SlideShare une entreprise Scribd logo
1  sur  57
Télécharger pour lire hors ligne
HIGH RISK INFANTS
BY
DR. AYODELE, NOSRULLAH
FMC, BIRNIN KEBBI
OUTLINE
 INTRODUCTION
 EPIDEMIOLOGY OF INFANT MORBIDITY AND
MORTALITY
 FACTORS THAT DEFINE AN INFANT AS BEING HIGH
RISK
 SPECIFIC HIGH RISK INFANTS AND MANAGEMENT
 DISCHARGE PROTOCOLS FOR HIGH RISK INFANTS
 COMPLICATIONS
 CONCLUSION
 REFERENCES
INTRODUCTION
 The term high-risk infant refers to any baby
exposed to any condition that puts the
survival of the neonate at danger.
 Such babies should be under close observation
by experienced physicians and nurses
 About 10-20% of all births require special or
neonatal intensive care
 Neonatal mortality largely depends on
birthweight and gestational age
INTRODUCTION
 For any given duration of gestation, the
lower the birthweight, the higher the
neonatal mortality
 For any given birthweight, the shorter the
gestational duration, the higher the neonatal
mortality
 Most neonatal mortality occurs within the 1st
hours and days after birth
 The highest risk of neonatal and infant
mortality occurs in infants who weigh <1,000
g at birth and whose gestation was <28 wk
INTRODUCTION
 The lowest risk of neonatal mortality occurs
in infants with a birthweight of 3,000-4,000 g
and a gestational age of 39-41 wk
EPIDEMIOLOGY
 In 2016, 4.2 million (75% of all under-five
deaths) occurred within the first year of life
 The risk of a infant mortality was highest in
the WHO African Region (52/1000 live
births), over 6x higher than that in the WHO
European Region (8/1000 live births).
 Globally, the infant mortality rate has
decreased from an estimated rate of
64.8/1000 live births in 1990 to 30.5/1000
live births in 2016
 In Nigeria, the MICS puts infant mortality
rate at 70/1000 LB in 2017
EPIDEMIOLOGY
 Neonatal mortality rates rise sharply for
infants weighing more than 4kg at birth and
for those whose gestational period is 42 wk or
longer.
 The perinatal mortality of twins is about 4
times that of singletons
 Triplet or higher-order births are associated
with an increased risk of death or
neurodevelopmental impairment when
compared with ELBW singleton and twin
infants
FACTORS THAT DEFINE AN
INFANT AS BEING HIGH RISK
 Demographic social factors
 Maternal age <16 or >40 yr
 Illicit drug - alcohol, cigarette use
 Poverty
 Unmarried
 Emotional or physical stress
FACTORS THAT DEFINE AN
INFANT AS BEING HIGH RISK
 Past medical history
 Genetic disorders
 Diabetes mellitus
 Hypertension
 Asymptomatic bacteriuria
 Rheumatologic illness (systemic lupus
erythematosus)
 Immune-mediated diseases (immunoglobulin G
crossing placenta)
 Long-term medication
FACTORS THAT DEFINE AN
INFANT AS BEING HIGH RISK
 History of previous pregnancy
 Intrauterine fetal demise
 Neonatal death
 Prematurity
 Intrauterine growth restriction
 Congenital malformation
 Incompetent cervix
 Blood group sensitization, neonatal jaundice
 Neonatal thrombocytopenia
 Hydrops
 Inborn errors of metabolism
FACTORS THAT DEFINE AN
INFANT AS BEING HIGH RISK
 Present pregnancy
 Vaginal bleeding
 Sexually transmitted infections
 Multiple gestation
 Preeclampsia
 Premature rupture of membranes
 Short interpregnancy time
 Poly-/oligohydramnios
 Acute medical or surgical illness
 Inadequate prenatal care
 Familial or acquired hypercoagulable states
 Abnormal fetal ultrasonographic findings
 Treatment of infertility
FACTORS THAT DEFINE AN
INFANT AS BEING HIGH RISK
 Labor and delivery
 Premature labor (<37 wk)
 Postdates pregnancy (≥42 wk)
 Fetal distress
 Breech presentation
 Meconium-stained fluid
 Nuchal cord
 Cesarean section
 Forceps delivery
 Apgar score <4 at 1 min
FACTORS THAT DEFINE AN
INFANT AS BEING HIGH RISK
 Neonate
 Birthweight <2,500 or >4,000 g
 Birth <37 or ≥42 wk of gestation
 Small or large for gestational age
 Respiratory distress, cyanosis
 Congenital malformation
 Pallor, plethora, petechiae
MULTIPLE GESTATION
 Incidence of spontaneous dizygotic twinning
is highest among blacks and East Indians,
followed by northern European whites, and is
lowest in the Asian races
 The incidence of monozygotic twins (3-
5/1,000) is unaffected by racial or familial
factors
 Triplets are estimated to occur in 1 in 86
pregnancies and quadruplets in 1 in 86
pregnancies in the United States (Check
Nigerian data)
PROBLEMS OF MULTIPLE
GESTATION
 Polyhydramnios
 Hyperemesis gravidarum
 Preeclampsia
 Premature rupture of membranes
 Vasa previa
 Velamentous insertion of the umbilical cord
 Abnormal presentations (breech)
 Premature labor.
PROBLEMS OF MULTIPLE
GESTATION
 Obstruction of the circulation secondary to
intertwining of the umbilical cords
 Respiratory distress syndrome and asphyxia
(second twin)
 Intrauterine growth restriction
 Twin–twin transfusion
 Congenital anomalies
MANAGEMENT
 Early detection and anticipation
 Quality antenatal care – adequate caloric
and protein intake, haematinics, iron and
folate supplementation, regular visits, fetal
surveillance / monitoring
 Prevention of preterm labour
 Administration of corticosteroid if preterm
labour is anticipated
 Appropriate labour management
 Management of prematurity
 Management of twin-twin transfusion ( if
present)
TWIN-TWIN TRANSFUSION
 Is a rare complication that can occur in
monozygotic monochorionic diamniotic
twins, which causes the blood to pass from
one twin to the other
 Usually occurs due to the presence of
placental vascular communication
 The donor becomes undernourished and
anaemic while the recipient grows normally
and plethoric
 Management more of obstetrics, surviving
infants are managed according to
presentation
High risk infants
PRETERM INFANTS
 Term = 37weeks to 42 weeks
 Subdivision by American College of Obstetrics
and Gynecology
