UNIT VII

HIGH RISK BABIES

PRESENTED BY
Aakriti Poudel
Shristi Baral
Susan Neupane
 CONTENTS
1. Introduction to high risk babies
2. Causes and Risk factors
3. Classification of high risk babies
4. Screening of high risk babies
5. Assessment including reliable assessment tools (INFANIB)
6. Physiotherapy management of high risk babies
7. Recent Advances
INTRODUCTION
• High-risk babies, also referred to as high-risk neonates or high-risk infants, are
newborns who have a higher likelihood of experiencing health complications or
developmental challenges due to various factors.
• A newborn, regardless of gestational age or birth weight who has a greater
chance of morbidity or mortality because of conditions or circumstances
superimposed on the normal course of events associated with birth.
• They’re the delicate little souls who often have a tougher start in life, struggling
against the odds to grow and thrive.
CAUSES AND RISK FACTORS
A. Maternal factors
1. Advanced maternal age
2. Medical conditions (e.g., diabetes, hypertension)
-Maternal health conditions can contribute to high-risk pregnancies and babies.
- Conditions such as diabetes, hypertension (high blood pressure), preeclampsia, gestational diabetes, or
infections (e.g., HIV, syphilis) can impact the health and development of the baby.

3. Substance abuse
-Substance abuse can cause various complications, including premature birth, low birth weight, developmental
delays, and neonatal withdrawal symptoms (neonatal abstinence syndrome).
 B. Fetal factors
1. Prematurity
-Can be caused by factors such as maternal health conditions, multiple pregnancies (e.g., twins or triplets), infections, or
complications during pregnancy.
-Premature babies often face challenges due to underdeveloped organ systems, including respiratory, digestive, and immune
systems.

2. Low birth weight

-Poor maternal nutrition, smoking causes LBW.
-Low birth weight babies may have difficulties with growth, feeding, maintaining body temperature, and are at higher risk for infections.

3. Genetic disorders
-These conditions can be inherited or result from abnormalities in the baby's genes or chromosomes.
- Examples include Down syndrome, cystic fibrosis, congenital heart defects, and neural tube defects.
Intrauterine Growth Restriction (IUGR):
- Intrauterine growth restriction occurs when a baby does not grow adequately in the womb.
-It can be caused by maternal factors such as high blood pressure, poor nutrition, smoking, placental
abnormalities, or fetal factors affecting blood supply or development.
-Babies with IUGR often have low birth weight and may experience challenges related to organ
development, nutrient deficiencies, and increased risk of complications.

C. Environmental factors
1. Exposure to toxins or pollution
2. Inadequate prenatal care
3. Socioeconomic factors
- Developmental research has clearly shown that both socioeconomic status (SES) and aspects of the home
environment account for a significant proportion of the problems in cognitive functioning of both healthy
and pre-term children.
 Classification of high risk babies
According to gestational age:
a. Preterm: Babies born before completing 28 weeks of gestation.
b. Extremely Preterm: Babies born between 23 and 28 weeks of gestation.
c. Post term : Babies born after 42 weeks of gestation

According to birth weight:

1.)Low birth weight (1500-2400g)
2.)Very low birth weight (1000-1500g)
3.)Extremely low birth weight (800-1000g)
4.)Micropremie –less than 800gm
• Biological risk
Birth weight <1500g
Gestational age <37 weeks
Apgar score 0-3
Neonatal seizures
Apnoea
Periventricular leucomalacia

• Established risk:

• Meningitis
• Hydrocephalus
• Hyperbilirubenemia
• Metabolic disorders
• Musculoskeletal abnormalities
• Congenital myopathies
Common Medical Conditions in High-Risk Babies

• A. Respiratory distress syndrome (RDS)

