This document discusses prematurity and its complications. It defines prematurity as a live birth before 37 weeks gestation. The incidence in Pakistan is estimated at 11-13%. Causes of prematurity include maternal, uterine, fetal and other factors such as infections and socioeconomic status. Complications of prematurity can be immediate such as respiratory issues, intraventricular hemorrhage, and infections, or long term such as cerebral palsy and developmental delays. Management involves proper delivery room care, maintaining temperature and fluids, screening for complications, proper feeding and supplementation. Outcomes depend on gestational age and birth weight, with survival rates increasing with advances in neonatal intensive care.
This presentation is about Malnutrition in Pediatrics; Epidemiology, Risk factors, etiology, Clinical Evaluation, plotting on Growth charts and Management are Covered.
A short presentation including a fictitious case study on prematurity. Focusing on the causes of prematurity, acute complications, chronic complications and bronchopulmonary dysplasia.
This presentation is about Malnutrition in Pediatrics; Epidemiology, Risk factors, etiology, Clinical Evaluation, plotting on Growth charts and Management are Covered.
A short presentation including a fictitious case study on prematurity. Focusing on the causes of prematurity, acute complications, chronic complications and bronchopulmonary dysplasia.
Pre-term, Small for gestational age and Post-term InfantLipi Mondal
Due to high risk of pregnancy there are several adverse outcome or poor perinatal outcome we can see.... So most commonly adverse out come should be known by health care providers.
INTRODUCTION
A newborn, regardless of gestational age or birth weight, who has a greater than average chance of morbidity or mortality because of conditions or circumstances superimposed on the normal course of events associated with birth and the adjustment to extra uterine existence.
FACTORS – TO DEFINE HIGH RISK NEWBORN
DEMOGRAPHIC SOCIAL FACTORS:
Maternal age <16 or >40, unmarried, physical stress, socio-economic status.
PAST MEDICAL HISTORY:
Diabetes Mellitus, genetic disorder, hypertension
PREVIOUS PREGNANCY:
Intrauterine death, neonatal death, IUGR, congenital malformations.
PRESENT PREGNANCY:
Vaginal bleeding, PROM, multiple gestation, pre-eclampsia, abnormal USG findings.
LABOR: AND DELIVERY:
Obstructed labor, fetal distress, forceps delivery, meconium stained liquor.
NEONATE:
Birth weight <2000 or >4000, gestation <37 or >42.
DEFINITIONS
Low birth weight: Live born baby weighing 2500 gram or less at birth. (VLBW: <1500 gm, ELBW: 000 gm).
Preterm: When the infant is born before term i.e. before 38 weeks of gestation.
Premature: When the baby is born before 37 weeks of gestation.
Full term: When the infant is born between 38-42 weeks of gestation.
Post term: When the baby is born after 42 weeks of gestation.
HYPOTHERMIA
DEFINITION
It is a condition characterized by lowering of body temperature than 36℃.
TYPES OF HYPOTHERMIA
It can be classified according to causes and according to severity.
CLASSIFICATION BASED ON CAUSE:
Primary Hypothermia:
Seen immediately after delivery.
Normal term baby delivered into a warm environment may drop its rectal temperature by 1 – 2℃ shortly after birth and may not achieve a normal stable body temperature until the age of 4 – 8 hours.
In low birth weight baby, the decrease of body temperature may be much greater and more rapid unless special precautions are taken immediately after birth. (Loss at least 0.25℃./min).
Secondary Hypothermia:
This occurs due to factors other than those immediately associated with delivery.
Important contributory factors are: e.g. acute infection especially septicaemia.
CLASSIFICATION BASED ON SEVERITY:
According to severity:
Mild Hypothermia: <36℃.
Moderate Hypothermia: <35.5℃.
Severe Hypothermia: <35℃.
CLINICAL FEATURES
Decrease in body temperature measurement.
Cold skin on trunk and extremities.
Poor feeding in the form of poor suckling
Shallow respiration
Cyanosis
Decrease activity, e.g. weak cry.
FOUR MODALITIES OF HEAT LOSS IN NEONATES
Evaporation: Heat loss that resulted form expenditure of internal thermal energy to convert liquid on an exposed surface to gases, e.g. amniotic fluid, sweat.
Prevention: Carefully dry the neonates after delivery or after bathing.
Radiation: It occurred from body surface to relatively distant objects that are cooler than skin temperature.
Conduction: Heat loss occurred from direct contact between body surface and cooler solid object.
Prevention: Keep the baby out of drafts and close end of heat shield in in
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. Definition
It is defined as live born infant delivered before 37
weeks from the first day of the last menstrual period.
4. Incidence
The exact incidence in Pakistan is not known.
