high-risk newborn

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 dysmaturitypreterm 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.

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 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

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

23. Thank You For Your Attention