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1. Your Date Here Your Footer Here
Complica)ons of
prematurity
YOUR LOGO Rahma Ammar
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2. COMPLICATIONS OF PREMATURITY
•Early:
• RDS, Jaundice, PDA, IVH, Early anemia of prematurity. These occur
while paCents are in hospital.
•Late:
•ROP, BPD (CLD), Late anemia of prematurity, Rickets, CNS damage.
These occur while pa)ent in hospital or aDer discharge.
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3. Early complica)ons of
prematurity
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4. EARLY COMPLICATIONS OF PREMATURITY
1.Respiratory distress syndrome (RDS) or (HMD)
2.Patent Ductus Arteriosus (PDA)
3.Intracranial hemorrhage (ICH)
4.Early anemia of prematurity
5.Jaundice of Prematurity
Your Date Here Your Footer Here 183

5. Patent Ductus Arteriosus (PDA)
De#ni&on: It is a failure of the ductus arteriosus to close in the Qrst few days of
life or reopening aRer funcConal closure. Typically it results in Lt – Rt shunt of
blood once pulmonary vascular resistance (PVR) has decreased. If PVR remain
high – blood may be shunted Rt—Lt resulCng in hypoxemia (PPHN).
INCIDENCE is up to 60% in preterm <1500 grams, higher in < 1000 grams up to
70%. Female: male raCo is 2:1. Obligatory PDA is found in 10% of infants with
other CHD.
Risk factors: in preterm babies, PDA most oRen related to hypoxia and
immaturity. Term infants with PDA usually have structural defects in the wall of
ductal vessels (CHD).
Your Date Here Your Footer Here 184 هاي الduct الغرض منها جان انتقال الدم ب5 aorta &
pulmonary artery بدون ميروح للرئة ا<ليانة amniotic fluid
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6. Clinical features and diagnosis: may be asymptomaCc or may cause apnea and
bradycardia , increased oxygen requirement and/or dibculty in weaning the
infant from arCQcial venClaCon
ExaminaCon show 1-4/6 conCnuous machinery murmur, loudest in the leR upper
sternal border (LUSB), or leR infra-clavicular area. They may have apical diastolic
rumbling murmur because of increased eow across mitral valve. Bounding
peripheral pulses with wide pulse pressure >60 mmHg diXerences between
systolic and diastolic BP. HyperacCve precordium and palmar pulses may also be
present in large shunt.
•ECG is normal or LVH in small-moderate PDA, Bilateral VH in larger PDA.
•Chest x ray may have cardiomegaly, increased pulmonary vascular markings.
•Echocardiography will con_rm the diagnosis of PDA.
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7. Management: `uid restric)on and diure)cs--- if no response in 24-48 hours ---
give indomethacin iv infusion in a dose of 0.2 mg / kg iv every 24 hours for 3
doses. Oral Brufen syrup is an alterna)ve. 80% will close by these measures in
preterm neonates. If failed-- surgical closure by ligaCon of the duct may be
needed.
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8. Intracranial hemorrhages (ICH)
•Periventricular Hg, intraventricular Hg, subarachnoid Hg, subdural Hg, and
intracerebral Hg. The most common Hg in Preterm NB is Intraventricular
Hg(IVH).
Intraventricular Hg (IVH):
•IVH usually arises in the germinal matrix and periventricular region of the brain.
Patho- physiology: in the periventricular germinal matrix, poor structural
support, failure of auto-regula)on of BP in these sick preterm NB, and venous
stasis due to many reasons.
Incidence: 30-40% of preterm NB <1500 grams, 50-60 % of those <1000 grams.
IVH is highest during _rst 72 hours of life.
Your Date Here Your Footer Here 187 هي ا<سؤولة عن differentiation &
proliferation of cells
موجودة فقط بالpreterm لذلك ها ل نزيف فقط بيهم يصي ر
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9. Clinical features: IVH can present with seizure, apnea, bradycardia, lethargy,
coma, hypotension, metabolic acidosis, anemia not corrected by blood
transfusion, increasing OFC, bulging fontanel, cutaneous mofling. Those with
grade I, II may be asymptomaCc, those with III,IV grades may have catastrophic
event that eventually lead to shock, coma and even death.
