The Big late-preterm baby

Not all late-peterm newborns are small. Some can be the size of a full term newborn, especially if the mother has diabetes. Infants of diabetic mothers (IDMs) are a category in themselves for increased risks.  Type II or gestational does not seem to make a difference.  The increased glucose level in the mothers blood stream provides more glucose than the fetus needs.  A consequence of this is that these newborns are at a higher risk for respiratory distress because their lungs do not mature at the same rate as a fetus with  normal levels of glucose during development. 

The lungs of an IDM newborn of 36 weeks gestation could have the same maturity as one that is 34 weeks.  Add onto this a larger body to oxygenate and you have a large baby with respiratory distress that very well may need ventilatory support.  Assessments of all newborns is important; there are many unexpected complications that could be missed without a thorough assessment.  Respiratory assessments are no different.  If the newborn has obvious respiratory distress with grunting and retracting, no matter what color it is, this baby will be monitored more closely with pulse oximiters for oxygen saturation.  There can also be an oxygen requirement with normal respirations, just because of the immaturity.

Relying on the color of a newborn is a very inaccurate means to evaluate oxygenation.  Any newborn can have a blue face from bruising, a white face from a tight nuchal cord or some short term shock and perfusion issues, but the tongue and gums are usually a good visual indicator of oxygenation.  Think about babies that you have seen during the frist 24-48 hours of life.  Sometimes their color is not at all what is expected.  Start paying attention to newborn pictures and their color, skin tone, bruising, jaundice.