Pediatric emergency medicine trisk 2459 2459
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Weight
Each newborn encounter should include a weight check. This should be compared
to weight at birth. The Centers for Disease Control (CDC) growth charts provide
normative values for weight and length in boys and girls. Birth weight below the
10th percentile identifies the small for gestational age (SGA) and that above the
90th percentile identifies the large for gestational age (LGA) infant. Both SGA
and LGA infants are at risk for physiologic disturbances. SGA infants have
decreased fat stores, which can leave the infant more susceptible to hypoglycemia
and electrolyte disturbances. Additionally, SGA infants are much more sensitive
to environmental changes and cannot thermoregulate as well as older infants.
Hypothermia in the SGA infant can depress the autonomic nervous system, which
may result in bradycardia and hypotension. The LGA infant is commonly born to
a diabetic mother. The high levels of growth hormone and insulin and lack of
sufficient postnatal glucose delivery result in hypoglycemia and electrolyte
disturbances, such as hypocalcemia. LGA infants are also at risk for
polycythemia. Severe polycythemia can compromise cardiovascular function, as
well as increase the risk of hyperbilirubinemia.
Normal weight patterns include a brief period of weight loss in the immediate
postnatal period, followed by regular, consistent weight gain for the first few
months of life. Weight loss is the most sensitive sign for dehydration in the
newborn, particularly as other common signs, such as decreased urine output or
skin turgor are not reliable findings in this group. A loss of more than 10% of
birth weight in the first week of life is cause for concern, and should be evaluated,
particularly for dehydration, hypoglycemia, and electrolyte disturbances.
Neonates that have not regained birth weight by 14 days of life should also be
evaluated thoroughly. Most commonly, slow weight gain is due to decreased milk
transfer in breast-fed infants, but can also signify increased caloric and metabolic
demands due to underlying congenital anomalies of the cardiovascular,
respiratory, gastrointestinal, or renal systems. Neurologic diseases, particularly
those with decreased tone and motor strength, may also present with weight loss
or poor weight gain if the infants do not have the strength to adequately suck and
swallow. A basic metabolic panel (BMP) should be checked for signs of
hypernatremia or other electrolyte disturbances. Neonates who are receiving
suboptimal feeds due to inadequate supply may need to be supplemented with
formula. Referral of the infant to the pediatrician for serial follow-up is
recommended. Alternately, those requiring assistance with poor breast-feeding
technique may be supplemented with expressed breast milk or formula and
referred to a lactation consultant.
