NCLEX Review Guide: Postterm Newborn Care

Postterm Newborn Overview

• A postterm newborn is born after 42 completed weeks of gestation (294 days) from the last menstrual period.
• These infants experience prolonged intrauterine exposure and may show signs of placental insufficiency due to aging placenta.
• Postterm newborns often exhibit postmaturity syndrome with characteristic physical features and complications.

Postmaturity Syndrome Characteristics

• Dry, cracked, peeling skin that appears wrinkled and leathery due to loss of vernix caseosa and subcutaneous fat.
• Long fingernails and toenails that may be stained yellow-green from meconium exposure.
• Abundant scalp hair and minimal lanugo, indicating advanced maturation.
• Alert, wide-eyed appearance with decreased subcutaneous fat giving a thin, wasted look.

Major Complications

• Meconium aspiration syndrome (MAS) occurs due to fetal hypoxia causing passage of meconium in utero and potential aspiration.
• Hypoglycemia develops from depleted glycogen stores and increased metabolic demands of the larger infant.
• Polycythemia results from chronic intrauterine hypoxia stimulating increased red blood cell production.
• Birth trauma risk increases due to macrosomia and difficult delivery requiring assisted extraction.

Priority Nursing Care

1. Assess respiratory status immediately - monitor for signs of meconium aspiration including tachypnea, retractions, and cyanosis.
2. Monitor blood glucose levels within first hour and every 2-4 hours until stable, watching for jitteriness or lethargy.
3. Assess for polycythemia by monitoring hematocrit levels and observing for plethora, poor feeding, or respiratory distress.
4. Provide thermoregulation support as postterm infants have decreased subcutaneous fat and increased surface area.
5. Monitor feeding tolerance and provide frequent, small feedings to prevent hypoglycemia.

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