 Early term = 37weeks + 0day to 38weeks + 6days
 Full term = 39weeks + 0day to 40weeks + 6days
 Late term = 41weeks + 0day to 41weeks +6days
 Preterm = less than 37weeks
 extremely preterm (less than 28 weeks)
 very preterm (28 to <32 weeks)
 moderate to late preterm (32 to <37 weeks) 2,4
PRETERM INFANTS
 Prematurity is the leading cause of death in
children under the age of 5 years 2
 Half of the babies born at or below 32 weeks
(2 months early) die due to a lack of
feasible, cost-effective care, such as
warmth, breastfeeding support, and basic
care for infections and breathing difficulties
CAUSES OF PRETERM BIRTH
 Idiopathic
 Induction of labour
 Caesarean section
 Multiple pregnancies
 Infections
 Diabetes mellitus
 Hypertensive diseases in pregnancy
 Extremes of maternal age
 Preterm premature rupture of
membranes
CAUSES OF PRETERM BIRTH
 Polyhydramnios
 Antepartum haemorrhage
 Stressful life event
 Uterine/cervical
malformations/abnormalities
 Cervical trauma
 Drug abuse
 Recurrent mid-trimester miscarriage
 Hematologic
COMPLICATIONS OF PRETERM
BABY
 Hypothermia
 Feeding difficulties
 Breathing difficulties - apnoea
 Pneumonia and early neonatal sepsis
 Intraventricular haemorrhage
 Jaundice
 Retinopathy of prematurity
 Fetal death
Williams Obstetrics 23rd edition
MANAGEMENT OF PRETERM
INFANTS
 Principles of management 3
 Identification of the clinical problem that the
infant is at risk of developing
 Prevention of the problem
 Identification of problems when they occur
 Early treatment of the problems
MANAGEMENT OF PRETERM
INFANTS
 At delivery
 clear the airway
 initiate breathing,
 care for the umbilical cord and eyes,
 administer vitamin K
 Subsequent management
 thermal control
 monitoring of the heart rate and respiration
 oxygen therapy (if indicated)
 fluid management
 nutrition.
 Prevention of infection
Thermal control
 Keep thermoneutral environment – provide
warm environment and humidity
 Maintain core temperature at 36.5-37.0°C
 Incubators or radiant warmers can be used
 Alternatives are: Kangaroo mother care with
direct skin-to-skin contact, a hat and blanket
covering the infant
FLUID BALANCE
 Very immature preterm infants (<1,000 g) may
lose as much as 2-3 mL/kg/hr
 Larger premature infant (2,000-2,500 g) nursed
in an incubator may have an insensible water
loss of approximately 0.6-0.7 mL/kg/hr.
 VLBW babies are less able to concentrate urine,
so they need higher fluid intake to excrete
solutes
 Adequate fluid intake is essential for excretion
of the urinary solute load (urea, electrolytes,
phosphate).
 Start with 70-80 mL/kg on day 1 and advance
gradually to 150 mL/kg/day.
TOTAL PARENTERAL NUTRITION
 The goal is to deliver sufficient calories from
glucose, protein, and lipids to promote
optimal growth
 Indication
 before complete enteral feeding has been established
 when enteral feeding is impossible for prolonged
periods
 Route of administration
 percutaneously
 surgically placed indwelling central venous catheter
 peripheral vein.
 umbilical vein ( for up to 2 wk)
TOTAL PARENTERAL NUTRITION
 The infusate should contain
 2.5-3.5 g/dL/day of synthetic amino acids and
 10-15 g/dL/day of glucose,
 2-3g/kg/day of fat emulsion e.g. intralipid 20%
 appropriate quantities of electrolytes, trace
minerals, and vitamins.
 The content of each day’s infusate should be
determined after careful assessment of the
infant’s clinical and biochemical status
TOTAL PARENTERAL NUTRITION
 Complications
Complication from catheter Complication from infusate
metabolism
Infection Hyperglycemia
Thrombosis osmotic diuresis
Extravasation of fluid Dehydration
Accidental dislodgment Azotemia
Phlebitis Nephrocalcinosis
Cutaneous sloughing, Hypoglycemia
Hypoxemia
hyperammonemia
ENTERAL FEEDING
 Oral feeding (nipple) should not be initiated
or should be discontinued in infants with
 respiratory distress
 hypoxia
 circulatory insufficiency
 excessive secretions
 gagging
 sepsis
 central nervous system depression
 severe immaturity
 signs of serious illness
ENTERAL FEEDING
 The main principle in feeding premature infants
is to proceed cautiously and gradually.
 Careful early feeding of breast milk or formula
tends to reduce the risk of hypoglycemia,
dehydration, and hyperbilirubinemia
 Preterm infants at 34 wk of gestation or more
can often be fed by bottle or at the breast.
 Direct breastfeeding may not be successful in
very preterm infants due to poor sucking effort,
so baby may need be fed by bottle or tube
ENTERAL FEEDING
 Trophic feeding is the practice of feeding very
small amounts of enteral nourishment to VLBW
preterm infants to stimulate development of
the immature gastrointestinal tract.
 Benefits of trophic feeding include
 enhanced gut motility,
 improved growth,
 decreased need for parenteral nutrition,
 fewer episodes of sepsis,
 shortened hospital
ENTERAL FEEDING
 For infants <1 kg, the initial trophic feedings
can be given at 10-20 mL/kg/24 hr as a
continuous nasogastric tube drip (or given by
intermittent gavage every 2-3 hr) for 5-10
days.
 If the initial feedings are tolerated, the
volume is increased by 20-30 mL/kg/24 hr to
a maximum of 150ml/kg/24hr
ENTERAL FEEDING
 For infants weighing >1.5 kg , feeding is
initiated at a volume of 20-30 mL/kg/24 hr
 Increase by total daily formula volume of 20-
30 mL/kg/24 hr.
 Indication for review/stoppage of feeding
 regurgitation,
 vomiting,
 abdominal distention,
 gastric residuals from previous feedings (as
indicated by gastric aspiration)
ENTERAL FEEDING
 LBW and preterm infants should be given
supplemental vitamins because the volume
of milk sufficient to satisfy daily
requirements may not be ingested for
several weeks
PREVENTION OF INFECTION
 Prevention strategies include:
