the high risk new born

23
Dr.LORN TRY Patrich, Pediatri Dr.LORN TRY Patrich, Pediatri cian,DHM cian,DHM THE HIGH RISK NEW THE HIGH RISK NEW BORN BORN Dr.LORN TRY Dr.LORN TRY Patrich,Pediatrician, DHM Patrich,Pediatrician, DHM

Upload: chhaiden

Post on 18-Nov-2014

655 views

Category:

Documents


2 download

TRANSCRIPT

Page 1: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

THE HIGH RISK NEW THE HIGH RISK NEW BORNBORN

Dr.LORN TRY Patrich,Pediatrician, Dr.LORN TRY Patrich,Pediatrician, DHMDHM

Page 2: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

IntroductionIntroduction

A high risk is define as any neonate when A high risk is define as any neonate when is in danger of serious illness or death as a is in danger of serious illness or death as a result of prenatal,perinatal, or neonatal result of prenatal,perinatal, or neonatal conditions, regardless of birth weigh or conditions, regardless of birth weigh or gestational age.gestational age.

Page 3: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Condition of high riskCondition of high risk

a)a) The preterm infantThe preterm infant Respiratory problem(shallow, rapid, and Respiratory problem(shallow, rapid, and

irregular with period of apnea).irregular with period of apnea). Heat loos (cold stress)Heat loos (cold stress) Intraventricalar hemorrhage ( More often in Intraventricalar hemorrhage ( More often in

the neonate of less than 32 weeks ‘gestation the neonate of less than 32 weeks ‘gestation ( signs of possible IVH include : hypotonia, ( signs of possible IVH include : hypotonia, apnea, bradycardia, a full (or bulging) apnea, bradycardia, a full (or bulging) fontanelle, cyanosis and increased head fontanelle, cyanosis and increased head circonference, convulsion, and circonference, convulsion, and stupor) .However mild bleeds can occur stupor) .However mild bleeds can occur without these symptome.without these symptome.

Page 4: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Condition of high risk(Conti..)Condition of high risk(Conti..) Hyperbilirubinemia. That may result in Hyperbilirubinemia. That may result in

brain domage.brain domage. Retinopathy of prematurityRetinopathy of prematurityb/ The post term (> 42 weeks )b/ The post term (> 42 weeks )

• Litth lanugo or vernix Litth lanugo or vernix • Scal hairScal hair• Skin drySkin dry• Infant risk :Infant risk :

• HypoglycemiaHypoglycemia• PolycytemiaPolycytemia• Cerebral ischemiaCerebral ischemia• Thrombus formationThrombus formation• Respiratory distress Respiratory distress

Page 5: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Le terme dépasséLe terme dépassé

Page 6: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Condition of high risk(Conti..)Condition of high risk(Conti..)

c/ The infant of diabetic mother risk :c/ The infant of diabetic mother risk :• Hypoglycemia in first few hours after birth. Hypoglycemia in first few hours after birth.

Untreated may cause severe, irreversible Untreated may cause severe, irreversible damage to the central nervous system.damage to the central nervous system.

• Congenital anomaliesCongenital anomalies• HypocalcemiaHypocalcemia• HyperbilirubinemiaHyperbilirubinemia• Hyaline membrane diseaseHyaline membrane disease

Page 7: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Condition of high risk(Conti..)Condition of high risk(Conti..)

d/ The infant with neonate sepsis :d/ The infant with neonate sepsis :• Infection from Infection from

• The mother (through the placenta, vaginal infection)The mother (through the placenta, vaginal infection)• Inhalation of contaminated amniotic fluid.Inhalation of contaminated amniotic fluid.

• Any specific signsAny specific signs• CyanosisCyanosis• Thermal instabilityThermal instability• ConvulsionsConvulsions• LethargyLethargy• JaundiceJaundice• ApneaApnea

Page 8: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Condition of high risk(Fin)Condition of high risk(Fin)

e/Necrosing enterocolitise/Necrosing enterocolitis• Often in small preterm may occur in full term Often in small preterm may occur in full term

neonatneonat• Cause: Cause:

• Hypoxia (Poor tissue perfusion)Hypoxia (Poor tissue perfusion)• Bacterial invasion of the bowelBacterial invasion of the bowel• Clinical : Abdominal distensionClinical : Abdominal distension

f/ The infant of an HIV positive motherf/ The infant of an HIV positive mother

g/ The infant of addicted mother (Alcool, g/ The infant of addicted mother (Alcool, Cocaïne, heroïne, methadone or other Cocaïne, heroïne, methadone or other narcotic )narcotic )

Page 9: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

PREMATUREPREMATURE5y MD IU5y MD IU

DR.LORN TRY Patrich, DR.LORN TRY Patrich, Pediatrician,DHMPediatrician,DHM

Page 10: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

DEFINITIONDEFINITION

Premature infant is a baby borne Premature infant is a baby borne before 37 weeks gestation .before 37 weeks gestation .

