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2. PREMATURITY & COMPLICATIONS in Neonates and infants

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[6/20, 11:58 AM] Meta AI: Prematurity, defined as birth before 37 weeks of gestation, can lead to various complications for the baby. Some potential complications include: 1. _Respiratory distress syndrome (RDS)_: Underdeveloped lungs may struggle to breathe, leading to RDS. 2. _Bronchopulmonary dysplasia (BPD)_: Chronic lung disease that can develop in premature babies. 3. _Intraventricular hemorrhage (IVH)_: Bleeding in the brain, which can lead to developmental delays or cerebral palsy. 4. _Necrotizing enterocolitis (NEC)_: Inflammation of the intestines, potentially causing tissue death. 5. _Retinopathy of prematurity (ROP)_: Abnormal blood vessel growth in the eyes, potentially causing blindness. 6. _Apnea and bradycardia_: Pauses in breathing and slow heart rate. 7. _Hypothermia_: Difficulty regulating body temperature. 8. _Hypoglycemia_: Low blood sugar. 9. _Infections_: Increased risk of infections due to underdeveloped immune systems. 10. _Long-term developmental delays_: Potential delays in growth, cognitive, and motor [6/20, 11:58 AM] Meta AI: Prematurity, defined as birth before 37 weeks of gestation, can lead to various complications for the baby. Some potential complications include: 1. _Respiratory distress syndrome (RDS)_: Underdeveloped lungs may struggle to breathe, leading to RDS. 2. _Bronchopulmonary dysplasia (BPD)_: Chronic lung disease that can develop in premature babies. 3. _Intraventricular hemorrhage (IVH)_: Bleeding in the brain, which can lead to developmental delays or cerebral palsy. 4. _Necrotizing enterocolitis (NEC)_: Inflammation of the intestines, potentially causing tissue death. 5. _Retinopathy of prematurity (ROP)_: Abnormal blood vessel growth in the eyes, potentially causing blindness. 6. _Apnea and bradycardia_: Pauses in breathing and slow heart rate. 7. _Hypothermia_: Difficulty regulating body temperature. 8. _Hypoglycemia_: Low blood sugar. 9. _Infections_: Increased risk of infections due to underdeveloped immune systems. 10. _Long-term developmental delays_: Potential delays in growth, cognitive, and motor skills development. It's important to note that not all premature babies will experience complications, and the risk of complications increases with decreasing gestational age. Medical care has improved significantly, and many premature babies go on to lead healthy lives with proper treatment and care.

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PREMATURITY Dr JD KABAMBA
LECTURE OUTLINE 1. Definition 2. Etiology / Risk factors 3. Clinical features 4. Management 5. Complications
1. DEFINITION Live born infants delivered before 37 weeks from the 1st day of the last menstrual period are termed premature by the World Health Organisation ( WHO). It is important to differentiate prematurity from Low Birth Weight ( LBW: Birth weight below 2500 g ) though causes might be the same in some cases 1. Late preterm: born between 34 and 36 completed weeks of pregnancy 2. Moderately preterm: born between 32 and 34 weeks of pregnancy 3. Very preterm: < 32 weeks 4. Extremely preterm: born at 28 weeks
The organs most commonly affected by preterm delivery are the lungs, as the lungs are one of the last organs to develop in utero. Stages of lung development: - Embryonic: 3 6 weeks - Pseudoglandular: 5 17 weeks - Canalicular: 16 -25 weeks: formation of gas exchanging portion of the lungs - Saccular: 24 weeks birth: Surfactant production ( not enough for function) 32 weeks: Enough surfactant for function - Alveolar: 36 weeks 8 years: increase of number and size of alveoli
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. ETIOLOGY The etiology of preterm birth is multifactorial and involves a complex interaction between fetal, placental, uterine, and maternal factors. Some of maternal factors are as follow: 1. Anaemia 2. Maternal undernutrition 3. Maternal histories of reproductive inefficiency such as abortions, stillbirths, premature or LBW infants. 4. Teenage pregnancies 5. Short inter-pregnancy interval
1. Foetal factors Fetal distress IUGR ( Intra-Uterine Growth Restriction) Congenital abnormalities Multiple gestation Erythroblastosis foetalis* Nonimmune hydrops**
3. Uterine and placental factors Incompetent cervix Intra-uterine mass: fibroid Uterine deformity ( bicornuate) Excessive uterine distension ( polyhydramnios, multiple pregnancies, LGA) Antepartum haemorrhage ( placenta praevia, abruptio placentae) Premature rupture of membranes 4. Maternal factors Psychological stressors Pre-eclampsia Infections Drugs : Diethylstilbestrol Drug abuse Chronic medical conditions ( cardiac, renal,) Low pre-pregnancy weight Pre-pregnancy obesity Maternal age (< 16 , > 35) A short inter-pregnancy interval
2. PREMATURITY & COMPLICATIONS in Neonates and infants
3. CLINICAL FEATURES The Ballard Scoring System remains the main tool used after delivery to confirm gestational age by means of physical examination. It is accurate to 賊2 weeks However the following are most obvious features of prematurity: The major parts of the anatomy used in determining gestational age include the following: Small size,with a disproportionately large head Ear cartilage: 28 wks , flattened pinna Sole: one anterior crease ( 33 wks) Breast tissue absent at 28 weeks Genitalia Fine hair covering much of the body: lanugo Low body temperature Laboured breathing Reduced tone
BALLARD SCORING SYSTEM
2. PREMATURITY & COMPLICATIONS in Neonates and infants
3. MANAGEMENT
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
4. COMPLICATIONS 1. Short-term complications Respiratory distress syndrome due to deficiency in surfactant ( Hyaline Membranes Disease), the substance that prevent pulmonary alveoli from collapsing during expiratory phase of breathing Persistent Arterial Canal: An opening between the aorta and the pulmonary artery that may lead to heart failure depending of its size. Intraventricular and Periventricular Heamorrhage Hypothermia. It is due to the inability of the baby to maintain body temperature due to lack of fat and generate enough heat to counteract heat loss through their skin. Hypoglycaemia due to lack of glycogen storage to maintain normal blood sugar levels Neonatal Hyperbilirubinaemia due to huge volume of red blood cells and Sepsis due to undeveloped immune system Haemorrhagic disease of the newborn due to the deficiency in Vitamin K
2. Long-term complications Cerebral palsy (risk in < 32 wks)caused by: - Periventricular leukomalacia - Infection Bronchopulmonary Dysplasia is caused by the disturbance of physiologic lung development mainly in the saccular stage with lifelong restrictions of pulmonary function Retinopathy of prematurity Behavioral and social-emotional problems Learning difficulties Increased risk of conditions such as Attention Deficit-Hyperactivity Disorder (ADHD) Increased risk for Sudden Infant Death Syndrome (SIDS)
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants
2. PREMATURITY & COMPLICATIONS in Neonates and infants