Diagnosis: clinical course with follow up of OFC and Hb, ultrasound of brain
through anterior fontanel in Qrst and second week, and may need CT scan.
•Ultrasound of brain is used in diagnosis and classiQcaCon of IVH. Screening is
indicated in premature <32 weeks in the _rst week and should be repeated in
the second week. Grading is based on maximal Hg seen in the second week of
age. Grade I – Hg in germinal matrix only, Grade II – IVH without ventricular
dilataCon, Grade III – IVH with ventricular dilataCon, Grade IV – IVH with
periventricular hemorrhagic infarcts
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10. Preven)on:
A single course of antenatal steroids for 24-34 wk pregnancies of gesta)on that
are at risk for preterm delivery
maintain acid base balance; avoid `uctua)on in BP
Outcome: death or surviving. Survivors with grade III may have 30-40% incidence
of motor and cogniCve impairment, while those with grade IV may have 60-80%
incidence of motor and cogniCve impairment.
Treatment: supporCve by venClaCon for apnea, packed blood transfusion for
anemia and shock, and plasma , vitamin k and platelets to correct coagula)on
disorder. Hydrocephalus when developed may require serial daily lumbar
puncture, external ventriculostomy or permanent ventriculo-peritoneal shunt.
Your Date Here Your Footer Here 189 RDS
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11. Early anemia of prematurity
•Usually occur in the _rst 2 weeks of life , could be caused by blood
loss or haemolysis or decreased RBCs produc)on. It is treated by
blood transfusion and vitamin E.
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12. Jaundice of Prematurity:
•Due to liver enzyme immaturity, poor enteral intake, delayed stooling
and increased entrohepaCc circulaCon
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13. Late complica)ons of
prematurity
Your Date Here Your Footer Here 192
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14. Late complica)ons of prematurity
1.Re)nopathy of prematurity (ROP), (Retrolental _broplasia)
2.Broncho-pulmonary dysplasia (BPD)
3.Late anemia of prematurity
4.Rickets
5.CNS damage
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15. Re)nopathy of prematurity (ROP),
(Retrolental _broplasia):
•ROP is the interrupCon of the normal progression of reCnal vascularizaCon. It is
responsible for many cases of blindness.
E)ology: ROP is due to exposure of the immature re)na to high 02
concentra)on for long periods, which will result in vasoconstric)on and
oblitera)on of the re)nal capillary network, which is followed by vaso-
proliferaCon. The risk is greatest in the most immature infants.
Clinically : No warning signs, so screening of babies at risk is mandatory.
ORen gradually occurring asCgmaCsm, reCnal detachment , and amblyopia.
Management: 1-PrevenCve : A-Screening of babies at risk is before discharge,
and at 3 months of age, B- Lowest O2 for the least duraCon if O2 therapy is
indicated (controversial)
CuraCve : A-Laser therapy , B-Follow up the ajected babies at 6 months intervals
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16. Broncho-pulmonary dysplasia (BPD)
•Classic BPD is a neonatal form of chronic lung disease that follows a primary
course of respiratory failure (RDS, Meconium aspiraCon syndrome) in the Qrst
days of life. BPD is also de_ned as persistent 02 dependencies up to 28 days of
life.
•Incidence is ineuenced by many factors, the most important of which is lung
immaturity. It increase with decreasing body weight, aject 30% of <1000 grams.
•The major contribuCng factors to BPD are ineammaCon, oxygen exposure, and
mechanical venClaCon (Volutrauma /barotraumas, which is now decreased by
early use of nasal CPAP).
•Chest X-ray :shows widespread areas of opaciQcaCon, someCmes with cysCc
changes
• These babies are more suscepCble to recurrent wheezing, severe bronchioliCs
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17. Late anemia of prematurity:
•It occurs in preterm infants aRer 6 weeks. It is purely iron de_ciency anemia, so
put paCents on prophylac)c iron 3mg/kg/day of elemental iron that started
from 6th week of life or once full enteral feeding is achieved.
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18. Rickets
•Preterm babies got poor vitamin D stores and rapid growth, so it is befer to put
them on vit. D supplements from 6th week of life of 400 iu/ day.
