First City Providential

College

High-Risk
Newborn
Presented by
Group 1
Presentation Outline High-risk Newborn: Definition, Goals, Concepts
and Principles

Today's Topics Identification of At-Risk Newborn

Newborn Classification based on gestational

age

Problems related to Maturity

Problems related to Gestational weight

Acute conditions of the neonates

Words to Live By

"Nurses are a unique kind. They have this

insatiable need to care for other, which
is both their greatest strength and fatal
flaw.
JEAN WATSON
High-risk Newborn: Definition, Goals,
Concepts and Principles
 Definition:

A high-risk newborn is defined as an infant who has a

greater than average risk of developing a medical or
developmental problem. This risk may be due to
factors such as prematurity, low birth weight,
congenital abnormalities, or maternal health problems
during pregnancy.
 Goals:

The primary goal of high-risk newborn care is to ensure that these

infants receive appropriate medical interventions to promote their
health and well-being. This may include specialized medical
treatments, nutritional support, and developmental interventions to
help these infants reach their full potential. Other goals may include
preventing long-term medical problems, promoting bonding
between the infant and parent, and ensuring that the infant is
discharged from the hospital in a safe and stable condition.
 Concepts:

High-risk newborn care is based on several key concepts. One of

these is the importance of early identification of risk factors that may
increase the likelihood of medical or developmental problems. This
may involve prenatal testing, careful monitoring during labor and
delivery, and postnatal assessments to identify any problems that
may require immediate intervention.
 Concepts:

Another important concept is the need for a multidisciplinary team

approach to care. This may involve healthcare professionals such as
neonatologists, pediatricians, nurses, respiratory therapists, and
social workers, who work together to provide comprehensive care to
the infant and family.
 Principles:

High-risk newborn care is guided by several principles. One of these

is the principle of family-centered care, which emphasizes the
importance of involving the family in the care of the infant. This may
include providing education and support to parents, encouraging
parental involvement in the infant's care, and respecting the cultural
and religious beliefs of the family.
 Principles:

Another principle is the importance of evidence-based practice,

which involves using the latest scientific research to guide the care of
the infant. This may involve using the most effective medical
treatments, nutritional interventions, and developmental
interventions to promote the health and well-being of the infant.
 Factors:

Several factors can increase the risk of a newborn developing

medical or developmental problems. These include:

Prematurity
Low birth weight
Maternal Health Problems
Multiple Births
Birth Defects
 Classifications:

High-risk newborns can be classified based on various criteria. These

classifications include:

Gestational Age
Birth Weight
Medical Conditions
Developmental Delays
Environmental Factors
 IDENTIFICATION OF AT-RISK NEWBORN

The high-risk neonate can be defined as a newborn, regardless of

gestational age or birth weight, who has a greater-than-average
chance of morbidity or mortality.

because of conditions or circumstances superimposed on the normal

course of events associated with birth and the adjustment to
extrauterine existance.

The high risk period encompasses human growth and development

from the time of viability up to 28 days following birth.
Newborn Classification based on
Gestational Age

Appropriate for Gestational Age (AGA)

Small for Gestational Age (SGA)
Large for Gestational Age (LGA)
Appropriate for Gestational Age (AGA)

Infants who fall between the 10th and 90th

percentiles of weight for their age regardless of
gestational age.
Full-term infants that are born, often be
between 2,500 grams (about 5.5 lbs or 2.5 kg)
and 4,000 grams (about 8.75 lbs or 4 kg).
Small for gestational age (SGA)

Infants who fall below the 10th percentile of

weight for their age.

Predisposing Factors:
Lack of adequate nutrition
Increased maternal age
Placental anomaly
Placental damage
Developmental defect in the placenta
Women with systemic diseases (Diabetes mellitus, PIH)
Cigarette smoking
Large for gestational age (LGA)

Also termed as “macrosomia”

Infants who fall above the 90th percentile of
weight for their age.

