Prematurity and its complication

COMPLICATIONS OF PREMATURITY

1. PREMATURITY AND ITS COMPLICATIONS SINGI

2. OUTLINES DEFINITIONS CLASSIFICATION RISK FACTORS CAUSES CLINICAL PRESENTATION Ddx COMPLICATIONS

3. DEFINITION “Live born infants delivered before 37 wk from the 1st day of the last menstrual period are termed premature “ by WHO Prematurity is associated with more M&M, compared to the full term infants The lower the GA the more Complications increase

4. Birth weight and its related gestational age

5. CLASSIFICATION Classifications based upon GA: Extremely preterm -GA <28 WKS Very preterm (VPT) –GA 28-32 WKS Moderate to Late preterm -GA btn 32 -37 WKS

6. Classifications based on BW: Low birth weight (LBW) –BW<2500g Very low birth weight (VLBW)-BW<1500g Extremely low birth weight (ELBW)-BW<1000g WHO

7. RISK FACTORS Low socio-economic status H/o previous prematurity,or VLBW Single-parent families Teanage pregancies Short interpregnancy interval Multiparity Tobacco Pediatrics blue prints 3 rd edition

8. Causes of prematurity Fetal   :   - Fetal distress    -Multiple gestation    - Erythroblastosis    - Congenital malformations -Twin-twin blood transfusions Intrauterine infection (TORCH, SYPHILIS) Nelson Textbook of pediatric 20th edition  (P.1102 )

9. Uterine causes Nelson Textbook of pediatric 20th edition  (P.1102 )

10. Causes of prematurity Maternal    Preeclampsia Malnutrition and anemia   Chronic medical illness (cyanotic heart disease, diabetes, HTN, renal disease)   Infection ( GBS, malaria, UTI, Chorioamnitis …. Drug abuse ( cocaine ) Pediatrics blue prints 3 rd edition

11. Causes of prematurity Other    Premature rupture of membranes   Polyhydramnios    Iatrogenic    Trauma Pediatrics blue prints 3 rd edition

12. CLINICAL PRESENTATION

13. Weak or absent moro reflex, sucking and grasping may be extended due to poor tone

14. The new BALLARD SCORE, Best- <12hrs( <26 wks ) upto 96 hrs ( >26 wks )

15. DDX Fetal growth restriction medscape

16. NEONATAL PROBLEMS ASSOCIATED WITH PREMATURE INFANTS RESPIRATORY Respiratory distress syndrome (hyaline membrane disease,) Pneumothorax , and baro trauma when providing oxygen Congenital pneumonia Apnea, immature respiratory centre Nelson Textbook of pediatric 20th edition  (P.1104 )

17. CARDIOVASCULAR Patent ductus arteriosus Hypotension Bradycardia (with apnea) Nelson Textbook of pediatric 20th edition  (P.1104 )

18. 19 Hematologic    Anemia (early or late onset)     Disseminated intravascular coagulopathy    Vitamin K deficiency   

19. GASTROINTESTINAL Poor gastrointestinal function—poor motility Necrotizing enterocolitis Hyperbilirubinemia —direct and indirect Nelson Textbook of pediatric 20th edition  (P.1104 )

20. METABOLIC -ENDOCRINE Hypocalcemia Hypoglycemia Hyperglycemia Hypothermia Nelson Textbook of pediatric 20th edition  (P.1104 )

21. CNS Intraventricular hemorrhage Seizures Retinopathy of prematurity Deafness Hypotonia Nelson Textbook of pediatric 20th edition  (P.1104 )

22. RENAL Hyponatremia Hypernatremia Hyperkalemia Renal tubular acidosis Renal glycosuria Edema Nelson Textbook of pediatric 20th edition  (P.1104 )

23. INFECTIONS Congenital Perinatal Nosocomial: bacterial, viral, fungal, protozoal Nelson Textbook of pediatric 20th edition  (P.1104 )

24. LONG TERM COMPLICATIONS Recurrent hospitalisations Broncho pulmonary displasia Retinopathy of prematurity Poor growth due to feeding problems , vit& Iron defociency CNS dysfunction , CP, Learning difficulty , deafness , hydrocephalus uptodate

25. CARE AFTER BIRTH The presence of a pediatrician in delivery room is very important Initiate breathing (resuscitation may be needed) Care for the umbilical cord Eye prophylaxis Vit K Thermal regulation  »  »36.5- 37.0°c + head cap+KMC Monitoring (HR and saturation) Oxygenotherapy Feeding , 105-130 kcal/kg/ day , hypoglycemia below 40mg/dl in 48h and then below 50 Discuss with mother on complications of prematurity Nelson Textbook of pediatric 20th edition  (P.1104 )

26. REFERENCE Nelson textbook of pediatrics Medscape

27. Thank you