At birth, a baby is classified as one At birth, a baby is classified as one the following :the following :– Premature Premature (less than 37 weeks (less than 37 weeks

gestation )gestation )– Full term Full term ( 37 to 42 weeks gestation )( 37 to 42 weeks gestation )– Post term Post term ( born after 42 weeks ( born after 42 weeks

gestation )gestation )

Page 11: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

RISKs FACTORsRISKs FACTORs Cause of preterm labor is unknownCause of preterm labor is unknown Multiple pregnancy (twins, triplet ……. Makes Multiple pregnancy (twins, triplet ……. Makes

up about 15% of all premature births )up about 15% of all premature births ) The following health conditions and events in The following health conditions and events in

the mother may contribute to preterm labor :the mother may contribute to preterm labor :– DiabeteDiabete - Heart disease- Heart disease– Kidney diseaseKidney disease - Lake of prenatal - Lake of prenatal

carecare– Poor nutritionPoor nutrition - Preeclampsia- Preeclampsia– Substance abusSubstance abus - Young age (the mother - Young age (the mother

age younger than age younger than 18 )18 )

Page 12: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

RISKs FACTORsRISKs FACTORs A women who has had any of the following is A women who has had any of the following is

increase risk of preterm labor :increase risk of preterm labor :– Premature rupture of the membrane or placenta Premature rupture of the membrane or placenta

previaprevia– Previous pretermPrevious preterm– Problems with the uterus or cerviProblems with the uterus or cervi– Unexplained high alpha foeto-protein level in the Unexplained high alpha foeto-protein level in the

seconde trimester .seconde trimester .– Untreated disease or infection ( such as urinary Untreated disease or infection ( such as urinary

tract infection or infection of amniotic tract infection or infection of amniotic membrane ) membrane )

Page 13: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

EVALUATION of AGE GESTATIONEVALUATION of AGE GESTATION

Page 14: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Page 15: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Page 16: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

The spectrum of prematurityThe spectrum of prematurity Mild prematurityMild prematurity refers to babies who are born refers to babies who are born

between 33 and 36 completed weeks between 33 and 36 completed weeks gestational age and/or have a birth weight gestational age and/or have a birth weight between 1500 and 2500 g .between 1500 and 2500 g .

Moderate prematurityModerate prematurity refers to babies who refers to babies who are born between 28 and 32 completed weeks are born between 28 and 32 completed weeks gestational age with a birth weight ranging gestational age with a birth weight ranging between 1000 and 1500 g .between 1000 and 1500 g .

Extreme prematurityExtreme prematurity refers to babies who are refers to babies who are born before 28 completed weeks gestational born before 28 completed weeks gestational age or who have a birth weight of less than age or who have a birth weight of less than 1000 g 1000 g

Page 17: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

SYMPTOMSSYMPTOMS A premature infant has organs that are not A premature infant has organs that are not

fully developped. The infant needs special fully developped. The infant needs special care in nursery until the organ have care in nursery until the organ have developed enough to sustain life without developed enough to sustain life without medical support . This may take weeks to medical support . This may take weeks to months. Common symptoms in a months. Common symptoms in a premature infant include:premature infant include:– Body hairBody hair– Episodes of absent breathingEpisodes of absent breathing– Elarged clitoris (female infant)Elarged clitoris (female infant)– Smooth without ridges (mal infant)Smooth without ridges (mal infant)– Transparent skin ( can see veins under skin )Transparent skin ( can see veins under skin )– Weak eyWeak ey

Page 18: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

SYMPTOMSSYMPTOMS

Common tests performed on a premature Common tests performed on a premature infant include :infant include :– Blood gas analysisBlood gas analysis– Blood test to check glucose calcium and Blood test to check glucose calcium and

bilirubine levels.bilirubine levels.– Chest X- rayChest X- ray

Page 19: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

TREATMENTTREATMENT When premature labor develop and can not be When premature labor develop and can not be

stopped . The mother may be moved to center that stopped . The mother may be moved to center that specifically care for premature infant.specifically care for premature infant.

In some cases, medicine called steroïds may be In some cases, medicine called steroïds may be given to the mother in the help the baby ‘s lung given to the mother in the help the baby ‘s lung mature. When born, the baby is placed under mature. When born, the baby is placed under warmer.warmer.

Since infants are usually unable to coordinate Since infants are usually unable to coordinate sucking and swallowing before 34 weeks gestation, sucking and swallowing before 34 weeks gestation, your baby may have a feeding tube placed into your baby may have a feeding tube placed into stomach. In very premature infants, nutrition may stomach. In very premature infants, nutrition may be given through a vein until the baby is stable be given through a vein until the baby is stable enough to receive feeding by mouth. enough to receive feeding by mouth.

Page 20: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

TREATMENTTREATMENT If the infant has breathing problems, a If the infant has breathing problems, a

tube may be placed in the trachea. A tube may be placed in the trachea. A machine called a respiration will help the machine called a respiration will help the baby breathe. Oxygen is given,baby breathe. Oxygen is given,

Nursery care is needed until the infant Nursery care is needed until the infant reaches a stable body weigh and is able to reaches a stable body weigh and is able to feed by mouth and maintain body feed by mouth and maintain body temperature.temperature.

Page 21: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

Page 22: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

COMPLICATIONCOMPLICATION AnemiaAnemia Bleeding into the brain (IVH)Bleeding into the brain (IVH) Bronchodysplasia (BPD)Bronchodysplasia (BPD) Congnitive or motor disability or delayCongnitive or motor disability or delay Delayed growth and developmentDelayed growth and development Infection or neonatal sepsisInfection or neonatal sepsis Heart disease (PDA)Heart disease (PDA) Low blood sugarLow blood sugar Newborn jaundiceNewborn jaundice Retinopathy and vision loss or blindnessRetinopathy and vision loss or blindness Severe intestinal inflammation (necrotizing Severe intestinal inflammation (necrotizing

enterocolitis)enterocolitis)

Page 23: The High Risk New Born

Dr.LORN TRY Patrich, Pediatrician,DDr.LORN TRY Patrich, Pediatrician,DHMHM

PREVENTIONPREVENTION One of the most important stepe to One of the most important stepe to

preventing prematurity is to receive preventing prematurity is to receive prenatal care as early as possible in the prenatal care as early as possible in the pregnancy, and continue such care until pregnancy, and continue such care until the baby is born.the baby is born.

Maternal treatmentMaternal treatment