High Risk Conditions in Newborn

1. High Risk Conditions in Newborns
Hira Ejaz
MSN Student

2. Objective
At the end of this session students would be
able to:
• Know about high risk conditions in newborns
including:
– Hypoglycemia
– Hypocalcaemia
– Hyperbilirubinemia
– G6PD deficiency
– Inborn errors of metabolism

3. Hypoglycemia
• It is a condition in which newborn’s blood
glucose concentration is lower than the body
requirement for the cellular energy and
metabolism
• Recommended normal glucose level is above
45 mg/dl
• Recommended rage is 50 to 110 mg/dl

4. High risk newborns
• Large for gestational age
• Small for gestational age
• Infants of diabetic mothers
• Newborn with intrauterine growth retardation

5. Sign & symptoms
• Jitteriness
• Tremors
• Twitching
• weak or high pitch cry
• Seizures
• Coma

7. Therapeutic management
• Early feed to the newborn and continue
feeding after 2 to 3 hour
• Intravenous glucose for unwell newborn or
blood glucose is less than 25 after feeding
• Continue monitoring
• Establish successful breastfeeding

8. Hypocalcaemia
• Normal infant total serum calcium levels are in
the range of 7 to 8 mg/dl. Hypocalcaemia is
labeled when it is below 7mg/dl.
• Causes
– Preterm or small for gestation newborn
– Infant of diabetic mother
– Maternal hyperparathyroidism

9. Sign & Symptoms
• Neuromuscular irritation:
– Twitching
– Tremors
– High pitched cry
– Tachycardia
– Seizures

10. Therapeutic management

11. Hyperbilirubinemia

12. Hyperbilirubinemia
• It is an excessive level of accumulated bilirubin in
the blood and characterized by the Jaundice, a
yellow discoloration of the skin and other organs.
• Mild jaundice is most common in newborns, but
excessive jaundice indicate pathologic state
• Bilirubin is one of the breakdown product of
hemoglobin that results from red blood cells
destruction.

13. Mechanism involved in physiological jaundice
• High concentration of RBCs and shorter life
span of 70 to 90 days as compared to 120
days.
• Liver ability to conjugate bilirubin is low.
• Undeveloped intestinal flora for conversion of
unconjugated bilirubin into urobilinogin.

16. Types
• Physiological Jaundice
• Breastfeeding associate jaundice
• Breast milk jaundice
• Hemolytic disease

18. Nomogram

20. Management
• Increase frequency of feeding
• Monitor stooling pattern
• Monitor transcutaneous bilirubin and serum bilirubin levels
• Risk assessment
• Phototherapy
• Exchange transfusion

22. Infant with G6PD
• G6PD is also responsible for keeping red blood cells healthy so
they can function properly and live a normal life span.
Without enough of it, red blood cells break down
prematurely. This early destruction of red blood cells is known
as hemolysis, and it can eventually lead to hemolytic anemia.
• Hemolytic anemia develops when red blood cells are
destroyed faster than the body can replace them, resulting in
reduced oxygen flow to the organs and tissues.
• Clinical manifestation is neonatal jaundice

24. Disorders linked with G6PD Deficiency
• Hemophilia
• Hemolytic anemia
• Aplastic anemia
• Megaloblastic anemia

26. Diagnosis
• G6PD deficiency is diagnosed by performing a
simple blood test to check G6PD enzyme
levels.
• Other diagnostic tests that may be done
include:
– Complete blood count
– Serum hemoglobin test
– Reticulocyte count

33. Laboratory Investigations
• Blood Investigations:
– TLC
– Blood sugar
– Serum electrolytes
– Serum ammonia
– Serum lactate
– Liver enzymes
– ABGs
• Urine Metabolic Screening
– Urine ketones
– Reducing substances

34. Management
• Stop feeding
• Start IV fluid
• Co-factor therapy
• Correct dehydration and acidosis
• Hemodialysis
• Exchange blood transfusion