High risk neonate

The high risk neonate is defined as one who has a greater than average chance of morbidity or mortality during the prenatal ,peri natal and postnatal periods..

1. By
Mr. Ravi Rai Dangi
Assistant Professor
MSc. Child Health Nursing

2. The high risk neonate is defined as one who has a greater than
average chance of morbidity or mortality during the prenatal
,peri natal and postnatal periods..

3. Prematurity, Low birth weight baby (LBW), Short for gestational
age (SGA)
Neonatal jaundice, respiratory distress, Infection, convulsions,
bleeding, congenital anomalies etc

4. Baby born before 37 weeks of gestation irrespective of birth
weight is known as preterm infants..

5. Maternal condition
Diseases of mother
Complication during pregnancy
Fetal Factor
Multiple pregnancy
Congenital malformation

6. The preterm baby is small in size. ( usually less than 47 cm long
)
The head is relatively large, sutures are widely separated and
fontanel is large.
The face appears small and the buccal pad of fat is minimal.

7. The thin ,pinkish skin appears shiny due to generalized edema,
It is covered with abundant lanugoand there is little vernix
caseosa.
The subcutaneous fat is reduced.
The breast nodule is absent or less than 5 mm wide

8. The ears are soft and flat with ear cartilage being deficient
Testes are not descended in the scrotal sac.
In female labia majoraappears widlyseparated, exposing the
labia minora

9. General activity is poor and neonatal reflexes such as Moro,
sucking and swallowing are sluggish.
There is marked hypotonia, with a poor recoil of fixed forearm
when they are extended.

10. Immaturity of the nervous system
The preterm infants are lethargic and inactive . They have
poor neonatal reflexes and un co-ordinatedsucking and
swallowing leading to difficulties in feeding.

11. Respiratory problem.
Respiration tends to be irregular in depth and rate with
periods of apnea lasting for a few seconds.
The surfactant , a pulmonary lipo protein is often deficient.
There for the surface tension in the lungs cannot reduced,
resulting in secondary atelectasis and RDS.

12. Immaturity of the Gastrointestinal system.
There is a tendency to regurgitate due to an incompetent
cardio-esophageal spincterand small capacity of the stomach.
The functional immaturity of the liver leads to
hyperbilirubinemia, hypoglycemia.

13. Temperature regulation.
The preterm infant loses more heat due to its larger surface
area. The subcutaneous fat is less. The brown fat which is
present in the term babies is deficient in the preterm babies.

14. Immature renal functions
The glomerular filtration rate and concentrating ability of the
kidney tubules are reduced.

15. Circulatory system
The closure of ductusarteriosismay be delayed in premature
infants. Peripheral circulation is inadequate.

16. Metabolic disturbances.
Infants are more likely to develop hypoglycemia,
hypocalcaemia, hypo protenemia, acidosis and hypoxia.

17. Increases susceptibility to infections.
Preterm infants are three to ten times more vulnerable to
infections as compared to normal neonates..

18. Babies weighing less than
2500 gm at birth are called Low birth weight baby
Very low birth weight Birth weight <1,500 g Extremely low birth
weight Birth weight <1,000g.

19. Thermoregulation
Feeding
Prevention of infection

20. KMC IS A SPECIAL WAY OF CARING FOR LBW BABIES.
It improves their health and well being by promoting effective
thermal control, breast feeding, infection prevention and
bonding.

21. SKIN-SKIN CONTACT
EXCLUSIVE BREAST FEEDING

22. Breast feeding
Thermal control
Early discharge
Less morbidity

23. Birth weight>1800 gm
Mother-
Willingness
General health and nutrition
Supportive family

24. Counseling
Clothing
Mother-KMC can be provided using any front open light
dress
Baby’s clothing-Baby is dressed with cap, socks, nappy .

25. Positioning
Baby should be placed between the mothers breasts in an
upright position

26. Head should be turned to one side and in a slightly extended
position.

27. Hips should be flexed and abducted in a frog position the arms
also should be flexed.
Baby’s abdomen should be at the level of the mothers
epigastrium
Support the babies bottom

28. Ensure that Baby’s neck is not too flexed or too extended
Monitor breathing