Chapter eight preterm disorders including Respiratory and GIT

Preterm disorders

1. Course: Neonatology Chapter Eight Dr. Abdiwahid MBBS

2. P r e t er m Abdiwahid Ahmed , M D ,

3. Prematurity S m a l l f o r g e s tati o n a l a g e L a r g e f o r g e s tati o na l a g e Spe c ia l N e w bor n G r ou p s

4. B irt h b e f o r e 37 - w ee k s g e s tati o n T e rm : 3 8 w eek s o r m o r e “ La t e p r ete r m : ” 3 4 t o 3 7 w eek s “ E xt r eme l y p r ete r m : ” <2 8 w ee k s Associated with many newborn complications M i l e s t o ne s m a y b e d e l ay e d d u rin g ch i l d h oo d U s e c o r r e c t e d a g e f o r m i l e s t o ne s u nti l 2 y ear s o l d Corrected age : Actual age – week premature (before 40) P r emat ur i t y

5. P r emat ur i t y I mm e d ia t e N e w b o r n C o m pl i c ati o n s Hypothermia L e s s w h it e ad i p o s e t i ss u e ( in s ul a t i o n ) L e s s b r o w n ad i p o s e t i ss u e (h e a t g ene r at i o n ) Large ratio surface area to weight (lose heat easily) Hypoglycemia Hypotension Nevit Dilmen/Wikipedia

6. P r emat ur i t y I mm e d ia t e N e w b o r n C o m pl i c ati o n s Hyperbilirubinemia ↑ un co njuga t e d bili r ubi n M a y le a d t o ne w b o r n j a un d i c e Hypocalcemia I n ute r o ca l c iu m f r o m m ot h e r N e w b o r n h yp oca l c e m i a co mm o n Us u a l l y r e c o v e r s o v e r 2 4 h o u r s M o r e co mm o n i n p r e m a tu r e b a bie s

7. N e on ata l RD S N e o nata l R e sp i r a t o r y D i s t r e s s S yn d r o m e Lungs “mature” when adequate surfactant present O ccu r s a r o u n d 3 5 w ee k s L e c it h i n–s ph i n g o m y e l i n r ati o (L / S r ati o ) B o t h p r od uc e d e qu a l l y u nti l ~ 3 5 w ee k s Ratio > 2.0 in amniotic fluid suggests lungs mature

8. N e on ata l RD S N e o nata l R e sp i r a t o r y D i s t r e s s S yn d r o m e S urf a c ta n t d e f i c ie nc y H i g h s u r f a c e t en s i o n  a t e l e c ta s i s H y p o x e m ia / ↑ pC O 2 (p oo r v enti l at i o n ) P oo r l y r e s p o n s iv e t o O 2 L un g s co ll a p s e d ( a lv e o li ) In t r a p u l m o n a r y sh un t i n g D ia g n os i s : cl ini c a l plu s C X R C X R : d i ff u s e g r o un d gl a s s a pp e a r a n c e Respiratory Distress Syndrome Public Domain

9. N e on ata l RD S R i s k F a c t o r s Prematurity M a t erna l d ia b e t e s H ig h in s uli n l e v el s d e c r e a s e s u r f ac ta n t p r od u c t i o n Ce s a r ea n d e l iv er y B a b y sp a r e d s t r e s s r e sp o n s e a t d el iv e r y R e d u c e d f e ta l co r t i s o l R e d u ct i o n i n s u r f ac tan t Cesarean Delivery

10. N e on ata l RD S P r e v e n t i o n an d T r eat m en t P r e t er m d e l iv er y : b etamet h aso n e Corticosteroid Given to mother to stimulate surfactant production T r eat m e n t : s u rfa c t a n t A d m ini s t e r e d v i a en dot r a c h ea l t ub e Wikipedia/Public Domain

11. R eti no pat h y o f P r emat ur i t y Un d e r d e v e l o p e d r etina l v e ss e l s b e f o r e b irt h N e o v a s cul ari z at i o n i n t h e r etin a Increased risk: exposure to high oxygen content R eti n a l d eta c h me n t  bl in d ne s s D ia g n os i s : r etina l e x a m T r eat m en t ( s e v e r e c a s e s ) : La s e r t h e r a p y V GE F in h ibit o r s Public Domain

12. A p n e a o f P r emat ur i t y I mm at u r e r e s p i r a t o r y c o nt r o l Center Ce ss ati o n o f b r eat h in g f o r a t l ea s t 2 s e c o n d s Respiratory pauses with desaturation and/or bradycardia Clinical Presentation Apnea presents as the cessation of respiration accompanied by bradycardia and/or cyanosis for more than 20 seconds Patrick J. Lynch

13. A p n e a o f P r emat ur i t y T r ea t w it h na s a l c o ntin u o u s p os it iv e air wa y p r e ss u r e ( nC P AP ) General therapy Begin with tactile stimulation. If no respond, bag and mask ventilation should be used during the spell. Use CPAP or PPV in recurrent and prolonged apnea M et h y l - x a n t h i n e t h e r a p y C af f ein e o r t h e o p h y l l in e B l oc k s ad en o s i n e r e c e p t o r s A d en os in e inhibi t s r e sp i r a t o r y dr iv e T r e at m e n t wil l ca u s e tac hy c a r d i a Patrick J. Lynch