Predisposing Factors:
Hormonal influence; overproduction of growth hormone in utero
Diabetes mellitus
Multiple gestation
Transposition of the great vessels
Beckwith syndrome
Congenital anomalies
PROBLEMS RELATED
TO
PREMATURITY
 Babies born preterm are at risk for serious health
problems. Even babies born only four to six weeks early
can have problems in preterm birth such as breathing
difficulties and effects on brain functions.
 Short-Term Effects and Problems
Related to Preterm Birth

-Respiratory Distress
-Immature Brains

Long-Term Effects and Problems

Related to Preterm Birth
-Cerebral palsy -Earing impairments
-Mental retardation -Poor health and growth.
-Visual impairments
Babies born only a few weeks early
(late preterm, 34-36 weeks)
-Learning difficulties

-Increased risk of conditions such as Attention Deficit-

Hyperactivity Disorder (ADHD)

-Increased risk for Sudden Infant Death Syndrome

(SIDS)
 CAUSES OF
PREMATURITY
 There are many factors that come into play when a
baby is born prematurely. Some directly cause early
labor and birth, while others can make the mother or
baby sick and require early delivery.
 MATERNAL FACTORS:
preeclampsia
chronic medical illness
infection
Smoking cigarettes, taking illicit drugs or drinking
alcohol often or heavily while pregnant.
Becoming pregnant before the age of 17 or after 35.
abnormal structure of the uterus
cervical incompetence
previous preterm birth
 Factors involving the
pregnancy:
abnormal or decreased function of the placenta
placenta previa
placental abruption
premature rupture of membranes
polyhydramnios
 Factors involving the fetus:
when fetal behavior indicates the intrauterine
environment isn't healthy
multiple gestation
CHARACTERISTICS
OF
PREMATURITY
CHARACTERISTICS OF PREMATURITY

Small baby, often weighing less than 2,500

grams (5 pounds 8 ounces)
Thin, shiny, pink or red skin, and able to see
veins
Little body fat
Little scalp hair, but may have lots of lanugo
(soft body hair)
Weak cry and body tone
Genitals may be small and underdeveloped
 TYPES OF
COMPLICATIONS
IN
PREMATURITY
POSSIBLE COMPLICATIONS OF PREMATURITY

ANEMIA OF PREMATURITY- Many preterm infants experience

normochromic, normocytic anemia, which can cause paleness,
lethargy, and poor appetite. This is due to the immaturity of their
hematopoietic system and low levels of vitamin E, which normally
protects red blood cells. Excessive blood drawing for tests can
worsen the anemia, so it's important to minimize blood draws and
keep track of blood loss. Delaying cord clamping at birth may also
help reduce anemia in preterm infants.
POSSIBLE COMPLICATIONS OF PREMATURITY

ACUTE BILIRUBIN ENCEPHALOPATHY- a condition where brain cells

are damaged by high levels of unconjugated bilirubin, which is
formed from excessive breakdown of red blood cells at birth. Preterm
infants are more susceptible to ABE due to factors such as poor
respiratory exchange and reduced availability of serum albumin to
bind bilirubin. ABE may occur at lower bilirubin levels in preterm
infants compared to term newborns. Phototherapy or exchange
transfusion can be initiated to prevent excessively high bilirubin
levels once jaundice occurs in preterm infants.
POSSIBLE COMPLICATIONS OF PREMATURITY
PERSISTENT PATENT DUCTUS ARTERIOSUS- Preterm infants often lack
surfactant, which makes their lungs less compliant and makes it difficult for
them to move blood from the pulmonary artery into the lungs. This can lead
to pulmonary artery hypertension, which interferes with the closure of the
ductus arteriosus. Intravenous therapy should be administered cautiously to
preterm infants as increasing blood pressure could worsen this issue.
Indomethacin or ibuprofen may be used in term infants to promote closure
of the ductus arteriosus and improve ventilation, but should be given
cautiously to preterm infants due to potential adverse effects on renal
function, platelet count, and gastric irritation. Monitoring of urine output and
observation for bleeding at injection sites is important when using
indomethacin in preterm infants.
POSSIBLE COMPLICATIONS OF PREMATURITY

PERIVENTRICULAR/INTRAVENTRICULAR HEMORRHAGE- Preterm

infants are at risk of periventricular hemorrhage or intraventricular
hemorrhage due to fragile capillaries and immature cerebral vascular
development. Rapid changes in cerebral blood pressure, such as
from hypoxia, intravenous infusion, ventilation, or pneumothorax, can
cause capillary rupture leading to brain anoxia downstream from the
rupture site.
POSSIBLE COMPLICATIONS OF PREMATURITY
PERIVENTRICULAR/INTRAVENTRICULAR HEMORRHAGE-
Intraventricular hemorrhage occurs most often in VLBW infants and is
classified as:

