1) The document discusses the premature newborn infant and issues surrounding prematurity such as general problems, survival rates, potential long-term sequels, and future challenges. 2) Premature infants are born before 37 weeks gestation and have immature organ systems, putting them at risk for problems like difficulties feeding and maintaining temperature as well as respiratory and brain issues. 3) While survival rates for extremely premature infants have increased due to medical advances, rates of disabilities like cerebral palsy and mental retardation have remained constant, demonstrating the need for continued research into preventing long-term injury.

1. The premature newborn infant
Ola Didrik Saugstad
Department of Pediatric Research
Rikshospitalet University Hospital
University of Oslo, Norway
Student lecture 9th semester

2. Prematurity
• GA < 259 days (37 weeks)
• Norway: 5.6% (1988) and 6.5% (1996)
• < 1.5 kg 0.7-1.0% (528 = 0.9% in 1996)
• < 1.0 kg 0.3 % (200 =0.3% in 1996)
• USA: 7% among caucasians 18%
among black

3. Preterm infants
• Slight 32-36 weeks
Feeding and temperature problems,
some have immature lungs
• Moderate 28-31 weeks
Immature lungs, temperature control,
feeding problems, apneas
• Severe < 28 weeks
Immature organ systems, intensive care
Slight and moderate approx 3000, severe 200 (0.3-0.4%) per year

4. Terminology
• Low birth weight < 2.5 kg
• Very Low Birth Weight < 1.5 kg
• Extremely Low birth Weight < 1.0 kg
• Premature < 37 weeks
• Immature < 28 weeks
• ELGAN: Extremely Low Gestational Age
Newborn < 26 weeks
• Small for gestational age < 2.5 percentile

5. General problems in premature infants
• Feeding: (IV – Gavage)
• Temperature control: (incubator-heated bed)
• Respiratory control: apneas, Respiratory
support CPAP, Artificial ventilation
• Immature lungs – lack of surfactant: Oxygen
suppl, Respiratory support (CPAP, ventilator)
• Immature brain: brain hemorrhage and cysts
• Immunology: risk of infections (antibiotics)
• Organ injury (Brain, Eye, Lung, Intestine,
Skin
• Long term consequences

6. Survival
1940: 50% with BW1500 gram survive
2000: 50% with BW 600 gram survive
Birth weight % Survival after 1 year
350-499 g 14
500-799 g 47
750-999 g 76_______________
Medical Birth Registry 1992-96

7. Survival
Gestational age weeks Survival %
21 0-4
22 0-12
23 8-36
24 12-62
25 31-79
26 53-85
NFR’s Consensus report 1999

8. Sequels
From 1979 to 1994 survival among
preterm infatns with BW 501-800 gr
increased from 20 to 59%.
The percentage of children with severe
neurosensory injury was however,
unchanged
(O’Shea 1997)

9. Injury of ELGANs 1972-1990
< 26 uker < 800 gram
Mental retardation 14% 14%
Cerebral palsy 12% 8%
Blindness 8% 8%
Deafness 3% 3%
”Major disability” 22% 24%
Survival increased, however rate of injury was
constant
Lorents JM et al 1998, (meta-analysis including > 4000 children)

10. Injury of preterm infants
• Eye ( Retinopathy of prematurity ROP
Stage 1-5)
• Brain injury (Intracranial hemorrhage (grade
1-4) Periventricular leukomalacia PVL).
Immature capillaries (plexus Choroides),
hemodynamic changes, intrauterine
inflammation
• Pulmonary ( Bronchopulmonary dysplasia -
BPD, Chronic lung disease - CLD)
• Intestinal (necrotizing enterecolitis - NEC)

11. Development and pathogenesis of ROP

12. Impact of BPD, Brain Injury &
ROP on 18 m Outcome of ELBW
Infants
Schmidt B et al. JAMA. March 2003;289:1121-
“ A simple count of 3 common neonatal morbidities
strongly predicts the risk of later death or disability ”
Overall probability of a
poor outcome @ 18 m
(35%)

13. School problems
• A Dutch study showed that > 50% with BW < 1500 gram
needed extra support at school
• No relation between Gestational age and injury
• Preterm infants have to be followed-up at least till
school age because these problems have a late debut.
Learning problems picked up around 8 years
ADHD
Hyperactivity
Intellectual problems (arithmetics, solving problems, cognitive
functions)
Short term memory
Coordination problems
Behavioral problems (shy, sport performance, sosialise )
Boys> girs
Low Socioeconomic conditions

14. Future challenges
• Prevent preterm birth
• Understand relation between intrauterine
conditions and postnatal injury
• Improved nutrition
• Improved technology
• New drugs (antioxidants, anti inflammatory,
etc)
• New insight into the needs and the
psychological development