High risk infant

Dr Prakash.I

Biological Genetic Metabolic Environmental No apparent riskDouble vulnerability

IVH- PVH- WMD- PVL Factors contributing- Less cerebral autoregulation Alteration in cerebral blood flow and

pressure

1- Isolated GMB 2- IVH without ventricular dilatation 3- IVH with ventricular dilatation 4- IVH with parenchymal hemorrhage

CP Visual impairment Hearing impairment IQ Learning difficulties ADHD Social development/ Psychological

problems Health outcomes

Perinatal asphyxia Neonatal seizures 45% survivors have NDD 6-23% of CP due to asphyxia Athetoid/ Dyskinetic CP- acute perinatal

HI Spastic tetraplegic CP- damage to gray

and white matter and cerebral atrophy Hemiplegic CP- focal cerebral infarction

Stage 1- Mild

Stage 2- Moderate

Stage 3- Severe

AGPAR score <_ 3 at > 5 mins Fetal HR <60 beats/ min Prolonged antenatal acidosis Seizures within 24- 48 hrs Need for PPV > 1 min or 1st cry delayed

>5 mins

Selective head cooling Systemic hypothermia Magnesium Sulphate Antioxidants Calcium Channel blockers Hyperbaric Oxygen treatment

30% risk of NDD Interrupts development of the maturing

nervous system High risk groups- HIE, Meningitis, Hypoglycaemia Low risk groups- Late hypocalcaemia Subarachnoid haemorrhage

Parieto occipital white matter abnormalities

Maternal conditions Diabetes Drugs Intrapartum glucose administration

Neonatal problems Preterm IUGR Perinatal HI Hypothermia Infections Polycythemia Following exchange transfusion

Bilirubin encephalopathy 80% die in neonatal period Athetoid CP, tone abnormalities, lower IQs, sensory

neural hearing deficits Classic perlstein’s tetrad of kernicterus- extrapyramidal

abnormalities, sensori neural hearing loss, gaze abnormality, dental dysplasia

1st year- poor feeding, high pitched cry, persistent ATNR, hypotonia, and increased DTRs

Athetosis- as early as 18 mths dysarthria, facial grimacing, drooling,

difficulty in chewing and swallowing

Responsible for 5% of MR and GDD Accumulation of a n/ abn metabolite or

deficiency resulting from enzyme defect Present as acute/ chronic

encephalopathy with or without non- neuronal involvement, seizures, movement disorders, muscle weakness etc

Apnea Meconium aspiration syndrome Persistent pulmonary hypertension of

newborn Neonatal shock Neonatal sepsis

Pain and analgesia Neonatal infant pain scale ( NIPS)1.Pharmacological- Opiods ( Morphine, fentanyl, codeine) Non opiods (paracetamol, sucrose,

midazolam) Anaesthetic agents ( EMLA, lidocaine,

ketamine, thiopental)

2. EnvironmentalMinimising/clustering painful IxDecreased handlingReducing ambient noise/ light3. BehaviouralGentle sensory stimulationOral sucroseKMC

Neonatal transport Perinatal steroids Mechanical ventilation

Neonatal behavioral assessment scale (NBAS)

Assessment of Preterm Infant’s behavior (APIB)

Neurological Assessment of the Fullterm and preterm newborn infant

Morgan Neonatal Neurobehavioral examination

Movement Assessment of infants Milani- Comparetti Motor Development

Screening Test