 strict compliance with handwashing and universal
precautions,
 minimizing the risk of catheter contamination and
duration,
 meticulous skin care,
 encouraging early appropriate advancement of
enteral feeding,
 education and feedback to staff,
 surveillance of nosocomial infection rates in the
nursery
 Prophyalctic antibiotics may be given 5
POSTTERM INFANTS
 Postterm infants are those born after 42
completed weeks of gestation (from LMP)
regardless of weight at birth.
 Cause is unknown, risk factors include
 Wrong dates
 Maternal factors - primiparity, previous history of
prolonged pregnancy, sedentary habits, genetic
predisposition and elderly multipara.
 Fetal factors - Fetal congenital anomalies such as
anencephaly and adrenal hypoplasia; fetal male
sex
 Placental factors - sulfatase deficiency
POSTTERM INFANTS
 Common features of post maturity syndrome
include
 Desquamation of the skin / wrinkling
 long nails,
 abundant hair,
 pale skin,
 alert faces,
 loose skin, especially around the thighs and
buttocks
 meconium-stained nails, skin, vernix, umbilical
cord, and placental membranes
POSTTERM INFANTS
 Common complications include
 macrosomia / IUGR
 perinatal depression,
 meconium aspiration,
 persistent pulmonary hypertension,
 hypoglycemia,
 hypocalcemia,
 polycythemia.
 birth injuries
 increased perinatal mortality
MANAGEMENT
 Careful obstetric monitoring, including
 nonstress testing,
 Biophysical profile,
 Doppler velocimetry
 Choosing appropriate mode of delivery less
risky for the baby
 nonintervention and subsequent vaginal delivery
 induction of labor, or
 Cesarean section
 Treatment of medical problems in the
newborn if they arise
LARGE FOR GESTATIONAL AGE
 Are infants with birthweight > the 90th
percentile for gestational age
 Predisposing factors include:
 Large parental size
 maternal diabetes
 Obesity
LARGE FOR GESTATIONAL AGE
 Complications –
 cervical and brachial plexus injuries,
 phrenic nerve damage with paralysis of the
diaphragm,
 fractured clavicles,
 cephalohematomas, subdural hematomas, and
ecchymoses of the head and face.
 hypoglycemia
 polycythemia.
 congenital anomalies
MANAGEMENT
 Antenatal detection of at risk infants
 Skilled delivery practices to prevent or
minimize birth injuries
 Management of hypoglycemia and metabolic
problems
 Management of birth injuries
INFANT OF DIABETIC MOTHER
 Common complications include
 Fetal macrosomia
 Impaired fetal growth
 Fetal congenital malformation
 Pulmonary disease – RDS, pulmonary hypertension
 Metabolic and electrolyte abnormalities –
hypoglycaemia, hypocalcemia, hypomagnesemia
 Haematological problems – polycythaemia, stroke,
seizure, NEC, renal vein thrombosis
 Cardiovascular abnormalities – VSD, TGA,
cardiomyopathy
 Congenital malformations
MANAGEMENT
 Preconception and frequent prenatal
evaluations of all women with diabetes and
pregnant women with gestational diabetes,
 Evaluation of fetal maturity, biophysical
profile, Doppler velocimetry, and planning of
the delivery of these infants in hospitals
where expert obstetric and pediatric care is
continuously available.
MANAGEMENT
 Check RBS, serum E/U/Cr
 Infants should initiate feedings within 1 hr
after birth
 A screen glucose test should be performed
within 30 minutes of the first feed
 Treatment is indicated if the plasma glucose
is <40 mg/dL and clinical symptoms of
hypoglycemia are present.
 In asymptomatic infants, treatment is
indicated if the plasma glucose is <30 mg/dl1
MANAGEMENT
 A dose of 200 mg/kg of dextrose (2 mL/kg of
10% dextrose) should be administered to
infants with plasma glucose below these
limits.
 If baby cannot tolerate orally, a continuous
peripheral intravenous infusion at a rate of
4-8 mg/kg/min should be given
 Avoid bolus hypertonic glucose, it may cause
further hyperinsulinemia and rebound
hypoglycaemia
 Treat other electrolyte problems accordingly
DISCHARGE CRITERIA FOR HIGH
RISK INFANTS
 Growth should be occurring at steady
increments of approximately 30 g/day.
 Temperature should be stabile in an open crib.
 Infants should have had no recent episodes of
apnea or bradycardia
 Parents, or alternative caregivers, who are
willing and able to provide all aspects of the
infant’s care
 Drugs should be oral
DISCHARGE CRITERIA FOR HIGH
RISK INFANTS
 Eye test to rule out retinopathy
 Hearing test
 Check Hb to rule out anaemia
 A coordinated plan for outpatient or home
nursing follow-up visits
CONCLUSION
 High risk infants require special attention
and optimal care to reduce morbidity and
mortality. Therefore adequate antenatal
care, specialized delivery and early referral
for optimal neonatal care will go a long way
in averting the series of problems associated
with them and help prevent both short term
and long term complications.
REFERENCES
1. Kliegman, Robert, Richard E. Behrman, and Waldo E.
Nelson. Nelson textbook of pediatrics. 20th edition.
2016.
2. World Health Organization - Preterm birth fact
sheets. Available at
http://www.who.int/mediacentre/factsheets/fs363
/en/
3. Howson CP, Kinney MV, Lawn JE. Born too soon: the
global action report on preterm birth. Geneva:
World Health Organization. 2012 May:1-126
4. Azubuike JC, Nkanginieme KE. Paediatrics and child
health in a tropical region. 2nd edition. African
Educational Services. 2007
REFERENCES
5. Saxena R. Bedside Obstetrics & Gynecology. JP
Medical Ltd; 2014
6. Medscape: Infant of diabetic mother. Available at:
https://emedicine.medscape.com/article/974230-
overview#a2
7. Multiple Indicator Cluster Survey. Nigeria Survey
Finding Report, 2016-2017
8. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D,
Spong C. Williams Obstetrics 23rd Edition McGraw
Hill. New York. 2010
High risk infants