•Grade 1, bleeding in the periventricular germinal matrix regions or

germinal
·matrix, occurring in one ventricle
•Grade 2, bleeding within the lateral ventricle without dilation of the
ventricle
•Grade 3, bleeding causing enlargement of the ventricles
•Grade 4, bleeding in the ventricles and intraparenchymal haemorrhage
OTHER POSSIBLE COMPLICATIONS
RESPIRATORY DISTRESS SYNDROME- Premature babies often have
immature lungs, which may cause difficulty breathing and require
oxygen therapy.
APNEA- Premature babies may have difficulty breathing regularly
and may experience pauses in breathing called apnea.
RETINOPATHY OF PREMATURITY- This is a condition in which the
blood vessels in the retina of the eye grow abnormally, which can
lead to vision problems or even blindness.
NECROTIZING ENTEROCOLITIS (NEC)- This is a condition in which
the intestine becomes inflamed and can lead to tissue death, which
can be life-threatening for premature babies.
INTERVENTIONS OF
PREMATURITY

A.ALTARIBA
 Taking progesterone
supplements
Progesterone is a hormone that plays a role
in pregnancy.
A lab-made version of it may be able to
lower the risk of preterm birth if you've had
a premature baby before.
It may also lower the risk of preterm birth if
you have a short cervix
 Cervical cerclage
This is a surgery that's done during pregnancy.
Your provider may suggest it if you have a short
cervix and you've had a preterm birth before.
During this procedure, the cervix is stitched closed
with a strong suture.
This may give the uterus extra support.
The suture is removed when it's time to have the
baby.
 TWO TYPES OF SUTURE

McDonald Shirodkar
TEMPORARY PERMANENT
SUPPORTIVE CARE
FOR PREMATURE
BABIES

A.ALTARIBA
Being placed in an
incubator
Babies who are born too early, before
37 weeks, can have problems such as
low birth weight, irregular
temperature, and unstable vital signs.
A baby incubator helps control their
temperature.
They will also be given high-calorie
formula and will get the treatment
they need for any other issues.
 Tracking of your baby's
vital signs
Sensors may be taped to your baby's
body to track blood pressure, heart
rate, breathing and temperature.
At birth, assessing vital signs helps
determine complications among the
body's most basic functions.
Vital signs trends can predict
impending clinical deterioration or
disease such as sepsis, and may also
predict long-term neurological or
respiratory outcomes.
Having a feeding tube
Sick or premature babies may not be
able to suck or swallow well enough to
bottle or breastfeed.
Tube feedings allow the baby to get
some or all of their feeding into the
stomach.
This is the most efficient and safest
way to provide good nutrition.
Oral medicines can also be given
through the tube
 Getting enough fluids.
Your baby needs a certain amount of
fluids each day.
The exact amount depends on the baby's
age and health.
The NICU team will closely track fluid,
sodium and potassium levels to make sure
that your baby's fluid levels stay on target
Premature infants may lose more water
through the skin or respiratory tract than
babies born at full term.
The kidneys in a premature baby have not
grown enough to control water levels in
the body.
Light therapy or
Phototherapy
Phototherapy is very safe and reasonably
comfortable.
Phototherapy is treatment with a special
type of light (not sunlight).
It's sometimes used to treat newborn
jaundice by making it easier for your
baby's liver to break down and remove the
bilirubin from your baby's blood.
Phototherapy aims to expose your baby's
skin to as much light as possible.
 Receiving blood from a
donor
Some preterm babies need blood
transfusions.
Very small premature infants are at
a high risk for anemia and often
need blood transfusions to survive.
This can be due to certain health
problems, or because many blood
samples have been taken for tests.
 DIAGNOSTIC
INTERVENTION
OF
PREMATURITY
 DIAGNOSTIC INTERVENTION
GESTATIONAL AGE ASSESSMENT:
Determines the newborn's gestational age using maternal history,
physical examination, and sometimes additional tests like ultrasound.

PHHYSICAL EXAMINATION:
Evaluates vital signs, physical characteristics, and identifies any signs
of distress or abnormalities associated with prematurity.

LABORATORY TESTS:
Assess blood count, glucose levels, electrolyte levels, and other
metabolic parameters for imbalances or abnormalities.
 DIAGNOSTIC INTERVENTION

RADIOLOGICAL TESTS:
X-rays or imaging studies to assess lungs, heart, and organs for
structural abnormalities or signs of respiratory distress syndrome.

NEUROLOGICAL ASSESSMENT:
Evaluates reflexes, muscle tone, and responsiveness to detect signs of
neurodevelopmental delays or abnormalities.
 DIAGNOSTIC INTERVENTION
SCREENING FOR COMMON COMPLICATIONS:
Monitors for respiratory distress syndrome, infections, jaundice, and
feeding difficulties, which are common complications in premature
infants.

