High Risk Newborn
‫األطفال حديثي الوالدة ذوي المخاطر العالية‬
Moataz Said Ahmed
‫معتز سيد احمد‬
Amal Abd Alsalam Solyman,Hanaa Abd Allateef Mohamed
‫ هناء عبداللطيف محمد‬،‫آمال عبدالسالم سليمان‬
Abstract:
The High-Risk infant designates that the newborn has a greater chance of complications because
of conditions that occur during fetal development, pregnancy, conditions of the mother, or
problems that may occur during labor and birth, some complications are unexpected and may
occur without warning. Other times, there are certain risk factors that make problems more
likely ,This means that such infant should be under close observation by experienced
physicians and nurses.
Prematurity , Post maturity, Very Low Birth weight, Small for Gestational Age, Large for
Gestational Age, Infant of Diabetic Mother ,HyDROPs Fetalis , Heart Disorders ,Digestive
Disorders ,Infection in Babies ,Birth Injury, Birth Defects are some conditions and complications
that place a newborn at higher risk.
Approximately 9% of all births require special or neonatal intensive care, such observation may
last from a few hours to several months. Some institutions find it advantageous to provide a
special or transitional care nursery for high-risk infants, often within the labor and delivery
suite. This facility should be equipped and staffed similar to a neonatal intensive care area.
Definite history should be taken about fetal development, pregnancy, conditions of the mother,
or problems that occurred during labor and birth. Each newborn baby is carefully checked at
birth for signs of problems or complications. Throughout the hospital stay, physicians, nurses,
and other healthcare providers continually assess a baby for changes in health and for signs of
problems or illness.
Summary and Conclusion
Neonates at risk should be identified as early as possible to decrease neonatal morbidity and
mortality.
Assessment and diagnosis of high-risk newborn is done through three assessment stages;
Prenatal Assessment, Antenatal Assessment, Postnatal Assessment.
As medical technology has advanced, outcomes for high-risk newborn infants have greatly
improved. With advanced technology, such as assisted ventilation, it is now possible to keep
some terminally or severely ill or extremely preterm infants alive for long periods of time. The
result of such treatment is that dying may be prolonged or the infant may survive with
profound neurologic or other debilitating problems.
Management of high-risk newborn can be divided in to 4 parts ; Prenatal management, Delivery
Room Management, Neonatal Intensive Care Unit (NICU) Management, Follow up of high-risk
newborn.
Approximately 10% of newborns require some assistance to begin breathing at birth; about 1%
need extensive resuscitative measures to survive. The American Academy of Pediatrics (AAP)
recommends that every birth should be attended by someone who has been trained in initiating
a neonatal resuscitation and two trained personnel attend for high risk newborn.
Preparation for a high-risk delivery is often the key to a successful outcome. Cooperation
between the obstetric and pediatric staff is important. Knowledge of potential high-risk
situations and appropriate interventions is essential.
During resuscitation of high-risk newborn, the Apgar score is not particularly useful during
resuscitation. During those long, tense moments, simultaneous assessment of heart rate, skin
color, and respiratory activity
Summary and Conclusion
provides the quickest and most accurate evaluation of the need for continuing resuscitation.
For preterm infants, Apgar scores may be particularly misleading (even in assessment of the
response to resuscitation) because of developmental differences in tone and response to
stimulation.
During delivery room resuscitation, efforts should be directed first to assisting ventilation and
providing supplemental oxygen.
Newborn babies who need intensive medical attention are often admitted into a special area of
the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced
technology and trained healthcare professionals to provide specialized care for the tiniest
patients. NICUs may also have intermediate or continuing care areas for babies who are not as
sick but do need specialized nursing care.
The availability of neonatal intensive care has improved outcomes for high-risk infants
including those born preterm or with serious medical or surgical conditions.
Giving birth to a premature or other high-risk baby (or babies) does not mean that cannot
breastfeed. Actually, the opposite may be the case. There is even more reason to provide the
mother milk for a premature or a sick newborn. Because the benefits of mother’s milk are so
important to the high-risk newborn, the mother is able to do something for her baby that no
one else can. Many neonatologists and NICU staff members now encourage mothers to provide
their own milk for high-risk babies, even if those mothers do not intend to breastfeed later.
The general principles of managing of high risk newborn babies as regarded by the WHO
guidelines for management of newborn problems are; Maintaining Normal Body Temperature,
Feeding and Fluid Management,
Summary and Conclusion
Oxygen Therapy, Antibiotics, Infection Prevention, Clinical Use of Blood, Immunization,
Assessing Growth, Discharge and Follow-Up.
The decision of when to discharge an infant from the hospital after a stay in the NICU is
complex. This decision is made primarily on the basis of the infant’s medical status but is
complicated by several factors. These factors include the readiness of families for discharge,
differing opinions about what forms of care can be provided at home, and pressures to contain
hospital costs by shortening the length of stay. Insofar as possible, determination of the
readiness for discharge should be based on peer-reviewed scientific evidence. So the AAP made
guidelines for discharge of high-risk newborn that should be fulfilled before taking the decision
of hospital discharge.
The infant is considered ready for discharge if, in the judgment of the responsible physician,
the following have been accomplished:
• Physiologic stability;
• An active program of parental involvement and preparation for care of the infant at home;
• Arrangements for health care after discharge by a physician or other health care professional
who is experienced in the care of high-risk infants; and
• An organized program of tracking and surveillance to monitor growth and development.
