CHAPTER 10 HIGH RISK OF NEW BORN
DEFINITION OF HIGH RISK NEWBORN:
HIGH RISK NEWBORN CAN BE DEFINED AS A NEONATES, REGARDLESS OF BIRTH
WEIGHT, SIZE OR GESTATIONAL AGE WHO HAS A GREATER THAN AVERAGE CHANCE
OF MORBIDITY AND MORTALITY, ESPECIALLY WITHIN THE FIRST 28 DAYS OF LIFE.
FACTORS THAT CAN CAUSE HIGH RISK NEWBORN:
DEMOGRAPHIC SOCIAL FACTORS; - MATERNAL AGE <16 OR >40, UNMARRIED,
PHYSICAL STRESS, SOCIOECONOMIC STATUS.
PAST MEDICAL HISTORY:- DIABETES MELLITUS, GENETIC DISORDERS,
HYPERTENSION
PREVIOUS PREGNANCY:- INTRAUTERINE DEATH, NEONATAL
DEATH,IUGR(INTRAUTERINE GROWTH RESTRICTION),IEMS(INBORN ERRORS OF
METABOLISM) ,CONGENITAL .
PRESENT PREGNANCY:- VAGINAL BLEEDING,PROM,MULTIPLE
GESTATION,PREECLAMPSIA,ABNORMAL USG FINDINGS
LABOR AND DELIVERY;- OBSTRUCTED LABOR,FETAL DISTRESS, FORCEPS DELIVERY,
MECONIUM STAINED LIQUOR.
NEONATE:- BIRTH WEIGHT < 2000 OR > 4000 ,GESTATION < 37 OR > 42 SGA( SMALL
FOR GESTATIONAL AGE), RESPIRATORY DISTRESS,CONGENITAL MALFORMATION.
CLASSIFICATION OF HIGH RISK NEWBORN:-
CLASSIFICATION OF HIGH RISK NEWBORN ACCORDING TO SIZE :-
1. LOW BIRTH WEIGHT (LBW) INFANT: - A BABY WHOSE BIRTH WEIGHT IS LESS
THAN 2.5KG (2500 GM), REGARDLESS OF GESTATIONAL AGE.
2. VERY LOW BIRTH WEIGHT (VLBW):- A BABY WHOSE BIRTH WEIGHT IS LESS
THAN 1500GM.
3. EXTREMELY LOW BIRTH WEIGHT (ELBW) INFANT:- A BABY WHOSE BIRTH
WEIGHT IS LESS THAN 1000 GMS.
4. APPROPRIATE FOR GESTATIONAL AGE (AGA) INFANT :- AN INFANT WHOSE
BIRTH WEIGHT FALLS BETWEEN THE 10TH AND 90TH PERCENTILES ON
INTRAUTERINE GROWTH CURVES.
5. SMALL FOR DATES (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.
6. INTRAUTERINE GROWTH RETARDATION;- BABIES WHO DONOT GROW
ADEQUATELY IN UTERO.
7. LARGE FOR GESTATIONAL AGE (LGA) INFANT:- AN INFANT WHOSE BIRTH
WEIGHT FALLS ABOVE THE 10TH PERCENTILE.
CLASSIFICATION ACCORDING TO GESTATIONAL AGE;-
1. PREMATURE (PRETERM) INFANT:- AN INFANT BORN BEFORE COMPLETION OF 37
WEEKS OF PREGNANCY .
2. FULL TERM INFANT:- AN INFANT BORN BETWEEN THE BEGINNING OF THE 38 WEEKS
AND COMPLETION OF THE 42 WEEKS OF GESTATION,REGARDLESS OF BIRTH
WEIGHT.
3. POSTTERM (POSTMATURE) INFANT;- AN INFANT BORN AFTER 42 WEEKS OF
GESTATIONAL AGE, REGARDLESS OF BIRTH WEIGHT.
CLASSIFICATION ACCORDING TO MORTALITY;-
1. LIVE BIRTH :- BIRTH IN WHICH THE NEONATE MANIFESTS ANY HEARTBEAT,
BREATHES OR DISPLAYS VOLUNATARY MOVEMENT, REGARDLESS OF
GESTATIONAL AGE.
2. FETAL DEATH:- DEATH OF THE FETUS AFTER 20 WEEKS OF GESTATION AND
BEFORE DELIVERY WITH THE ABSENCE OF ANY SIGNS OF LIFE AFTER DEATH.
3. 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.
4. PERINATAL MORTALITY:- TOTAL NUMBER OF FETAL AND EARLY NEONATAL
DEATHS PER 1000 LIVE BIRTHS.
CLINICAL SIGNS OF HIGH RISK NEWBORN;-
1. HEART RATE:- THE INFANT MAY HAVE A :- TACHYCARDIA ( A HEART RATE MORE
THAN 160 BEATS PER MINUTE), BRADYCARDIA ( A HEART RATE LESS THAN 120
BEATS PER MINUTE)
2. RESPIRATION RATE AND PATTERN:- ABNORMAL SIGNS ARE: SLOW,SHALLOW,
IRREGULAR RESPIRATION, RAPID RESPIRATION ( TACHYPNEA) MORE THAN 60
BREATHS PER MINUTE, GRUNTING, RECESSION OR GASPING AND APNEA.
3. TEMPERATURE:- THE INFANT MAY BE HYPOTHERMIC ( COLD) OR PYREXIA( HOT).
4. ACTIVITY:- THE INFANT MAY BE: LETHARGIC AND RESPOND POORLY TO
STIMULATION, HYPOTONIC AND LESS ACTIVE THAN BEFORE FEEDING POORLY.
5. COLOR;- THE INFANT MAY BE PALE, PLETHORIC ( VERY RED), CYANOSED AND
JAUNDICE.