Neonatology, Pediatrics

1. PREMATURITY
Agrima Satheesh
Roll no.08
19th batch

2. PREMATURITY
• This refers to preterm babies
• These are child born before 37 completed weeks of gestation
• These are babies “born too soon”
• Prematurity accounts for 16% neonatal death and 2% postneonatal deaths

3. PRETERM BIRTH CLASSIFICATION
• Extremely preterm <28 weeks
• Very preterm 28-<32 weeks
• Moderate to late preterm 32-37 weeks

4. CAUSES: MATERNAL CAUSES
• Age: Common in adolescents and elderly women
• Short stature women
• Lack of birth spacing
• Undernutrition, obesity, anemia
• Lifestyle factors: Smoking, alcohol, drug abuse
• Multiparity
• Maternal conditions: Cervical incompetence, placental insufficiency, antepartum
hemorrhage, pre-eclampsia and eclampsia, uterine rupture, diabetes

5. PREVIOUS PREGNANCY RISK FACTORS
• Previous preterm birth
• Previous first or second trimester loss
• Previous induced abortion

6. GESTATIONAL AGE ASSESMENT: NEW BALLARD
SCORE

7. PREDICTION OF PRETERM LABOUR
• Prior preterm birth
• Ultrasound cervical length: Cervical length assessment by transvaginal ultrasound
Cervical length <25mm at 24 weeks Preterm delivery
Cervical length >25mm at 24 weeks: Risk of preterm birth low
• Fetal fibronectin: Fibronectin is a fetal glycoprotein ie, expressed in first half of
pregnancy. After 20 weeks, it is not detectable until membrane rupture
If detected in cervicovaginal secretion before rupture of membrane
indicates disruption of maternal fetal interface Preterm labour
Measured by ELISA: >/= 50 ng/mL indicate preterm labour

8. FEATURES OF PRETERM NEONATES
(a) Flat and soft pinna cartilage not reaching upto periphery
(b) Light pigmentation and not yet descended testes
(c) Faint marks on sole, no deep creases
(d) Poorly developed breast bud
(e) Fuzzy hair
(f) Prominent labia minora and clitoris only present

9. PROBLEMS OF PRETERM BABIES
• Immediate
• Long term

10. IMMEDIATE COMPLICATIONS
• Hypothermia
• Hypoglycemia
• Respiratory difficulties
• Intra-ventricular hemorrhage
• Liver immaturity
• Increased susceptibility to infections
• Pectus ductus arteriosus
• Feeding problems
• Retinopathy

11. HYPOTHERMIA
• It occurs due to:
High surface area to body weight ratio
Little subcutaneous fat
Muscular inactivity
Immature heat regulation mechanism
Inadequate swaeting mechanism

12. RESPIRATORY PROBLEMS
• Surfactant deficiency leads to respiratory distress syndrome
• Immaturity of respiratory centre lead to periodic breathing and frequent apneic
spells

13. INTRA-VENTRICULAR HEMORRHAGE
• It is due to immature vasculature
• Clotting factor deficiency
• Disturbed cerebral auto-regulation of blood flow

14. LIVER IMMATURITY
• It results in prolonged physiological jaundice due to immaturity of liver enzymes
• Increased risk of kernicterus at lower bilirubin level

15. SUSCEPTIBILITY TO INFECTIONS
• Due to lack of maternal immunoglobulins (IgG) ie, transferred across placenta
during last trimester
• Delicate skin surface and mucous membrane predispose to infections
• Insertion of IV cannula, endotracheal tubes, nasogastric tubes increase risk of
infections

16. PATENT DUCTUS ARTERIOSUS
• Duct remain open in premature babies leading to heart failure
FEEDING PROBLEMS
• It results from uncoordinated sucking and swallowing
• Also due to gastro-esophageal reflux leading to frequent aspiration

17. CHRONIC PROBLEMS
• Chronic lung disease
• Poor growth
• CNS dysfunction

18. CHRONIC LUNG DISEASE
• Prolonged ventilation and oxygen toxicity results in chronic oxygen dependency
POOR GROWTH
• Growth is restricted due to feeding problems, vitamin and iron deficiency

19. CNS DYSFUNCTION
• Cerebral palsy due to intra-ventricular hemorrhage
• Pst hemorrhagic hydrocephalus
• Learning problems
• Deafness
• Mental subnormality

20. THANK YOU