High risk infant

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  • 1. Dr Prakash.I
  • 2. Biological Genetic Metabolic Environmental No apparent riskDouble vulnerability
  • 3. IVH- PVH- WMD- PVL Factors contributing- Less cerebral autoregulation Alteration in cerebral blood flow and pressure
  • 4. 1- Isolated GMB 2- IVH without ventricular dilatation 3- IVH with ventricular dilatation 4- IVH with parenchymal hemorrhage
  • 5. CP Visual impairment Hearing impairment IQ Learning difficulties ADHD Social development/ Psychological problems Health outcomes
  • 6. 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 andwhite matter and cerebral atrophy Hemiplegic CP- focal cerebral infarction
  • 7. Stage 1- Mild Stage 2- Moderate Stage 3- Severe
  • 8. AGPAR score 5 mins Fetal HR 1 min or 1stcry delayed >5 mins
  • 9. Selective head cooling Systemic hypothermia Magnesium Sulphate Antioxidants Calcium Channel blockers Hyperbaric Oxygen treatment
  • 10. 30% risk of NDD Interrupts development of the maturingnervous system High risk groups- HIE, Meningitis, Hypoglycaemia Low risk groups- Late hypocalcaemia Subarachnoid haemorrhage
  • 11. Parieto occipital white matter abnormalities Maternal conditions Diabetes Drugs Intrapartum glucose administration
  • 12. Neonatal problems Preterm IUGR Perinatal HI Hypothermia Infections Polycythemia Following exchange transfusion
  • 13. Bilirubin encephalopathy 80% die in neonatal period Athetoid CP, tone abnormalities, lower IQs,sensory neural hearing deficitsClassic perlsteins tetrad of kernicterus-extrapyramidal abnormalities, sensori neuralhearing loss, gaze abnormality, dental dysplasia
  • 14. 1styear- poor feeding, high pitched cry,persistent ATNR, hypotonia, and increasedDTRs Athetosis- as early as 18 mths dysarthria, facial grimacing, drooling, difficultyin chewing and swallowing
  • 15. Responsible for 5% of MR and GDD Accumulation of a n/ abn metabolite ordeficiency resulting from enzyme defect Present as acute/ chronic encephalopathy withor without non- neuronal involvement,seizures, movement disorders, muscleweakness etc
  • 16. Apnea Meconium aspiration syndrome Persistent pulmonary hypertension of newborn Neonatal shock Neonatal sepsis
  • 17. 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)
  • 18. 2. EnvironmentalMinimising/clustering painful IxDecreased handlingReducing ambient noise/ light3. BehaviouralGentle sensory stimulationOral sucroseKMC
  • 19. Neonatal transport Perinatal steroids Mechanical ventilation
  • 20. Neonatal behavioral assessment scale (NBAS) Assessment of Preterm Infants behavior (APIB) Neurological Assessment of the Fullterm andpreterm newborn infant Morgan Neonatal Neurobehavioral examination Movement Assessment of infants Milani- Comparetti Motor Development ScreeningTest