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: 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 Associated with the state of maturity of the infant. Chemical disturbances. eg: hypoglycemia, hypocalcemia. 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: absent of lanugo. Little if any vernix caseosa. Abundant scalp hair. 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 & chylamydial 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 <1500g

MANAGEMENT OF HIGH RISK INFANT SKIN CARE OF PREMATURE- increased sensitivity MEDICATION DECREASE STRESS

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