Estimated 11-13%
It includes both small for gestational age (SGA) and
appropriate for gestational age (AGA)
5. Appropriate birth weight at different
gestational ages
Gestational age Mean birth weight
24 weeks 600 g
25 weeks 750 g
26 weeks 850 g
28 weeks 1000 g
30 weeks 1400 g
32 weeks 1750 g
34 weeks 2000 g
36 weeks 2500 g
38 weeks 3000 g
40 weeks 3500 g
6. Scenario 1
2days old female born at 28 weeks of gestation with
birth weight of 800 g
What can be the probable causes of this preterm
birth?
12. Scenario 2
1 hour old male neonate born at 25 weeks of
gestation due to abruptio placenta
Birth weight of 575 g
APGAR score: 6
1. Blue extremities
2. Pulse 102
3. Feeble cry at stimulation
4. Some flexion
5. Weak irregular breathing
What can be the complications faced by this
neonate?
14. Immediate (acute) problems
1. Hypothermia
2. Hypoglycemia
3. Hypocalcemia
4. Respiratory difficulties
5. Intra-ventricular hemorrhage (IVH)
6. Liver immaturity
7. Increased susceptibility to infections
8. Necrotizing enterocolitis (NEC)
9. Patent ductus arteriosus
10. Feeding problems
11. Anemia of prematurity
12. Retinopathy of prematurity
13. Metabolic bone diseases of prematurity
15. Hypothermia
It occurs in preterm babies due to:
High surface area to body weight ratio
Little subcutaneous fat
Muscular inactivity
Inadequate sweating mechanism
Decreased brown fat
Immature heat regulation mechanism
16. Hypoglycemia
It is common due to lack f glycogen stores and
immature hepatic and autonomic responses
18. Respiratory difficulties
Hyaline membrane disease due to surfactant
deficiency leading to IRDS
Apneic spells: the immaturity of respiratory centre
may lead to periodic breathing and frequent apneic
apells
19. Intra-ventricular hemorrhage (IVH)
It is common in preterm infants due to:
Immature vasculature
Disturbed cerebral auto-regulation of blood flow
Clotting factor deficiency
20. Liver immaturity
It results in prolonged physiological jaundice due to
immaturity of liver enzymes and there is increased
risk of kernicterus at relatively lower bilirubin level
21. Increased susceptibility to infections
It results from lack of the protective maternal
immunoglobulins (IgG), which are transferred across
the placenta during the last trimester
In addition to this, delicate surfaces of skin and
mucous membranes also predispose to infections
Insertion of IV cannula, endotracheal tubes,
nasogastric tubes also increase the risk of infections
22. Necrotizing enterocolitis (NEC)
There is increased susceptibility to NEC due to
immaturity of gut endothelial surfaces and enzyme
deficiencies
The risk increases with lack of breast feeding,
umbilical catheterization and septicemia
23. Patent ductus arteriosus (PDA)
The duct may remain open in premature babies
leading to heart failure
24. Feeding problems
These result from uncoordinated sucking and
swallowing and also from gastro-esophageal reflux
leading to frequent aspirations
25. Anemia of prematurity
Anemia occurs due to decreased iron stores, vitamin
E deficiency and exaggerated physiological anemia
26. Retinopathy of prematurity
There is abnormal vascularization due to immaturity
and oxygen therapy leading to partial or complete
blindness
27. Metabolic bone disease of prematurity
There is a lack of substrate (calcium and phosphate)
and vitamin D deficiency resulting in rickets
28. Long term problems
Chronic lung disease (bronchopulmonary dysplasia)
Poor growth
CNS dysfunctions
29. Chronic lung disease (bronchopulmonary
dysplasia)
Prolonged ventilation and oxygen toxicity results in
chronic oxygen dependency
30. Poor growth
Growth is restricted due to feeding problems, vitamin
and iron deficiency
31. CNS dysfunctions
Cerebral palsy due to intraventricular hemorrhage
Post hemorrhagic hydrocephalus
Learning problems
Deafness
Mental subnormality
32. Assessment of gestational age
Gestational age can be assessed appropriately in
weeks by simple visual assessment of certain
physical signs and more accurately by using Ballard
scoring system
33. Rapid visual assessment of gestational age
Physical signs Assessment Gestational age
Sole creases Absent 32 wks or less
1-2 anterior sole 36 weeks
All over sole 40 weeks
Breast nodule Not palpable 34 weeks
3 mm 36 weeks
4-10 mm 40 weeks
Scalp hair Short fuzzy 37 weeks
Coarse, individual 40 weeks
Ear cartilage Poorly developed 32-34 weeks
Well developed 36-40 weeks
Testicular descent Un-descended 25 weeks
Inguinal region 32 weeks
Completer descent 40 weeks in 90%
Scrotal rugae Anterior 36 weeks
Entire scrotum 40 weeks
34. Ballard score
Physical and neuromuscular criteria of maturity are
given in Expanded New Ballard score (NBS). It now
also includes extremely premature infants and has
been refined to improve accuracy in more mature
infants
In Ballard score, physical and neurologic scores are
added and by this added score, gestational age is
calculated
The score is accurate within 2 weeks of gestation in
infants weighing >999 g at birth and is most accurate
at 30-42 hours of age
35.
