high-risk newbornhigh-risk newborn

Identification of high-risk newbornsIdentification of high-risk newbornsThe high-risk neonate :can be defined as a The high-risk neonate :can be defined as a newborn, regardless of gestational age or birth newborn, regardless of gestational age or birth weight, who has a greater-than-average chance weight, who has a greater-than-average chance of morbidity or mortality.of morbidity or mortality.

because of conditions or circumstances because of conditions or circumstances superimposed on the normal course of events superimposed on the normal course of events associated with birth and the adjustment to associated with birth and the adjustment to extrauterine existence.extrauterine existence.

The high risk period encompasses human The high risk period encompasses human growth and development from the time of growth and development from the time of viability up to 28 days following birth.viability up to 28 days following birth.

Classification of high-risk newbornsClassification of high-risk newborns

Classified according to:Classified according to:

1.1. Birth weight.Birth weight. Low-birth-weight (LBW): an infant whose birth Low-birth-weight (LBW): an infant whose birth

weight is less than 2500 g, regardless of weight is less than 2500 g, regardless of gestational age.gestational age.

Very low-birth-weight (VLBW) infant :an infant Very low-birth-weight (VLBW) infant :an infant whose birth weight is less than 1500g.whose birth weight is less than 1500g.

Extremely-low-birth-weight (ELBW) infant: an Extremely-low-birth-weight (ELBW) infant: an infant whose birth-weight is less than1000g.infant whose birth-weight is less than1000g.

Classified according to Birth weightClassified according to Birth weight..

Appropriate-for-gestational-ageAppropriate-for-gestational-age (AGA)INFANT: (AGA)INFANT: an infant whose birth-weight is falls between the an infant whose birth-weight is falls between the 1010thth and 90 and 90thth percentiles on intrauterine growth percentiles on intrauterine growth curves.curves.

Small-for-date (SFD) Small-for-date (SFD) or small-for-gestational age or small-for-gestational age (SGA) infant: an infant whose rate of intrauterine (SGA) infant: an infant whose rate of intrauterine growth was slowed and whose birth weight falls growth was slowed and whose birth weight falls below the 10below the 10thth percentile on intrauterine growth percentile on intrauterine growth curvescurves

Intrauterine growth restriction (IUGR) Intrauterine growth restriction (IUGR) found in found in infants whose intrauterine growth is restrictedinfants whose intrauterine growth is restricted

Classified according to Birth weightClassified according to Birth weight..

Symmetric IUGR:Symmetric IUGR: growth restriction in which the growth restriction in which the weight, length, and head circumference are all weight, length, and head circumference are all affected.affected.

asymmetric IUGR: asymmetric IUGR: growth restriction in which growth restriction in which the head circumference remains within normal the head circumference remains within normal parameters while the birth weight falls below the parameters while the birth weight falls below the 1010thth percentile percentile

Large-for-gestational-age (LGA): Large-for-gestational-age (LGA): an infant an infant whose birth weight falls above the 90whose birth weight falls above the 90 thth percentile percentile on intrauterine growth curves.on intrauterine growth curves.

Classification according to Classification according to Gestational ageGestational age

PrematurePremature (preterm) infant: an infant born before (preterm) infant: an infant born before completion of 37 weeks of gestation, regardless completion of 37 weeks of gestation, regardless of birth weight.of birth weight.

Full-term infant: Full-term infant: an infant born between the an infant born between the beginning of the 38 weeks and the completion of beginning of the 38 weeks and the completion of the 42 weeks of gestation, regardless of birth the 42 weeks of gestation, regardless of birth weight.weight.

PostmaturePostmature (postterm) infant: an infant born after (postterm) infant: an infant born after 42 weeks of gestational age ,regardless of birth 42 weeks of gestational age ,regardless of birth weight.weight.

