High risk infant

 Biological
 Genetic
 Metabolic
 Environmental
 No apparent risk
Double 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. Environmental
Minimising/clustering painful Ix
Decreased handling
Reducing ambient noise/ light
3. Behavioural
Gentle sensory stimulation
Oral sucrose
KMC

 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

High risk infant

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