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A PREMATURE NEWBORN
Definition Liveborn infants delivered before 37 week from the 1st day of
the last menstrual period
Term : 37-42weeks
Prem : < 37weeks Gestation
Moderate Prem : 31/32 36weeks
Severe prem : 24-30weeks
Etiology FETAL MATERNAL
Fetal distress Preeclampsia
Multiple gestation Chronic medical illness
Erythroblastosis (cyanotic heart disease,
Nonimmune hydrops renal disease)
PLACENTAL Infection (Listeria
Placental dysfunction monocytogenes, group B
Placenta previa streptococcus,
Abruptio placentae urinary tract infection,
UTERINE bacterial vaginosis,
Bicornuate uterus chorioamnionitis)
Incompetent cervix Drug abuse (cocaine)
(premature dilation) OTHER
Premature rupture of
membranes
Polyhydramnios
Iatrogenic
Trauma
CF Skull Ear - Earlobe has no cartilage
may suggest hydrocephaly Soles - One or two transverse
Lung creases; posterior three fourths
high respiratory rate of sole smooth
Heart Breast - barely perceptible or,
higher resting heart rate, up flat, or small bud (2mm)
to about 160 beats/min Genitalia -
Skin Male: Smooth or faint rugae
thin and delicate and tends of scrotum
to be deep red Female: Prominent clitoris,
gelatinous and flat or small labia minora
translucent (extremely
premature)
Fine, soft, immature hair
called lanugo frequently
covers the scalp and brow
and may also cover the face
of premature infants.
Assessme Prenatal gestational age Postnatal gestational age
nt Of assessment assessment
Gestation Determined by -Usually done because prenatal
maternal history, estimation are not always
clinical examination, accurate.
and 1. Rapid assessment of
ultrasound gestational age in
FALAH 16/17
Criteria
For Rapid
Gestatio
nal Age
At
Delivery
Grade Description
transfer
Maintain SaO between 89-92% for ELBW; 90-94% for the
larger preterm
Bathing can be omitted.
Head circumference (OFC), length measurements, examine
and weigh the infant.
Assess the gestational age with Dubowitz or Ballard score
when stable
Monitor temp, HR, RR, BP and SaO.
5) Immediate Care for Symptomatic Infants
Investigations ( Blood gases, blood glucose, FBC, Blood
culture, CXR if respiratory signs and symptoms are present
Start on 10% dextrose drip
Correct anemia
Correct hypotension
Correct hypovolaemia
Start antibiotics after taking cultures
Start IV Aminophylline or caffeine in premature infants <32-
34weeks
Maintain SaO2 at 89-92% and PaO2 at 50-70mmHg
General Care of prem babies
1) Monitor temperature, Vital signs, DXT
2) I/O
3) Ventilation
4) IV line / Central Line
5) Feeding trickle feeding, multivitamin, folic acid, FAC (6wks) -
increase slowly, start 2.5cc/kg/feed, if tolerating x 2, increase
slowly, maximum 200cc/kg/day 6) strict hand hygiene
7) antibx
8) aminophyline (<34wks)
9) Immunization BCG (wt >1.8kg), Vit K (at birth)
Hypothermia
Thermoregul ability to balance heat production and heat loss in order to
ation maintain normal body temperature.
Normal skin temperature: 36.0-36.5
Normal rectal temperature: 36.5-37.5
Axillary temperature may be 0.5-1.0 lower.
FALAH 16/17
Management Rewarming by
Closed incubation
-usually used for infants who weight <1800g.
-convectively heated (heated airfow)
Radiant warmer
-used for very unstable infants or during performance of
medical procedure.
-heating is provided by radiation
Infant >2500g
Place the infant under a preheated radiant warmer
immediately after delivery
Dry the infant completely, cover the infants head
with a cap
Place the infant, wrapped the blankets, in a crib
Infant who weighs 1800-2500g with no medical problems,
Use crib,cap, and blanket
Infant who weighs 1000-1800g
A well infant should be placed in a closed incubator
with servo control
A sick infant should be placed under a radiant warmer with
servo-control
FALAH 16/17
2. Surfactant replacement
Surfactant prophylaxis (within 15 minutes of birth) to all
infants <27 weeks.
Consider prophylaxis if 27-29 weeks if baby was intubated
or mother did not get antenatal steroids
Repeated doses every 6-12 hours for a total of 3-4 doses.
3. Respiratory support
Endotracheal intubation and mechanical ventilation
Continuous positive airway pressure (CPAP) and Nasal
Synchronized Intermittent Mandatory Ventilation (SIMV).
4. Fluid & nutritional support
5. Antibx
Etiology
decreased carbohydrate stores (premature, IUGR)
infant of a diabetic mother (IDM): maternal hyperglycemia -+ fetal
hyperglycemia and
hyperinsulinism -+ hypoglycemia in the newborn infant because of high insulin
levels
sepsis
endocrine: hyperinsulinism due to islet cell hyperplasia (e.g. Beckwith-
Wiedemann syndrome),
panhypopituitarism
inborn errors of metabolism: fatty add oxidation defects, galactosemia
Clinical Findings
Jitteriness and irritability.
Apnoea and cyanosis.
Hypotonia and poor feeding.
Convulsions.
Management
identify and monitor infants at risk (pre-feed blood glucose checks)
begin oral feeds within first few hours of birth
if hypoglycemic, provide glucose IV (DlO, D12.5)
if persistent hypoglycemia (past day 3), hypoglycemia unresponsive to IV
glucose, and/or no
predisposing cause for hypoglycemia, send the following a critical bloodwork"
during an episode
of hypoglycemia:
insulin, cortisol, growth hormone (GH), beta-hydroxybutyrate, lactate,
ammonia
free fatty acids (FF.A's), ABG
treat hyperinsulinism with glucagon and diazoxide
Apnea of = pause of breathing > 20secs with brady or desaturation, HR
prematurit drop 30bpm from baseline
y 3 types
central: no chest wall movement
obstructive: chest wall movement continues
mixed: combination of central and obstructive apnea
Necrotizing Enterocolitis
Definition intestinal inflammation associated with focal or diffuse ulceration
and necrosis
primarily affecting terminal ileum and colon
affects 1-5% of preterm newborns admitted to NICU
Pathophysi postulated mechanism of bowel ischemia ->mucosal damage,
o and enteral feeding providing a substrate for bacterial growth
and mucosal invasion, leading to bowel necrosis or gangrene
and perforation
Risk prematurity (immature defenses)
Factors asphyxia, shock (poor bowel perfusion)
hyperosmolar feeds
enteral feeding with formula (breast milk can be protective)
sepsis
CF distended abdomen
increased amount of gastric aspirate/vomitus with bile staining
gross or occult blood in stool
feeding intolerance
diminished bowel sounds
signs of bowel perforation (sepsis, shock, peritonitis, DIC)
IX abdominal x-ray: pneumonitis intestinalis (intramural air,
hallmark ofNEC), free air, fixed loops, ileus, thickened bowel
wall, portal venous gas
CBC, ABG, blood culture
high or low WBC,low platelets, hyponatremia, acidosis,
hypoxia, hypercapnea
MX NPO (minimum 1 week), vigorous IV fluid resuscitation, NG
decompression, supportive therapy
total parenteral nutrition (TPN)
antibiotics (usually ampicillin, gentamicin metronidazole if risk
of perforation x 7-10 days)
serial abdominal x-rays detect early perforation
peritoneal drain/surgery if perforation
surgical resection of necrotic bowel and surgery for
FALAH 16/17