DEVELOPMENTAL ASSESSMENTS:
Monitors growth, motor skills, and cognitive development over time to
identify any developmental delays or issues that may require early
intervention and support.
 POST TERM INFANT
Description
A post term infant born after the 41st week of a
pregnancy. (<41 weeks of gestation)
Infants who stay in utero past week 41 are at
special risk because a placenta appears to
function effectively for only 40 weeks. After that
time, it seems to lose its ability to carry nutrients
effectively to the fetus, and the fetus begins to
lose weight (postterm syndrome)
The mortality rate of the newborn who is
delivered after 42 weeks gestation is higher than
that of newborn delivered in term.
Characteristics of a Post term Infant
Stage 1 – Chronic placental insufficiency
Dry, cracked, peeling, loose, and wrinkled skin
Malnourished appearance
“wide-eyed” and demonstrate alertness much
more like a 2-week-old baby than a newborn.
Stage 2 – Acute placental insufficiency
All features of stage 1 except point iii
Meconium staining
Stage 3 – Subacute placental insufficiency
Findings of stage 1 and 2
Green staining of skin, nails, cord, and
placental membrane.
A high risk of fetal intrapartum or neonatal
death.
Creases cover soles
Absence of vernix and lanugo
Overgrown nails
To confirm fetal maturity

Sonogram is usually obtained to measure the biparietal diameter of

the fetus.
Non-stress test or complete biophysical profile may be done to
establish whether the placenta is still functioning adequately.

A cesarean birth may be indicated if a nonstress test reveals that

compromised placental functioning is apt to occur during labor.
Complications
Placental Insufficiency, which might cause;
Oligohydramnios
Oligohydramnios
Poor oxygen supply
Polycythemia may have developed from
decreased oxygenation in final weeks.
Hematocrit is elevated.
Meconium aspiration syndrome
Hypoglycemia may develop in the first hours
of life because the fetus had to use stores of
glycogen for nourishment in the last weeks of
intrauterine life.
Subcutaneous fat levels may also be low,
having been used in utero. This loss of fat
can make temperature regulation difficult.
General supportive care is provided
Nursing Implications
Maintenance of temperature
Make certain a woman spends enough time with her newborn to assure
herself that although birth did not occur at the predicted time, the baby
should do well with appropriate interventions.
Manage meconium aspiration syndrome.
Infants are at risk of hypoglycemia, so glucose monitoring should be done
regularly.
Respiratory support by high frequency ventilation, supportive therapies and
inhaled nitric oxide or other pulmonary vasodilators.
Maintain skin integrity.
All post term infants need follow-up care until at least school age to tract
their developmental abilities because the lack of nutrients and oxygen in
utero may have left them with neurologic symptoms that will not become
apparent until they attempt fine motor tasks.
PROBLEMS RELATED TO GESTATIONAL
WEIGHT
· Low birth weight
· Very low birth weight
· Extremely low birth weight
 LOW BIRTH WEIGHT
Low birth weight is a term used to describe
babies who are born weighing less than 5 pounds,
8 ounces (2,500 grams). An average newborn
usually weighs about 8 pounds. A low-birth-
weight baby may be healthy even though they are
small. But a low-birth-weight baby can also have
many serious health problems.
VERY LOW BIRTH WEIGHT

Very low birth weight (VLBW) is a

term used to describe babies who are
born weighing less than 3 pounds, 4
ounces (1.5 kilograms). It is very rare
that babies are born this tiny.
EXTREMELY LOW BIRTH WEIGHT
An extremely low birth weight (ELBW)
infant is defined as one with a birth weight of
less than 1000 g (2 lb, 3 oz). Most extremely
low birth weight infants are also the youngest
of premature newborns, usually born at 27
weeks' gestational age or younger.
WHAT CAUSES A BABY TO HAVE A LOW
LOW BIRTH WEIGHT?

Preterm birth (Premature birth)

