:​
If confused on test day, always prioritize airway, breathing,
Apnea Immature brain No breath Stimulate,
circulation (ABC)!
>20 sec + monitor
Bradycardia

RDS ↓ Surfactant Grunting, Surfactant,

flaring, CPAP,
retracting ventilator

MAS Inhaled poop Meconium Suction before

stain, low birth, O2,
APGAR antibiotics

SIDS Unknown Sudden Back sleeping,

death 2-4 pacifier, no
mos smoke

ABO Blood type Jaundice @ Phototherapy

Incompati mismatch (O <24h
bility mom + A/B
baby)
🧠 High-Risk Newborn Mnemonics 📌 MAS Management: "SUCTION"
S uction mouth/nose BEFORE shoulders deliver​

📌 SGA Risks: "THIN BABY"

U se oxygen carefully​
C heck ABG and CXR​
T reat with antibiotics​
T hermoregulation poor​ I ntervene early (intubation if needed)​
H ypoglycemia​ O bserve for pneumothorax​
I nfection risk ↑​ N ICU care if severe
N utrition needs ↑

B lood thick (polycythemia)​

🥇 QUICK TIPS TO WIN THE QUIZ:

A sparated (wasted appearance)​
B rain risk (low oxygen delivery)​
Y ellow skin (jaundice)
●​ If it's a lung problem → think oxygen + surfactant.
●​ If it's hypoglycemia → feed the baby fast.
●​ If it's meconium-stained fluid → suction before full

📌 LGA Risks: "BIG FAT BABY" ●​

delivery.
SIDS → always think "sleep on back."

B irth injury (shoulder dystocia)​

I mmature reflexes​
G lucose crash (hypoglycemia) ✏️ Identification (15 items)
F at baby (large)​ 1.​ ➡️ The condition where a newborn is born weighing less
➡️ Baby’s breathing stops for more than 20 seconds —
A nomalies (Beckwith, heart defects)​ than 2,500 grams.
T umbling sugar levels 2.​

➡️ Name of the scoring system used to estimate

can cause bradycardia.
B ruise easily​ 3.​
A nemia (polycythemia-related issues)​ gestational age based on neuromuscular and physical

➡️
B reathing may be hard if trauma​ signs.
Y ellow skin (jaundice risk) 4.​ Type of newborn that is above the 90th percentile for

5.​ ➡️
weight.
Eye infection in newborns caused by gonorrhea or

6.​ ➡️
chlamydia.

📌 RDS Signs: "GRUNT" Dangerous condition when a newborn inhales

7.​ ➡️
meconium-stained amniotic fluid.
The syndrome that describes sudden, unexplained
G runting​
8.​ ➡️
death of an infant under 1 year old.
R etractions (chest sucking in)​ Lung problem in preterm infants due to lack of
U p tachypnea (rapid breathing)​
9.​ ➡️
surfactant.
N ose flaring​ Test done routinely for preterm babies to check for eye
T ool oxygen (cyanosis)
10.​ ➡️
problems due to oxygen therapy.
Excessive breakdown of red blood cells leading to high

11.​ ➡️
bilirubin and jaundice.
Device used to provide gentle, continuous airflow into a
📌 Postterm Baby Signs: "OLD BABY" 12.​ ➡️
baby’s lungs.

13.​ ➡️
The skin appearance of a postterm baby.
O utdated placenta (aging)​ A blood mismatch between O+ mother and A/B/AB

14.​ ➡️
L oose, dry, cracked skin​ baby causing jaundice.
D epleted fat (wasted appearance) Extra blood cells produced due to chronic hypoxia,

15.​ ➡️
leading to thicker blood.
B rown meconium stain (green skin)​ The name of the therapy machine similar to a
A spartate fat (gone)​ heart-lung bypass for very sick newborns.
B reathing trouble (MAS)​
Y ellow (polycythemia)
✅ True or False (15 items)
16.​ ➡️ T/F: SGA babies are at risk for hypoglycemia and
17.​ ➡️ T/F: The earlier a baby is born, the less chance of
polycythemia.
✅ True or False
✅ True
❌ False (Earlier birth = Higher RDS risk)
16.​
18.​ ➡️ T/F: An LGA baby is often born to a mother with
developing RDS.
✅ True
17.​

❌ False (Ballard Score must be done within 12 hours of

18.​
19.​ ➡️ T/F: Ballard Score is used after 1 week of age to
diabetes or obesity.
19.​

20.​ ✅ True
birth)
20.​ ➡️ T/F: Post-term babies are at risk for meconium
determine gestational age.
21.​ ❌ False (Apnea needs monitoring!)
22.​ ✅ True
21.​ ➡️ T/F: Apnea in newborns always resolves without
aspiration syndrome.
23.​ ❌ False (RDS is caused by lack of surfactant, not
22.​ ➡️ T/F: Feeding early can help prevent hypoglycemia in
monitoring.
24.​ ✅ True
infection)

25.​ ❌ False (Sleeping on back reduces risk but doesn't

23.​ ➡️ T/F: Respiratory Distress Syndrome is mainly due to
both SGA and LGA babies.

26.​ ✅ True
100% prevent SIDS)
24.​ ➡️ T/F: ROP (Retinopathy of Prematurity) can lead to
infection.
27.​ ❌ False (ABO incompatibility happens after birth, not
25.​ ➡️ T/F: SIDS can be completely prevented by sleeping
blindness if untreated.
28.​ ✅ True
intrauterine)

29.​ ❌ False (Preterm babies have soft, underdeveloped

26.​ ➡️ T/F: TTN (Transient Tachypnea) usually resolves within
babies on their backs.

30.​ ✅ True
ears)
27.​ ➡️ T/F: ABO incompatibility is a prenatal (inside womb)
3 days without major interventions.

28.​ ➡️ T/F: In MAS, suctioning before the shoulders deliver

problem.

29.​ ➡️ T/F: Preterm babies have fully developed ears with

can help prevent severe lung problems.

30.​ ➡️ T/F: Hypoglycemia can cause brain damage if not

thick cartilage at birth.

treated quickly in newborns.

✏️ Identification
1.​ Low Birth Weight (LBW)
2.​ Apnea
3.​ Ballard Score
4.​ Large for Gestational Age (LGA)
5.​ Ophthalmia Neonatorum
6.​ Meconium Aspiration Syndrome (MAS)
7.​ Sudden Infant Death Syndrome (SIDS)
8.​ Respiratory Distress Syndrome (RDS)
9.​ Retinopathy of Prematurity (ROP) Screening
10.​ Hyperbilirubinemia
11.​ Continuous Positive Airway Pressure (CPAP)
12.​ Parchment-like skin
13.​ ABO Incompatibility
14.​ Polycythemia
15.​ ECMO (Extracorporeal Membrane Oxygenation)