• B. Necrotizing enterocolitis (NEC)
• C. Intraventricular hemorrhage (IVH)
• D. Congenital heart defects
• E. Developmental delays
• F. Cerebral palsy
 Screening
• Newborn Screening:
• Newborn screening is a routine screening performed shortly after birth. It aims to detect certain genetic, metabolic, and
congenital disorders that may not be apparent at birth but can have significant health consequences if left untreated.
• Common tests included in newborn screening vary by country but often cover conditions like phenylketonuria (PKU),
hypothyroidism, cystic fibrosis, sickle cell disease, and others. Screening typically involves a blood sample taken from the
baby's heel.
• Developmental Screening:
• Developmental screening is a brief assessment procedure designed to identify children who should receive more
intensive diagnosis.
• Developmental screening assesses a baby's milestones and identifies any potential delays or concerns in their overall
development.
• These screenings typically evaluate areas such as gross motor skills, fine motor skills, language and communication,
cognitive abilities, and social-emotional development.
• Developmental screening tools, such as the Ages and Stages Questionnaires (ASQ) or the Denver Developmental
Screening Test, are commonly used.
 Importance of screening

• Screening examinations aim to identify potential health issues or developmental concerns as early as possible. Early
detection allows for timely intervention and management, which can significantly improve outcomes and prevent or
minimize complications.
• Screening examinations help identify risk factors or conditions that may lead to future health problems. By identifying
these risks early on, healthcare professionals can implement preventive measures or interventions to reduce the
likelihood of complications or adverse outcomes.
• Regular screening examinations allow healthcare providers to monitor the progress and development of high-risk
babies over time.
• Screening examinations provide opportunities for families to ask questions, gain understanding, and seek support,
fostering a collaborative and supportive environment.
• Screening examinations may identify the need for further assessment or specialized services and may refer to
specialized services.
 Assessment of high risk babies
• Apgar Score: The Apgar score is used to assess the newborn's overall health and well-being immediately after birth. It evaluates
five essential signs: heart rate, respiratory effort, muscle tone, reflex irritability, and color.
• Neonatal Behavioral Assessment Scale (NBAS): The NBAS is a comprehensive assessment tool that evaluates the behavioral and
neurological responses of newborns. It assesses various domains, including motor activity, state regulation, reflexes, social
interaction, and autonomic stability.
• Bayley Scales of Infant and Toddler Development (BSID): The BSID is widely used to assess the development of infants and toddlers
up to 42 months of age. It measures cognitive, language, motor, social-emotional, and adaptive skills, providing valuable
information about a child's developmental progress.
• Developmental Assessment of Preterm Infants (DAPI): The DAPI is specifically designed to assess the development of preterm
infants. It evaluates their cognitive, motor, and behavioral skills, taking into account the potential challenges and delays associated
with prematurity.
• Denver Developmental Screening Test (DDST): The DDST is a widely used screening tool for children from birth to 6 years old. It
assesses gross motor, fine motor, language, and personal-social skills, providing an indication of a child's developmental progress
and potential delays.
• Ages and Stages Questionnaires (ASQ): The ASQ is a series of questionnaires completed by parents or caregivers to assess a child's
development in multiple domains, including communication, gross motor skills, fine motor skills, problem-solving, and personal-
social skills.
• Pediatric Evaluation of Disability Inventory (PEDI): The PEDI assesses the functional abilities and performance of infants and young
children with disabilities. It measures self-care, mobility, and social function to identify areas of impairment and guide intervention
planning.
INFANIB
Management of high risk babies
The management of high-risk babies involves a multidisciplinary approach,
with the goal of providing specialized care and interventions to optimize
their health and development. High-risk babies are those who have a
higher likelihood of experiencing complications or adverse outcomes due
to factors such as prematurity, low birth weight, congenital abnormalities,
or medical conditions.
Here are some key aspects of the management of high risk babies:
1. Antenatal care: Early identification of high-risk pregnancies and close
monitoring of maternal and fetal well-being during pregnancy is
crucial. Regular prenatal check-ups, ultrasounds, and specialized tests
can help identify potential risks and plan for appropriate interventions.
1. Neonatal Intensive Care Unit (NICU): High-risk babies often require specialized care in a NICU, where they
can receive round-the-clock monitoring, advanced medical equipment, and specialized medical staff. The
NICU provides a controlled environment that supports the baby's vital functions and addresses their specific
needs.
2. Respiratory support: Many high-risk babies may have underdeveloped lungs or respiratory distress, requiring
respiratory support. This can range from supplemental oxygen therapy to mechanical ventilation, depending
on the severity of the respiratory condition.
3. Nutritional support: Adequate nutrition is essential for the growth and development of high-risk babies. In
some cases, infants receive parenteral nutrition (intravenous feeding) or enteral nutrition (tube feeding or
special formula) to ensure they receive adequate nutrition for growth and development
4. Temperature regulation: Maintaining a stable body temperature is crucial for high-risk babies, as they are
more susceptible to hypothermia. Incubators or radiant warmers are used to provide a controlled environment
and prevent heat loss.
5. Infection prevention: High-risk babies have a higher susceptibility to infections. Stringent infection control
measures, including hand hygiene, proper isolation protocols, and limited visitor access, are implemented to
reduce the risk of infections in the NICU.
6. Developmental Care: High-risk babies are at an increased risk of developmental delays and disabilities.
Developmental care involves creating a nurturing environment that promotes optimal development through
strategies like positioning, gentle handling, minimizing exposure to excessive noise and light, and providing
developmental stimulation appropriate to their gestational age.
7. Multidisciplinary Team: The care of high-risk babies typically involves a multidisciplinary team of healthcare
professionals, including neonatologists, pediatricians, nurses, respiratory therapists, occupational and
physical therapists, and nutritionists. This team collaborates to provide comprehensive care and address the
unique needs of each baby.
• Family-centered care: Supporting and involving the family in the care
of high-risk babies is crucial. Providing emotional support, education,
and involving parents in the decision-making process helps improve
the overall well-being of the infant and facilitates a smoother
transition from the NICU to home.
Role of physiotherapist in management of high risk babies

