PRETERM BABY

DEFINITION:

• A baby born before 37 completed weeks of gestation calculating from the first day of last menstrual period is arbitrarily defined as preterm baby

ETIOLOGY:

Spontaneous:

• Health status of the mother low socio ( economic status )

Multiple pregnancy : 

• Number of multiple pregnancies are increasing due to advanced parental age from delayed child bearing and ART
• It is the most common complication of pregnancy and is occurring in 6- 10% of pregancies and is rising 
• Placental problems 
• Preterm labour and premature rupture of membrane 
• Low maternal weight 
• Chronic and acute systemic maternal disease
• Antepartum haemorrhag
• Cervical incompetence 
• Maternal genital colonization and infections 
• Cigarette smoking during pregnancy
• Threatened abortion 
• Acute emotional stress 
• Physical exertion 
• Sexual activity 
• Trauma 
• Bicornuate uterus 
• Congenital malformations

Induced:

• Maternal diabetes mellitus 
• Placental dysfunction as indicated by unsatisfactory fetal growth 
• Eclampsia
• Fetal hypoxia 
• Antepartum haemorrhage 
• Severe rhesus iso immunization

CLINICAL FEATURES:

Measurements:

• Size is small with relatively large head
• Crown heel length is less than cm – 47
• Head circumference is less than cm 33
• But exceeds the chest circumference by more than cm 3

Activity and posture : 

• General activity is poor 
• Automatic reflex response such as moro response

Face and head : 

• Face appears small 
• large head size 
• Sutures are widely separated 
• Fontanels are large 
• Small chin 
• Protruding eyes 
• Optic nerve is usually unmyelinated 
• Ear cartilage is deficient or absent with poor recoil 
• Hair appears woolly and fuzzy and , individual hair fibres can be seen separately

Skin and subcutaneous tissues : 

• Skin is thin gelatinous Shiny and  excessively pink 
• Abundant lanugo 
• Very little vernix caseosa 
• Edema may be present 
• Subcutaneous fat is deficient 
• Breast nodule is small or absent 
• Deep sole creases are often not present 

Genitals: 

MALE: 

• Testes undescended (30%)
• scrotum poorly developed 

FEMALES: 

• Labia majora widely separated exposing labia minora 
• Hypertrophied clitoris

COMPLICATIONS:

Central nervous system :

• Immaturity of CNS
• Poor cough reflex
• Incoordinated sucking and swallowing 
• Retrolental fibroplasias 
• Intra ventricular and periventricular hemorrhage

Respiratory system

• Resuscitation difficulties at birth
• Hyaline membrane disease
• Breathing is periodic and associated with intercostal recessions due to soft rib 
• Pulmonary aspiration 
• Atlectasis
• Apnoea in a Preterm baby are Associated with bradycardia & may Leads to hypoxia & cyanosis
• Broncho pulmonary dysplasia 

Cardio vascular system

• The closure of ductus arteriosus is delayed 
• Blood volume in preterm neonate is  90 ml/kg

G I system 

• Regurgitations and aspirations 
• Abdominal distention and functional intestinal obstruction
• Enterocolitis
• Hyperbilirubinemia 
• Physiological jaundice in preterm infant lasts upto 14 days
• Hypoglycemia

Thermo regulation –

• Excess heat loss 
• Infections 
• Renal immaturity
  • The blood urea nitrogen is high 
  • Acidosis 
  • Late metabolic acidosis is seen in Preterm baby getting cow milk
  • Edema 
• Toxicity of drug 
• Nutritional problems
  • Anemia 
  • Deficiencies of folic acid and vit E 
  • Osteopenia and rickets 
  • Biochemical disturbance 
  • Hypoglycemia hypocalcemia hypoxia

MANAGEMENT:

CARE OF A PRETERM NEONATE:

• The cord is to be clamped quickly to prevent hypervolemia and development of hyperbilirubinemia.
• Cord length is kept long (about 10–12 cm) in case exchange transfusion is required 
• Air passage should be cleared of mucus promptly and gently using a mucus sucker.
• Adequate oxygenation through mask or nasal catheter in concentration not exceeding 35%.
• Baby should be wrapped including head in a sterile warm towel 
• Aqueous solution of vitamin K
• Color, Heart rate & Muscle tone is used in a preterm infant to assess need for resuscitation

NICU:

• Cushioned bed 
• Avoid excessive light excessive sound , rough handling and painful procedures . 
• Use effective analgesia and sedation for procedures 
• Provide warmth 
• Ensure asepsis 
• Cover the baby appropriately 
• Provide effective and safe oxygenation 
• Nutrition 
• Tactile and kinesthetic stimulation
• Prone position 
• Photo therapy 
• Prevention of nosocomial infection 
• Weight record 
• Immunizations 
• Manage 
  • Respiration , thermoregulation 
  • Fluid and electrolyte imbalance 
  • Infection Pain 
  • Parental maternal separation

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