High risk newborn – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
High risk newborn
High risk newborn
High risk newborns are those who need special attention and close observation because of presence of certain adverse factors.
Or
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 result of prenatal, perinatal, or neonatal conditions, regardless of birth weight or conditions, regardless of birth weight or gestational age.
Or
Any baby exposed to any condition that make the survival rate of the neonate at danger.
Figure: High risk newborn
Danger signs for a neonate
Danger signs are the clinical features which may suggest that the neonate is sick and needs early referral to an appropriate health care facility. Parents and health workers should be aware of these signs so that there is no undue delay in seeking care. Some of the common danger signs are enumerated below:
1. Failure to pass meconium within 24 hours.
2. Failure to pass urine within 48 hours.
3. Lethargy/poor feeding.
4. Respiratory distress: fast breathing, retraction, grunting.
5. Abnormal color: Pallor/cyanosis/ jaundice.
6. Jaundice within 24 hours or persisting beyond 14 days.
7. Hypothermia/Hyperthermia.
8. Abnormal movements (seizures)
9. Persistent vomiting.
10. Diarrhea.
11. Abdominal distension.
12. Bleeding from any site.
13. Poor weight gain/weight loss.
Identify high risk new born
Identification of high risk neonates is very important responsibility of the personnel at delivery room. Careful assessment should be done to detect the problems and to initiate prompt management in better health care facilities or in special care neonatal units.
The following babies are transferred to the special care nursery for better supervision and management without unnecessary delay. Such as-
1. Birth weight less than 2000 g.
2. Gestational age less than 36 weeks.
3. Severe birth asphyxia with 5 minutes Apgar score of 3 or less
4. Rh-incompatibility.
5. Gross congenital malformations.
6. Maternal diabetes mellitus.
7. Respiratory distress or any other systematic problems of neonates.
8. Unwell or unwed or unwilling mother.
A. Classification According To Size
a. Low-birth-weight (LBW) infant-Infant whose birth weight is less than 2500 g (5 lbs 8 oz), regardless of gestational age.
b. Very low-birth-weight (VLBW) infant – Infant whose birth weight is less than 1500 g (3 lbs 5 oz).
c. Extremely low-birth-weight (ELBW) infant-Infant whose birth weight is less than 1000 g (2 lb 3 oz).
d. Appropriate-for-gestational-age (AGA) infant-Infant whose weight falls between the 10th and 90th percentiles on intrauterine growth curves.
e. Small-for-date (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.
f. Intrauterine growth restriction (IUGR)-Found in infants whose intrauterine growth is restricted (sometimes used as a more descriptive term for SGA infants).
g. Symmetric IUGR-Growth restriction in which the weight, length, and head circumference are all affected.
h. Asymmetric IUGR-Growth restriction in which the head circumference remains within normal parameters while the birth weight falls below the 10th percentile.
i. Large-for-gestational-age (LGA) infant-Infant whose birth weight falls above the 90th percentile on intrauterine growth charts.
B. Classification According to Gestational Age
a. Preterm (premature) infant-Infant born before completion of 37 weeks of gestation, regardless of birth weight.
b. Full-term infant-Infant born between the beginning of the 38 weeks and the completion of the 42 weeks of gestation, regardless of birth weight.
c. Late-preterm infant-Infant born between 34 0/7 and 36 6/7weeks of gestation, regardless of birth weight.
d. Postterm (postmature) infant-Infant born after 42 weeks of gestational age, regardless of birth weight.
C. Classification According to Mortality
a. Live birth- Birth in which neonate manifests any heartbeat, breathes, or displays voluntary movement, regardless of gestational age.
b. Fetal death-Death of fetus after 20 weeks of gestation and before birth with absence of any signs of life after birth.
c. Neonatal death-Death that occurs in the first 27 days of life; early neonatal death
occurs in the first week of life; late neonatal death occurs at 7 to 27 days.
d. Perinatal mortality-Total number of fetal and early neonatal deaths per 1000 live births.
Factors associated with high risk neonate
| Conditions | Associated risks | |
| Maternal conditions | Age of the mother
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Obstetric conditions
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Medical conditions
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Personal factors
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Factors of labour and delivery
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| Foetal factors |
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Nursing diagnosis of the high-risk newborns
1. Ineffective breathing pattern related to pulmonary and neuromuscular immaturity, decrease energy and fatigue.
2. Ineffective thermoregulation related to immature temperature control and decreased subcutaneous body fat.
3. Risk for infection related to deficient immunologic defect
4. Risk for fluid volume deficit or excess related to immature physiologic characteristics of preterm infant and/or illness.
5. Imbalance nutrition: Less than body requirement related to inability ingest nutrients
because of immaturity and/or illness.
6. Risk for impaired skin integrity related to immature skin structure, immobility, decrease nutritional state invasive procedures.
7. Risk for injury from variable cerebral blood flow, systems hypertension or hypotension, and decreased cellular nutrients related to immature central nervous system and physiologic stress response
8. Pain related to procedures, treatment, handing
9. Delayed growth and development related to preterm birth, unnatural NICU environment, separation from parents.
10. Interrupted family process related to situation/maturational crisis, knowledge deficit, interruption of parental attachment process.
11. Anticipatory grieving related to unexpected birth of high-risk infant, grave prognosis, and /or death of infant.
Management of high risk neonates
1. Anticipate the need of resuscitation; a skilled team should be present for delivery.
2. The cord blood and placenta should be saved after delivery.
3. Observation for at least 72 hours after delivery for development of complications.
4. Admission to the neonatal unit at earliest suspicion and provision of appropriate management.
5. Transfer to higher facility, if necessary
6. At discharge, parents should be made aware of the possible danger signs.
Nursing care of high risk newborns
1. Thermoregulation: Pathophysiology, maintaining thermoneutrality
2. Respiratory support: Appropriate’ positionilg. in order to ensure an open airway to maximize oxygenation and ventilation
3. Hydration: Parenteral fluid
4. Nutrition: Nutritional needs, nipple feeding, gavage feeding.
5. Protection from infection: Hand washing standard precaution technique.
6. Feeding resistance
- Provide regular oral stimulation.
- Stimulation program for infants who exhibit aversion.
7. Energy conservation.
8. Administration of medication: Hazard, of administering antibiotics and hyperosmolarsolution. Avoid using medication with preservatives such as benzyl.
9. Infant stress.
10. Developmental intervention and care.
11. Family involvement.
12. Facilitating parent-infant relationship: Encourage and facilitate parental involvement in caring infant.
13. Discharge planning and home care: instruction parent about:
14. Infant care:
- Follow up medical care.
- Immunization.
- Nutrition (overfeeding, underfeeding, feeding resistance, interaction etc.)
15. Developmental outcome:
- Developmental assessment.
- Sensory system.
- Therapeutic handling.
- Kangaroo care.
- Therapeutic positioning.
- Auditory environment.
- Visual environment.
16. Neonatal loss:
- Anticipatory grieving.
- Provide emotional and
- Physical support.
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