HIGH RISK INFANT

• Problems Related to Maturity

  • Prematurity
  • Respiratory Distress Syndrome (RDS)
  • Post-maturity
  • Meconium Aspiration syndrome
• Problems Related to Gestational Weight

  • Small for Gestational Age (SGA)
  • Large for Gestational Age (LGA)
• Preterm Infants


  Born before 37 weeks
• Preterm Infants


  • Frail, weak, limp, skin translucent, abundant vernix & lanugo
  • Easily exhausted, from noise and routine activities, feeble cry
• Assessment of Preterm Infants

  • Inadequate respirations
  • Inadequate thermoregulation
  • Fluid and electrolyte imbalance – dehydration sunken fontanels <1ml/kg/hr or over hydration bulging, edema and urine output >3ml/kg/hr
  • Signs of pain – high-pitched cry, >VS
  • Signs of over stimulation – >P, >RR, stiff extended extremities, turning face away
  • Nutrition – signs of readiness to nipple – respiratory rate <60/m, rooting, sucking, gag reflex
• Complications of Preterm Infants

  • Respiratory Distress Syndrome – RDS
  • Bronchopulmonary dysplasia – chronic lung disease
  • Periventricular – Intraventricular Hemorrhage 30% infants <32 week gestation or <1500 g
  • Retrolenthal fibroplasia – visual impairment or blindness from O2 & ventilator
  • Necrotizing Enterocolitis (NEC) – distention, increased residual, Treatment - rest bowel
• Post-Term Infants


  Born after 42 weeks
• Characteristics of Post-Term Infants

  • Increase risk of meconium aspiration
  • Hypoglycemia
  • Loss of subcutaneous fat
  • Skin – peeling, vernix sparse, lanugo absent, long fingernails
• Focus on prevention of post-term infants is "due date"
• Attention to thermoregulation & feeding is important for post-term infants
• Large for Gestational Age (LGA)

  Infants weight is in the 90th % for neonates same gestational age, may be pre, post, or full term infants
• LGA does not mean post term
• Causes of LGA


  Most Common Cause – maternal diabetes
• Risks for LGA Infants

  • birth injuries
  • hypoglycemia
  • polycythemia – macrosomia
• Small for Gestational Age (SGA)


  Infant whose weight is at or below the 10th %
• SGA


  Is a high risk condition
• SGA does not mean "premature"
• Causes of SGA


  • anything restricting utero-placental blood flow
  • Smoking
  • DM
  • PIH
  • Infections
• Complications of SGA


  • Hypoglycemia
  • Meconium Aspiration
  • Hypothermia
  • Polycythemia
• Respiratory Distress Syndrome (RDS)


  Also known as "Hyaline Membrane Disease"
• Causes of RDS

  • Besides prematurity
  • C/S
  • diabetic mothers
  • birth asphyxia – interfere with surfactant
• Signs & Symptoms of RDS

  • Tachypnea - over 60/min
  • Retractions - sternal or intercostal
  • Nasal flaring
  • Cyanosis- central
  • Grunting- expiratory
  • Seesaw respirations
  • Asymmetry
• Silverman-Andersen Index


  Used to evaluate Respiratory Status
• Therapeutic Management of RDS


  • Surfactant replacement therapy
  • Installed into the infant's trachea
  • Improvement in breathing occurs in minutes
  • Doses repeated PRN
• Other Treatment for RDS

  • Mechanical ventilation
  • Correction of acidosis
  • IV fluids
• Meconium Aspiration Syndrome


  Occurs most often among post term infants, decreased amniotic fluid /cord compression
• Meconium enters lung – obstruction
• Signs & Symptoms of Meconium Aspiration Syndrome

  • Tachypnea
  • Cyanosis
  • Retractions
  • Nasal flaring
  • Grunting
• Treatment of Meconium Aspiration Syndrome

  • Suction at birth
  • May need warmed, humidified oxygen
  • May need ventilators
• Neonatal Sepsis (Sepsis Neonatorum)


  It occurs in less than 1 % of newborns (1 out of 100), but accounts for up to 30 percent of deaths in the first few weeks of life
• Early-Onset Sepsis (EOS)


  Refers to sepsis presenting in the first 7 days of life (although some refer to EOS as within the first 72 hours of life)
• Late-Onset Sepsis (LOS)


  Refers to presentation of sepsis after 7 days (or 72 hours, depending on the system used)
• Signs of Neonatal Sepsis

  • Body temperature changes
  • Breathing problems
  • Diarrhea
  • Low blood sugar (hypoglycemia)
  • Reduced movements
  • Reduced sucking
  • Seizures
  • Bradycardia
  • Swollen belly area
  • Vomiting
  • Yellow skin and whites of the eyes (jaundice)
• A heart rate above 160 can also be an indicator of sepsis, this tachycardia can present up to 24 hours before the onset of other signs
• Criteria for Low-Risk of Serious Bacterial Illness in Infants ≤ 60 days old


  • Generally well-appearing
  • Previously healthy
  • Full term (at ≥37 weeks gestation)
  • No perinatal antibiotics
  • No unexplained hyperbilirubinemia that required treatment
  • No antibiotics since discharge
  • No hospitalizations
  • No chronic illness
  • Discharged at the same time or before the mother
  • No evidence of skin, soft tissue, bone, joint, or ear infection
  • White Blood Cells (WBCs) count 5,000-15,000/mm3
  • Urine WBC count ≤ 10 per High Power Field (HPF)
  • Stool WBC count ≤ 5 per High Power Field (HPF) only in infants with diarrhea
• Meeting the low-risk criteria likely do not require a lumbar puncture, and are safe for discharge without antibiotic treatment, or with a single dose of intramuscular antibiotics, but will still require close outpatient follow-up
• Group B Streptococcal Infection (GBS)


  One risk is Preterm Premature Rupture of Membranes (PPROM)
• Screening women for GBS (via vaginal and rectal swabbing) and treating culture positive women with intrapartum chemoprophylaxis is reducing the number of neonatal sepsis caused by GBS
• Treatment for Neonatal Sepsis

  • Frequently treated with antibiotics empirically until cultures are sufficiently proven to be negative
  • In addition to fluid resuscitation and supportive care, a common antibiotic regimen in infants with suspected sepsis is a beta-lactam antibiotic (usually ampicillin) in combination with an aminoglycoside (usually gentamicin)
  • Although uncommon, if anaerobic species are suspected (such as in cases where necrotizing enterocolitis or intestinal perforation is a concern, clindamycin is often added
• Pathologic Jaundice


  Occurs within first 24 hours