High-Risk Neonatal

Newborns or neonates includes ages 0-28 days. Life in the neonatal period is extremely vulnerable due to physiological adjustments needed for babies outside the womb to live as well as possible.
Neonatal period: 0-28 days
- Early neonatal period: 0-7 days
- Advanced neonatal period: 8-28 days


High risk of neonatal

A. LBW (low birth weight)
Birth weight <2500 g with gestational age is the moon that is between 37-40 weeks
Usually caused by low birth weight:
- Mothers with pregnancy malnutrition
- Congenital disease that is caused from toxemia grafidarum pets (cats, dogs, rats)
- Birth with gemeli (double or twin pregnancy)

Premature Baby

Definition:
Newborns with gestational age 37 weeks or less at birth called a premature baby. Although small, the size of premature infants according to gestational age but not yet perfect intrauterine growth can cause complications during post-natal. Newborns who weigh 2500 grams or less with gestational age more than 37 weeks of pregnancy is called small, this is different from prematurity, although 75% of neonates who weigh under 2500 grams was born premature.

Clinical problems occur more often in premature babies than in babies born to normal. Prematurity causes immaturity of development and function of the system, limiting the ability of infants to perform coping on disease problems.

A common problem among disstres respiratory syndrome (RDS), necrotic enterocolitis, hyperbilirubinemia, hypoglikemia, thermoregulation, patetnt ductus arteriosus (PDA), pulmonary edema, hemorrhage intraventrikular. Other additional stressor in infant and parents include hospitalization for the disease in infants. Parental responses and coping mechanisms they may cause interference with the relationship between them. Required planning and actions are adequate to permasalahn.

Premature babies can survive depends on their weight, gestational age, and disease or abnormality. Premature donate 75% - 80% of neonatal morbidity and mortality.

Etiology and precipitation factors:
The problems in the mother during pregnancy:
- Diseases / disorders such as hypertension, toxemia, placenta previa, abruptio placenta, cervical incompetence, multiple fetuses, malnutrition and diabetes mellitus.
- Low socioeconomic level and inadequate prenatal care
- Delivery before his time or induced abortion
- Abuse of consumption in the mother such as drugs, alcohol, smoking and caffeine

Assessment
1. History of pregnancy
- Age of mother under 16 years old with low educational background
- Twin Pregnancy
- Socio-economic status, inadequate prenatal care, poor nutrition
- The possibility of genetic disease
- History of preterm birth
- Such as TORCH infections, sexually transmitted diseases, etc.
- Conditions such as toxemia, premature rupture of membrane, abruptio placenta and prolapsed umbilical
- Penyalahgunaaan drugs, smoking, and alcohol consumption kafeine
- Blood type, Rh factor, amniocentesis.

2. Status of newborn
- Age of pregnancy between 24-37 weeks, low birth weight or gestational age greater
- Body weight below 2500 grams
- Thin, minimal subcutaneous fat
- The physical abnormalities seen
- Apgar score of 1-5 min: 0-3 indicated severe distress, 4 - 6 show disstres medium and 70-10 is the normal value.

3. Cardiovascular
- Heart rate 120-160 x per minute on the apical side with a regular rhythm
- At birth, there was a murmur

4. Gastrointestinal
- Protruding abdomen
- Exodus meconium after 12 hours
- Weakness and decreased sucking reflex
- Make sure the anus without / with congenital abnormalities

5. Integumentary
- Cyanosis, jaundice, mottling, redness, or yellow skin
- Verniks caseosa slightly with lanugo hair all over body
- Skinny
- General or local edema
- Short Nails
- Sometimes there are petechie or ekimosis

6. Musculoskeletal
- Cartilago on immature ears
- Skull soft
- The state relaxed, inaktive or lethargi

7. Neurologic
- Reflexes and movements on neurologic tests without resistance
- Sucking reflexes, swalowing, gag reflex and cough reflex is weak or ineffective
- No or minimal signs of neurologic
- The eyes are still closed in infants with gestational age 25-26 weeks
- Body temperature is not stable: typically hipotermik

8. Pulmonary
- Respiratory rate is between 40 - 60 x / min with a period of apnea
- Irregular respiration with nasal flaring, grunting and retraction (intercostal, suprasternal, substrenal)
- There was crakles on auscultation

9. Renal
- Micturition occurred 8 hours after birth
- Possible inability mengekresikan sulution in urine

10. Reproduction
- Women: the labia majora not yet cover the clitoris so that it appears prominently
- Male: testes have not dropped perfectly into the pockets of the scrotum, may have inguinal hernias.

11. Supporting Data
- X-ray of the chest and other organs to determine the presence of abnormalities
- Ultrasound to detect organ abnormalities
- Stick glucose to determine glucose levels decreased
- Serum calcium levels, decreased levels means there is hypocalcaemia
- Levels of bilirubin to identify the improvement (due to the premature are more sensitive to hyperbilirubinemia)
- Levels of electrolytes, blood gas analysis, blood group, blood cultures, urinalysis, fecal analysis and so forth.