This document discusses prematurity and its complications. It defines prematurity as infants born before 37 weeks gestation according to the WHO. Prematurity is classified based on gestational age as extremely, very, or moderate to late preterm. It can also be classified based on birth weight as low, very low, or extremely low. Risk factors include socioeconomic status, previous prematurity, and maternal health conditions. Causes include fetal, uterine, maternal, and iatrogenic factors. Clinical presentation includes weak reflexes and poor muscle tone. Complications involve respiratory, cardiovascular, gastrointestinal, metabolic, central nervous system, renal, and infectious issues. Long term complications may include developmental delays. Care after birth focuses on stabilization, monitoring,

1. PREMATURITY AND ITS COMPLICATIONS
SINGI

2. OUTLINES
i. DEFINITIONS
ii. CLASSIFICATION
iii. RISK FACTORS
iv. CAUSES
v. CLINICAL PRESENTATION
vi. Ddx
vii. 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 3rd 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 3rd edition

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

16. DDX
• Fetal growth restriction
medscape

17. 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)

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

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

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

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

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

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

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

25. 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

26. 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)

27. REFERENCE
• Nelson textbook of pediatrics
• Medscape

28. Thank you