The High Risk New Born

THE HIGH RISK NEW BORN Dr.LORN TRY Patrich,Pediatrician, DHM

Dr.LORN TRY Patrich, Pediatrician,DHM

Introduction 

A high risk is define as any neonate when is in danger of serious illness or death as a result of prenatal,perinatal, or neonatal conditions, regardless of birth weigh or gestational age.

Dr.LORN TRY Patrich, Pediatrician,DHM

Condition of high risk a)

The preterm infant  Respiratory problem(shallow, rapid, and irregular with period of apnea).  Heat loos (cold stress)  Intraventricalar hemorrhage ( More often in the neonate of less than 32 weeks ‘gestation ( signs of possible IVH include : hypotonia, apnea, bradycardia, a full (or bulging) fontanelle, cyanosis and increased head circonference, convulsion, and stupor) .However mild bleeds can occur without these symptome. Dr.LORN TRY Patrich, Pediatrician,DHM

Condition of high risk(Conti..) Hyperbilirubinemia. That may result in brain domage.  Retinopathy of prematurity b/ The post term (> 42 weeks ) 

• • • •

Litth lanugo or vernix Scal hair Skin dry Infant risk : • • • • •

Hypoglycemia Polycytemia Cerebral ischemia Thrombus formation Respiratory distress Dr.LORN TRY Patrich, Pediatrician,DHM

Le terme dépassé Dr.LORN TRY Patrich, Pediatrician,DHM

Condition of high risk(Conti..) c/ The infant of diabetic mother risk : • Hypoglycemia in first few hours after birth. Untreated may cause severe, irreversible damage to the central nervous system. • Congenital anomalies • Hypocalcemia • Hyperbilirubinemia • Hyaline membrane disease

Dr.LORN TRY Patrich, Pediatrician,DHM

Condition of high risk(Conti..) d/ The infant with neonate sepsis : • Infection from • The mother (through the placenta, vaginal infection) • Inhalation of contaminated amniotic fluid.

• Any specific signs • • • • • •

Cyanosis Thermal instability Convulsions Lethargy Jaundice Apnea

Dr.LORN TRY Patrich, Pediatrician,DHM

Condition of high risk(Fin) e/Necrosing enterocolitis • Often in small preterm may occur in full term neonat • Cause: • • •

Hypoxia (Poor tissue perfusion) Bacterial invasion of the bowel Clinical : Abdominal distension

f/ The infant of an HIV positive mother g/ The infant of addicted mother (Alcool, Cocaïne, heroïne, methadone or other narcotic ) Dr.LORN TRY Patrich, Pediatrician,DHM

PREMATURE 5y MD IU DR.LORN TRY Patrich, Pediatrician,DHM

Dr.LORN TRY Patrich, Pediatrician,DHM

DEFINITION  Premature

infant is a baby borne before 37 weeks gestation .  At birth, a baby is classified as one the following : – Premature (less than 37 weeks gestation ) – Full term ( 37 to 42 weeks gestation ) – Post term ( born after 42 weeks gestation ) Dr.LORN TRY Patrich, Pediatrician,DHM

RISKs FACTORs  

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Cause of preterm labor is unknown Multiple pregnancy (twins, triplet ……. Makes up about 15% of all premature births ) The following health conditions and events in the mother may contribute to preterm labor : – Diabete - Heart disease – Kidney disease - Lake of prenatal care – Poor nutrition - Preeclampsia – Substance abus - Young age (the Dr.LORN TRY Patrich, Pediatrician,DHM

RISKs FACTORs 

A women who has had any of the following is increase risk of preterm labor : – Premature rupture of the membrane or placenta previa – Previous preterm – Problems with the uterus or cervi – Unexplained high alpha foeto-protein level in the seconde trimester . – Untreated disease or infection ( such as urinary tract infection or infection of amniotic membrane ) Dr.LORN TRY Patrich, Pediatrician,DHM

EVALUATION of AGE GESTATION

Dr.LORN TRY Patrich, Pediatrician,DHM

Dr.LORN TRY Patrich, Pediatrician,DHM

Dr.LORN TRY Patrich, Pediatrician,DHM

The spectrum of prematurity 

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Mild prematurity refers to babies who are born between 33 and 36 completed weeks gestational age and/or have a birth weight between 1500 and 2500 g . Moderate prematurity refers to babies who are born between 28 and 32 completed weeks gestational age with a birth weight ranging between 1000 and 1500 g . Extreme prematurity refers to babies who are born before 28 completed weeks gestational age or who have a birth weight of less than 1000 g Dr.LORN TRY Patrich, Pediatrician,DHM

SYMPTOMS

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A premature infant has organs that are not fully developped. The infant needs special care in nursery until the organ have developed enough to sustain life without medical support . This may take weeks to months. Common symptoms in a premature infant include: – – – – – –

Body hair Episodes of absent breathing Elarged clitoris (female infant) Smooth without ridges (mal infant) Transparent skin ( can see veins under skin ) Weak ey Dr.LORN TRY Patrich, Pediatrician,DHM

SYMPTOMS 

Common tests performed on a premature infant include : – Blood gas analysis – Blood test to check glucose calcium and bilirubine levels. – Chest X- ray

Dr.LORN TRY Patrich, Pediatrician,DHM

TREATMENT 

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When premature labor develop and can not be stopped . The mother may be moved to center that specifically care for premature infant. In some cases, medicine called steroïds may be given to the mother in the help the baby ‘s lung mature. When born, the baby is placed under warmer. Since infants are usually unable to coordinate sucking and swallowing before 34 weeks gestation, your baby may have a feeding tube placed into stomach. In very premature infants, nutrition may be given through a vein until the baby is stable enough to receive feeding by mouth. Dr.LORN TRY Patrich, Pediatrician,DHM

TREATMENT 

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If the infant has breathing problems, a tube may be placed in the trachea. A machine called a respiration will help the baby breathe. Oxygen is given, Nursery care is needed until the infant reaches a stable body weigh and is able to feed by mouth and maintain body temperature.

Dr.LORN TRY Patrich, Pediatrician,DHM

Dr.LORN TRY Patrich, Pediatrician,DHM

COMPLICATION           

Anemia Bleeding into the brain (IVH) Bronchodysplasia (BPD) Congnitive or motor disability or delay Delayed growth and development Infection or neonatal sepsis Heart disease (PDA) Low blood sugar Newborn jaundice Retinopathy and vision loss or blindness Severe intestinal inflammation (necrotizing enterocolitis) Dr.LORN TRY Patrich, Pediatrician,DHM

PREVENTION 

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One of the most important stepe to preventing prematurity is to receive prenatal care as early as possible in the pregnancy, and continue such care until the baby is born. Maternal treatment

Dr.LORN TRY Patrich, Pediatrician,DHM