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2. PREMATURITY & COMPLICATIONS in Neonates and infants

  • 2. LECTURE OUTLINE 1. Definition 2. Etiology / Risk factors 3. Clinical features 4. Management 5. Complications
  • 3. 1. DEFINITION Live born infants delivered before 37 weeks from the 1st day of the last menstrual period are termed premature by the World Health Organisation ( WHO). It is important to differentiate prematurity from Low Birth Weight ( LBW: Birth weight below 2500 g ) though causes might be the same in some cases 1. Late preterm: born between 34 and 36 completed weeks of pregnancy 2. Moderately preterm: born between 32 and 34 weeks of pregnancy 3. Very preterm: < 32 weeks 4. Extremely preterm: born at 28 weeks
  • 4. The organs most commonly affected by preterm delivery are the lungs, as the lungs are one of the last organs to develop in utero. Stages of lung development: - Embryonic: 3 6 weeks - Pseudoglandular: 5 17 weeks - Canalicular: 16 -25 weeks: formation of gas exchanging portion of the lungs - Saccular: 24 weeks birth: Surfactant production ( not enough for function) 32 weeks: Enough surfactant for function - Alveolar: 36 weeks 8 years: increase of number and size of alveoli
  • 6. 2. ETIOLOGY The etiology of preterm birth is multifactorial and involves a complex interaction between fetal, placental, uterine, and maternal factors. Some of maternal factors are as follow: 1. Anaemia 2. Maternal undernutrition 3. Maternal histories of reproductive inefficiency such as abortions, stillbirths, premature or LBW infants. 4. Teenage pregnancies 5. Short inter-pregnancy interval
  • 7. 1. Foetal factors Fetal distress IUGR ( Intra-Uterine Growth Restriction) Congenital abnormalities Multiple gestation Erythroblastosis foetalis* Nonimmune hydrops**
  • 8. 3. Uterine and placental factors Incompetent cervix Intra-uterine mass: fibroid Uterine deformity ( bicornuate) Excessive uterine distension ( polyhydramnios, multiple pregnancies, LGA) Antepartum haemorrhage ( placenta praevia, abruptio placentae) Premature rupture of membranes 4. Maternal factors Psychological stressors Pre-eclampsia Infections Drugs : Diethylstilbestrol Drug abuse Chronic medical conditions ( cardiac, renal,) Low pre-pregnancy weight Pre-pregnancy obesity Maternal age (< 16 , > 35) A short inter-pregnancy interval
  • 10. 3. CLINICAL FEATURES The Ballard Scoring System remains the main tool used after delivery to confirm gestational age by means of physical examination. It is accurate to 賊2 weeks However the following are most obvious features of prematurity: The major parts of the anatomy used in determining gestational age include the following: Small size,with a disproportionately large head Ear cartilage: 28 wks , flattened pinna Sole: one anterior crease ( 33 wks) Breast tissue absent at 28 weeks Genitalia Fine hair covering much of the body: lanugo Low body temperature Laboured breathing Reduced tone
  • 17. 4. COMPLICATIONS 1. Short-term complications Respiratory distress syndrome due to deficiency in surfactant ( Hyaline Membranes Disease), the substance that prevent pulmonary alveoli from collapsing during expiratory phase of breathing Persistent Arterial Canal: An opening between the aorta and the pulmonary artery that may lead to heart failure depending of its size. Intraventricular and Periventricular Heamorrhage Hypothermia. It is due to the inability of the baby to maintain body temperature due to lack of fat and generate enough heat to counteract heat loss through their skin. Hypoglycaemia due to lack of glycogen storage to maintain normal blood sugar levels Neonatal Hyperbilirubinaemia due to huge volume of red blood cells and Sepsis due to undeveloped immune system Haemorrhagic disease of the newborn due to the deficiency in Vitamin K
  • 18. 2. Long-term complications Cerebral palsy (risk in < 32 wks)caused by: - Periventricular leukomalacia - Infection Bronchopulmonary Dysplasia is caused by the disturbance of physiologic lung development mainly in the saccular stage with lifelong restrictions of pulmonary function Retinopathy of prematurity Behavioral and social-emotional problems Learning difficulties Increased risk of conditions such as Attention Deficit-Hyperactivity Disorder (ADHD) Increased risk for Sudden Infant Death Syndrome (SIDS)