This document provides an overview of prematurity, including definitions, epidemiology, complications, management, and feeding recommendations. Prematurity is defined as birth before 37 weeks gestation and can be classified by gestational age or birth weight. Complications of prematurity include respiratory distress, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and apnea. Management involves prevention strategies like antenatal steroids and supportive care like supplemental oxygen and antibiotics. Feeding recommendations start with minimal enteral feeds advancing slowly based on tolerance to minimize risks like necrotizing enterocolitis.

1. PREMATURITY
Presented by:
Kpehe Jig Maimie - Intern
Complications
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2. Content
 Overview
 Assessment of Gestational Age
 Ballard Score
 Epidemiology
 Complications ( Short & Long Term)
 Management
 Feeding
 References

3. Overview
 Birth that occurs before 37 completed weeks ( < 259 days) of
gestation (Uptodate)
 Can be classified by: a) Gestational Age
b) Birth Weight
GESTATIONAL AGE
a) Late Preterm Birth : GA b/w 34 & < 37 weeks
b) Very Preterm Birth : GA less than 32 weeks
c) Extremely Preterm Birth : GA at or <28 weeks
BIRTH WEIGHT
a) Low Birth Weight (LBW) : BW less than 2500g
b) Very Low Birth Weight (VLBW) : BW less 1500g
c) Extremely Low Birth Weight (ELBW) : BW less than 1000g

4. ETIOLOGY
Fetal Placenta Uterine
a) Fetal Distress
b) Multiple Gestation
c) Erythroblastosis
d) Nonimmune Hydrops
e) TORCH
f) Chromosomal disorders
a) Placenta Dysfunction
b) Placenta previa
c) Abruptio Placentae
a) Bicornuate Uterus
b) Incompetent Cervix
(Premature Dilatation)
Maternal Others
a) Pre-clampsia
b) Chronic Dz (Cyanotic CHD, Renal Dz)
c) Infections (Group B Strep, Listeria, Bacterial Vaginosis,
Chorioamnionitis)
d) Drug Abuse (Cocaine)
a) ROM
b) Polyhydramnios
c) Latrogenic
d) Trauma

5. Assessment of Gestational Age
Assessed by:
A. Simple Visual Assessment of
Certain Physical Signs
B. Using the Ballard Scoring
System (Accurate)

6. Rapid
Visual
Assessment
of
Gestational Age

7. Ballard Score

8. Ballard Score

9. EPIDEMIOLOGY
 Estimated 15 million babies are born Preterm worldwide
( > 1 in 10 babies)
 Accounts for 11.1% of the World live births w/ 60% occurring
in Sub – Saharan Africa & Asia
 Globally, prematurity is the leading cause of death ↓ 5 yrs
 With 1 million children dying each year due to preterm
complications
 Many survivor face lifetime of disability (Neurological or
Educational, Visual & Hearing Impairments)

10. COMPLICATIONS
Short Term
Long Term

11. SHORT TERM COMPLICATIONS
Respiratory
1. Respiratory Distress Syndrome (Hyaline Membrane dz)
2. Bronchopulmonary dysplasia
3. Pneumothorax, Pnuemomediastinum, Interstitial Emphysema
4. Congenital Pnuemonia
5. Apnea
Cardiovascular
1. Patent Ductus Arteriosus
2. Hypertension
3. Bradycardia w/ apnea
Hematologic
1. Anemia (early or late Onset)

12. Gastrointestinal
1. Poor Motility
2. Necrotizing Enterocolitis
3. Hyperbilibinemia - Direct or indirect
4. Spontaneous Gastrointestinal isolated Perforation
Metabolic – Endocrine
1. Hypoglycemia
2. Hyperglycemia
3. Hypocalcemia
4. Late Metabolic Acidosis
5. Hypothermia
6. Euthyroid but low thyroxine status
7. Hyponatremia
8. Hypernatremia
SHORT TERM COMPLICATIONS

13. Central Nervous System
1. Intraventricular Hemorrhage
2. Periventricular Leukomalacia
3. Seizures
4. Retinopathy of Prematurity
5. Deafness
6. Hypotonia
Renal
1. Renal Tubular Acidosis
2. Renal glycosuria
3. Edema
INFECTION: Congenital, Perinatal, Nosocomial, Viral, Bacterial, Fungal
Protozoal
SHORT TERM COMPLICATIONS

14. 1. Neurodevelopmental Disabilities
 Impaired Cognitive skills
 Motor deficits (mild fine or gross motor delay & Cerebral Palsy)
 Sensory Impairment eg. Vision & Hearing Loss
 Behavioral & Psychological problem
2. Growth Impairment
3. Impairment of Lung Function
4. Effects on Adult Health
 Insulin Resistance
 Hypertension & Vascular Changes
 Decrease Reproduction
LONG TERM COMPLICATIONS