• We offer them the warmth of our touch, the gentleness of our care,
and the expertise of our knowledge.
• We create an environment where they feel safe, nurtured, and loved,
fostering their growth and development.
• In their gentle hands, physiotherapists employ a variety of techniques
to support the physical and motor development of high-risk babies.
• They skillfully guide them through therapeutic exercises, positioning
techniques, and sensory integration activities, always considering the
baby's comfort and individual needs.
• Role if physiotherapist in management of risk babies.

• Respiratory management: Physiotherapists assist in the assessment and management of respiratory conditions in high-risk babies. They provide
interventions such as chest physiotherapy, positioning techniques, and breathing exercises to optimize lung function and promote effective breathing
patterns.
• Motor development and mobility: Physiotherapists work closely with high-risk babies to promote their motor development and achieve age-appropriate
milestones. They design and implement therapeutic exercises, activities, and positioning strategies to improve muscle strength, coordination, balance,
and overall motor skills.
• Neurodevelopmental support: High-risk babies may be at risk for neurodevelopmental delays or disabilities. Physiotherapists contribute to early
intervention programs that focus on stimulating and enhancing the baby's neurological development through specific techniques and activities.
• Postural management: Physiotherapists assist in maintaining proper postural alignment for high-risk babies. They assess the infant's positioning and
provide recommendations for appropriate seating or positioning equipment to support optimal alignment and prevent complications such as pressure
sores or musculoskeletal deformities.
• Sensory integration: Physiotherapists may employ sensory integration techniques to help high-risk babies integrate and process sensory information
effectively. This can include activities that stimulate the baby's senses, such as touch, sight, sound, and movement, to promote sensory development and
enhance overall well-being.
• Parent and caregiver education: Physiotherapists play a vital role in educating parents and caregivers on strategies and techniques to support their high-
risk babies' physical development and functional abilities. They provide guidance on exercises, positioning, handling techniques, and home programs to
ensure consistent and appropriate care beyond the clinical setting.
• Collaborative approach: Physiotherapists work as part of a multidisciplinary team, collaborating with other healthcare professionals, such as
neonatologists, occupational therapists, and speech therapists, to provide comprehensive care to high-risk babies. They contribute their expertise in
assessing and addressing the physical aspects of the infant's condition while considering the overall care plan.
Goals of Physiotherapeutic Management
A. Promoting optimal motor development and functional abilities
B. Enhancing respiratory function and preventing complications
C. Facilitating sensory-motor integration
D. Supporting overall growth and development
 Techniques and Interventions
A. Positioning and Handling
1. Importance of proper positioning to prevent deformities and optimize function.
2. Techniques for maintaining neutral alignment and supporting postural control
3. Strategies for handling and promoting movement patterns