Your Date Here Your Footer Here 197 >
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19. CNS damage
•Preterm baby is more prone to develop the following:
1.Major developmental delay (MR, CP, epilepsy, blindness, deafness).
2.Other less severe sequels: cranial nerve palsies, progressive hydrocephalus,
learning problem, behavioral problem.
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20. EARLY COMPLICATIONS OF PREMATURITY:
1.Respiratory distress syndrome (RDS) or (HMD)
•It is a de)ciency of pulmonary surfactant (phospholipid- protein mixture ) that
decrease surface tension and prevent alveolar collapse .The surfactant is
produced by type 2 pneumocyte in increasing quan@@es from 24-25 weeks of
gesta@on onwards , reaching normal concentraFon at 34 weeks.
•Risk factors that increase or decrease the risk of RDS:
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21. •Clinical features: Incidence of RDS is about 44% of those with 501-1500 grams.
RDS is more in males than females. It is rare in full term neonates except in IDM,
hypoxia, acidosis, hypothermia. It worsens in )rst few hours of life and then
progress over 48-96 hours and subsequently improves. They presents with
tachypnea, expiratory granFng, chest recession with retracFon of subcostal,
intercostal, suprasternal muscles and diaphragm causing chest indrawing. There
is also cyanosis and tachycardia. Recovery is accompanied by brisk diuresis. Death
is rare in the )rst day, but it occurs in 2-7th day due to intersFFal emphysema,
pneumothorax, pulmonary hemorrhage, and IVH.
•Diagnosis: Clinical course, chest x ray, blood gases, other Inves@ga@ons and
echocardiogram when needed.
•Chest x ray classically show increased re@culogranular paTern of lung )eld that
may obscure the heart border (ground-glass appearance, or white lung).
Some@mes air bronchogram is seen
•Blood gases usually show increased paCO2, decreased paO2, and PH.
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22. RDS
DiUuse ground-glass
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Your Date Here Your Footer Here 161 "airbronchogrem

23. •DiWerenFal diagnosis:
•Transient tachypnea of newborn (TTN) may be dis@nguished by its short and
mild clinical course and is characterized by low or no need for oxygen
supplementa@on. More in term baby, especially aXer ElecFve C/S.
•OTHER D.D,
•Group B streptococcal infecFon, CyanoFc congenital heart diseases, aspiraFon
syndromes, primary pulmonary hypertension of newborn (PPHN), spontaneous
pneumothorax, diaphragmaFc hernia, pleural eWusion, lobar emphysema,
congenital anomalies of lung.
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24. •PrevenFon of RDS:
1.Prevent premature delivery by:
a.Appropriate management of high risk pregnancies
b.Prenatal diagnosis of high risk neonates
c.Avoid unnecessary or poorly Fmed caesarian secFon
2.Antenatal steroid to enhance in utero lung maturity by 2 doses of
betamethasone 12 mg i.m at 24 hours interval ,administered 48 hours before
premature delivery of fetuses between 24-34 weeks of gesta@on.
3.ProphylacFc Surfactant (human or bovine). The )rst dose is given into the
trachea of premature neonate immediately aZer birth or during the )rst 15
minutes of life.
4.the most recent evidence base medicine is Immediate Delivery room ini@a@on
of CPAP with or without early surfactant administra@on.
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25. •Treatment of RDS:
1.SupporFve: a. Fluid and nutri@on b. Gentle minimal handling c. Circulatory
monitoring d. Temperature control by incubator care. e. Warmed humidi]ed
oxygen. f. CPAP (con@nuous posi@ve airway pressure) which decrease the need
for ven@la@on and surfactant if given early to preterm neonates. g. Assisted
mechanical ven@la@on via endotracheal tube, if severe RDS or complica@ons
like recurrent apnea
2.Speci]c: By ins@lla@on of mul@dose exogenous surfactant via endotracheal
tube, given every 6-12 hours for 1-3 doses, best started in the )rst 24 hours of
life, usually aZer con)rming the diagnosis of RDS by clinical course, chest x ray
and blood gas analysis
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26. •ComplicaFons of RDS & its intensive care:
1.Endotracheal tube complicaFons like tracheal perfora@on and trauma,
esophageal perfora@on, laryngeal edema, tube obstruc@on or kinking,
infec@on, subglo^c stenosis
2.Umbilical artery and vein catheteriza@on including too far or too close inser@on,
perfora@on.