Contenu connexe

Tendances (20)

Management of lbw low birthweight babies
Management of lbw low birthweight babiesManagement of lbw low birthweight babies
Management of lbw low birthweight babies
 
Developmental Milestones
Developmental MilestonesDevelopmental Milestones
Developmental Milestones
 
High risk infant new
High risk infant newHigh risk infant new
High risk infant new
 
Developmental assessment and screening
Developmental assessment and screeningDevelopmental assessment and screening
Developmental assessment and screening
 
Ppt on developmental delay
Ppt on developmental delayPpt on developmental delay
Ppt on developmental delay
 
Apgar score care of newborn ppt
Apgar score care of newborn pptApgar score care of newborn ppt
Apgar score care of newborn ppt
 
High risk newborn
High risk newbornHigh risk newborn
High risk newborn
 
Cerebral Palsy
Cerebral PalsyCerebral Palsy
Cerebral Palsy
 
Microcephaly
MicrocephalyMicrocephaly
Microcephaly
 
High risk neonate
High risk neonateHigh risk neonate
High risk neonate
 
Developmental assessment
Developmental assessmentDevelopmental assessment
Developmental assessment
 
Developmental Assessment
Developmental AssessmentDevelopmental Assessment
Developmental Assessment
 
Spinal Bifida
Spinal BifidaSpinal Bifida
Spinal Bifida
 
CEREBRAL PALSY
CEREBRAL PALSY CEREBRAL PALSY
CEREBRAL PALSY
 
Breastfeeding
BreastfeedingBreastfeeding
Breastfeeding
 
High risk newborn 1
High risk newborn 1High risk newborn 1
High risk newborn 1
 
Paediatric Anthropometry
Paediatric AnthropometryPaediatric Anthropometry
Paediatric Anthropometry
 
Meconium aspiration syndrome_
Meconium aspiration syndrome_Meconium aspiration syndrome_
Meconium aspiration syndrome_
 
Low birth weight
Low birth weightLow birth weight
Low birth weight
 
Geriatric assessment
Geriatric assessmentGeriatric assessment
Geriatric assessment
 

Similaire à High risk infants

prematurity-140511202330-phpapp01-converted.pptx
prematurity-140511202330-phpapp01-converted.pptxprematurity-140511202330-phpapp01-converted.pptx
prematurity-140511202330-phpapp01-converted.pptxFaisalRafique27
 
The concept of prematurity.pdf
The concept of prematurity.pdfThe concept of prematurity.pdf
The concept of prematurity.pdfNaaWay
 
prematurity
prematurityprematurity
prematurityssn zhd
 
-PREMATURITY -MM.pptx
-PREMATURITY -MM.pptx-PREMATURITY -MM.pptx
-PREMATURITY -MM.pptxRuthNalavwe
 
pretermbabies-130723101340-phpapp01-converted.pptx
pretermbabies-130723101340-phpapp01-converted.pptxpretermbabies-130723101340-phpapp01-converted.pptx
pretermbabies-130723101340-phpapp01-converted.pptxAlanSudhan
 
Preterm infant,small for gestation age and postterm infant
Preterm infant,small for gestation age and postterm infantPreterm infant,small for gestation age and postterm infant
Preterm infant,small for gestation age and postterm infantjagadeeswari jayaseelan
 
0. Classification of Newborn.pptx
0. Classification of Newborn.pptx0. Classification of Newborn.pptx
0. Classification of Newborn.pptxFenembarMekonnen
 
management of preterm LBW.pptx
management of preterm LBW.pptxmanagement of preterm LBW.pptx
management of preterm LBW.pptxRaheelAhmed210939
 
PREMATURITY NEONATOLOGY.PPT
PREMATURITY NEONATOLOGY.PPTPREMATURITY NEONATOLOGY.PPT
PREMATURITY NEONATOLOGY.PPTdrmedardmlenda
 
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...IRAGUHA BANDORA Yves
 
Management of LOW BIRTH WEIGHT BABY
Management  of  LOW BIRTH WEIGHT BABY Management  of  LOW BIRTH WEIGHT BABY
Management of LOW BIRTH WEIGHT BABY msholehkosim
 
Intrauterine Growth Restriction (IUGR) / Small For gestational Age
Intrauterine Growth Restriction (IUGR) / Small For gestational Age Intrauterine Growth Restriction (IUGR) / Small For gestational Age
Intrauterine Growth Restriction (IUGR) / Small For gestational Age POOJA KUMAR
 
Pre term babies
Pre term babiesPre term babies
Pre term babiesRINKIDAS9
 
Ch10-Child.ppt
Ch10-Child.pptCh10-Child.ppt
Ch10-Child.pptT Gupta
 
Prematurity Pediatrics
Prematurity Pediatrics Prematurity Pediatrics
Prematurity Pediatrics NITISH SHAH
 
Intrauterine growth restriction Intrauterine growth restriction
Intrauterine growth restriction Intrauterine growth restrictionIntrauterine growth restriction Intrauterine growth restriction
Intrauterine growth restriction Intrauterine growth restrictionDr Praman Kushwah
 

Similaire à High risk infants (20)

prematurity-140511202330-phpapp01-converted.pptx
prematurity-140511202330-phpapp01-converted.pptxprematurity-140511202330-phpapp01-converted.pptx
prematurity-140511202330-phpapp01-converted.pptx
 
The concept of prematurity.pdf
The concept of prematurity.pdfThe concept of prematurity.pdf
The concept of prematurity.pdf
 
prematurity
prematurityprematurity
prematurity
 
-PREMATURITY -MM.pptx
-PREMATURITY -MM.pptx-PREMATURITY -MM.pptx
-PREMATURITY -MM.pptx
 
pretermbabies-130723101340-phpapp01-converted.pptx
pretermbabies-130723101340-phpapp01-converted.pptxpretermbabies-130723101340-phpapp01-converted.pptx
pretermbabies-130723101340-phpapp01-converted.pptx
 
Preterm infant,small for gestation age and postterm infant
Preterm infant,small for gestation age and postterm infantPreterm infant,small for gestation age and postterm infant
Preterm infant,small for gestation age and postterm infant
 
0. Classification of Newborn.pptx
0. Classification of Newborn.pptx0. Classification of Newborn.pptx
0. Classification of Newborn.pptx
 
LBW
LBWLBW
LBW
 
management of preterm LBW.pptx
management of preterm LBW.pptxmanagement of preterm LBW.pptx
management of preterm LBW.pptx
 
PREMATURITY NEONATOLOGY.PPT
PREMATURITY NEONATOLOGY.PPTPREMATURITY NEONATOLOGY.PPT
PREMATURITY NEONATOLOGY.PPT
 
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...
 
