2. high-risk newborn

3. 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.

4. 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.

5. 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

6. 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.

7. 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.

8. 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

9. 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

10. High risk related to dysmaturity preterm infants
Etiology of preterm birth:
Unknown
Maternal factors:
Malnutrition.
Chronic disease: heart, renal, diabetes.
Factors related to pregnancy
Hypertension.
Abruptio placenta or placenta previa.
Incompetent cervix.
Premature rupture of membranes or chorioasmniotis.
Polyhydratmnios.
Fetal factors:
Chromosomal abnormalities.
Intrauterine infection.
Anatomic abnormalities.

11. 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.

12. 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)

13. HIGH RISK NEWBORN MOST COMMON PROBLEMS hypoglycemia hypocalcemia
resp. Distress
hypothermia

14. Hypoglycemia Threat to Brain Cells
Less than 30 mg/100 ml of blood = harmful
After birth levels fall
Infants prone to hypoglycemia
Treatment

15. HYPOCALCEMIA RISK- preterm with hypoxia, IDM, hypoglycemic
serum calcium <7 mg/dl
increase milk feedings, cal. supplements, Vit D

16. PRETERM INFANTS- Potential Complications
Anemia
Kernicterus
Persistent Patent Ductus Arteriosus
Periventricular/Intraventricular Hemorrhage

17. CONGENITAL HYPOTHYROIDISM
INADEQUATE THYROXINE (T4)
CLINICAL SIGNS- Hypotonia, wide-spread fontanelles, large thyroid, prolonged jaundice
TREATMENT- Thyroid hormone replacement

18. GALACTOSEMIA DISORDER OF GALACTOSE METABOLISM
GLACTOSE ACCUMULATES IN BLOOD ORGANS
SIGNS- Lethargy, hypotonia, diarrhea
TREATMENT- Eliminate galactose (Prosobee)

19. 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

20. 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

21. MANAGEMENT OF HIGH RISK INFANT
HYDRATION- IVF for calories, electrolytes & H2O
NUTRITION- no coordination of sucking until weeks; not synchronized until weeks; gag reflex not developed until 36 weeks
EARLY FEEDING- within 3-6 hours
BREAST FEEDING
GAVAGE FEEDING- <32 wks. or <1500g

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

23. Thank You For Your Attention