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INTRODUCTION:
The term ‘ high risk new born’ identifies a group of new born
who very will develop a severe acute or an adverse outcome.
A new born, regardless of gestational age or birth weight ,
who has a greater than average chance of morbidity or
mortality because of condition or circumstances super imposed
on the normal course of events associated with birth and the
adjustments to extra uterine existence.
CONCEPT
To predict a in fund is at high risk allows for
advanced preparation so that specialized skilled
healthcare personal can be present at the time of
childbirth to perform intervention.
It helps to save the newborn's life and also
prevent future problem such as neurological
disorders.
Mother should be council regarding the mode of
feeding before delivery.
National health goals on high risk
newborn :
Reduction of IMR and MMR by 50% from existing level in
next 7 years
Universal access to public health services
1. Women HEALTH
2. Child Health
3. Water Sanitation And Hygiene
4. Immunization
5. Nutrition
Principles of HIGH RISK newborn care:
Promoting Warmth
Normal Breathing ( RESUSCITATION)
Mother's Milk
Protection From Infection
Prevention
Female LITERACY And Formal Education
Maternal Health State
Antenatal Care
Maternal Infection
Goals
Perinatal Prevention
Resuscitation And Stabilization
Evaluate And Manage
Monitoring
Family Centered Care
Factors- to define high risk newborn
Democratic Social Factors
Past Medical History
Previous Medical History
Present Pregnancy
Labour And Delivery
Neonate
Demographic social factors
Maternal Age < 16 Or > 40 Years
Poverty
Unmarried
Emotional Or Physical Stress
Illicit Drug, Alcohol, Cigarette Use.
Nose :
Non Patent Canals
Thick, Blood Nasal Discharge, Flaring Of
Nares (Alae Nasi)
Copious Nasal Secretions Or Stuffness.
MOUTH AND THROAT :
CleftLip , Cleft Palate, Large Protruding Tongue
Or Posterior Displacement Of Tongue
Profuse Salivation Or Drooling,
Candidiasis (Thrush )
White Adherent Patches On Tongue Palate And
Buccal Surfaces
In Ability To Pass Naso Gastric Tube
Hoarse High Pitched Weak Absent
Neck:
excessive skin folds
resistance to flexion
absence of tonic neck reflex
Fractured clavicle
Chest:
depressed sternum
marked retractions of chest
asymmetric chest expansion readiness and
firmness around nipples
wide spaced nipples
Lungs :
Inspiratory Stridor Expiratory Grunt
Retractions Persistent
Irregular Breathing
Periodic Breathing With Repeated Apneic Spells
See Saw Respiration
Paradoxical
Wheezing
Diminished Breath Sound
Peristaltic Bowel Sounds On One Side
Heart:
Dextrocardia( heart on right side
displacement of Apex )
muffled cardiomegaly
abdominal shunts
Murmur
Thrill
persistence Central cyanosis
hyperactive pericardium.
Abdomen:
Abdominal Distension
Localized Bulging
Descended Veins
Absent Bowel Sounds
Enlarged Liver And Spleen.
Ascites
Scaphoid Or Concave Abdomen
Moist Umbilical Cord
Presence Of Only Pus Leaking From Cord Or Cord Insertion
Site.