Management of LOW BIRTH WEIGHT BABY
Management  of  LOW BIRTH WEIGHT BABY Management  of  LOW BIRTH WEIGHT BABY
Management of LOW BIRTH WEIGHT BABY
 
Iugr obs
Iugr obsIugr obs
Iugr obs
 
Intrauterine Growth Restriction (IUGR) / Small For gestational Age
Intrauterine Growth Restriction (IUGR) / Small For gestational Age Intrauterine Growth Restriction (IUGR) / Small For gestational Age
Intrauterine Growth Restriction (IUGR) / Small For gestational Age
 
Pre term babies
Pre term babiesPre term babies
Pre term babies
 
Ch10-Child.ppt
Ch10-Child.pptCh10-Child.ppt
Ch10-Child.ppt
 
Low birth weight baby
Low birth weight babyLow birth weight baby
Low birth weight baby
 
Prematurity Pediatrics
Prematurity Pediatrics Prematurity Pediatrics
Prematurity Pediatrics
 
Iugr
IugrIugr
Iugr
 
Intrauterine growth restriction Intrauterine growth restriction
Intrauterine growth restriction Intrauterine growth restrictionIntrauterine growth restriction Intrauterine growth restriction
Intrauterine growth restriction Intrauterine growth restriction
 

Plus de Nosrullah Ayodele

Plus de Nosrullah Ayodele (9)

Polycystic ovarian syndrome
Polycystic ovarian syndromePolycystic ovarian syndrome
Polycystic ovarian syndrome
 
Cervical cancer
Cervical cancerCervical cancer
Cervical cancer
 
Gestational trophoblastic diseases
Gestational trophoblastic diseasesGestational trophoblastic diseases
Gestational trophoblastic diseases
 
Neonatal resuscitation
Neonatal resuscitationNeonatal resuscitation
Neonatal resuscitation
 
Physiology of transition
Physiology of transitionPhysiology of transition
Physiology of transition
 
Newborn feeding
Newborn feedingNewborn feeding
Newborn feeding
 
Neonatal jaundice
Neonatal jaundiceNeonatal jaundice
Neonatal jaundice
 
Neonatal infections
Neonatal infectionsNeonatal infections
Neonatal infections
 
Neonatal asphyxia
Neonatal asphyxiaNeonatal asphyxia
Neonatal asphyxia
 

Dernier

Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)bishwabandhuniraula
 
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfAnatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfhezamzaki1
 
person with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxperson with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxMUKESH PADMANABHAN
 
Identifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxIdentifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxsandhulove46637
 
Pharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxPharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxCliniminds India
 
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYCECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYRMC
 
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdfCompliatric Where Compliance Happens
 
21 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 202421 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 2024Traumasoft LLC
 
Understanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsUnderstanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsNeha Sharma
 
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....sharyurangari111
 
Health literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxHealth literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxPamela McKinney
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborHealth Catalyst
 
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11crzljavier
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementIris Thiele Isip-Tan
 
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsArtificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsIris Thiele Isip-Tan
 
ARTHRITIS.pptx Prepared by monika gopal Tutor
ARTHRITIS.pptx Prepared  by monika gopal TutorARTHRITIS.pptx Prepared  by monika gopal Tutor
ARTHRITIS.pptx Prepared by monika gopal TutorNehaKewat
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadAlex Clapson
 

Dernier (20)

Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)Basics of Giant Cell Tumor of bone (GCTB)
Basics of Giant Cell Tumor of bone (GCTB)
 
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdfAnatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
Anatomy Shelf Notevbhhhhhhhhhhhhhhhs.pdf
 
Annual Training
Annual TrainingAnnual Training
Annual Training
 
person with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptxperson with disability and pwd act ppt.pptx
person with disability and pwd act ppt.pptx
 
Identifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptxIdentifying Signs of Mental Health Presentation (1).pptx
Identifying Signs of Mental Health Presentation (1).pptx
 
Pharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptxPharmacovigilance audits inspections.pptx
Pharmacovigilance audits inspections.pptx
 
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHYCECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
CECT NECK NECK ANGIOGRAPHY CAROTID ANGIOGRAPHY
 
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
2024 Compliatric Webianr Series - Contracts and MOUs from a HRSA Perspective.pdf
 
SCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATIONSCOPE OF CRITICAL CARE ORGANIZATION
SCOPE OF CRITICAL CARE ORGANIZATION
 
21 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 202421 NEMT Trends & Statistics to Know in 2024
21 NEMT Trends & Statistics to Know in 2024
 
Understanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common LocationsUnderstanding Warts and Moles: Differences, Types, and Common Locations
Understanding Warts and Moles: Differences, Types, and Common Locations
 
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
Toothpaste for bleeding gums and sensitive teeth. Teeth whitening, Mouthwash....
 
