High risk neonate

High risk neonates& Complication

Dr. S Ghaemi, MD

High risk pregananciesHigh risk infantsWhy high risk infants?Neonatal morbidityLong term morbidity and disabilityNeonatal death

Why high risk pregnancies?75%Physiological pregnancies 5% ill neonates25% abnormal pregnancies 15-25% ill neonates2The goalScreening risk factors

Prevention

Early management and therapy of ongoing complications

3Risk factorsPreconception

Postconception

Delivery4Risk factorsPreconceptionEconomic, socialCultural behavioralBiologic geneticReproductive

Previous pregnancies and deliveryChromosomal abnormalitiesMother deseaseDiabetes, epilepsy, alergy, Fenylketonuria, endocrine disorders, congenital deseaseDrug, alcohol abuseUterus anomalyMother age, weight5Risk factorsPostconceptionMother deseaseMother infections, gestosisChorioamnionitisDiabetes, epilepsy, alergy, Fenylketonuria, endocrine disorders, congenital deseaseDrug, alcohol abuseRh incompatibilyHydramniosMultiple pregnanciesIntrauterine growth retardationPost-term infants

6Risk factorsDelivery

Cephalopelvic disproportionDystociaProlonged laborAbruptio placentaeIntrapartal hypoxiaForceps (breus)

7Risk factorsHypoxiaHIE, IVH, PVLSevere infectionMeningitis, TORCH, Metabolic complicationsHypoglycemia, hypocalcemia, acidosisIntrauterine drug exposureHeroin, methadon, cocaine, alcohol

8High Risk Neonates Term Post term SGA Preterm

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10Post mature infants are prone to develop asphyxia during labor secondary to placental insufficiency meconium aspiration syndrome which may be unusually severe because post term, amniotic fluid volume is decreased and the aspirated meconium is less diluted; neonatal hypoglycemia due to insufficient glycogen stores at birth. Because anaerobic metabolism rapidly uses the last of the glycogen stores, hypoglycemia is exaggerated if perinatal asphyxia has occurred. Postmature Infant 11Small for gestational age infant or (IUGR)SGAIntrauterine growth restriction12Mortality and morbidity are increased in SGA infants compared to those who are appropriate for gestational age (AGA). 13

1414Approximately 10 percent of term infants in developed countries are SGA compared to 23 percent of term infants in developing countries.15CLASSIFICATION

SGA infants have either symmetric or asymmetric IUGR. Infants with symmetric IUGR have reductions in both body and head growth. Symmetric IUGR begins in early gestation.16Infants with asymmetric IUGR have reduced body weight and relatively normal length and head growth. Abnormal growth typically begins in the late second or third trimestersAsymmetric1717CLINICAL FEATURESSGA infants appear thin with loose, peeling skin and decreased skeletal muscle mass and subcutaneous fat tissue. The face has a typical shrunken or "wizened" appearance, and the umbilical cord often is thin (picture 118

19Meconium staining may be present (picture 2). In newborns with asymmetric IUGR, the head appears relatively large compared to the size of the trunk and extremities.20

2121Prematurity Short term disability

Intracranial pathologyIVH, PVL, brain atrophy, ventriculomegalyRetinopathyChronic lung diseaseNecrotising enterocolitisEarly and late onset sepsis22Long term disability Cerebral palsyVisual impairmentSensorineural hearing lossEpilepsyMental retardationGrowth retardation, failure to thrive

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Cerebral Palsy SyndromeA term used broadly to describe a number of motor disorders characterized by impaired voluntary movement resulting from prenatal developmental abnormalities or perinatal or postnatal CNS damage occurring before age 5 yr.

The term cerebral palsy (CP) is not a diagnosis but identifies children with nonprogressive spasticity, ataxia, or involuntary movements. Between 0.1 and 0.2% of children have CP syndromes; up to 1% of premature newborns or those small for gestational age are affected.25Cerebral Palsy SyndromeEtiology The cause often is hard to establish, but prematurity, in utero disorders, neonatal jaundice, birth trauma, and perinatal asphyxia play important roles. Birth trauma and perinatal asphyxia probably cause