Classification according to mortalityClassification according to mortality

Live birth: Live birth: birth in which the neonate manifests birth in which the neonate manifests any heartbeat, breathes, or displays voluntary any heartbeat, breathes, or displays voluntary movement, regardless of gestational age.movement, regardless of gestational age.Fetal death: Fetal death: death of the fetus after 20 weeks of death of the fetus after 20 weeks of gestation and before delivery, with absence of gestation and before delivery, with absence of any signs of life after birth.any signs of life after birth.::Neonatal deathNeonatal death death that occurs in the first 27 death that occurs in the first 27 days of life; early neonatal death occurs in the days of life; early neonatal death occurs in the first weeks of life ; late neonatal death occurs at first weeks of life ; late neonatal death occurs at 7-27 days.7-27 days.Perinatal mortality: Perinatal mortality: total number of fetal and total number of fetal and early neonatal deaths per 1000 live birthsearly neonatal deaths per 1000 live births

Classification according to Classification according to Pathophysiologic problemsPathophysiologic problems

a.a. Associated with the state of maturity of the infant. Associated with the state of maturity of the infant. Chemical disturbances. eg: hypoglycemia, Chemical disturbances. eg: hypoglycemia, hypocalcemia.hypocalcemia.

b.b. Immature organs and systems. eg Immature organs and systems. eg hyperbilirubinemia, respiratory distress, hyperbilirubinemia, respiratory distress, hypothermia.hypothermia.Newborn exposed to HIV/AIDSNewborn exposed to HIV/AIDSNewborn with congenital anomaliesNewborn with congenital anomalies

High risk related to dysmaturityHigh risk related to dysmaturitypreterm infantspreterm infants

Etiology of preterm birth:Etiology of preterm birth:1. 1. Unknown Unknown 2. 2. Maternal factors:Maternal factors: Malnutrition.Malnutrition. Chronic disease: heart, renal, diabetes.Chronic disease: heart, renal, diabetes.3. 3. Factors related to pregnancyFactors related to pregnancy Hypertension.Hypertension. Abruptio placenta or placenta previa.Abruptio placenta or placenta previa. Incompetent cervix.Incompetent cervix. Premature rupture of membranes or chorioasmniotis.Premature rupture of membranes or chorioasmniotis. Polyhydratmnios.Polyhydratmnios.4. 4. Fetal factors:Fetal factors: Chromosomal abnormalities.Chromosomal abnormalities. Intrauterine infection.Intrauterine infection. Anatomic abnormalitiesAnatomic abnormalities..

Postterm infantPostterm infant

Causes: Unknown.Causes: Unknown.Characteristics:Characteristics:

1.1. absent of lanugo.absent of lanugo.2.2. Little if any vernix caseosa.Little if any vernix caseosa.3.3. Abundant scalp hair.Abundant scalp hair.4.4. Long fingernails.Long fingernails. There is significant increase in fetal and neonatal There is significant increase in fetal and neonatal

mortality, mortality, causes: fetal distress associated with the decreasing causes: fetal distress associated with the decreasing

efficiency of the placenta, macrosomia, and meconium efficiency of the placenta, macrosomia, and meconium aspiration syndrome.aspiration syndrome.

The greatest risk occurs during the stresses of labor The greatest risk occurs during the stresses of labor and delivery, particularly in infants of primigravdas.and delivery, particularly in infants of primigravdas.

MATERNAL INFECTIONMATERNAL INFECTION

T- ToxoplasmosisT- Toxoplasmosis

O- Other ( hepatitis, measles, mumps, HIV)O- Other ( hepatitis, measles, mumps, HIV)

R- Rubella- pregnant no contactR- Rubella- pregnant no contact

C- Cytomegalovirus infection-pregnant no C- Cytomegalovirus infection-pregnant no contact contact

H- Herpes simplex- Stop transmissionH- Herpes simplex- Stop transmission

S- Syphilis (Gonococcal conjunctivitis & S- Syphilis (Gonococcal conjunctivitis & chylamydial conjunctivitis) chylamydial conjunctivitis)

HIGH RISK NEWBORNHIGH RISK NEWBORN

MOST COMMON PROBLEMSMOST COMMON PROBLEMS

hypoglycemiahypoglycemia

hypocalcemiahypocalcemia

resp. Distressresp. Distress

hypothermiahypothermia

HypoglycemiaHypoglycemia

Threat to Brain CellsThreat to Brain Cells

Less than 30 mg/100 ml of blood = Less than 30 mg/100 ml of blood = harmfulharmful