Health literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptxHealth literacies in marginalised communities LILAC 24.pptx
Health literacies in marginalised communities LILAC 24.pptx
 
Three Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and LaborThree Keys to a Successful Margin: Charges, Costs, and Labor
Three Keys to a Successful Margin: Charges, Costs, and Labor
 
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES  11
FINAL PROJECT IN EMPOWERMENT TECHNOLOGIES 11
 
Painting Rats White Angers Them to No End
Painting Rats White Angers Them to No EndPainting Rats White Angers Them to No End
Painting Rats White Angers Them to No End
 
Artificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes ManagementArtificial Intelligence: Diabetes Management
Artificial Intelligence: Diabetes Management
 
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, BenefitsArtificial Intelligence in Healthcare: Challenges, Risks, Benefits
Artificial Intelligence in Healthcare: Challenges, Risks, Benefits
 
ARTHRITIS.pptx Prepared by monika gopal Tutor
ARTHRITIS.pptx Prepared  by monika gopal TutorARTHRITIS.pptx Prepared  by monika gopal Tutor
ARTHRITIS.pptx Prepared by monika gopal Tutor
 
Empathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion insteadEmpathy Is a Stress Response - Choose Compassion instead
Empathy Is a Stress Response - Choose Compassion instead
 

High risk infants

  • 1. HIGH RISK INFANTS BY DR. AYODELE, NOSRULLAH FMC, BIRNIN KEBBI
  • 2. OUTLINE  INTRODUCTION  EPIDEMIOLOGY OF INFANT MORBIDITY AND MORTALITY  FACTORS THAT DEFINE AN INFANT AS BEING HIGH RISK  SPECIFIC HIGH RISK INFANTS AND MANAGEMENT  DISCHARGE PROTOCOLS FOR HIGH RISK INFANTS  COMPLICATIONS  CONCLUSION  REFERENCES
  • 3. INTRODUCTION  The term high-risk infant refers to any baby exposed to any condition that puts the survival of the neonate at danger.  Such babies should be under close observation by experienced physicians and nurses  About 10-20% of all births require special or neonatal intensive care  Neonatal mortality largely depends on birthweight and gestational age
  • 4. INTRODUCTION  For any given duration of gestation, the lower the birthweight, the higher the neonatal mortality  For any given birthweight, the shorter the gestational duration, the higher the neonatal mortality  Most neonatal mortality occurs within the 1st hours and days after birth  The highest risk of neonatal and infant mortality occurs in infants who weigh <1,000 g at birth and whose gestation was <28 wk
  • 5. INTRODUCTION  The lowest risk of neonatal mortality occurs in infants with a birthweight of 3,000-4,000 g and a gestational age of 39-41 wk
  • 6. EPIDEMIOLOGY  In 2016, 4.2 million (75% of all under-five deaths) occurred within the first year of life  The risk of a infant mortality was highest in the WHO African Region (52/1000 live births), over 6x higher than that in the WHO European Region (8/1000 live births).  Globally, the infant mortality rate has decreased from an estimated rate of 64.8/1000 live births in 1990 to 30.5/1000 live births in 2016  In Nigeria, the MICS puts infant mortality rate at 70/1000 LB in 2017
  • 7. EPIDEMIOLOGY  Neonatal mortality rates rise sharply for infants weighing more than 4kg at birth and for those whose gestational period is 42 wk or longer.  The perinatal mortality of twins is about 4 times that of singletons  Triplet or higher-order births are associated with an increased risk of death or neurodevelopmental impairment when compared with ELBW singleton and twin infants
  • 8. FACTORS THAT DEFINE AN INFANT AS BEING HIGH RISK  Demographic social factors  Maternal age <16 or >40 yr  Illicit drug - alcohol, cigarette use  Poverty  Unmarried  Emotional or physical stress
  • 9. FACTORS THAT DEFINE AN INFANT AS BEING HIGH RISK  Past medical history  Genetic disorders  Diabetes mellitus  Hypertension  Asymptomatic bacteriuria  Rheumatologic illness (systemic lupus erythematosus)  Immune-mediated diseases (immunoglobulin G crossing placenta)  Long-term medication
  • 10. FACTORS THAT DEFINE AN INFANT AS BEING HIGH RISK  History of previous pregnancy  Intrauterine fetal demise  Neonatal death  Prematurity  Intrauterine growth restriction  Congenital malformation  Incompetent cervix  Blood group sensitization, neonatal jaundice  Neonatal thrombocytopenia  Hydrops  Inborn errors of metabolism
  • 11. FACTORS THAT DEFINE AN INFANT AS BEING HIGH RISK  Present pregnancy  Vaginal bleeding  Sexually transmitted infections  Multiple gestation  Preeclampsia  Premature rupture of membranes  Short interpregnancy time  Poly-/oligohydramnios  Acute medical or surgical illness  Inadequate prenatal care  Familial or acquired hypercoagulable states  Abnormal fetal ultrasonographic findings  Treatment of infertility
  • 12. FACTORS THAT DEFINE AN INFANT AS BEING HIGH RISK  Labor and delivery  Premature labor (<37 wk)  Postdates pregnancy (≥42 wk)  Fetal distress  Breech presentation  Meconium-stained fluid  Nuchal cord  Cesarean section  Forceps delivery  Apgar score <4 at 1 min
  • 13. FACTORS THAT DEFINE AN INFANT AS BEING HIGH RISK  Neonate  Birthweight <2,500 or >4,000 g  Birth <37 or ≥42 wk of gestation  Small or large for gestational age  Respiratory distress, cyanosis  Congenital malformation  Pallor, plethora, petechiae
  • 14. MULTIPLE GESTATION  Incidence of spontaneous dizygotic twinning is highest among blacks and East Indians, followed by northern European whites, and is lowest in the Asian races  The incidence of monozygotic twins (3- 5/1,000) is unaffected by racial or familial factors  Triplets are estimated to occur in 1 in 86 pregnancies and quadruplets in 1 in 86 pregnancies in the United States (Check Nigerian data)
  • 15. PROBLEMS OF MULTIPLE GESTATION  Polyhydramnios  Hyperemesis gravidarum  Preeclampsia  Premature rupture of membranes  Vasa previa  Velamentous insertion of the umbilical cord  Abnormal presentations (breech)  Premature labor.
  • 16. PROBLEMS OF MULTIPLE GESTATION  Obstruction of the circulation secondary to intertwining of the umbilical cords  Respiratory distress syndrome and asphyxia (second twin)  Intrauterine growth restriction  Twin–twin transfusion  Congenital anomalies
