HIGH RISK INFANT, NEC

• High risk infant


  Any infant, regardless of gestational age or weight, who will require or is expected to require special medical attention to survive
• Conditions that can indicate a high risk infant

  • Prenatal, postnatal or maternal conditions
• Maternal signs for a high risk infant

  • Overweight mother
  • Multiple births
  • Viral infections during first trimester
  • Drug addiction – cocaine use
  • Diabetes mellitus
  • Toxemia of Pregnancy (eclampsia)
  • Early pregnancy (<17 y.o.)
  • First pregnancy in later life (>35 y.o.)
  • Exposure to ionizing radiation
  • Extreme emotional stress
  • Heavy use of alcohol
  • Cigarette smoking
• Eclampsia (Toxemia of Pregnancy)

  The gravest form of pregnancy-induced hypertension, characterized by grand mal seizures, coma, hypertension, proteinuria and edema
• Symptoms of impending eclampsia seizures

  • Body temperature of up to 40 ̊C, anxiety, epigastric pain, severe headache and blurred vision
• Preventing eclampsia convulsions


  1. Bed rest in a quiet, dimly lit room

  2. Parenteral administration of MgSO4 and antihypertensive medications
• Obstetrical complications


  • Breech positioning
  • Cesarean section
  • Placental abnormality/ insufficiency (placenta previa, placenta abruptio)
  • Prolapsed cord

  
• Placenta previa


  Placenta grows at the lowest part of uterus, covers all or part of the cervix
• Placenta abruption


  Placenta separates early before childbirth
• Umbilical cord prolapse
• Other maternal signs for a high risk infant

  • Premature rupture of amniotic sac
  • Post-maturity
  • Previous premature births or stillborns
  • Meconium stained amniotic fluid
  • Perinatal asphyxia
  • Prolonged labor
  • Beta streptococcus infection
  • Certain drugs – anesthetics, narcotic agents; cocaine use

  
• Fetal/ Neonatal signs or factors for a high risk infant

  • Gestational period of less than 36 weeks
  • Respiratory Distress Syndrome (RDS)
  • Meconium staining
  • Infection
  • Congenital abnormalities (blood dyscrasia, cardiac anomalies)
  • Surgery
  • Intracranial hemorrhage
  • Retrorental fibroplasia
  • Fetal hypotension; fetal hypothermia
  • Necrotizing enterocolitis (NEC)

  
• Necrotizing Enterocolitis (NEC)


  A serious neonatal disease that affects mostly the intestine of premature infants
• NEC


  1. Walls of the intestines is invaded by bacteria

  2. Cause local infection and inflammation

  3. Can ultimately damage them

  
• NEC


  • Typically occurs in the 2nd – 3rd week of life in premature, formula-fed infants
  • Affects close to 10% of infants who weigh less than 1500 g
  • Mortality rates of ≥50% depending on severity
  • May also occur in term and near-term babies