AT RISK/ HIGH RISK/ SICK NEWBORN

High-Risk Neonate

– a newborn with increased risk of illness or death

• Risk is due to conditions beyond normal birth and extrauterine adjustment

• The high-risk period starts at viability and ends at 28 days after birth

• Includes prenatal, perinatal, and postnatal threats.

Classification of High-Risk Newborns

• Based on birth weight, gestational age, and pathophysiologic problems

• Common problems include immaturity, organ system dysfunction, and chemical imbalances.

Low Birth Weight (LBW)

Birth weight less than 2500 grams (5.5 pounds).

Very Low Birth Weight (VLBW)

Birth weight less than 1500 grams (3.3 pounds).

Extremely Low Birth Weight (ELBW)

Birth weight less than 1000 grams (2.2 pounds).

Appropriate for Gestational Age (AGA)

Weight between 10th and 90th percentile.

Small for Date / Small for Gestational Age (SFD/SGA)

Weight below 10th percentile with slowed growth.

Intrauterine Growth Restriction (IUGR)

Restricted fetal growth in the uterus.

Large for Gestational Age (LGA)

Weight above 90th percentile.

Preterm (Premature)

Born before 37 weeks gestation.

Full-term

Born between 38 and 42 weeks gestation.

Post-term (Postmature)

Born after 42 weeks gestation.

Late-preterm

Born between 34 and 36 weeks gestation.

Live Birth

Presence of heartbeat, breathing, or movement.

Fetal Death

Death after 20 weeks gestation before delivery.

Neonatal Death

Death from 1 to 27 days of life.

Early Neonatal Death

Death in the first week of life.

Late Neonatal Death

Death from 7 to 27 days of life.

Perinatal Mortality

Fetal and early neonatal deaths per 1000 live births.

Postnatal Death

Death from 28 days to 1 year of life.

Assessment of High-Risk Newborn

• Done immediately after birth;

• Focus on cardiovascular and neurologic function

• Includes Apgar score, congenital anomalies, and signs of neonatal distress.

General Assessment

• Weight, length, and circumferences measured

• Body shape and posture observed

• Breathing effort assessed

• Edema checked

• Anomalies noted

• Distress signs monitored

Respiratory Assessment

• Chest shape and symmetry assessed

• Respiratory distress signs observed

• Rate and pattern monitored

• Breath sounds auscultated

• Suction need evaluated

• Oxygen type and delivery noted

• Oxygen saturation monitored.

Cardiovascular Assessment

• Heart rate and rhythm assessed

• Heart sounds evaluated

• Point of maximal impulse PMI located

• Skin and mucous membrane color observed

• Blood pressure measured

• Peripheral pulses checked

• Capillary refill assessed

• Tissue perfusion evaluated

Gastrointestinal Assessment

• Abdominal distention checked

• Regurgitation and feeding relation observed

• Residual amount and character assessed

• Suction drainage monitored

• Emesis amount, color, consistency noted

• Liver edge palpated

• Stool amount, color, consistency assessed

• Bowel sounds auscultated.

Genitourinary Assessment

• Genital abnormalities assessed

• Urine amount measured

• Urine color observed

• Urine pH tested

• Urine specific gravity measured.

Neurologic–Musculoskeletal Assessment

• Movement observed

• Activity with stimulation assessed

• Position and attitude noted

• Reflexes checked

• Response level evaluated

• Consolability assessed

• Head circumference changes monitored.

Temperature and Skin Assessment

• Temperature monitored

• Skin discoloration observed

• Redness and irritation assessed

• Blisters and abrasions noted

• Skin texture and turgor evaluated

• Rashes and lesions checked

• Birthmarks documented

• IV infiltration signs assessed.

Ongoing Observation

Changes in feeding, activity, color, oxygen saturation (SpO₂), and vital signs indicate problems; Early detection prevents deterioration.

Observation Level

• Depends on severity of condition

• Critically ill infants require close monitoring

• Continuous pulse oximetry required

• Electrolytes monitored

• Blood gases assessed regularly.