  • 17. MANAGEMENT  Early detection and anticipation  Quality antenatal care – adequate caloric and protein intake, haematinics, iron and folate supplementation, regular visits, fetal surveillance / monitoring  Prevention of preterm labour  Administration of corticosteroid if preterm labour is anticipated  Appropriate labour management  Management of prematurity  Management of twin-twin transfusion ( if present)
  • 18. TWIN-TWIN TRANSFUSION  Is a rare complication that can occur in monozygotic monochorionic diamniotic twins, which causes the blood to pass from one twin to the other  Usually occurs due to the presence of placental vascular communication  The donor becomes undernourished and anaemic while the recipient grows normally and plethoric  Management more of obstetrics, surviving infants are managed according to presentation
  • 20. PRETERM INFANTS  Term = 37weeks to 42 weeks  Subdivision by American College of Obstetrics and Gynecology  Early term = 37weeks + 0day to 38weeks + 6days  Full term = 39weeks + 0day to 40weeks + 6days  Late term = 41weeks + 0day to 41weeks +6days  Preterm = less than 37weeks  extremely preterm (less than 28 weeks)  very preterm (28 to <32 weeks)  moderate to late preterm (32 to <37 weeks) 2,4
  • 21. PRETERM INFANTS  Prematurity is the leading cause of death in children under the age of 5 years 2  Half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties
  • 22. CAUSES OF PRETERM BIRTH  Idiopathic  Induction of labour  Caesarean section  Multiple pregnancies  Infections  Diabetes mellitus  Hypertensive diseases in pregnancy  Extremes of maternal age  Preterm premature rupture of membranes
  • 23. CAUSES OF PRETERM BIRTH  Polyhydramnios  Antepartum haemorrhage  Stressful life event  Uterine/cervical malformations/abnormalities  Cervical trauma  Drug abuse  Recurrent mid-trimester miscarriage
  • 25. COMPLICATIONS OF PRETERM BABY  Hypothermia  Feeding difficulties  Breathing difficulties - apnoea  Pneumonia and early neonatal sepsis  Intraventricular haemorrhage  Jaundice  Retinopathy of prematurity  Fetal death
  • 27. MANAGEMENT OF PRETERM INFANTS  Principles of management 3  Identification of the clinical problem that the infant is at risk of developing  Prevention of the problem  Identification of problems when they occur  Early treatment of the problems
  • 28. MANAGEMENT OF PRETERM INFANTS  At delivery  clear the airway  initiate breathing,  care for the umbilical cord and eyes,  administer vitamin K  Subsequent management  thermal control  monitoring of the heart rate and respiration  oxygen therapy (if indicated)  fluid management  nutrition.  Prevention of infection
  • 29. Thermal control  Keep thermoneutral environment – provide warm environment and humidity  Maintain core temperature at 36.5-37.0°C  Incubators or radiant warmers can be used  Alternatives are: Kangaroo mother care with direct skin-to-skin contact, a hat and blanket covering the infant
  • 30. FLUID BALANCE  Very immature preterm infants (<1,000 g) may lose as much as 2-3 mL/kg/hr  Larger premature infant (2,000-2,500 g) nursed in an incubator may have an insensible water loss of approximately 0.6-0.7 mL/kg/hr.  VLBW babies are less able to concentrate urine, so they need higher fluid intake to excrete solutes  Adequate fluid intake is essential for excretion of the urinary solute load (urea, electrolytes, phosphate).  Start with 70-80 mL/kg on day 1 and advance gradually to 150 mL/kg/day.
  • 31. TOTAL PARENTERAL NUTRITION  The goal is to deliver sufficient calories from glucose, protein, and lipids to promote optimal growth  Indication  before complete enteral feeding has been established  when enteral feeding is impossible for prolonged periods  Route of administration  percutaneously  surgically placed indwelling central venous catheter  peripheral vein.  umbilical vein ( for up to 2 wk)
  • 32. TOTAL PARENTERAL NUTRITION  The infusate should contain  2.5-3.5 g/dL/day of synthetic amino acids and  10-15 g/dL/day of glucose,  2-3g/kg/day of fat emulsion e.g. intralipid 20%  appropriate quantities of electrolytes, trace minerals, and vitamins.  The content of each day’s infusate should be determined after careful assessment of the infant’s clinical and biochemical status
  • 33. TOTAL PARENTERAL NUTRITION  Complications Complication from catheter Complication from infusate metabolism Infection Hyperglycemia Thrombosis osmotic diuresis Extravasation of fluid Dehydration Accidental dislodgment Azotemia Phlebitis Nephrocalcinosis Cutaneous sloughing, Hypoglycemia Hypoxemia hyperammonemia
  • 34. ENTERAL FEEDING  Oral feeding (nipple) should not be initiated or should be discontinued in infants with  respiratory distress  hypoxia  circulatory insufficiency  excessive secretions  gagging  sepsis  central nervous system depression  severe immaturity  signs of serious illness
  • 35. ENTERAL FEEDING  The main principle in feeding premature infants is to proceed cautiously and gradually.  Careful early feeding of breast milk or formula tends to reduce the risk of hypoglycemia, dehydration, and hyperbilirubinemia  Preterm infants at 34 wk of gestation or more can often be fed by bottle or at the breast.  Direct breastfeeding may not be successful in very preterm infants due to poor sucking effort, so baby may need be fed by bottle or tube
  • 36. ENTERAL FEEDING  Trophic feeding is the practice of feeding very small amounts of enteral nourishment to VLBW preterm infants to stimulate development of the immature gastrointestinal tract.  Benefits of trophic feeding include  enhanced gut motility,  improved growth,  decreased need for parenteral nutrition,  fewer episodes of sepsis,  shortened hospital
  • 37. ENTERAL FEEDING  For infants <1 kg, the initial trophic feedings can be given at 10-20 mL/kg/24 hr as a continuous nasogastric tube drip (or given by intermittent gavage every 2-3 hr) for 5-10 days.  If the initial feedings are tolerated, the volume is increased by 20-30 mL/kg/24 hr to a maximum of 150ml/kg/24hr
  • 38. ENTERAL FEEDING  For infants weighing >1.5 kg , feeding is initiated at a volume of 20-30 mL/kg/24 hr  Increase by total daily formula volume of 20- 30 mL/kg/24 hr.  Indication for review/stoppage of feeding  regurgitation,  vomiting,  abdominal distention,  gastric residuals from previous feedings (as indicated by gastric aspiration)
