Prematurity Lec. 6 Dr. Athl Humo 2016-2017

Premature (preterm) baby: Prematurity Premature (preterm) baby: Birth before 37 completed weeks gestation. 8% of all births. Most problems seen with infants born <32 completed weeks.

Predisposing Factors

Complications Of Prematurity * Common.

Thin gelatinous skin and dark red in color. Signs Of Prematurity Thin gelatinous skin and dark red in color.

Poorly developed breast tissue, no palpable breast tissue or it is flat and less than 1cm in diameter. The ear auricle is soft, no cartilage and there is slow or no recoil.

Genitalia: Male: the testes are not descended in the scrotum and no creases on the scrotum. Female: labia majora are not covering completely labia minora.

Plantar creases are absent or only seen on the anterior 2/3 of the sole

Intrauterine Growth Restriction (IUGR) Low birth weight (LBW) and Intrauterine Growth Restriction (IUGR)

Low birth weight (LBW) infants, defined as infants having birth weights of less than 2500 g, represent a large component of the neonatal and infant mortality rates. IUGR is the most common cause of LBW in developing countries, whereas prematurity is the cause in developed countries. Very low birth weight (VLBW) infants, weighing less than 1500 g at birth, represent about 1% of all births but account for 50% of neonatal deaths. IUGR is present when fetal growth stops and, over time, declines to less than the 5th percentile of growth for gestational age or when growth proceeds slowly, but absolute size remains less than the 5th percentile.

Maternal factors associated with a LBW caused by premature birth or IUGR include: Previous LBW birth Low socioeconomic status Low level of maternal education No antenatal care Maternal age younger than 16 years or older than 35 years Short interval between pregnancies Cigarette smoking, alcohol and illicit drug use Physical (excessive standing or walking) or psychological (poor social support) Stresses, unmarried status, low pre-pregnancy weight (<45kg), poor weight gain during pregnancy (<10 lb), and African American race.

Factors Often Associated with Intrauterine Growth Restriction

Problems of IUGR and SGA Intrauterine fetal demise Temperature instability Perinatal asphyxia Hypoglycemia Polycythemia -hyperviscosity Reduced oxygen consumption/ hypothermia Dysmorphology Pulmonary hemorrhage

Symmetric IUGR ((head circumference, length, and weight equally affected) often has an earlier onset and is associated with diseases that seriously affect fetal cell number, such as conditions with chromosomal, genetic, malformation, teratogenic, infectious, or severe maternal hypertensive etiologies. Asymmetric IUGR (with relative sparing of head growth) is often of late onset, and is associated with poor maternal nutrition or with late onset or exacerbation of maternal vascular disease (preeclampsia, chronic hypertension).

NURSERY CARE: At birth, the measures needed to clear the airway, initiate breathing, care for the umbilical cord and eyes, and administer vitamin K are the same for immature infants as for those of normal weight and maturity. Special care is required to maintain a patent airway. Additional considerations are the need for thermal control and monitoring of the heart rate and respiration. Oxygen therapy Special attention to the details of fluid requirements and nutrition. Safeguards against infection. Routine procedures that disturb these infants may result in hypoxia. The need for regular and active participation by the parents in the infant’s care in the nursery, the need to instruct the mother in at-home care of her infant, and the question of prognosis for later growth and development require special consideration.

Large for Gestational Age Infants Infants with birth weight > the 90th percentile for gestational age are called large for gestational age (LGA). Neonatal mortality rates decrease with increasing birth weight until approximately 4,000 g, after which they increase. Maternal diabetes and obesity are predisposing factors. LGA infants, regardless of their gestational age, have a higher incidence of: Birth injuries, such as cervical and brachial plexus injuries, phrenic nerve damage with paralysis of the diaphragm, fractured clavicles, cephalohematomas, subdural hematomas, and ecchymoses of the head and face. Hypoglycemia. Polycythemia. Congenital anomalies, particularly CHD. Intellectual and developmental retardation.

GOOD LUCK