Chapter 25: The High-Risk Newborn

The High-Risk Newborn educational overview focuses on the specialized care and clinical management of neonates classified as high-risk due to various physiological, environmental, or gestational factors. It begins by defining neonates at risk based on birth weight categories—such as low, very low, or extremely low birth weight—and gestational timelines ranging from preterm to postmature. Clinical focus is placed on birth-related physical injuries, including skeletal fractures and peripheral nerve damage like Erb-Duchenne paralysis, alongside significant neurological conditions such as hypoxic-ischemic encephalopathy and the application of therapeutic hypothermia. A major portion of the material is dedicated to neonatal infections, distinguishing between early and late-onset sepsis while detailing the TORCH complex of congenital infections like cytomegalovirus and rubella. The discussion deeply explores the impact of maternal substance use, detailing the presentation of neonatal abstinence syndrome (NAS) and the utilization of assessment tools like the Finnegan scale or the Eat, Sleep, Console model. Furthermore, it addresses hematologic complications, specifically Rh and ABO incompatibilities that lead to erythroblastosis fetalis, and the vital role of Rh immune globulin in prevention. Special attention is given to the unique needs of infants born to diabetic mothers, emphasizing the risks of macrosomia and rebound hypoglycemia. The chapter also outlines the care of preterm infants, highlighting the pathophysiology of respiratory distress syndrome (RDS) and the administration of exogenous surfactant, as well as the prevention of necrotizing enterocolitis (NEC) through careful feeding protocols and the use of human milk. Finally, the discussion encompasses inborn errors of metabolism like phenylketonuria (PAH) and congenital hypothyroidism, emphasizing the necessity of early universal screening and lifelong dietary management, while providing sensitive guidelines for supporting families through the challenges of neonatal intensive care, discharge planning, and potential bereavement.