high-risk newborn

Identification of high-risk newborns

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 existence.

The high risk period encompasses human

growth and development from the time of
viability up to 28 days following birth.
Classification of high-risk newborns
Classified according to:
1. Birth weight.
 Low-birth-weight (LBW): an infant whose birth
weight is less than 2500 g, regardless of
gestational age.
 Very low-birth-weight (VLBW) infant :an infant
whose birth weight is less than 1500g.
 Extremely-low-birth-weight (ELBW) infant: an
infant whose birth-weight is less than1000g.
 Classified according to Birth weight.
 Appropriate-for-gestational-age (AGA)INFANT:
an infant whose birth-weight is falls between the
10th and 90th percentiles on intrauterine growth
curves.
 Small-for-date (SFD) or small-for-gestational
age (SGA) infant: an infant whose rate of
intrauterine growth was slowed and whose birth
weight falls below the 10th percentile on
intrauterine growth curves
 Intrauterine growth restriction (IUGR) found in
infants whose intrauterine growth is restricted
 Classified according to Birth weight.

 Symmetric IUGR: growth restriction in which the

weight, length, and head circumference are all
affected.
 asymmetric IUGR: growth restriction in which
the head circumference remains within normal
parameters while the birth weight falls below the
10th percentile
 Large-for-gestational-age (LGA): an infant
whose birth weight falls above the 90th percentile
on intrauterine growth curves.
 Classification according to
Gestational age
Premature (preterm) infant: an infant born before
completion of 37 weeks of gestation, regardless
of birth weight.
Full-term infant: an infant born between the
beginning of the 38 weeks and the completion of
the 42 weeks of gestation, regardless of birth
weight.
Postmature (postterm) infant: an infant born after
42 weeks of gestational age ,regardless of birth
weight.
Classification according to mortality
Live birth: birth in which the neonate manifests
any heartbeat, breathes, or displays voluntary
movement, regardless of gestational age.
Fetal death: death of the fetus after 20 weeks of
gestation and before delivery, with absence of
any signs of life after birth.
:Neonatal death death that occurs in the first 27
days of life; early neonatal death occurs in the
first weeks of life ; late neonatal death occurs at
7-27 days.
Perinatal mortality: total number of fetal and
early neonatal deaths per 1000 live births
 Classification according to
Pathophysiologic problems

a. Associated with the state of maturity of

the infant. Chemical disturbances. eg:
hypoglycemia, hypocalcemia.
b. Immature organs and systems. eg
hyperbilirubinemia, respiratory distress,
hypothermia.
Newborn exposed to HIV/AIDS
Newborn with congenital anomalies
 High risk related to dysmaturity
preterm infants
Etiology of preterm birth:
1. Unknown
2. Maternal factors:
 Malnutrition.
 Chronic disease: heart, renal, diabetes.
3. Factors related to pregnancy
 Hypertension.
 Abruptio placenta or placenta previa.
 Incompetent cervix.
 Premature rupture of membranes or chorioasmniotis.
 Polyhydratmnios.
4. Fetal factors:
 Chromosomal abnormalities.
 Intrauterine infection.
 Anatomic abnormalities.
 Postterm infant
Causes: Unknown.
Characteristics:
1. absent of lanugo.
2. Little if any vernix caseosa.
3. Abundant scalp hair.
4. Long fingernails.
 There is significant increase in fetal and neonatal
mortality,
 causes: fetal distress associated with the decreasing
efficiency of the placenta, macrosomia, and meconium
aspiration syndrome.
 The greatest risk occurs during the stresses of labor
and delivery, particularly in infants of primigravdas.
MATERNAL INFECTION

T- Toxoplasmosis
O- Other ( hepatitis, measles,
mumps, HIV)
R- Rubella- pregnant no contact
C- Cytomegalovirus infection-
pregnant no contact
H- Herpes simplex- Stop transmission
S- Syphilis (Gonococcal conjunctivitis
 HIGH RISK NEWBORN
MOST COMMON PROBLEMS
hypoglycemia
hypocalcemia
resp. Distress
hypothermia
 Hypoglycemia
Threat to Brain Cells
Less than 30 mg/100 ml of blood = harmful
After birth levels fall
Infants prone to hypoglycemia
Treatment
 HYPOCALCEMIA

RISK- preterm with hypoxia, IDM,

hypoglycemic
serum calcium <7 mg/dl
increase milk feedings, cal.
supplements, Vit D
PRETERM INFANTS- Potential
Complications
Anemia
Kernicterus
Persistent Patent Ductus Arteriosus
Periventricular/Intraventricular
Hemorrhage
 CONGENITAL
HYPOTHYROIDISM
INADEQUATE THYROXINE (T4)

CLINICAL SIGNS- Hypotonia, wide-

spread fontanelles, large thyroid,
prolonged jaundice

TREATMENT- Thyroid hormone

replacement
 GALACTOSEMIA
DISORDER OF GALACTOSE
METABOLISM
GLACTOSE ACCUMULATES IN
BLOOD ORGANS
SIGNS- Lethargy, hypotonia, diarrhea
TREATMENT- Eliminate galactose
(Prosobee)
 PHENYLKETONURIA
ABSENSE OF PHENYLALANINE
HYDROXYLASE
AFFECTS DEVELOPMENT OF BRAIN
AND CNS
SCREENING OF NEWBORNS,
REPEAT SCREENING
TREATMENT- Diet restricts
phenylalanine (Lofenalac), meat and
diary products restricted
MANAGEMENT OF HIGH RISK
INFANT
PHYSICAL ASSESSMENT
THERMOREGULATION- need neutral
thermal environment, use brown fat
CONSEQUENCES OF COLD STRESS-
hypoxia, metabolic acidosis, hypoglycemia
GLUCOSE & CALCIUM
PROTECT FROM INFECTION
MANAGEMENT OF HIGH RISK
INFANT
HYDRATION- IVF for calories,
electrolytes & H2O
NUTRITION- no coordination of
sucking until 32-34 weeks; not
synchronized until 36-37 weeks; gag
reflex not developed until 36 weeks
EARLY FEEDING- within 3-6 hours
BREAST FEEDING
GAVAGE FEEDING- <32 wks. or
MANAGEMENT OF HIGH RISK
INFANT

SKIN CARE OF PREMATURE-

increased sensitivity
MEDICATION
DECREASE STRESS
Thank You For
Your Attention