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High Risk Newborn
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The birth of a newborn is a joyful and exciting time. However, sometimes, a baby is born with complications that require special medical care. Newborns may have difficulties associated with pregnancy complications, fetal development or related to labour and birth. Some of these newborns are at high-risk for developmental problems as they grow older.Fortunately, specialized care and advances in medical technology can help improve the health of a high-risk newborn and new mother. Babies have a much greater chance of surviving and having favourable outcomes than ever before.
Overview For Parents
Medical advances have allowed more newborns to survive into adulthood than ever before.
Brain development accelerates rapidly during the third trimester of gestation. Infants born early are vulnerable to altered brain development or brain injury.
Brain injury is most common among extremely premature infants who are born before 27 – 28 weeks of gestation, when the third trimester begins.
Newborn babies born at term may also be at high-risk for developmental problems if their brain didn’t develop optimally during pregnancy, or if the baby was exposed to a brain injury.
Current advances in brain imaging with MRI are making it easier to recognize brain abnormalities so that newborns and children can be targeted for appropriate supportive and protective treatment and early therapeutic interventions to maximize their developmental outcomes.
Overview For Clinicians
Early identification of at-risk newborns is important because it allows for intervention while the central nervous system is still forming new connections and reorganizing itself.
Early treatment is more effective in influencing long-term outcome than treatment that begins after the first presentation of neurodevelopmental disability, which is often around two years of age or even later.
Imaging studies should carefully examine the basal ganglia and cerebellum in addition to cortical and subcortical structures, as areas that are vulnerable to brain injury.
Most parents expect a normal term birth and the NICU experience alters expectations and can be an emotional roller coaster. This newsletter provides an overview of challenges and advances in research to improve outcomes for premature babies.
Pediatric stroke is rarely fatal but about half of those who survive will develop a long-term neurological deficit. Current advances in neuroimaging are making it easier to recognize stroke so that newborns and children can be targeted for appropriate supportive and neuroprotective treatment to minimize long-term damage.
Seizures in newborns may cause brain injury or they may be indicative of an underlying brain injury, and it is essential to treat injuries in addition to the seizures. For decades, neonatal seizures have been treated with phenobarbitol and phenytoin, even though these have limited success and may be harmful to the developing brain. Rigorous studies may show that topiramate is a safer and more effective treatment for seizures in newborns.
Depending on the extent of brain injury, one or more developmental disorders may emerge in newborns who experience seizures following birth. The indicators described in this study do not precisely predict which disorder will appear or how severely it will affect the child, but they do provide a good idea of whether or not the possibility for future developmental deficits exists.
This report of a survivor of extreme prematurity with cerebellar injury, who was diagnosed with autism spectrum disorder (ASD), adds to growing evidence of a link between this spectrum of disorders and prematurity associated cerebellar injury.
Arterial ischemic stroke (AIS) is caused by a blockage in an artery feeding the brain. Newborns who suffer a stroke may display seizures immediately, in which case they are easier to identify and support, or they may only display symptoms of the stroke in the long-term. Long-term effects of perinatal stroke may include seizures, motor impairment, developmental delay, and cognitive and behavioral problems. It is possible that brain perfusion levels can be used to detect and treat salvageable tissues, mitigating these long-term effects.
Brain development accelerates rapidly during the third trimester of gestation, and infants born before this process are vulnerable to brain injury. This injury can affect neurodevelopment, impairing later motor, social, behavioral, cognitive, and language abilities. Improved early detection of brain injuries and a deeper understanding of their full extent will allow practitioners to develop valuable therapies for improving long-term outcomes among preterm infants.
This study shows us that perfusion rate following asphyxiation does influence the extent of brain injury that leads to neurological deficits in high-risk newborns. Hypothermia is currently the only effective treatment for minimizing neurological deficits in high-risk newborns following asphyxiation. It is thought that hypothermia therapy prevents reperfusion injury by slowing the cascade of events that lead to cell death.
Enteroviral infection is the most frequently diagnosed viral infection among newborns and is treated according to its severity. Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal disorder of an exaggerated immune response, treated with chemotherapy or immunosuppressive agents. Because HLH is so rare, it should only be diagnosed with great care in newborn patients displaying enteroviral infection
Medical advances have allowed more newborns experiencing seizures to survive into adulthood than ever before. Early identification of children likely to develop developmental disorders following neonatal seizures will allow for early treatment, which can minimize eventual cognitive and motor delays.