36.
37. Management
The management of preterm baby is based upon the
proper anticipation and prevention of complications
38. Delivery room care
Every preterm delivery should be attended by a
pediatrician
Proper resuscitation at birth, early stabilization of
vital signs, prevention of hypothermia and
hypoglycemia in delivery room is related with good
outcomes with minimal complications
39. If baby is of good size and vigorous, then by simply
cleaning airways, wrap the baby properly and shift
to well baby nursery with instructions of early
feeding and monitoring for hypoglycemia and
hypothermia
If baby weight is very low < 1kg, then electively
incubate the baby and shift to NICU for ventilator
care
Babies weighing 1-1.5kg should also be shifted to
NICU for observation and management of potential
problems
40. After birth care
Maintain thermo-neutral environment
Maintenance of fluid and electrolyte balance
Oxygen administration
Feeding
Supplementation of iron and vitamins
Protection from infection
Early detection and management of complications of
prematurity
Immaturity of drug metabolism
41. Maintain thermo-neutral environment
It is environmental temperature at which heat
production and O2 consumption is minimal yet the
core temperature is maintained within normal range
Maintain temperature of nursery in range of 25-
30°C
Place the baby in incubator, keep humidity at 70%
42. Temperature of incubator varies with age by setting
air temperature or by setting skin temperature of
baby
Temperature can be maintained by the use of
radiant heaters by wrapping the baby properly and
by the use of mitten on hands and socks on feet and
cap on head if nursed in cot
Weight Temperature
> 2 kg 31-33˚ C
1.5-2.0 kg 32-34° C
1.0-1.5 kg 32-35˚ C
< 1 kg 35-37° C
43. Maintenance of fluid and
electrolyte balance
Preterm babies need more fluids as compared to full
term infants
Baby should be carefully monitored for
hypoglycemia, hypo or hyper-natremia and hyper-
kalemia by frequent blood samples and their
correction
Fluid requirement of premature baby
1st day 60-80 ml/kg/day
2nd day 80-100 ml/kg/day
3rd day 100-110 ml/kg/day
4th day 120-130 ml/kg/day
5th day and onwards 150-160 ml/kg/day
44. Oxygen administration
O2 administration should be carefully monitored in a
very premature infant because concentration of O2
more than 40% increases the risk of lung and visual
toxicity (bronchopulmonary dysplasia and retrolental
fibroplasia)
45. Feeding
The method of feeding should be individualized as it
varies with weight and gestational age of infant
The process of oral feeding in addition to sucking
requires coordination of swallowing, epiglottic
closure of larynx, normal esophageal motility, a
synchronized process which is usually absent prior
to 34 weeks of gestation
46. If the infant is more than 35 wk gestation, weighing
> 2kg and there is no contraindication of feeding like
persistent vomiting, RDS, sepsis, seizures etc; he
should be started on oral feeding preferably by
breast milk or infant formula with bottle or cup and
spoon
If baby cannot suck and general condition is better,
tube feeding is preferred
If very sick or premature, then total or partial
parenteral nutrition is the choice
47. Supplementation of iron and vitamins
Every preterm infant should receive supplement
vitamins in addition to breast milk until full mixed
feeding is established or weight is more than 2250
gm
All preterm babies should receive vitamin K
prophylaxis 1 mg at birth
Requirement of vitamin A, D, B6 and C is fulfilled by
simply prescribing 0.6ml Vidaylin drops per oral
48. Iron supplementation should be started at the age
of 4-8 weeks at dose of 2mg/kg/day
Before this age it is not well absorbed and also
increases the risk of gastrointestinal infection and
also predisposes to vitamin E deficient hemolysis
49. Protection from infection
Proper antiseptic measures should be taken in
maintenance of nursery, incubator and other
equipment and in addition proper hand washing,
cleansing of preterm baby, proper cord care are very
important
All procedures in nursery should be done with strict
aseptic measures
50. Early detection and management of
complications of prematurity
It can be done by good nursery care, monitoring of
heart rate, respiratory rate, temperature, blood
pressure, activity, daily weight and intake and output
record
Oxygen saturation monitoring is very important in
care of preterm babies
51. Immaturity of drug metabolism
Due to renal and hepatic immaturity and diminished
renal and hepatic clearance of almost all drugs,
intervals between doses should be extended
52. Prognosis
It is related to gestation and birth weight
With new advancement in neonatal intensive care in
developed countries, the survival rate for 24 wk
gestation is 25%. But still there is marked disability in
survivors
5-10% of babies with birth weight less than 1500 gm
have major handicap such as cerebral palsy,
developmental delay, blindness or deafness
Risk increases with decreasing gestational age and
weight
53. Discharge criteria for preterm
A premature infant should be taking feed by nipple
(either bottle or breast feed)
Baby should be gaining weight properly (10-30
g/day)
Temperature should be stabilized in an open cot
There should be no recent episode of apnea or
bradycardia
There should be no parenteral drug administration, it
may be converted to oral dosing