3.Extra pulmonary extravasa@ons of air like pneumothorax, pulmonary inters@@al
emphysema, pneumomedias@num
4.PDA. 5. Apnea and bradycardia. 6. Chronic lung disease (BPD).
Your Footer Here 165
A child who is oxygen dependent for
more than 28 days lead to
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27. •Prognosis: prenatal diagnosis of high risk pregnancies and neonates,
improvement in intensive care, antenatal steroid, postnatal surfactant use, and
improved modes of ven@la@ons, all above measures, reduce the mortality to <
10%. The mortality rate is inversely related to gestaFonal age. The outlook is
be_er in NB > 1500 grams. 80% of those < 1500 grams have no neurologic or
mental sequel. 80-90% of those surviving RDS and its care are normal. The long
term prognosis for normal pulmonary funcFon in most infants surviving RDS is
excellent.
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28. Other causes of neonatal respiratory distress
Transient tachypnea of newborn.
Commonest self-limited respiratory distress in full term
 Due to delay in clearance of fetal lung liquid
•Risk factors
Cesarean secFon
Maternal asthma and smoking
Maternal diabetes
Maternal excess analgesia
Perinatal asphyxia
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29. •Clinical picture
Mild respiratory distress (tachypnea) within few hours aZer birth.
The chest generally sounds clear without rales or rhonchi ( "quiet" tachypnea)
Spontaneous resolu@on usually occur within 72 hours
•Chest X-ray
Prominent perihilar streaking, which correlates with the engorgement of the
lympha@c system with retained lung cuid
Fluid in the )ssures
Hyperincated lung& mild cardiomegaly
Your Date Here Your Footer Here 168 3
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30. X-ray
Chest x-ray of a term
newborn infant
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streaky opaci@es, mild
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pleural eUusion.
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31. Meconium aspira@on syndrome
 Meconium-stained amnio@c cuid (MSAF) occurs in about 15 % of deliveries
Not all neonates with MSAF develop meconium aspira@on syndrome (MSA)
MAS occurs only in 5 % of infants with MSAF
Pathophysiology :
1. Factors that promote the passage of meconium in utero include the following:
o Perinatal asphyxia
o Oligohydramnios
o Maternal infec@on/chorioamnioni@s
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32. 2. Meconium may be aspirated before, during, or just aZer
birth
3. Outcome of meconium aspiraFon: -
Complete airways obstruc@on→ Patchy collapse
Incomplete airways obstruc@on →Air trapping.
Secondary infec@on & chemical pneumoni@s→ Surfactant
dysfunc@on
Pulmonary hypertension
Your Date Here Your Footer Here 171 *

33. •Clinical picture
 MAS occur typically in term and post-term infants
Skin, nails and umbilical cord may be meconium stained
Signs of severe respiratory distress with grun@ng and cyanosis
Barrel chest in the presence of air trapping
 Auscultated rales and rhonchi (in some cases)
Chest radiograph
Hyperincated chest with patchy consolida@ons and collapse
May be air leak e.g. pneumothorax, pneumopericardium
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34. •Treatment of meconium stained baby in delivery room
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35. Treatment of MAS
Respiratory support in NICU as before
Consider early conven@onal mechanical ven@la@on (high oxygen,
high rate, long expiratory @me ,low pressures, use seda@on)
An@bio@cs
Surfactant
High frequency ven@la@on for conven@onal ven@la@on failure
Extra Corporeal Membrane Oxygena@on (ECMO) for severe MAS
Your Date Here Your Footer Here 174 /Supportive)
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36. Your Date Here Your Footer Here
Prematurity
YOUR LOGO Rahma Ammar
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37. •Neonatal period: It is the 0rst 4 weeks of human life (28 days). It is divided into:
•Early Neonatal period: is the 0rst week of life (7 days)
•Late Neonatal period: > 7- 28 days of life
•Perinatal mortality rate (PMR): Is the number of sEll born babies aFer 20 weeks
of gestaEon + number of deaths in the 0rst week of life per 1000 total births.