15. Management
Commonly Seen Complications

16. HYPOTHERMIA (< 36 0C )
Rapid heat loss due to large body surface area & inability to produce
enough heat (↓ Subcutaneous Fat)
PREVENTION - Standard Care in Delivery Room
a) Delivery room Temp. at a minimum of 26 0C
b) Dry Baby immediately after birth
c) Remove wet blankets
d) Use of pre – warmed Radiant Heater
NICU -
• Place infant in Incubator or Radiant warmer
• Kangaroo Care (Skin to Skin Contact)
• Conductive thermal Mattresses
• Polyethylene bags for Pre – term b/w 26 to 36 weeks

17. HYPOTHERMIA (< 36 0C )
Incubator Temperature varies w/ Age

18. NECROTIZING ENTERCOLITIS
 ↑ Mortality ( 2 – 10%, VLBW Infants)
 ↑ Risks of growth delay & Neurodevelopmental disability
 Signs: Abd. Distension, Bile stained Vomitus, Blood in Stool
TREATMENT - SUPPORTIVE
a) Bowel Rest - discontinue enteral feeding
b) GI Decompression via NG tube until ileus resolves or
Pneumatosis disappears on Abd X – ray
ANTIOBIOTICS – BROAD SPECTRUM (Duration: 10 – 14 days)
• Ampicillin + Gentamicin + Metronnidazole
• Ampillicin + Gentamicin + Clindamycin
• Ampicillin + Cefataxime + Metronidazole
• Vancomycin + Piperacillin Tazobactam + Gentamicin
Perforation : SURGERY
a) Primary Peritoneal Lavage
b) Laporotomy

19. INTRAVENTRICULAR HEMORRAHGE
 No Specific therapy to limit the extend of IVH once it
occurs or Prevent it’s sequela – Post Hemorrhagic
Hydrocephalus
PREVENTION - ↓ Risks
a) Antenatal Corticosteroid
b) Delay in clamping of Umbilical
Cord (30 – 60s )
a) Administration of :
Indomethacin & Vit E + Gentamicin

20. RETINOPATHY OF PREMATURITY
 Developmental vascularized proliferative disorder occurring
in the incompletely vascularized retina of the Preterm
 Resolves Spontaneously in maturity of Patients
 Severe untreated ROP → Vision Impairment

21. Patent Ductus Arteriosus
 Characterized by Left – Right Shunt
 ↑ Bld flow to Pulmonary Circulation & Hypo-perfusion of
Systemic Circulation
 Significant PDA → Apnea, Resp. Distress, Heart Failure
Closing Defect is Contraindicative -
* Indomethacin & Iburofen must not be given.

22. Respiratory Distress Syndrome
 Results from Surfactant deficiency
 Occurs w/in the first 3 days of life
 Clinical features become obvious w/in 4 hrs
 Tachypnea
 Expiratory Grunts
 Intercostal / Subcoastal Retractions
 Cyanosis
Rx : Supplemental O2 - keep Sat. > 90% but < 95% (Avoid Eye Damage)
Initially, No oral feeding; Give IV fluid (glucose – NS); IV Antibiotics
- Continue Positive Airway Pressure [CXR – Pneumothorax]

23. APNEA
PREVENTION
DRUGS: Caffeine Citrate or Aminophylline
Dosing :
• LOADING - Caffeine Citrate @ 20mg/kg PO/IV (over 30 mins)
• Maint - @ 5mg/kg/day; 24 hrs later. Can ↑ 5mg/kg/day
max: 20mg/day (Cont’d 4 -5 days after cessation of apnea)
• LOADING – Aminophylline @ 6mg/kg IV (over 20 mins)
• Maint - @ 2.5mg/kg IV Q12hr

24. FEEDING
 Preterms have feeding difficulties
 Wt < 1.5kg at Birth have ↑ risk of Feeding Problem & NEC
BW < 1.5kg - 60ml/day
- 10ml/day of enteral Feeds remaining 50ml/kg IV fluid
INFANT WELL & ACTIVE
 Give : 2 – 4ml EBM Q12hr via NG Tube
 Check Bld Sugar Q6hr
 Add: 10ml of 5% glucose to 90ml of 4.3 glucose + 0.18 NS
Start Enteral Feeding
 No Abdominal Distension & tenderness, + BS, Meconium passed

25. Enteral Feeding
• Initial: 2 – 4 ml (EBM) Q1-2hr via orogastric or NG tube
↑ by 1 – 2 ml per each feed
Pre-terms Babies need more fluid than Full term Babies

26. Daily Supplementation
a) Vit D @ 400 IU
b) Calcium @ 120 – 140mg / kg
c) Phosphorus 69 – 90 ml / kg
d) Iron @ 2 wks of Age ( 2 – 4mg /kg / day till 6 months)

28. References
 Nelson’s Essentials, 2017 Edition
 Medscape
 MOH / RL (PBF) – Hospital Quarterly Quality Assessment Tool
 WHO, Hospital Care for Children, 2nd Edition
 Uptodate.com
 Video (Youtude.com)
 Slideshare.com
.

29. Thank you