Fetal Growth Restriction (aslo called
intrauterine growth restriction or small for
gestational age)
Medical risk factors for having a low-birth
weight baby:
Preterm labor
Chronic health conditions
Taking certain medicines to treat health conditions
Infections
Problems with the placenta.
Not gaining enough weight during pregnancy
Having a baby who was born too early or who had low birthweight in the past.
Being pregnant with multiples (twins, triplets or more).
Smoking, drinking alcohol, using street drugs and abusing prescription drugs
Exposure to air pollution or lead
Being a member of a group that experiences the effects of racism and health
disparities
Domestic violence
Age
POSSIBLE COMPLICATIONS OF LOW BIRTH
WEIGHT:
Low oxygen levels at birth
Trouble staying warm
Trouble feeding and gaining weight
Infection
Breathing problems and immature lungs (infant respiratory distress syndrome)
Nervous system problems, such as bleeding inside the brain (intraventricular hemorrhage)
Digestive problems, such as serious inflammation of the intestines (necrotizing enterocolitis)
SIDA (sudden infant death syndrome)
Yellow color to the skin or eyes (jaundice)
Persistent ductus arteriosus (PDA). This happens when an open blood vessel needed for
fetal circulation does not close correctly at birth. This causes extra blood to flow through
the lungs.
Retinopathy of prematurity (ROP). This is a disease of the eye where the retina does not
develop correctly.
 Respiratory Distress
Syndrome
formerly termed hyaline membrane disease,
happens when a baby's lungs are not fully
developed and cannot provide enough
oxygen, causing breathing difficulties. It
usually affects premature babies.
WHY IT HAPPENS?
NRDS usually occurs when the baby's lungs have not produced enough
surfactant.
This substance, made up of proteins and fats, helps keep the lungs inflated and
prevents them collapsing.
A baby normally begins producing surfactant sometime between weeks 24 and
28 of pregnancy.
Most babies produce enough to breathe normally by week 34.
If your baby is born prematurely, they may not have enough surfactant in their
lungs.
Around half of all babies born between 28 and 32 weeks of pregnancy develop
NRDS.
In recent years the number of premature babies born with NRDS has been
reduced with the use of steroid injections, which can be given to mothers
during premature labour.
SYMPTOMS:
The symptoms of NRDS are often noticeable immediately after birth and get worse over
the following few days.
They can include:
blue-coloured lips, fingers and toes
rapid, shallow breathing
flaring nostrils
a grunting sound when breathing

!! COMPLICATIONS !!
Most babies with NRDS can be successfully treated, although they have a high risk of
developing further problems later in life.
1. Air leaks
2. Internal bleeding
3. Lung scarring
4. Developmental disabilities
Transient Tachypnea of
the Newborn (TTN)
Transient Tachypnea of the Newborn
(TTN)
Also known as "wet lungs"

"At birth, a newborn may have a rapid rate of

respirations, up to 80 breaths per minute when crying,
caused by retained lung fluid"
1 hour ,rapid rate slows to between 30 and 60 breaths per
minute.
10 in 1000 live births, respiratory rate remains at a high
level, between 80 and 120 breaths per minute.
(Raab, 2007)
Clinical assessment:
1. The infant does not appear to be in a great deal of
distress, aside from the tiring effort of breathing so
rapidly.
2. Mild retractions but not marked cyanosis, mild
hypoxia, and hypercapnia may be present.
3. Feeding is difficult because the child cannot suck and
breathe this rapidly at the same time.
4. A chest radiograph will reveal some fluid in the
central lung, but aeration is, overall, adequate.
(Copetti & Cattarossi, 2007)
Factors:

TTN may reflect a slight decrease in production of phosphatidyl

glycerol or mature surfactant but is a direct result of retained lung
fluid.

It occurs more often in infants who are born by cesarean birth, in

infants whose mothers received extensive fluid administration
during labor, and in preterm infants.
 Therapeutic Management:
1. Close observation of such a newborn is a priority.
Watch carefully to be certain the increased effort is not tiring.
Also watch for beginning signs of a more serious disorder.
2. Oxygen administration may be necessary.

Transient tachypnea of the newborn peaks in intensity at

approximately 36 hours of life and then begins to fade. Typically,
by 72 hours of life, it spontaneously fades as the lung fluid is
absorbed and respiratory activity becomes effective
 s pira tio n
coniu m A
Me [M AS ]
ro me
Synd
Is a Respiratory Distress in an
Infant born through Meconium
stained amniotic fluid whose
symptoms cannot be otherwise
explained.
 s pira tio n
coniu m A Umbilical cord stained with
Me [M AS ]
ro me meconium
Synd

Composition of
meconium:
Epithelial Cells
Fetal Hair
Mucus
Bile
 s pira tio n
coniu m A
Me [M AS ]
ro me
Synd
Meconium is present in the fetal bowel as early as 10 weeks of gestation.

In both instances, the appearance of the fluid at birth is green to greenish black from the
staining.

Meconium aspiration does not tend to occur in ELBW infants

because the substance has not passed far enough in the bowel for it to be at the rectum in these
infants.

An infant may aspirate meconium either in utero or with the first breath at birth.

Meconium can cause severe respiratory distress (tachypnea, retractions, and grunting).
 s pira tio n
coniu m A
Me [M AS ]
ro me
Synd Assesment
Infants with meconium-stained amniotic fluid can have difficulty establishing
respirations at birth (those who were not born breech have had a hypoxic episode in
utero to cause the meconium to be in the amniotic fluid).

