2. PREMATURITY & COMPLICATIONS in Neonates and infants

[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.

1. PREMATURITY
DrJD KABAMBA

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 prematureby 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.Foetalfactors
•Fetal distress
•IUGR ( Intra-Uterine Growth Restriction)
•Congenital abnormalities
•Multiple gestation
•Erythroblastosisfoetalis*
•Nonimmunehydrops**

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, abruptioplacentae)
•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 ±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,witha 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
•Labouredbreathing
•Reduced tone

11. BALLARD SCORING SYSTEM

13. 3. MANAGEMENT

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.
•Hypoglycaemiadue to lack of glycogen storage to maintain normal blood
sugar levels
•Neonatal Hyperbilirubinaemiadue to huge volume of red blood cells and
•Sepsis due to undeveloped immune system
•Haemorrhagicdisease 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)