2. What is prematurity?
What is prematurity?
A baby born before 37 weeks of
pregnancy is considered
premature, that is, born before
complete maturity.
A baby born
before 37
weeks of
pregnancy is
considered
premature,
that is, born
before
complete
maturity.
Slightly fewer
than 12
percent of all
babies are
premature.
Overall, the
rate of
premature
births is
rising, mainly
due to the
large
numbers of
multiple births
in recent
years. Twins
and other
multiples are
about six
times more
likely to be
premature
than single
birth babies.
The rate of
premature
single births
is slightly
increasing
each year.
3. Many premature babies also weigh
less than 2.5 kg and may be referred
to as low birthweight (LBW).
5. Maternal factors :
Preeclampsia (also known as
toxemia or high blood pressure of
pregnancy).
Chronic medical illness (such as
heart or kidney disease).
Infection (such as group B
streptococcus, urinary tract
infections, vaginal infections,
infections of the fetal/placental
tissues).
6. Drug use (such as cocaine).
Abnormal structure of the uterus.
Cervical incompetence.
Previous preterm birth.
7. Factors involving the pregnancy:
Abnormal or decreased function of the
placenta.
Placenta previa (low lying position of
the placenta).
Placental abruption (early detachment
from the uterus).
Premature rupture of membranes
(amniotic sac).
Polyhydramnios (too much amniotic
fluid)
8. Factors involving the fetus :
When fetal behavior indicates the
intrauterine environment is not healthy.
Multiple gestation (twins, triplets or
more).
9. Why is prematurity a concern?
There are Some problems premature
babies may experience include:
1. Temperature instability :
- inability to stay warm due to low body
fat.
10. 2. Respiratory problems :
Hyaline membrane disease/respiratory distress
syndrome - a condition in which the air sacs cannot
stay open due to lack of surfactant in the lungs.
Chronic lung disease/ bronchopulmonary dysplasia
- long-term respiratory problems caused by injury to
the lung tissue.
Air leaking out of the normal lung spaces into other
tissues.
Incomplete lung development.
11. 3. Cardiovascular :
Patent ductus arteriosus (PDA) - a
heart condition that causes blood to
divert away from the lungs.
Too low or too high blood pressure.
Low heart rate - often occurs with
12. 4. Blood and metabolic:
Anemia - may require blood
transfusion.
Jaundice - due to immaturity of liver
and gastrointestinal function.
Too low or too high levels of minerals
and other substances in the blood such
as calcium and glucose (sugar).
13. 5. Gastrointestinal :
Difficulty feeding - many are unable to
coordinate suck and swallow before 34
weeks gestation.
Poor digestion.
Necrotizing enterocolitis (NEC) - a
serious disease of the intestine common
in premature babies.
14. 6. Neurologic :
Intraventricular hemorrhage - bleeding in the
brain.
Periventricular leukomalacia - softening of
tissues of the brain around the ventricles (the
spaces in the brain containing cerebrospinal
fluid).
Poor muscle tone.
Seizures - may be due to bleeding in the
brain.
15. 7. Infections :
- premature infants are more susceptible
to infection and may require antibiotics
16. Premature babies can have long-term
health problems as well. Generally, the
more premature the baby, the more
serious and long lasting are the health
problems.
17. What are the characteristics of
prematurity?
The most common characteristics of a
premature baby
Small baby, often weighing less than 2,500
grams .
Thin, shiny, pink or red skin, able to see
veins.
Little body fat.
Little scalp hair, but may have lots of lanugo
(soft body hair).
19. GA is estimated from:
The mother’s menstrual history,
An ultrasound done before 20 weeks
gestation
Assessment, using the Ballard
(Dubowitz) assessment tool.
Determine if the infant is small,
Large or appropriate for
gestational age.
20. Postnatal assessment of gestational age
Ballard Score
Accuracy within 1-2 weeks
2 parts
Neurologic characteristic
Physical characteristic
Part of general examination
21. Physical Maturity
Skin: thicker , less translucent, dry,
peeling
Lanugo:
fine non pigmented hair all over 27-
28 wks
disappears gradually
Plantar surface: presence or absence
of creases
Breast: areola development
Ear cartilage
Eyelid opening
External genitalia
25. Treatment of prematurity :
Specific treatment for prematurity will be
determined based on:
The baby's gestational age, overall health
and medical history.
Extent of the disease.
Tolerance for specific medications,
procedures or therapies.
Expectations for the course of the disease.
26. Treatment may include:
Prenatal corticosteroid therapy:
One of the most important parts of care for
premature babies .
Research has found that giving the
mother a steroid medication at least 48
hours prior to delivery greatly reduces
the incidence and severity of respiratory
27. Another major benefit of steroid
treatment is lessening of intraventricular
hemorrhage.
prenatal steroids may also help reduce
the incidence of NEC and PDA.
Mothers may be given steroids when
preterm birth is likely between 24 and 34
weeks of pregnancy.
28. Care of premature babies may also
include:
Temperature-controlled beds.
Monitoring of temperature, blood
pressure, heart and breathing rates and
oxygen levels.
Giving extra oxygen by a mask or with
a breathing machine.
Mechanical ventilators (breathing
machines) to do the work of breathing for
29. Intravenous (IV) fluids - when feedings
cannot be given
placement of catheters (small tube)
into the umbilical cord to give fluids and
medications and to draw blood.
30. X-rays (for diagnosing problems and
checking tube placement).
Special feedings of breast milk or formula,
sometimes with a tube into the stomach if a
baby cannot suck. Breast milk has many
advantages for premature babies as it
contains immunities from the mother and
many important nutrients.
Medications and other treatments for
complications, such as antibiotics.
Kangaroo Care - a method of caring for
premature babies using skin-to-skin contact
with the parent to provide contact and aid
parent-infant attachment.
31. When can a premature baby go home
from the hospital?
Premature babies often need time to
"catch up" in both development and
growth. Depending on their condition,
premature babies often stay in the
hospital until they reach the pregnancy
due date.
32. Serious illnesses are resolved.
Stable temperature - able to stay
warm in an open crib.
Taking all feedings by breast or
bottle.
No recent apnea or low heart rate.
Parents are able to provide care
including medications and feedings.
General goals for discharge may include
the following:
33. Before discharge, premature babies
also need an eye examination and
hearing test to check for problems related
to prematurity.
Parents need information about follow-
up visits with the pediatrician for baby
care and immunizations.
34. Prevention of prematurity:
Prenatal care is a key factor in
preventing preterm births and low
birthweight babies.
Some ways to help prevent prematurity
and to provide the best care for
premature babies may include the
following:
35. Maternal Nutrition.
Identifying mothers at risk for preterm
labor.
Prenatal education of the symptoms of
preterm labor.
Avoiding heavy or repetitive work or
standing for long periods of time which
can increase the risk of preterm labor.
Early identification and treatment of
preterm labor.