14. N e c r o ti z i n g E n t e r o c o l i t i s I n t e s ti n a l ne c r os i s an d o b s tr uc ti o n U s u a l l y t er m ina l i l e u m o r c o l o n Can lead to perforation and infection Mos t ( 90 % ) c a s e s i n p r e t e r m i n f a n t s A sso c ia t e d w it h anti bi o t i c t h e r a p y Of t e n i n f o r m u l a -f e d b a b ie s R i s k f ac t o r : No n - h u m a n m il k Mikael Häggström/Public Domain

15. N e c r o ti z i n g E n t e r o c o l i t i s F ee d in g in t o l e r an c e A b do m ina l d i s t enti o n D ia gn o s i s : X - r a y ( a l t er n at i v e : C T ) Pn e u ma t osi s i n t esti n a l i s G a s i n t h e b o w e l w a l l Pathognomonic finding of NEC in newborns Treatment: S u ppor t i v e ca r e Antibiotics Surgery

16. P n e u ma t os i s I n t e s t in a l i s Public Domain

17. GE R D G a s t r o e sop h ag e a l R ef l u x D i so r d e r Ca n o ccu r i n a n y ne w b o r n Mo r e c o mm o n i n p r e m at u r e b a b ie s M u l ti f a c t o r i a l m e ch a n i s m s C l ini c a l m ani f e s tat i o n s No n sp e c i f i c i rr i t abilit y Vomiting F a ilu r e t o t hr iv e Diagnosis: usually clinical suspicion (challenging) T r eat m ent : d ie t , p os iti o ni n g , m e d i c ati o n s Wikipedia/Public Domain

18. I n t r a v e n t r i c ul a r H em or r h a g e H e m o r r h a g e in t o l a t e r a l v e n t r i cl e Hypotonia Lo s s o f s po n ta n e o u s m o v e m e n t s S ei z u r e s , c o m a G er m ina l m atri x p r o bl e m H ig h l y v a s c ul a r a r e a ne a r v en t r i c le s Prematurity: poor autoregulation of blood flow here F ull- t e r m in f a n t s : d e c r e a s e d v a s c ul a r it y D ia g n os i s : c r ania l ul t r a so u n d T r eat m ent : s upp o rt iv e

19. I n t r a v e n t r i c ul a r H em or r h a g e

20. P r emat ur i t y I mmu n e F u n c ti o n Ce llul a r i mmu nit y i mp ai r e d ↓ T -c e ll s an d B-c e ll s a t b irt h So m e b a b ie s h av e n e u t r op e n i a R i s k o f in f e c t i o n /s e p s i s Mgiganteus/Wikipedia A fraTafreeh.c o m exclusive

21. P r emat ur i t y Lo ng - t er m C o m pl i c at i o n s I nc r ease d mo r ta l it y a n d mo r b i d it y SIDS Leading cause infant mortality 1 month to 1 year in US Increased risk with preterm birth or low birth weight I n c r ea s e d ri s k o f n e u r o c og n it i v e p r o b l em s Cognition S oc i a l s k ill s B e h a v i o r a l a n d e m ot i o n a l s k ill s G r o w t h i mp air m en t I mp ai r e d r e s p i r a t o r y f u n c ti o n

22. Sma l l f o r Ge s tati o n a l A g e L o w B irt h W ei g h t L e s s t h a n 250 g r a m s ( 5 . 5 lb s ) o r 10 t h p e r c enti l e O ccu r s i n ~ 10 % o f t er m b a b ie s Ca u s e d b y IU G R I n c r ea s e d ri s k o f : N e o n at a l m o r t al i t y N e w b o r n co mp li c ati o n s L o w e r b irt h w ei g h t  g r ea t e r ri s k c o mpl i c ati o n s Pixabay/Public Domain

23. Sma l l f o r Ge s tati o n a l A g e N e w b o r n C o m pl i c at i o n s P erina t a l a s p h y xi a Ch r o ni c un d e r n o u r i s hm en t f r o m p l ac en t a C o n t r a c ti o n s a t bi r t h  h yp o x i a Hypothermia Hypoglycemia I mp ai r e d i mmu n e f u n c ti o n Hypocalcemia Polycythemia Nevit Dilmen/Wikipedia

24. La r g e f o r Ge s tati o n a l A g e G r ea t e r t h a n 400 g r a m s ( 8 . 8 lb s ) o r 90 t h p e r c enti l e Associations: Maternal diabetes (gestational or preexisting) E x c e ss iv e m a te r n a l w eig h t (Obesity) Øy v ind Hol m s tad /Wiki p e dia

25. La r g e f o r Ge s tati o n a l A g e Complications M a c r oso m i a a sso c ia t e d w it h b i r t h i n jur ie s M a t erna l c o mpl i c ati o n s V ag in a l l ac e r a ti o n s S e v e r e p o s t p a r tu m h e m o r r h a g e In c r e a s e d li k eli h oo d o f c e s a r e a n d el iv e r y I n f an t c o mpl i c ati o n s Sh o ul d e r d y s t oc i a B r ac hi a l p l e x u s inju r y C l a v i c ula r f r ac tu r e Shoulder Dystocia Wikipedia/Public Domain

26. The end 7/17/2023 Dr. Abdiwahid Ahmed MBBS 26