•Neonatal mortality rate (NMR): Is the number of infants died during the 0rst 28
days of life per 1000 live births.
•NB by gesta<onal age is classi>ed as
•PRETERM: NB delivered before 37 completed weeks (<259 days).
•FULL TERM: NB delivered between 37-42 weeks (260- 294 days).
•POST TERM: NB delivered aFer 42 weeks (>295 days).
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38. NB gesta<onal age is assessed by
1.History: LMP & EDD and quickening (Date of 0rst reported fetal acEvity, usually
occurs at 16-18 weeks)
2.Examina<on: Fundal height by obstetrician ExaminaEon and Expanded new
Ballard score by Pediatrician
3.Inves<ga<ons: First reported fetal heart sounds (10-12 weeks by Doppler
ultrasound examinaEon) and Ultrasound examina<on (very accurate if
obtained before 20 weeks' of gestaEon).
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39. •NB by birth weight on growth charts is classi>ed as
•Small for gesta<onal age (SGA) Is NB with birth weight of < 10 th cenEle
•Appropriate for age (AGA) Is NB with birth weight between 10th -90th cenEles
•Large for gesta<onal age (LGA) Is NB with birth weight of > 90 th cenEle
•Full term neonates normally have the following:
•BW: Average 3.250 g (7.5 pounds), 95 % (2.500 – 4.250 g)
•Length: 50 cm, 95 % (46 – 56 cm)
•OFC 35 cm, 95 % (33 – 38 cm)
•Hb 14 – 22 g/ dl
•WBC 5000 - 20000 / cm3
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40. •BP 80/50 mm Hg
•RR 40 – 60 breaths/ minutes
•PR 120 – 160 beats / minutes
•Urine passed within 24 hours of birth, max. 40 hours
•Meconium passed within 24 hours, max 48 hours, If > 48 hours, think of
imperforated anus. Preterm neonates might normally have delayed passage of
meconium longer than 48 hours.
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41. •LOW BIRTH WEIGHT NEONATES (LBWN):
•They are neonates whose birth weight < 2500 grams. They represents 6-7 % of all
births, but they accounts for 2/3 of all neonatal deaths.
•LBWN could be preterm, SGA, or both
•PRETERM NEONATES: Any neonate who was born before 37 weeks completed
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42. Prematurity
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43. Causes
1.Maternal causes: maternal age <16 - >35 years, grand parity, smoking, poor
housing, short stature, alcohol consumpEon, chronic maternal diseases like
chronic HT, cyanoEc CHD, chronic renal diseases, acute infecEons during
pregnancy and drug abuse like cocaine.
2.Placental causes: placenta previa, abrupEon of placenta.
3.Uterine causes: Bicornuate uterus, cervical incompetence.
4.Fetal causes: Fetal distress, mulEple gestaEons, erythroblastosis fetalis,
congenital anomalies, and non-immune hydropis fetalis.
5.Others: Premature rupture of membranes, polyhydraminos, iatrogenic e.g.
poorly Emed C/S, trauma including surgery
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44. PROBLEMS OR DISADVANTAGES OR COMPLICATIONS
OF PREMATURITY
1.Birth asphyxia and the need for resuscita<on at birth (perinatal depression):
due to immaturity of respiratory Centre, thin eail chest wall, and de0ciency of
surfactant.
2.Thermal instability (hypothermia or hyperthermia): Hypothermia may be due
to large S.A compared to BWT, lible or no subcutaneous fat, poor muscular
ac<vity, poor swea<ng mechanism, immature heat regula<ng centre in brain.
So protect preterm neonates by pufng him in plasEc bag (<750 g) or under
overhead heater aFer delivery and then in incubator.
3.Weak cough, sulking, swallowing and coordinaEon reeexes: so they are prone
to aspira<on pneumonia if given direct fed before 34 weeks.
4.Respiratory problems: RDS, pneumothorax, apnea and bradycardia, congenital
pneumonia and later BPD.
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45. 5.Jaundice and liver immaturity: jaundice may be severe leading to kernicterus.
Liver immaturity may lead to bleeding, hypoproteinemia--edema.
6.Metabolic: hyper or hypoglycemia, hypocalcaemia, electrolyte disturbances,
osteopenia of prematurity, acidosis, low thyroxin status.