Fortunately, Advances in technology have helped improve the care of sick newborns. Under the
care of specialized physicians and other healthcare providers, babies have much greater
chances for surviving and getting better today than ever before rehabilitation.
‫الملخص‬
‫إنها لحظه حاسمه في حياة االسره الكل ينتظرها بشغف ولكن في بعض األحيان قد ال تسير األمور على ما يرام ونواجه‬, ‫تتطلع كل أسرة إلى والدة مولود كامل الصحة‬
‫صعوبات وتحديات‬.
‫ أو المشاكل‬،‫ ظروف األم‬،‫ الحمل‬،‫الطفل حديث الوالدة ذو المخاطر العالية هو الوليد الذي لديه قابليه أكبر لحدوث مضاعفات بسبب الظروف التي تحدث خالل نمو الجنين‬
‫ هناك بعض العوامل المنبهة لحدوث‬،‫ولكن فى أوقات أخرى‬.‫ هناك بعض المشاكل تكون غير متوقعه وتحدث فجاءه دون سابق إنذار‬.‫التي قد تحدث أثناء المخاض والوالدة‬
‫ وهذ ا يعني أن هذه الرضيع ينبغي أن يكون تحت مالحظه من قبل ذوي الخبرة من األطباء والممرضات‬، ‫المشكالت‬.
‫ بعض المؤسسات تجد‬.‫ وتتفاوت مده هذه المالحظة من بضعة ساعات لعدة أشهر‬، ‫ من جميع الوالدات تتطلب اهتماما خاصا أو العناية المركزة لحديثي الوالدة‬٪٩ ‫تقريبا‬
‫ وهذا الرعاية االنتقالية ينبغي أن تكون‬.‫من األفضل توفير الرعا ية االنتقالية الخاصة أو دور الحضانة للوليد ذو المخاطر العالية ومن المفضل توفيرها في غرفه الوالدة‬
‫مجهزه بالمعدات واألفراد تماثل مثيلتها في العناية المركزة لحديثي الوالدة‬.
‫تعتبر الوالدات المبكرة والوالدات المتأخرة والول يد منخفض الوزن عند الوالدة والوليد لالم الصغيرة السن ولالم المتقدمة في السن والوليد لألم ألمريضه بالسكر والوليد‬
‫بأمراض القلب والوليد باضطرابات الجهاز الهضمي والعدوى في الرضع والوليد ذو العيوب الخلقية هي بعض الظروف التي تضع الوليد في إطار الوالدات العالية‬
‫المخاطر‬.
‫ أيضا يجب فحص كل مولود‬.‫ أو المشاكل التي وقعت أثناء المخاض والوالدة‬،‫ و ظروف األم‬،‫ و تاريخ الحمل‬،‫كل مولود جديد ينبغي التحقق بدقة عن تاريخ نمو الجنين‬
‫ أيضا أثناء فتره البقاء في المستشفى ينبغي على األطباء والممرضات وغيرهم من مقدمي الرعاية الصحية تقييم‬.‫عند الوالدة عن وجود عالمات لمرض أو مشكالت‬
‫التغيرات الصحية باستمرار و متابعه ظهور عالمات لمرض أو مشاكل‬.
‫ فبفضل الرعاية من األطباء المتخصصين‬.‫ فان التقدم المحرز في التكنولوجيا قد ساعدت على تحسين رعاية المرضى والمواليد ذوى المخاطر العالية‬، ‫ولحسن الحظ‬
‫‪.‬وغيرهم م ن مقدمي الرعاية الصحية أصبحت فرص البقاء والحصول على نتائج أفضل أكبر بكثير اليوم عن أي وقت مضى‬
‫إن القرار بشأن توقيت الخروج من المستشفى لألطفال حديثي الوالدة العالية الخطورة هو قرار معقد وصعب لذلك فان األكاديمية األمريكية لطب األطفال قد وضعت‬
‫‪:‬مبادئ توجيهية وشروط بشان قرار الخروج لألطفال حديثي الوالدة العالية الخطورة ومن بعض هذه الشروط‬‫أن يكسب الوزن بشكل مطرد •‬
‫أن تكون درجه حرارة المولود مستقرة في درجة الحرارة العادية •‬
‫يمكنه أن يتغذي من زجاجة الرضاعة دون صعوبة في التنفس أو غيرها من المشاكل •‬
‫أن تكون قدرة القلب والتنفس مستقرة •‬
‫‪ :‬هناك توصيات هامه يجب إعطاؤها للوالدين بعد الخروج من المستشفى منها‬‫كيفيه التعامل مع هذا المولود العال المخاطر •‬
‫توفر البيئة المنزلية المناسبة •‬
‫ونظام الرعاية الصحية •‬
‫كيفيه التعامل عند حدوث مشكالت ومن تستشير •‬
‫والهدف من هذه المادة هو تسليط الضوء على األطفال الحديثى الوالدة ذوى المخاطر العالية وكيفيه التعرف عليهم والظروف التي تؤدى إلى والدتهم وتحديد من منهم‬
‫يحتاج إلى رعاية خاصة أو العناية المركزة وشروط الخروج من المستشفى وكيفيه التعامل معهم في البيت‬