High Risk Neonate

High risk newborn is any infant regardless of

gestational age or birth weight, who has morbidity
and mortality because of conditions or
circumstances superimposed on the normal course
of events associated with birth and the adjustment
to uterine existence
High-risk neonate is defined as one who has a
greater than average chance of morbidity or
mortality during the prenatal ,perinatal and
postnatal periods because of conditions or
circumstances that are superimposed on the
normal course of events associated with birth and
the adjustment to extra uterine existence.
Classification

According to weight
According to gestational age
According to mortality
According to weight -regardless of gestational age

Low birth weight baby (<2500gms)

Very low birth weight (<1500gms)
Extremely L BW (<1000gms)
Appropriate for gestational age between
10th and 90th percentile on an intrauterine
growth curve.
IUGR
 LGA
According to gestational age
Preterm infant
Postterm
Full term
According to mortality

Live birth
Fetal death(after 20 weeks, before
delivery )
Postnatal death
Factors that can place baby at high
risk
Maternal conditions
Age at delivery
Personal factors –poverty ,smoking , drug/alcohol
abuse , poor diet ,trauma(acute/chronic)
Medical history –diabetes, thyroid renal disease,
urinary tract infections , heart disease, lung
disease hypertension ,anemia Rh/ABO
incompatability
Obstetric history _Infertility ,past history of neonatal
illness or death, maternal medications, bleeding in
early pregnancy/third trimister, premature rupture
of membrane
Fetal conditions
LBW
SGA
Birth defects
Respiratory distress seizures
Hypoglycemia
CONDITIONS OF LABOR AND
DELIVERY
Premature labour
PIH
Meconium stained amniotic fluid
prolapsed cord
Fetal distress /birth asphyxia
Breech delivery presentation
Immediate neonatal
conditions
Prematurity
Postmaturity
Pallor /shock
Low 1minute or 5minute apgar score
Identification of At Risk
neonate
Weight
Axillary temp -36 to 36.5d c
Late cry
Sucking poor
Depressed sensorium but is arousable
Respiratory rate >60 /mt (no chest retractions
Jaundice present but no staining of palms /soles
Severe birth asphyxia with 5minutes
Apgar score of less or 3
Maternal diabetes mellitus
Respiratory distress
Neonate may have
Fever
Diarrhea or vomitting or abdominal
distention
Umbalicus draining pus or pustules on skin