7.CVS: Hypotension due hypovolemia, cardiac dysfuncEon and vasodilataEon due
to sepsis. PDA leading to heart failure especially if associated with RDS.
8.CNS: Perinatal CNS depression, increase incidence of IVH, periventricular
leukomalacia, seizures, deafness and hypotonia.
9.GIT: intolerance to formula feed especially fat, ParalyEc ileus,
hyperbilirubinemia, NEC, while breast feeding is protecEve against NEC.
10.Increased suscep<bility to infec<ons: due to very low immunoglobulin levels
and impaired cell mediated immunity.
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46. 11.Hematologic: Anemia which may be exaggerated by frequent blood samplings.
It may be early in the >rst 2 weeks and late ager 6 weeks.
12.Ophthalmologic: ReEnopathy of prematurity (ROP) which may lead to ParEal or
total blindness especially if received high 02 concentra<on for long period.
They require follow up by fundoscopic examinaEons.
13.Surgical problems: especially inguinal hernia which can be dangerous as it
might strangulate at any <me so operate as early as possible.
14.Renal problems: hypernatremia, hyponatremia, hyperkalemia, edema,
decreased GFR, inability to handle water and solute overload. Fluid and
electrolyte management is more dijcult.
15.De>ciency of iron, vitamin D: so they require supplement earlier than full term
neonates, usually at 6 weeks or even earlier.
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47. CLINICAL FEATURES OF PRETERM NEONATES:
•It depends on the degree of prematurity, but generally they got:
-Larger head size compared with the body size
- Pink skin color or even dark red thin transparent skin
- sleeps almost all the Eme
- Hypotonic with full extension of legs, arms (frog like posture with poor
muscle tone).
- No palpable breast <ssue, shapeless sog ears
- Undescended testes in males and widely separated labia in females with labia
minora not covered by labia majora
- Weak cry, weak sulking, swallowing, coordinaEon, cough reeexes
- Limle subcutaneous Essue
- The body is covered with black soF brimle hair all over the back and shoulder
(lanugo hair)
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48. MANAGEMENT OF PRETERM NEONATES:
1.IMMEDIATE POSTNATAL: a. Delivery should be in appropriately equipped and
staied hospital. b. resuscitaEon and stabilizaEon with quali>ed personnel and
equipment with 02 supply , temp. Control, etc.
2.NEONATAL MANAGEMENT:
a.Thermal regulaEon by controlling environmental temperature with minimal
02 consump<on using overhead radiant heater and closed incubator.
b.Respiratory support by O2 therapy and assisted venElaEon by CPAP,
surfactant for RDS. CPAP shown to decrease the need for intuba<on,
mechanical ven<la<on and surfactant if used early in preterm neonates.
c.Circulatory support by blood , plasma, saline infusion
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49. d.Monitoring of HR, PR, RR, TEMP, 02 monitoring by pulse oximetry, trans-
cutaneous measurement of arterial 02, blood gas analysis from peripheral
venous or arterial or umbilical arterial cath. keep paO2 50-80 mmHg,
paCO2 35-50 mmHg. Chest x ray to con0rm diagnosis of respiratory
diseases like RDS, and to con0rm the posiEon of endotracheal tube and
umbilical catheters.
e.Metabolic disturbances: blood glucose is checked regularly and I.V dextrose
5%, 10% given to prevent hypoglycemia. Fluid requirement is variable from
60 ml/kg/day reaching 150- 180 ml/kg (<1 kg) in the 5th day, as they have
high insensible water loss and to maintain good hydraEon and
normoglycemia.
f.Minimal handling: Most procedures could be done inside the incubator, and
be done as rapid and ejcient as possible.
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50. g.Nutri<on: parenteral (parEal, total TPN) and enteral (NG tube, direct oral). They
are unable to suckle and swallow well or tolerate enteral feeding before 34
weeks. So start with i.v euids then cavage (NG tube) then breast or bomle
feeding if older than 34 weeks. Breast feeding is beber than formula for its
nutri<onal, immunity, protec<ve advantages against NEC, and developmental
bene>ts.
h.Supplements of calcium, phosphate, vitamin D, iron and folic acid started at
6th week. Recombinant human erythropoieEn may decrease the need for
frequent blood transfusions. Delayed cord clamping can decrease anemia.
i.Hyperbilirubinemia: it is inevitable in many preterm NB, so monitor TSB,
phototherapy and exchange transfusion may be needed early.