FEMALE GENITALIA:
Enlarged Clitoris With Urethral Meatus At Tip
Fuse Labia
Absence Of Vaginal Opening
Meconium From Vaginal Opening
No Urination Within 24 Hours
Masses In Labia
Ambiguous Genitalia
MALE GENITALIA :
Hypospadias's
Urethral Opening On Ventral Surface Of Penis
Ventral Curvature Of Penis
Testis Not Palpable In Scrotum Or Inguinal Canal
No Urination With 24 Hours
Inguinal Hernia
EXTREMITIES:
Polydactyly( Extra Digit)
Syndactyly (Fused Or Webbed Digit)
Phocomelia
Hemimelia
Hyper Flexibility Of Joints
Sole Covered With Creases
Decreased Or Absent Range Of Motion
Unequal Knee Height Or Abduction
Audible Clunk On Abduction
A Symmetry Of Extremities
NEUROMUSCULAR SYSTEM:
hypotonic floppy, poor head control
extremities limp
hypertonia jittery
arms and hands tightly flexed
legs stiffly extended
a symmetric posturing
opisthotonics postering
CLASSIFICATION OF HIGH
RISK NEWBORN:
LOW BIRTH WEIGHT (LBW) INFANT
An infant whose birth weight is less than
2500 grams regardless of gestational age
1. VERY LOW BIRTH WEIGHT: < 1500 GRAM
2. VERY VERY LOW BIRTH WEIGHT:
extremely low birth weight < 1000 gram
3. MODERATELY LOW BIRTH WEIGHT:
birth weight is 1500 to 2500g
4. APPROPRIATE GESTATIONAL AGE( AGA) INFANT:
An infant whose weight falls between the 10th- 90th percentile on intra
uterine growth curves
3. parental education:
The baby can
breathe without support
can maintain a stable body temperature
can breast or bottle feed
is gaining weight steadily
is free of infection
INTRA UTERINE GROWTH RETARDATION
DEFINITION:
Babies with a birth weight less than 10 th percentile for
their gestational age.
Incidence:
comprise about 1/3 of low birth weight
2-8% in developed countries
5 % among term baby
15% among post term baby
CLASSIFICATION:
Depending upon the relative size of their head, abdomen and femur,
the fetuses are subdivided into
1. symmetrical or type – 1
2. asymmetrical or type- 2
SYMMETRICAL TYPE:
ONSET - early in utero
Etiology –congenital, infections, genetic disorder.
pathophysiology- impaired cell division, decrease cell number irreversible
clinical features – inadequate growth of head and body
head:abdomen ratio may be normal
prognosis- poor prognosis
ASYMMETRICAL TYPE 2
ONSET - later onset
ETIOLOGY - Uteroplacental insufficiency, maternal malnutrition,
hypertension
PATHOPHYSIOLOGY: Impaired cellular hypertrophy , decreased cell s
size reversible
CLINICAL FEATURES: Brain is Spared, head to abdomen ratio is
increased
PROGNOSIS : most favorable prognosis
CAUSES
causes of fetal growth restriction divided into four
groups
1. maternal condition
Constitutional
small women
maternal genetic and racial background
maternal nutrition before and during pregnancy
2. MATERNAL DISEASE
Anaemia
hypertension
thrombophilia
Heart disease
chronic renal disease
collagen vascular disease
toxins
3.FETAL
structural anomalies
chromosomal abnormality
infection torch agent
multiple pregnancies
4.PLACENTAL
poor uterine blood flow
chronic placental insufficiency
placenta previa
circumvallates placenta
infarction and mosaicism
CLINICAL FEATURES
Length is unaffected
weight is about 600 gram below at birth
dry and wrinkled skin
Thin meconium stained vernix caseosa
scaphoid abdomen
planter creases are well defined
thin umbilical cord
all these give a old man appearance
the baby is alert, active
has normal crying
reflexes or normal
DIAGNOSTIC EVALUATION :
Bio physical examination
Sonography predictive values (HC/ AC)
Amniotic fluid volume
Doppler velocimetry
CARE OF HIGH RISK NEWBORN:
Care At Neonatal Intensive Care Unit
Maintenance Of Breathing
Maintenance Of Stable Body Temperature
Gentle Early Stimulation
Prevention, Early Deduction And Prompt Management
Of Complication
Vaccination
Transport Of Sick Baby
Family Support Discharge
Follow And Home Care
COMPLICATIONS
1. FETAL
Antenatal - chronic fetal distress
- fetal death
intranatal - hypoxia
- acidosis
2. IMMEDIATE
Asphyxia
Micro Coagulation Leading To DIC During First Day Of
Life
Hypothermia
Pulmonary Haemorrhage
Polycythaemia
Hyper Viscosity Syndrome
Necrotising Enterocolitis
Intra Ventricular Haemorrhage
Hypoglycaemia
Meconium Stained Syndrome