The infant should be placed on the warmer, and resuscitation should begin including the
initiation of positive pressure ventilation as necessary

After the initiation of respirations, an infant's respiratory rate may remain rapid
(tachypnea) and coarse bronchial sounds may be heard on auscultation.

This air trapping may also cause enlargement of the anteroposterior diameter of the chest
(barrel chest).

A chest X-ray will show bilateral coarse infiltrates in the lungs, with spaces of
hyperaeration (a peculiar honeycomb effect).
 s pira tio n
coniu m A Therapeutic Management
Me [M AS ]
ro me
Synd
Amnioinfusion can be used to dilute the amount of meconium in the amniotic fluid and
has shown to improve the outcomes for the newborn with meconium in situations where
perinatal observation is limited.

The benefits may be related to dilution of the meconium

or having an effect on the oligohydramnios

If deeply stained amniotic fluid is identified during labor, the infant may be scheduled for a
cesarean birth.

After birth, infants may need to be treated with oxygen administration

and assisted ventilation.

Antibiotic therapy may be prescribed to forestall the

development of pneumonia as a secondary problem.
 s pira tio n
coniu m A Therapeutic Management
Me [M AS ]
ro me
Synd
Unfortunately, this can cause a pneumothorax or pneumomediastinum (air in the chest
cavity).

Observe the infantclosely, therefore, for signs of trapping air in the alveoli because the
alveoli can expand only so far and then will rupture, sending air into the pleural space
(pneumothorax).

To detect this, observe an infant closely for signs of heart failure such as increased heart
rate or respiratory distress.

Maintain a temperature-neutral environment to prevent the infant from having to increase

metabolic oxygen demands.

A chest physiotherapy with percussion and vibration may be helpful to encourage the
removal of remnants of meconium from the lungs .
SUDDEN INFANT DEATH SYNDROME
Course Outline

What is SIDS?
Causes of SIDS
What are the risk factors?
Prevention
SUDDEN INFANT DEATH SYNDROME
Definition
unexplained death of an infant younger than 1 year old
"Crib death"
cause of death in children between 1 month and 1 year old
most SIDS occur when babies are between 2 months and 4
months
6000-7000 babies
SUDDEN INFANT DEATH SYNDROME
Infant Development
reflect a delay or abnormality in the development of
nerve cells within the brain that are critical to
normal heart and lung function.
delay in the formation and function of several
serotonin-binding nerve cell pathways within the
brain; breathing, heart rate, and blood pressure
responses during awakenin from sleep.
SUDDEN INFANT DEATH SYNDROME
Symptoms
without any warning or symptoms
death occure wheen the infant is thought to be
sleeping.
SUDDEN INFANT DEATH SYNDROME
Causes
Physical and sleep environmental factors can make
an infant more vulnerable to SIDS
Brain abnormalities
Low birth weight
Respiratory infection
SUDDEN INFANT DEATH SYNDROME
Causes
Sleeping on the stomach or side. babies may
experience difficuly in breathing
SUDDEN INFANT DEATH SYNDROME
Causes
Sleeping on a soft surface.lying face down on a fluffy
comforter or a waterbed can block an infant's airway.
draping a blanket over a baby's head is also risky.
SUDDEN INFANT DEATH SYNDROME
Causes
Sleeping with parents. risk increases if the baby sleeps
in the same bed; more soft surfaces to impair breathing
SUDDEN INFANT DEATH SYNDROME
Risk factors
sex
age
race
family history
secondhand smoke
being premature
SUDDEN INFANT DEATH SYNDROME
Maternal Factors
younger than 20
smokes cigarettes
uses drugs or alcohol
has inadequate prenatal care
SUDDEN INFANT DEATH SYNDROME
Maternal Factors
place your baby on their back to sleep, in a crib in the
room with you.
dont smoke during pregnancy or let others smoke in the
same room as your baby
dont share bed with your baby if actively on drugs and
alcohol.
never sleep with your baby on a sofa or armchair
dont let your baby get too hot or too cold
SUDDEN INFANT DEATH SYNDROME
Maternal Factors
keep your baby's head uncovered. blankets should be
tucked in no hinger than their shoulders
place your baby in the "feet to foot" position
if possible, breastfeed your baby.
 APPARENT LIFE-THREATINING EVENT
DEFINITION
ALTE stands for "Apparent Life-Threatening
Event." It is a term used in pediatrics to describe an
episode in an infant or young child that frightening
to the observer by some combination of apnea
(temporary cessation of breathing), color change
(usually cyanotic or pallid), limpness, choking or
gagging.
The peak age is between 1 and 3 months, although
they can occur in neonates (newborns) and in older
infants as well. Some potential causes of ALTEs
include gastroesophageal reflux (GER), respiratory
infections, seizures, cardiac arrhythmias, or other
medical conditions. In some cases
 APPARENT LIFE-THREATINING EVENT
SIGNS AND SYMPTOMS
Apnea
Color change
Change in muscle
tone.
Choking or gagging
Altered level of
consciousness
Abnormal
movements
General considerations for prevention and management of ALTEs:

