Management of High-Risk Newborn

Monitoring

• Placed in controlled thermal environment

• Vital signs (heart rate, respiratory rate, temperature) monitored

• Alarms signal abnormal values

• Hands-on assessment essential (auscultation of heart and lungs).

Respiration

• First moments critical for prognosis

• Death in first 48 hours usually due to failed respiration

• Poor breathing leads to cerebral hypoxia

• Goal is to establish and maintain respiration

• Positioning ensures airway and oxygenation

• Oxygen or assisted ventilation as needed

• Respiratory acidosis common at birth must be corrected immediately

• Ineffective breathing may keep ductus arteriosus open

• Struggle to breathe uses glucose → risk of hypoglycemia

1. Establish airway

2. Expand lungs

3. Maintain ventilation

4. Perform cardiac massage if heart fails.

Resuscitation Steps

Circulation

• No heartbeat or HR <80 bpm requires chest compressions;

• Use 2 fingers on sternum, compress 1/3 depth at 100/min;

• Ventilate at 30/min with 1:3 ratio;

• Monitor oxygenation and cardiac efficiency;

• Check femoral pulse;

• Persistent low HR treated with epinephrine via endotracheal tube;

• Severe cases transferred to high-risk nursery.

Fluid and Electrolyte Balance

• Hypoglycemia common post-resuscitation;

• Dehydration due to high insensible water loss;

• Treat hypoglycemia with 10% dextrose;

• Maintain fluids using Ringer’s lactate or 5% dextrose;

• Add electrolytes/glucose as needed;

• Monitor fluid rate to prevent heart failure or PDA;

• Radiant warmer increases water loss;

• Dehydration monitored via urine output (<2 mL/kg/hr) or specific gravity (>1.015–1.020);

• Hypotension treated with dopamine if no hypovolemia, or saline/Ringer’s lactate if hypovolemic;

• Prevent fluid overload.

Thermoregulation

• High-risk infants have difficulty maintaining temperature;

• Neutral thermal environment reduces metabolic stress;

• Too hot decreases metabolism, too cold increases metabolism and oxygen demand;

• Cold stress causes vasoconstriction and poor pulmonary perfusion;

• Prevent chilling by drying infant, covering head, using warmer/incubator/skin-to-skin;

• Maintain stable environment until infant is stable.

Nutrition

• Critical for preterm infants due to immature digestion;

• Suck-swallow coordination develops at 32–34 weeks and matures at 36–37 weeks;

• Feeding depends on condition (enteral/parenteral);

• Breast milk preferred for nutrients and IgA;

• If unable to suck, use expressed milk for gavage feeding;

• Pacifiers promote nonnutritive sucking;

• Exceptions include very immature infants or those with tracheoesophageal fistula.

Waste Elimination

• Most infants void within 24 hours, delayed in immature infants;

• Monitor urine output for kidney perfusion;

• Stool passage may be delayed;

• Meconium may not reach intestine end.

Infection Protection

• Infections increase metabolic and oxygen demand;

• Causes include prenatal, perinatal, postnatal;

• Risk increased with PROM, pneumonia, skin lesions;

• Strict handwashing required;

• Infected staff restricted or must use PPE.

Skin Care

• Preterm skin fragile;

• Avoid alkaline soaps;

• Use zinc oxide-based tape;

• Skin barriers protect and promote healing.

Parent-Infant Bonding

• Keep parents informed during resuscitation;

• Encourage visits and physical contact;

• Support parental confidence after discharge;

• If infant dies, allow viewing without equipment;

• Helps coping and future planning.