The Premature infant

DR Husain alsaggaf

الرحيم الرحمن الله بسم

THE PREMATURE INFANT

DEFINITION : NEWBORN BABY LESS THAN 37 weeks.

Physical characteristic

Length related to weight. Head circumference>chest

circumference. Weak cry. In active and sleep most of the time. Ears are floppy and respiration is.

irregular labia minora covered labia majora. Testicles are incompletely descended.

The premature

Birth asphyxia weak respiratory muscles Weak thoracic cage

Hypothermia

Increased heat loss Lack of insulation. Increase surface area to weight

Decreased heat production Decrease activity. Lack of brown fat

Respiratory difficulties decrease amount of

surfactant. Poor gag and cough

reflex. In coordination o

swallowing and sukingaspiration of food.

Soft thoracic cage and weak respiratory muscle-ineffective ventilation.

Immature respiratory centerapnea.

High incidence of bronchopulmonary dysplasia.

Gastrointestinal and nutrition

Poor sucking and swallowing<35 weeks decrease intestinal motilityabdominal

distension Decrease gastric volume and gastric

emptying time Decrease digestion and absorption of fat

and fat soluble vitamins,cetain minerals High incidence of necrotizing colitis

Gastrointestinal problems

gastrointestinal problems

Hepatic problems

Impaired conjugation and excretion of bilrubin jaundice.

Deficiency of vitamin k dependant factorsbleeding.

Decrease glycogen storageHypoglyceamia.

Renal problems

The concentration and delution ability is reduced.

The kidneys are unable to hold large solute load.

Increased lose of salt. Increased lose of sodium bicarbonate.

Neurological problems

Defective sucking and swallowing.Recurrent apnoea.Increase incidence of intracranial

haemorrhage.

Blood and cardiovascular problems

Delayed closure of the ducts. Weak capillary. High haemoglobin at birth and then law

level at 6 weeks .

Immunological problems

Decrease level of antibodies. Decrease ability to produce antibodies. Relative impairment of cellular

immunity.

Metabolic problems

Liability to rickets.Hypoglycaemia.Hypocalcaemia.

Other problems

Retinopathy of prematurity. Increase incidence of non

accidental injuries. Congenital malformations.

Management

PREVENTION: Rest. Adrenergic drugs. Steroid to prevent (IRDS).

During labour and delivery

Paediatrician should be informed. Delivery in well equipped hospital. Analgesia to mother should be withheld. Prompt Resuscitation with endotracheal

intubations.

Monitoring

Temperature. Apnoea monitor. Heart and respiratory rate. Oxygen saturation. Blood sugar and calcium.

Temperature management

Incubators in thermonuetral range.

Head caps and heat shield.

Suitable Room temperature.

Humidification.

Feeding

Early feedings at (2-3 hours). Less than 34 weeks tube feeding. Less than 1750 gm / hourly. Between 1750-2000 gm two hourly. More than 2000 gm 3 hourly.

Feeding

Breast milk, premature formula. Cal 110-130/kg cal day. 50ml / kg increase by 25ml / kg / day. Weight increase 30 gm / day.

Vitamins

Vit D 800 iu day. Vit C 50 mg day. Vit E 10mg day. Folic acid 50 mg day if less than 2kilo. Vit K at birth.

Management

Oxygen: No oxygen except for hypoxia. Keep PO2 50-80 mmg. Surfactants and Mechanical Ventilation. Encourage mother to visit the baby.

Small for date infant

Physical characteristics Lack of subcutaneous fat. Wasting of soft tissues. Skin is lose with peeling. Scalp hair is spare, skull bone is

hard. Vigorous and active. Eager to feed.

Small of date. Special Hazards Conception---Malformation. Anti-natal------Intrauterine death. Labour and delivery----Asphyxia…

Neonatal---Meconium aspiration. Hypoglycaemia . Hypothermia. Polycythemia. Pulmonary haemorrhage. Infection