Regular check-ups: Regular visits to a pediatrician for well-child check-

ups can help identify and manage any underlying medical conditions
early, potentially reducing the risk of ALTEs.
Safe sleep practices: Following safe sleep practices for infants, such as
placing them on their backs to sleep, using a firm mattress, avoiding soft
bedding, keeping the sleeping environment free of hazards, and avoiding
bed sharing, can reduce the risk of sudden infant death syndrome (SIDS)
and other sleep-related incidents that may contribute to ALTEs.
Avoidance of smoking and secondhand smoke: Avoiding exposure to
secondhand smoke, as well as keeping the home smoke-free, can reduce
the risk of respiratory issues that may contribute to ALTEs.
Prompt management of underlying medical conditions: If a child has an
underlying medical condition such as respiratory, gastrointestinal, cardiac,
or neurologic disorders, it's important to work with healthcare providers to
manage and treat the condition according to recommended guidelines.
Education and training: Educating caregivers, parents, and other caregivers
on infant and child safety, including safe sleep practices, CPR, first aid, and
recognition of signs and symptoms of potential medical issues, can empower
them to take appropriate preventive measures and respond effectively in
case of an emergency.
Follow-up and monitoring: Children who have experienced an ALTE may
require close follow-up and monitoring by healthcare providers to evaluate
their condition, manage any underlying issues, and provide appropriate care
and support.
APPARENT LIFE-THREATINING EVENT

Evaluation typically includes:

History and physical
examination
Laboratory tests
Imaging studies
Cardiac evaluation
Respiratory evaluation
Neurologic evaluation
Hemolytic Disease of the Newborn
(Hyperbilirubinemia)

“hemolytic” - is Latin for “destruction” (lysis) of

red blood cells.
Hemolytic disease is present when there is
excessive destruction of red blood cells, which
leads to elevated bilirubin levels
(hyperbilirubinemia)
 Hyperbilirubinemia
Description:
Hyperbilirubinemia results from the destruction of red blood cells,
owning either to a usual physiologic response or an abnormal
destruction of red blood cells.
Hemolytic disease of the newborn occurs from destruction of red blood
cells from Rh or ABO incompatibility.
The administration of RHIG (Rh antibodies) to Rh-negative mothers
during pregnancy and after the birth of an Rh-positive infant to an Rh-
negative mother has greatly reduced the incidence of the condition.
Affected infants appear jaundiced from the release of bilirubin from
injured red blood cells.
Phototherapy and an exchange transfusion are used to prevent ABE (the
deposition of bilirubin in brain cells, causing destruction of the cells).
 Hyperbilirubinemia
Hyperbilirubinemia is caused by the accumulation
of excess bilirubin in blood serum.
In the average newborn, the skin and sclera of the
eyes begin to appear noticeably yellow on the
second or third day of life as a result of a
breakdown of fetal red blood cells (called
physiologic jaundice)
 Hyperbilirubinemia
Heme is further broken down into iron (which is reused
and not involved in the jaundice) and photoporphyrin.
Photoporphyrin is then broken down into indirect
bilirubin, a compound which is fat-soluble and therefore
cannot be excreted by the kidneys. In order to be removed
from the body, it must be converted by the liver enzyme
glucoronyl transferase into direct bilirubin, which is water-
soluble, and is then incorporated into the stool and
excreted as feces.
 Hyperbilirubinemia

Carefully observe infants who are prone to extensive

bruising (large, breech, or preterm babies) for jaundice.

Cephalohematoma is a collection of blood under the

periosteum of the skull bone caused by pressure at birth.
 Hyperbilirubinemia

Risk factors for jaundice:

Premature birth
Significant bruising during birth
Blood type
Breast- feeding
 Hyperbilirubinemia

Another reason indirect bilirubin levels can increase is if a

newborn has an intestinal obstruction.
Above normal indirect bilirubin levels are potentially
dangerous because, if enough indirect bilirubin about
20mg/100ml) leaves the bloodstream, it can interfere with
the chemical synthesis of brain cells, resulting in
permanent cell damage, a condition termed Acute
bilirubin encephalopathy or kernicterus.
Hemolytic Disease of the Newborn

In the PAST, hemolytic disease of the newborn was

most often caused by an Rh blood type
incompatibility.