  • 39. ENTERAL FEEDING  LBW and preterm infants should be given supplemental vitamins because the volume of milk sufficient to satisfy daily requirements may not be ingested for several weeks
  • 40. PREVENTION OF INFECTION  Prevention strategies include:  strict compliance with handwashing and universal precautions,  minimizing the risk of catheter contamination and duration,  meticulous skin care,  encouraging early appropriate advancement of enteral feeding,  education and feedback to staff,  surveillance of nosocomial infection rates in the nursery  Prophyalctic antibiotics may be given 5
  • 41. POSTTERM INFANTS  Postterm infants are those born after 42 completed weeks of gestation (from LMP) regardless of weight at birth.  Cause is unknown, risk factors include  Wrong dates  Maternal factors - primiparity, previous history of prolonged pregnancy, sedentary habits, genetic predisposition and elderly multipara.  Fetal factors - Fetal congenital anomalies such as anencephaly and adrenal hypoplasia; fetal male sex  Placental factors - sulfatase deficiency
  • 42. POSTTERM INFANTS  Common features of post maturity syndrome include  Desquamation of the skin / wrinkling  long nails,  abundant hair,  pale skin,  alert faces,  loose skin, especially around the thighs and buttocks  meconium-stained nails, skin, vernix, umbilical cord, and placental membranes
  • 43. POSTTERM INFANTS  Common complications include  macrosomia / IUGR  perinatal depression,  meconium aspiration,  persistent pulmonary hypertension,  hypoglycemia,  hypocalcemia,  polycythemia.  birth injuries  increased perinatal mortality
  • 44. MANAGEMENT  Careful obstetric monitoring, including  nonstress testing,  Biophysical profile,  Doppler velocimetry  Choosing appropriate mode of delivery less risky for the baby  nonintervention and subsequent vaginal delivery  induction of labor, or  Cesarean section  Treatment of medical problems in the newborn if they arise
  • 45. LARGE FOR GESTATIONAL AGE  Are infants with birthweight > the 90th percentile for gestational age  Predisposing factors include:  Large parental size  maternal diabetes  Obesity
  • 46. LARGE FOR GESTATIONAL AGE  Complications –  cervical and brachial plexus injuries,  phrenic nerve damage with paralysis of the diaphragm,  fractured clavicles,  cephalohematomas, subdural hematomas, and ecchymoses of the head and face.  hypoglycemia  polycythemia.  congenital anomalies
  • 47. MANAGEMENT  Antenatal detection of at risk infants  Skilled delivery practices to prevent or minimize birth injuries  Management of hypoglycemia and metabolic problems  Management of birth injuries
  • 48. INFANT OF DIABETIC MOTHER  Common complications include  Fetal macrosomia  Impaired fetal growth  Fetal congenital malformation  Pulmonary disease – RDS, pulmonary hypertension  Metabolic and electrolyte abnormalities – hypoglycaemia, hypocalcemia, hypomagnesemia  Haematological problems – polycythaemia, stroke, seizure, NEC, renal vein thrombosis  Cardiovascular abnormalities – VSD, TGA, cardiomyopathy  Congenital malformations
  • 49. MANAGEMENT  Preconception and frequent prenatal evaluations of all women with diabetes and pregnant women with gestational diabetes,  Evaluation of fetal maturity, biophysical profile, Doppler velocimetry, and planning of the delivery of these infants in hospitals where expert obstetric and pediatric care is continuously available.
  • 50. MANAGEMENT  Check RBS, serum E/U/Cr  Infants should initiate feedings within 1 hr after birth  A screen glucose test should be performed within 30 minutes of the first feed  Treatment is indicated if the plasma glucose is <40 mg/dL and clinical symptoms of hypoglycemia are present.  In asymptomatic infants, treatment is indicated if the plasma glucose is <30 mg/dl1
  • 51. MANAGEMENT  A dose of 200 mg/kg of dextrose (2 mL/kg of 10% dextrose) should be administered to infants with plasma glucose below these limits.  If baby cannot tolerate orally, a continuous peripheral intravenous infusion at a rate of 4-8 mg/kg/min should be given  Avoid bolus hypertonic glucose, it may cause further hyperinsulinemia and rebound hypoglycaemia  Treat other electrolyte problems accordingly
  • 52. DISCHARGE CRITERIA FOR HIGH RISK INFANTS  Growth should be occurring at steady increments of approximately 30 g/day.  Temperature should be stabile in an open crib.  Infants should have had no recent episodes of apnea or bradycardia  Parents, or alternative caregivers, who are willing and able to provide all aspects of the infant’s care  Drugs should be oral
  • 53. DISCHARGE CRITERIA FOR HIGH RISK INFANTS  Eye test to rule out retinopathy  Hearing test  Check Hb to rule out anaemia  A coordinated plan for outpatient or home nursing follow-up visits
  • 54. CONCLUSION  High risk infants require special attention and optimal care to reduce morbidity and mortality. Therefore adequate antenatal care, specialized delivery and early referral for optimal neonatal care will go a long way in averting the series of problems associated with them and help prevent both short term and long term complications.
  • 55. REFERENCES 1. Kliegman, Robert, Richard E. Behrman, and Waldo E. Nelson. Nelson textbook of pediatrics. 20th edition. 2016. 2. World Health Organization - Preterm birth fact sheets. Available at http://www.who.int/mediacentre/factsheets/fs363 /en/ 3. Howson CP, Kinney MV, Lawn JE. Born too soon: the global action report on preterm birth. Geneva: World Health Organization. 2012 May:1-126 4. Azubuike JC, Nkanginieme KE. Paediatrics and child health in a tropical region. 2nd edition. African Educational Services. 2007
  • 56. REFERENCES 5. Saxena R. Bedside Obstetrics & Gynecology. JP Medical Ltd; 2014 6. Medscape: Infant of diabetic mother. Available at: https://emedicine.medscape.com/article/974230- overview#a2 7. Multiple Indicator Cluster Survey. Nigeria Survey Finding Report, 2016-2017 8. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics 23rd Edition McGraw Hill. New York. 2010