• B. Respiratory Management
1. Chest physiotherapy techniques (e.g., percussion, vibration) to facilitate lung
expansion and secretion clearance
2. Respiratory exercises and techniques to improve respiratory muscle strength and
endurance
3. Use of respiratory support devices (e.g., nasal CPAP, mechanical ventilation) and
weaning protocols
C. Developmental Support
1. Age-appropriate activities and exercises to promote motor development
2. Facilitating sensory integration through touch, visual stimulation, and auditory input
3. Encouraging early mobilization and play to enhance overall development

D. Neurodevelopmental Techniques
1. Bobath/Neurodevelopmental Treatment (NDT) approach for facilitating motor control and functional
movements
2. Use of positioning aids, splints, and adaptive equipment to support optimal alignment and movement patterns
3. Sensory stimulation techniques (e.g., proprioceptive, tactile, vestibular) to enhance motor responses

E. Parent/Caregiver Education and Involvement

1. Teaching parents/caregivers techniques for positioning, handling, and facilitating motor development at home
2. Providing guidance on environmental modifications and appropriate toys/activities for stimulation
3. Emotional support and counseling to address parental concerns and promote bonding
• A. Working closely with neonatologists, Collaboration with
Multidisciplinary Team
• Pediatricians, occupational therapists, speech therapists, and other
healthcare professionals
• B. Coordinating care plans and interventions to address the holistic
needs of high-risk babies
• C. Regular communication and sharing of progress to ensure a
comprehensive approach
Recent Advances
1.) Therapeutic Hypothermia: Therapeutic hypothermia, also known as cooling
therapy, is a technique used to reduce brain damage in newborns who have
experienced oxygen deprivation during birth (hypoxic-ischemic encephalopathy).
By lowering the body temperature of the baby, typically to around 33-34 degrees
Celsius, for a specific duration, it can help protect the brain and improve long-term
outcomes.

2.) Surfactant Replacement Therapy: Surfactant replacement therapy is a well-

established treatment for preterm babies with respiratory distress syndrome (RDS).
Recently, advancements have been made in the development and administration of
surfactant therapies, improving the survival rates and reducing complications
associated with RDS.
3.)Non-invasive Ventilation: Non-invasive ventilation techniques, such as nasal continuous
positive airway pressure (CPAP) and high-flow nasal cannula (HFNC), have become
increasingly popular in managing respiratory distress in premature infants. These techniques
provide respiratory support without the need for intubation and mechanical ventilation,
reducing the risks of complications.

4.)Enhanced Parent-Infant Bonding: Recognizing the importance of early parent-infant

bonding, efforts have been made to facilitate and support this bond in the NICU setting.
Kangaroo care (skin-to-skin contact) and family-centered care approaches are increasingly
emphasized, allowing parents to actively participate in the care of their high-risk babies and
promoting emotional attachment.
Recent advances
• A recent meta-analysis to review the effectiveness of early developmental intervention post-
discharge from hospital for pre-term (less than 37 weeks) infants on motor or cognitive
development concluded that intervention improved cognitive outcomes at infant age (0 to 2
years). However, there was significant heterogeneity between studies for cognitive outcomes at
infant age.