It is now, most often caused by an ABO

incompatibility
Hemolytic Disease of the Newborn

In both instances, the mother builds antibodies

against an infant’s red blood cells, leading to
hemolysis. The destruction of red blood cells causes
severe anemia and hyperbilirubinemia from the
bilirubin released from red cells.
Rh Incompatibility
No direct connection exists between the fetal and
maternal circulation.
occasionally a placental villi may break and a drop or two of
fetal blood will enter the maternal circulation.
Rh Incompatibility
Most anti-bodies form in the first 72 hours after birth
Because of the active exchange of fetal–maternal
blood as placental villi loosen and the placenta is
delivered.
Rh Incompatibility
By the end of pregnancy, a fetus can be severely compromised.
Some infants require intrauterine transfusions to combat red
cell destruction.
Preterm labor may be induced to remove the fetus from the
destructive maternal environment.

"Administering phenobarbital to women during their last

weeks of pregnancy has been tried to reduce symptoms in
newborns as it speeds liver maturity so that the infant
liver better converts indirect to direct bilirubin. This,
unfortunately, also carries the risk of fetal sedation."
(Thomas, Muller, & Wilkinson, 2009)
ABO Incompatibility
In most cases, the maternal blood type is O and the fetal blood
type is A; it may also occur when the fetus has type B or AB blood.
A reaction in an infant with type B blood is often the most
serious.

Hemolysis can become a problem with a first pregnancy in

which there is an ABO incompatibility as the antibodies to A
and B cell types are naturally occurring antibodies
Or are present from birth in individuals whose red cells lack
these antigens
ABO Incompatibility
Unlike the antibodies formed against the Rh D factor, these
antibodies are of the large (IgM) class and do not cross the
placenta.

Infant of an ABO incompatibility, is not born anemic.

Hemolysis of the blood begins with birth.

exchanged during the mixing of maternal and fetal blood as the
placenta is loosened
destruction of red cells may continue for up to 2 weeks of age
ABO Incompatibility
Preterm infants do not seem to be affected by ABO
incompatibility.
receptor sites for anti-A or anti-B antibodies do not appear

A direct Coombs’ test may be only weakly positive because of the few
anti-A or anti-B sites present.
The reticulocyte count is usually elevated.
Therapeutic Management
Initiation of early feeding, use of phototherapy, and exchange
transfusion all may be immediate measures necessary to reduce indirect
bilirubin levels in an infant affected by ABO or Rh incompatibility.

Initiation of Early Feeding.

Bilirubin is removed from the body by being incorporated into feces.

Early feeding (either breast milk or formula), therefore, stimulates
bowel peristalsis and accomplishes this.
Therapeutic Management

Phototherapy.

An infant’s liver processes little bilirubin

in utero because the mother’s circulation
does this for an infant. With birth,
exposure to light apparently triggers the
liver to assume this function. Additional
light supplied by phototherapy appears to
speed the conversion potential of the
liver.
Therapeutic Management

Phototherapy.

The stools of an infant under bilirubin lights are often bright

green because of the excessive bilirubin that is excreted as
the result of the therapy. They are also frequently loose and
may be irritating to skin. Urine may be dark-colored from
urobilinogen formation. Monitor axillary temperature to
prevent an infant from overheating under the bright lights.
Assess skin turgor and intake and output to ensure that
dehydration is not occurring from the warm environment.
Therapeutic Management

Exchange Transfusion

The therapy may be used for any condition that leads to

hyperbilirubinemia or polycythemia. When used as therapy for
blood incompatibility, it removes approximately 85% of sensitized
red cells. It reduces the serum concentration of indirect bilirubin
and often prevents heart failure in infants.

It may be used if the serum bilirubin level is rising more than 0.5
mg/hr in infants with Rh incompatibility or 1.0 mg/hr in infants with
ABO incompatibility.
Therapeutic Management

Exchange Transfusion

Because indirect bilirubin levels rise at relatively predictable levels,

standards for performing exchange transfusion depend on the
indirect bilirubin concentration, and transfusion is used when this
level exceeds:

• 5 mg/100 mL at birth
• 10 mg/100 mL at age 8 hours
• 12 mg/100 mL at age 16 hours
• 15 mg/100 mL at 24 hours
Thank You!