20.1 Introduction
Learning Objectives
- Integrate principles of evidence-based practice when using the nursing process
- Correlate the pathophysiology, etiology, and clinical manifestations
- Incorporate screening, diagnostic, and treatment procedures in the nursing plan of care
- Plan nutritional interventions for clients
- Identify multidisciplinary and community resources to promote care of clients
- Integrate pharmacological therapy in the care of clients
- Develop teaching and learning plans
- Support diversity across the life span in client-centered care
- Integrate psychosocial support in the care of clients
A high-risk newborn is an infant who is born prematurely or with a health condition that increases their risk of developmental and health problems. Many of these conditions require specialized, multidisciplinary care of the newborn in a neonatal intensive care unit (NICU) with prolonged hospitalizations and ongoing outpatient care. Care in the NICU may include mechanical ventilation of the newborn’s delicate, immature lung; provision of adequate nutrition that may include tube feeding or parenteral nutrition to support the growth and development of key organs; and facilitation of transition to life outside the uterus, including cardiovascular support. Nurses provide health teaching to parents related to the treatment plan; promote secure attachment and create a soothing, non-intimidating environment where they can bond with their newborn; and help parents cope with feelings of helplessness as their newborn receives care in a NICU environment.[1],[2],[3]
This chapter will discuss common conditions that place a newborn at higher risk for morbidity (illness) and mortality (death). Infant mortality is defined as the death of an infant before their first birthday. In 2022, the infant mortality rate in the United States was 5.6 deaths per 1,000 live births, with the five leading causes of infant death, including the following[4]:
- Preterm birth and low birth weight
- Congenital disorders
- Maternal pregnancy complications
- Sudden infant death syndrome
- Unintentional injuries (e.g., car crashes)
A newborn can be at risk for poor short-term and long-term health and developmental outcomes related to several maternal, delivery, and neonatal factors. These factors include the following[5]:
- Maternal Factors
- Maternal age younger than age 16 or older than 40
- Alcohol or illicit drug use during pregnancy
- Type 1, type 2, or gestational diabetes
- High blood pressure disorders of pregnancy, such as preeclampsia
- Pregnancy and Delivery Factors
- Complications causing birth asphyxia (a condition that occurs when the fetal brain and organs don’t receive enough oxygen and nutrients before, during, or after birth that can result in brain damage, organ damage, or death), such as placental abruption or prolapsed umbilical cord.
- Multiple gestation (twins, triplets, or more)
- Premature rupture of membranes (PROM)
- Preterm labor
- Breech presentation or other malpresentation
- Forceps- or vacuum-assisted vaginal delivery or cesarean delivery
- Meconium aspiration
- Neonatal Factors
- Preterm birth (gestational age less than 37 weeks) and post-term birth (gestational age greater than 42 weeks) and associated conditions such as respiratory distress, gastrointestinal complications, and neurological complications
- Birth weight less than 2500 grams (5 lbs, 8 ounces) or over 4000 grams (8 lbs, 13 ounces) and associated conditions
- Infections from birth canal, such as group B streptococcus or chlamydia, or health care-associated infections that can result in sepsis
- Congenital and genetic defects
- Exposure to maternal substance(s) use in utero
- Neonatal resuscitation required after delivery
The remaining sections of this chapter will discuss neonatal factors related to neonatal morbidity and mortality, including preterm birth, post-term birth, birth weight, neonatal sepsis, congenital disorders, maternal diabetes, and exposure to maternal substance use. Neonatal resuscitation is discussed in the final section.
Nurses recognize and respond to many complications that may occur when caring for an otherwise healthy newborn, such as hypothermia, hypoglycemia, feeding issues, hyperbilirubinemia, and jaundice. Review these complications in the “Common Complications During the Neonatal Period” section in the “Healthy Newborn Care” chapter.
Nurses recognize and respond to many complications that may occur during labor and delivery that can affect the health of the newborn. Review the “Fetal Heart Rate Monitoring,” “Complications Associated With Labor,” “Complications and Medical Interventions During The Second Stage of Labor” sections in the “Labor and Delivery Care” chapter.
Review additional details about nursing care during high-risk pregnancies in the “High Risk Perinatal Client Care” chapter.
- The Royal Children’s Hospital. (n.d.). High risk infants flagship. Murdoch Children’s Research Institute. https://www.mcri.edu.au/research/strategic-collaborations/flagships/high-risk-infants ↵
- Nationwide Children’s. (2023). The Neonatal intensive care unit. Nationwide Children’s Hospital. https://www.nationwidechildrens.org/conditions/health-library/the-neonatal-intensive-care-unit-nicu ↵
- Ewellsbeede. (2022). Chapter 8 Care of the complicated newborn client. In Nursing care of women, children, and newborns. https://pressbooks.pub/nurs323/chapter/care-of-the-complicated-newborn-client/ ↵
- U.S. Centers for Disease Control and Prevention. (2024). Infant mortality. Centers for Disease Control and Prevention. https://www.cdc.gov/maternal-infant-health/infant-mortality/index.html ↵
- Ewellsbeede. (2022). Chapter 8 Care of the complicated newborn client. In Nursing care of women, children, and newborns. https://pressbooks.pub/nurs323/chapter/care-of-the-complicated-newborn-client/ ↵
An infant who is born prematurely or with a health condition that increases their risk of developmental and health problems.
A specialized hospital unit that provides critical care for newborns who are premature, have low birth weight, or have medical conditions requiring intensive monitoring and treatment.
The death of an infant before their first birthday.
A condition that occurs when the fetal brain and organs don't receive enough oxygen and nutrients before, during, or after birth that can result in brain damage, organ damage, or death.
