Pediatrics

1. High Risk Newborn
19th March 2024
Dr S.K.Singh
Senior Consultant

2. Introduction
• High-risk newborns are those who need
special attention and close observation
because of presence of certain adverse
factors.
• Health care personnel & parents should be
aware of these situations and be prepared for
the associated difficulties.

3. Definition
• High risk neonate is defined as Newborn--
regardless of Gestational Age or Birth Weight,
- having more-than-average chance of
Morbidity or Mortality
because of
Conditions associated with BIRTH
& adjustment to EXTRA UTERINE EXISTENCE.
• High risk period covers from time of
Viability up to 28 days following birth.

4. Danger signs in Neonates
• Failure to pass meconium < 24 hrs
• Failure to pass urine < 48 hrs
• Lethargy/poor feeding
• Respiratory distress, fast breathing,
retraction, grunting,
• Abnormal color:
pallor/cyanosis/jaundice

5. • Jaundice < 24 hrs or persisting > 14 days.
• Hypothermia/ hyperthermia
• Abnormal movements (seizures)
• Persisting vomiting
• Diarrhea
• Abdominal distension
• Bleeding from any site
• Poor weight gain/weight loss.
Danger signs in Neonates-----

6. Factors Associated with
High-risk Newborn

7. 1. Maternal Age at delivery ;
• Over 35 years
• Teenage pregnancy
2. Personal Factors :
• Poverty
• Lack of Antenatal Care (ANC)
• Smoking
• Drug - Alcohol abuse
• Poor Nutritional status
• Trauma (Acute, Chronic)

8. 3. Medical History:
• Diabetes mellitus
• Thyroid Disease
• Renal Disease
• Urinary Tract Infection
• Heart, Lung disease
• Hypertension (Chronic or preeclampsia);
• Anemia
• Isoimmunization (Rh, ABO, minor blood
groups )

9. 4. Obstetric History:
• Past history of infant with prematurity,
jaundice, RDS, or anomalies
• Maternal medications
• Bleeding in early pregnancy
• Hyperthermia
• Bleeding in third trimester
• Premature rupture of membranes
• Fever
• Infection

10. 5. Fetal Conditions:
• Multiple Gestation
• Intrauterine Growth Restriction (IUGR)
• Macrosomia
• Abnormal Fetal Position
• Abnormality of Fetal Heart Rate or Rhythm
• Decreased activity
• Polyhydramnios
• Oligohydramnios

11. 6. Conditions of labor and delivery
• Premature Labor
• Labor occurring 2 wks or more after term
• Maternal Fever ; Maternal Hypotension
• Rapid labor ; Long Labor
• Abnormal presentation
• Uterine Tetany
• Meconium-stained Amniotic fluid
• Prolapsed cord

12. • Cesarean section
• Obstetric analgesia and anesthesia
• Placentral anomalies –
a. Small placenta
b. Large placenta
c. Torn placenta
d. Vasa praevia

13. 7. Immediate Neonatal Condition :
• Prematurity
• Low birth Weight/IUGR
• Foul smell of Amniotic fluid or membranes
• Low 5-minute Apgar Score
• Birth weight >4 kg
• Absent/delayed cry
• Congenital malformations

14. Who Needs Follow up Care?

15.  Birth weight <1500 g and/or
Gestation <32 wks
 Perinatal asphyxia: Apgar score : <3 at 5 min
and/or Hypoxic Ischemic Encephalopathy
 Mechanical ventilation for >24 hr
 Metabolic problems: Symptomatic
Hypoglycemia and Hypocalcemia
 Infections: Meningitis and/or culture positive
sepsis
 Hyperbilirubinemia >20 mg/dl or requirement
of exchange transfusion

16. Followup Schedule
 2 weeks after discharge
 At 6, 10, 14 weeks of postnatal age
 At 3, 6, 9, 12 and 18 months of
corrected age
 6 monthly until at least 5 yr.

17. What should be Done at
Followup?

18.  Assessment of Feeding and dietary
counseling
 Growth Monitoring
 Developmental Assessment:
 Immunization
 Ongoing problems
 Neurological Assessment
 Eye evaluation
 Hearing evaluation
What should be Done at Followup?

19. Most common problems
• Hypoglycemia
• Hypocalcemia
• Resp. Distress
• Hypothermia

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
 Hydration- IVF for calories, Electrolytes & H2O

21.  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
 Skin care of premature- increased sensitivity
 Medication
 Decrease stress

22. Take Home Massage
 Anticipate the need of resuscitation.
 Skilled team should be present for
delivery.
 The cord blood and placenta should be
saved after delivery
 Observation for at least 72 h after
delivery of complications.

23. Take Home Massage---
• Admission to the Neonatal unit at
earliest suspicion and provision of
appropriate management.
• Transfer to higher facility, if necessary.
• At discharge, parents should be made
aware of the possible danger signs.

24. Thank you