Chapter 30: The High-Risk Newborn: Acquired and Congenital Conditions

Respiratory complications form a central focus, beginning with asphyxia and its consequences of metabolic and respiratory acidosis, requiring immediate neonatal resuscitation through positive-pressure ventilation and chest compressions. The chapter differentiates transient tachypnea of the newborn, arising from delayed clearance of fetal lung fluid, from meconium aspiration syndrome, where aspiration causes airway obstruction and chemical pneumonitis leading to severe respiratory compromise. Persistent pulmonary hypertension of the newborn represents another critical respiratory challenge, characterized by sustained elevation of pulmonary vascular resistance that promotes right-to-left shunting and hypoxemia. Hyperbilirubinemia receives extensive coverage, with distinction between physiologic and pathologic jaundice patterns, and exploration of bilirubin encephalopathy and its permanent neurologic sequela, kernicterus. The chapter details hemolytic disease mechanisms in Rh and ABO incompatibility, along with therapeutic interventions including phototherapy and exchange transfusion protocols. Neonatal sepsis is analyzed according to early and late onset infection patterns, with particular attention to vertical transmission of Group B Streptococcus and other perinatal pathogens. Metabolic complications in infants of diabetic mothers are examined, including macrosomia, hypoglycemia secondary to hyperinsulinemia, and impaired surfactant production. Additional metabolic disorders covered include polycythemia with associated blood viscosity complications and hypocalcemia presenting with neuromuscular irritability and tremors. The chapter addresses neonatal abstinence syndrome resulting from prenatal drug exposure, highlighting nursing interventions such as swaddling, environmental modification, and pharmacologic support. Finally, phenylketonuria is introduced as a genetic metabolic disorder requiring early screening and lifelong dietary protein restriction to prevent intellectual disability, underscoring the importance of newborn screening programs and long-term developmental follow-up.