High risk newborn 2 (2)

high risk new born

1. HIGH RISK NEWBORN II ULFAT AMIN M.Sc. CHN, DNA, RN

2. MANAGEMENT OF LBW BABIES Delivery Room Management The delivery room management consists of an expert resuscitation—maintaining good thermoregulation, minimal handling, and use of nasal continuous positive airway pressure (CPAP) and intubation when required for preterm births.

3. Low birth weight neonates who need care in a special care unit include those with birth weight less than 1,800 g, gestation less than 34 weeks, any neonate who is unable to feed from the breast and any sick neonate.

4. THERMOREGULATION Low birth weight babies are more prone to develop hypothermia due to deficient heat regulatory mechanisms. Soon after delivery, the unclothed baby with the head and feet covered should be placed in between the breasts of the mother to have skin-to-skin contact position (Kangaroo mother care ). It not only maintains the temperature of the baby but also helps in the prompt initiation of breastfeeding.

5. Fluids If a LBW needs fluids, then in the first 48 hours after birth, neonates less than 1,250 g should be provided 5% dextrose and those more than 1,250 g should receive 10% dextrose.

6. The fluid requirements of neonates(ml/kg body weight) volumes are given in Table: Day of life Birth weight 1000-1500g Birth weight >1500g 1 60ml 80 ml 2 75 ml 95 ml 3 90 ml 110 ml 4 105 ml 125 ml 5 120 ml 140 ml 6 135 ml 155 ml 7 150 ml 170 ml

7. Enteral Feeding of the Low Birth Weight Neonate The goal of nutritional management of the LBW infant should be to achieve full enteral nutrition as soon as possible. Breast milk is the best milk for the neonate and the mother should be supported and counseled for the maintenance of regular lactation and the need for expression and its technique .

8. The guidelines for providing enteral feeds to the LBW neonate are summarized in Table: Birth weight (g) < 1,200 1,200–1,800 >1800 Gestation Condition <30 (weeks) 30-34 (weeks) >34 (weeks) Initial Intravenous fluids; Try gavage feeds if not sick Gavage Breastfeeding; if unsatisfactory, give spoon or paladai feeds After 1–3 days Gavage Spoon or paladai feeds Breastfeeding Later (1–3 weeks) Try spoon or paladai feeding Breastfeeding Breastfeeding After ( 4–6 weeks) Breastfeeding Breastfeeding Breastfeeding

9. Monitoring for Feed Intolerance Vitamin and Mineral Supplementation: Supplementation should be started as soon as the infant is receiving at least 120–150 mL/kg of enteral feeds. Adequacy of Nutrition Immunization

10. Follow-up Protocol : After discharge from the hospital, babies should be regularly followed up and screened for the following parameters: • Feeding and nutrition • Anemia and osteopenia • Growth and development: Neurobehavioral problems • Immunization • Retinopathy of prematurity, vision, strabismus and hearing • Problems resulting from previous morbidities, e.g. bronchopulmonary dysplasia.

11. PRETERM BABIES A baby born with a gestational age of less than 37 complete weeks (or less than 295 days) is termed as preterm baby. These babies are also termed as immature born, early or premature. These babies are vulnerable to various physiological handicapped conditions with high mortality rate due to their anatomical functional immaturity.

12. Sub categories of preterm Extremely preterm (less than 28 weeks of gestation). Very preterm (28-32 weeks of gestation). Moderate to late preterm (32-37 weeks of gestation).

13. CAUSES APH, cervical incompetence and bicornuate uterus. Chronic and systemic maternal diseases or infections. Threatened abortion, acute emotional stress, physical exertion, sexual activity and trauma. Low maternal weight gain and poor socioeconomic condition . Maternal malnutrition. Cigarette smoking and drug addiction. Multiple pregnancy Very young and unmarried mother. Too frequent child birth.

14. Induced causes Maternal diabetes mellitus and severe heart disease. Placental dysfunction with unsatisfactory fetal growth. Eclampsia, severe pre-eclampcia and hypertension. Fetal hypoxia and fetal distress. APH. Severe Rh-isoimmunization. Artificial rupture of membranes.

15. Characteristics of preterm babies: Compared with the term infant, the preterm infant is tiny, scrawny, and red. The extremities are thin, with little muscle or subcutaneous fat. The head and abdomen are disproportionately large, and the skin is thin, relatively translucent, and usually wrinkled.

16. Veins of the abdomen and scalp are more visible. Lanugo is plentiful over the extremities, back, and shoulders. The ears have soft, minimal cartilage and thus are extremely pliable. The soft bones of the skull tend to flatten on the sides, and the ribs yield with each labored breath.

17. Complications of the Preterm Newborn Respiratory Distress Syndrome Intraventricular Hemorrhage Cold Stress Retinopathy of Prematurity Necrotizing Enterocolitis

18. Management of preterm neonates: Improving Respiratory Function. Maintaining Body Temperature Preventing Infection Maintaining Adequate Nutrition Preserving Skin Integrity Promoting Energy Conservation and Sensory Stimulation Reducing Parental Anxiety

19. THANK YOU