Large-for-Gestational Age (LGA) Newborn Nursing Care Plan & Management

Notes

Description
  1. A LGA newborn is one weighs more than 4,000 g, is above the 90th percentile, or is two standard deviations above the mean.
  2. The LGA infant can be pre-term, term, or post-term.
Etiology

Predisposing factors include:

  1. Genetic predisposition
  2. Excessive maternal weight gain during pregnancy.
  3. Poorly controlled maternal diabetes secondary to high levels of maternal glucose that cross the placenta during pregnancy.

Pathophysiology
  1. Infants who are large for gestational age have been subjected to an overproduction of growth hormone in utero. This most frequently happens with infants of diabetic mothers who are poorly controlled. It may also occur in multiparous pregnancies because with each pregnancy babies tend to grow larger.
  2. Other associated conditions include transposition of the great vessels, Beckwith syndrome and congenital anomalies.
Assessment Findings

Clinical manifestations include:

  1. Complications associated with maternal diabetes
  2. Birth injuries due to disproportionate size of newborn to birth passageway
    1. Fractured clavicle
    2. Facial nerve injury
    3. Erb-Duchenne palsy or brachial plexus paralysis
    4. Klumpke paralysis
    5. Phrenic nerve palsy
    6. Possible skull fracture
 Nursing Management

1. If IDM, observe for potential complications 2. Monitor for, and manage, birth injuries and complications of birth injuries.

a. Clavicle fracture
  • Confirm by x-ray.
  • Assess the infant for crepitus, hematoma, or deformity over the clavicle; decreased movement of arm on the affected side; and asymmetrical or absent. Moro reflex.
  • Limit arm motion by pinning the infant’s sleeve to the shirt.
  • Manage the pain
b. Facial nerve injury
  • Assess for symmetry of mouth while crying.
  • Wrinkles are deeper on the unaffected side.
  • The paralyzed side is smooth with a swollen appearance.
  • The nasiolabial fold is absent.
  • If the eye is affected, protect it with patches and artificial tears.
c. Erb-Duchenne palsy and Klumpke paralysis
  • Erb-Duchenne palsy. Assess for adduction of the affected arm with internal rotation and elbow extension. The Moro reflex is absent on the affected side. The grasp reflex is intact.
  • Klumpke paralysis. Assess for absent grasp on the affected side. The hand appears claw-shaped.
  • Management includes:
    • X-ray studies of the shoulder and upper arm to rule out bony injury
    • Examination of the chest to rule out phrenic nerve injury
    • Delay of passive movement to maintain range of motion of the affected joints until the nerve edema resolves (7 to 10 days)
    • Splints may be useful to prevent wrist and digit contractures on the affected side
d. Phrenic nerve palsy
  • Assess for respiratory distress with diminished breath sounds.
  • X-ray usually shows elevation of the diaphragm on the affected side.
  • Provide pulmonary toilet to avoid pneumonia during the recovery phase (1 to 3 months).
e. Skull fracture.
  • Assess for soft-tissue swelling over fracture site, visible indentation in scalp, cephalhematoma, positive skull x-ray, and CNS signs with intracranial hemorrhage (e.g., lethargy,seizures, apnea, and hypotonia).

Exam

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