After birth levels fallAfter birth levels fall

Infants prone to hypoglycemiaInfants prone to hypoglycemia

TreatmentTreatment

HYPOCALCEMIAHYPOCALCEMIA

RISK- preterm with hypoxia, IDM, RISK- preterm with hypoxia, IDM, hypoglycemichypoglycemic

serum calcium <7 mg/dlserum calcium <7 mg/dl

increase milk feedings, cal. increase milk feedings, cal. supplements, Vit Dsupplements, Vit D

PRETERM INFANTS- Potential PRETERM INFANTS- Potential Complications Complications

AnemiaAnemia

KernicterusKernicterus

Persistent Patent Ductus ArteriosusPersistent Patent Ductus Arteriosus

Periventricular/Intraventricular Periventricular/Intraventricular HemorrhageHemorrhage

CONGENITAL CONGENITAL HYPOTHYROIDISMHYPOTHYROIDISM

INADEQUATE THYROXINE (T4)INADEQUATE THYROXINE (T4)

CLINICAL SIGNS- Hypotonia, wide-CLINICAL SIGNS- Hypotonia, wide-spread fontanelles, large thyroid, spread fontanelles, large thyroid, prolonged jaundiceprolonged jaundice

TREATMENT- Thyroid hormone TREATMENT- Thyroid hormone replacementreplacement

GALACTOSEMIAGALACTOSEMIA

DISORDER OF GALACTOSE DISORDER OF GALACTOSE METABOLISMMETABOLISM

GLACTOSE ACCUMULATES IN GLACTOSE ACCUMULATES IN BLOOD ORGANSBLOOD ORGANS

SIGNS- Lethargy, hypotonia, diarrheaSIGNS- Lethargy, hypotonia, diarrhea

TREATMENT- Eliminate galactose TREATMENT- Eliminate galactose (Prosobee) (Prosobee)

PHENYLKETONURIAPHENYLKETONURIA

ABSENSE OF PHENYLALANINE ABSENSE OF PHENYLALANINE HYDROXYLASEHYDROXYLASE

AFFECTS DEVELOPMENT OF BRAIN AFFECTS DEVELOPMENT OF BRAIN AND CNSAND CNS

SCREENING OF NEWBORNS, SCREENING OF NEWBORNS, REPEAT SCREENINGREPEAT SCREENING

TREATMENT- Diet restricts TREATMENT- Diet restricts phenylalanine (Lofenalac), meat and phenylalanine (Lofenalac), meat and diary products restricteddiary products restricted

MANAGEMENT OF HIGH RISK MANAGEMENT OF HIGH RISK INFANTINFANT

PHYSICAL ASSESSMENTPHYSICAL ASSESSMENT

THERMOREGULATION- need neutral THERMOREGULATION- need neutral thermal environment, use brown fatthermal environment, use brown fat

CONSEQUENCES OF COLD STRESS- CONSEQUENCES OF COLD STRESS- hypoxia, metabolic acidosis, hypoglycemiahypoxia, metabolic acidosis, hypoglycemia

GLUCOSE & CALCIUMGLUCOSE & CALCIUM

PROTECT FROM INFECTIONPROTECT FROM INFECTION

MANAGEMENT OF HIGH RISK MANAGEMENT OF HIGH RISK INFANTINFANT

HYDRATION- IVF for calories, electrolytes & HYDRATION- IVF for calories, electrolytes & H2OH2O

NUTRITION- no coordination of sucking until NUTRITION- no coordination of sucking until 32-34 weeks; not synchronized until 36-37 32-34 weeks; not synchronized until 36-37 weeks; gag reflex not developed until 36 weeks; gag reflex not developed until 36 weeksweeks

EARLY FEEDING- within 3-6 hoursEARLY FEEDING- within 3-6 hours

BREAST FEEDINGBREAST FEEDING

GAVAGE FEEDING- <32 wks. or <1500gGAVAGE FEEDING- <32 wks. or <1500g

MANAGEMENT OF HIGH RISK MANAGEMENT OF HIGH RISK INFANTINFANT

SKIN CARE OF PREMATURE- SKIN CARE OF PREMATURE- increased sensitivity increased sensitivity

MEDICATION MEDICATION

DECREASE STRESSDECREASE STRESS

Thank You For Your Attention