2. What is High Risk babies ?
◦ A High risk infant is broadly defined as one who requires more than
the standard monitoring & care offered to a healthy term newborn
infant. They require special attention and optimal care to reduce the
morbidity and mortality.
◦ According to American Academy of Pediatrics, High risk infant may be
defined as
◦ - Preterm Infant
◦ - Infant with special healthcare needs or dependence on technology
◦ - Infant at risk because of family issues
◦ - Infant with anticipated early death .
3. Factors that define an infant as being
high risk :
◦ - Maternal age (<16 or >40)
◦ - Illicit drug, alcohol , cigarette use .
◦ - Poverty.
◦ - Emotional/physical stress .
◦ - Genetic disorders .
◦ - History of intrauterine fetal demise , IU growth restriction,
congenital malformation, incompetent cervix etc
◦ - Preeclampsia, multiple gestation, poly/oligohydramnios .
◦ - Premature labor .
4. ◦ - Breech presentation
◦ - Meconium stained fluid
◦ Immune-mediated diseases (immunoglobulin G
crossing placenta)
◦ APGAR score < 4 at 1min
◦ – Birthweight ( < 2500g or > 4000g)
◦ - Birth < 37 or ≥ 42 weeks of gestation
◦ -Respiratory distress
◦ -Cyanosis etc .
◦ -Cramped-synchronized movements (Abnormalities of kicking described by
Prechti as “cramped-synchronized,” that is, limited in variety and characterized
by “rigid movement with all limbs and the trunk contracting and relaxing
almost simultaneously”)
6. ◦ - Early detection and anticipation
◦ - Quality antenatal care – adequate caloric & protein intake ,
haematinics , iron and folate supplementation, regular visits , fetal
surveillance/monitoring .
◦ - Management of pregnant women (identify n treat hypertensive
disease in pregnancy, monitor multiple pregnancies, smoking n alcohol
consumption cessation, promote antenatal & skilled delivery care for all
women)
◦ - Prevention of preterm labour ( tocolytics to slow down labour ,
antibiotics to prevent infection, provision of magnesium sulphate for
neuroprotection of newborn)
7. ◦ Administration of corticosteroid if preterm labour is anticipated.
◦ - Appropriate labour management
◦ - Management of prematurity (care & feeding support, thermal care ,
kangaroo mother care , chlorhexidine cord care , comprehensive NICU )
◦ - Management of twin-twin transfusion (if present)
◦ High risk infants require special attention and optimal care to reduce
morbidity and mortality. Therefore adequate antenatal care , specialized
delivery & early referral for optimal neonatal care will go a long way in
averting the series of problems associated with them & help prevent
both short term and long term complications.
10. ◦ Parent education is required . Parents receiving early intervention
services reported parent education on ways to support infant motor
development & they should have awareness of developmental
capabilities & response to treatment should be taught .
11.
12. Prevention
Knowing all of the potential sequelae of preterm birth, prevention where
possible is key. When prevention is not possible, understanding the best
ways to handle preterm birth and care for the newborn are essential to
attain the best possible outcome. Below are suggestions from the Global
Action Report on Preterm Birth to reduce the risk, manage and care for
preterm babies.
