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Preterm Neonate
Whose birth occurs through the end of the
last day of the 37 week following onset of
the last menstrual period.
Incidence
• 12% of all US births
• 2% are less than 32 weeks gestation
• Demographic play in major role in the
incidence 2
Can be categorized by birth weight:
LBW (low birth weight) = infant < 2500 g
at birth
VLBW (very low birth weight) = infant <
1500 g at birth
ELBW (extremely low birth weight) =
infant < 1000 g at birth
‘Micropremie’ if infant < 750 g at birth
3
Etiology
1. Low socioeconomic status (SES)
Family income
Educational level
Residency
Sosial class
Occupation
4
Etiology
2. Women < 16 or >36
3. Maternal activity
Long periods of standing
Physical stress
5
Etiology
6. Multiple gestation birth
7. Prior poor births outcome
8. Obstetric factors
Uterine malformation
Uterine trauma
Placenta previa
Abruptio placenta
Hypertensive disorder
etc
6
Etiology
9. Fetal condition
Nonreassuring testing
IUGR
Severe hydrops
7
Problems of prematurity
1. Respiratory
Prenatal depression due to poor
adaptation to air breathing
Respiratory distress syndrome
Apnea due to immaturity in mechanisms
controlling breathing
Chronic lung disease: bronchopulmonary
dysplasia, and chronic pulmonary
insufficiency of prematurity
8
Problems of prematurity
2. Neurologic
Perinatal depression
Intracranial hemorrhage
3. Cardiovascular
Hypotension due to: hypovolemia, cardiac
dysfunction, vasodilatation due to sepsis
Patent ductus arteriosus (PDA)
9
Problems of prematurity
4. Hematologic
Anemia
Hyperbilirubinemia
10
Problems of prematurity
5. Nutritional
6. Gastrointestinal,
single greatest risk
factor for
necrotizing
enterocolitis, reflux
19 % of preterm babies on
treatment for reflux
11
Necrotizing enterocolitis Clinical
Findings
Non-specific: feeding intolerance,
abdominal distension, occult blood
(stool)
2. Neonatal management
Thermal regulation
Oxygen therapy and
assisted ventilation
14
Management of the
premature infant
15
Management of the
premature infant
Fluid and electrolite therapy
must account for potentially high IWL
Nutrition
mother’s milk is the optimal primary
source of enteral nutrition
Hyperbilirubinemia
- photothetapy
- exchange transfusion
16
Composition of human milk
17
Management of the
premature infant
Infection
broad-spectrum antibiotics should be
begun when suspicion is strong
18
Management of the
premature infant
If the infant hospitalized at the
appropriate chronologic age (usually at 2,
4, and 6 months)
- acellular DPT
- multivalent pneumocaccal are given
- HIB
- Pertussis is contraindicated in infant with
possible or documented evolving
neurologic disorders
19
Management of the
premature infant
Oral polio vaccine should not be given
Administer inactivated polio vaccine (IPV)
Mothers with HBsAg (+)
20
Management of the
premature infant
Mothers with HBsAg (-)
- optimal timing for HBV with birth weight
< 2 kg is not clear
- 1st vaccination for birth weight < 2 kg
should be delayed until just before
hospital discharge if weight 2 kg or
more, or until approximately 2 months
21
Management of the
premature infant
- between 32 and 35 week with: plans for
day care during RSV season, smoker in
the houshold, other young children in
the household
- chronic lung disease
Immunization should be given at least 48
hours to discharge so that any febrile
response will occur in the hospital
22
Long-term problems
of prematurity
Developmental disability
- Major handicaps (cerebral palsy, mental
retardation)
- Sensory impairments (hearing loss,
visual impairment
- Minimal cerebral dysfunction (language
disorder, learning disability, hyperactivity)
23
Long-term problems
of prematurity
Retinopaty of prematurity
Chronic lung disease
Poor growth
Increased rates of postneonatal illness and
rehospitalization
Increased frequency of congenital
anomalies
24
Retinopathy of Prematurity
Confined to immature
retinal vascular system
Develops at border
between vascular and
avascular retina.
25
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