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51. j.Infec<ons: they are treated by combinaEon of broad spectrum AB started aFer
strong suspicion of infecEon and aFer taking samples for C&S. Consider
anEstaph for VLWT neonates as they need many procedures, manipulaEons and
increased risk of nosocomial infecEons.
Preven<on of infec<on: Hand washing is the most important preven<ve
measure. Clean incubators , educaEon of stap, avoid nosocomial infecEon from
infected stap, use of disposable materials ,napkins, cloths, isolate infected
preterm NB , try to use AB according to results of C&S, avoid new admissions if
outbreaks occur, avoid overcrowding of paEents and stap.
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52. Immuniza<on of All preterm infants
•Vaccine doses should not be reduced for preterm infants.
•Use thimerosal-free vaccines.
•Intramuscular injecEons to preterm infants might require a shorter needle than
the standard 5/8- to 1-inch needle.
•ImmunizaEons may be given during corEcosteroid administraEon.
• Palivizumab (Synagis) should be given according to the respiratory syncyEal virus
(RSV) policy.
•Preterm infants should receive a full dose of diphtheria and tetanus toxoids and a
cellular pertussis (DTaP), Haemophilus in.uenzae type B (Hib) conjugate,
inacEvated poliovirus (IPV) at 60 days’ chronologic age, regardless of birth weight
and gestaEonal age, as long as they are medically stable and consistently gaining
weight.
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53. •Immuniza(ons for preterm infants may be given over 2 or 3 days to minimize the
number of injec(ons at a single (me.
•Hospitalized infants with birth weight lower than 1000 g should be observed for
apnea for 72 hours a:er the primary series of immuniza=ons.
•Breast feeding by a mother who is posi=ve for hepa==s B surface an=gen
(HBsAg) poses no addi=onal risk for acquisi=on of hepa==s B virus (HBV)
infec=on by the infant.
•Infants with chronic respiratory tract disease should receive the in>uenza
immuniza(on annually, before or during the in>uenza season, once they are 6
months postnatal age or older:
The infant should receive two doses of vaccine, 1 month apart.
Family and other caregivers should also receive in>uenza vaccine annually in
the fall to protect the infant from exposure. Your Footer Here 155

54. •The American Academy of Pediatrics recommends rou(ne immuniza(on of
infants in the United States with rotavirus vaccine.
Preterm infants who are clinically stable should be immunized on the same
schedule and with the same precau=ons as term infants. The infant’s
postnatal age must be between 6 weeks and 14 weeks, 6 days postnatal
age.
Preterm infants who are in the NICU or nursery may be immunized at the
(me of discharge if they are clinically stable and age-eligible for the vaccine.
Any rotavirus vaccine-immunized infant who requires readmission to the
NICU or nursery within 2 weeks of vaccina(on should remain under contact
precau(ons for 2 to 3 weeks aRer vaccine administra(on
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55. PROGNOSIS
•The prognosis of those infants with only moderate problems adjus(ng to extra
uterine life is good. The risk of mortality and morbidity is decreased with
increasing age. Severe impairment occurs in small popula(on. Un(l recently,
infants born before 28 weeks had bad prognosis, but now with intensive care
including ar(Tcial ven(la(on, CPAP, IV nutri(on, more and more preterm NB are
surviving.
•For long term sequels, 10-15% of those < I 500 grams are found to have major
handicap such as CP, developmental delay, blindness, and deafness.
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56. Discharge from incubator
• Criteria for discharge
Infant > 1800 grams with good suckling.
Adequate oral feeding ( can tolerate 150 ml/kg per day)
Maintain his temperature outside the incubator
Normal vital data outside the incubator.
No cri(cal illness nor abnormal lab Tndings
Infants with mild BPD may be discharged home on home oxygen therapy with nasal
cannula
•Make notes for
Clinical examina(on with discharge weight and head circumference
Discharge summary and discharge medica(ons prescribed
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