the premature infant

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The Premature infant. DR Husain alsaggaf. . The Premature Infant. THE PREMATURE INFANT. DEFINITION : NEWBORN BABY LESS THAN 37 weeks. Physical characteristic. Length related to weight. Head circumference>chest circumference. Weak cry. - PowerPoint PPT Presentation

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  • The Premature infantDR Husain alsaggaf

  • THE PREMATURE INFANTDEFINITION : 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. irregularlabia minora covered labia majora.Testicles are incompletely descended.

  • The prematureBirth asphyxia weak respiratory musclesWeak thoracic cage

  • Hypothermia Increased heat loss Lack of insulation.Increase surface area to weight Decreased heat productionDecrease activity.Lack of brown fat

  • Respiratory difficultiesdecrease 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 nutritionPoor sucking and swallowing
  • Gastrointestinal problems

  • gastrointestinal problems

  • Hepatic problemsImpaired conjugation and excretion of bilrubin jaundice.Deficiency of vitamin k dependant factorsbleeding.Decrease glycogen storageHypoglyceamia.

  • Renal problemsThe 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 problemsDefective sucking and swallowing.Recurrent apnoea.Increase incidence of intracranial haemorrhage.

  • Blood and cardiovascular problemsDelayed closure of the ducts.Weak capillary.High haemoglobin at birth and then law level at 6 weeks .

  • Immunological problemsDecrease level of antibodies.Decrease ability to produce antibodies.Relative impairment of cellular immunity.

  • Metabolic problemsLiability to rickets.Hypoglycaemia.Hypocalcaemia.

  • Other problemsRetinopathy of prematurity.Increase incidence of non accidental injuries.Congenital malformations.

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

  • During labour and deliveryPaediatrician should be informed.Delivery in well equipped hospital.Analgesia to mother should be withheld.Prompt Resuscitation with endotracheal intubations.

  • MonitoringTemperature.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.

  • FeedingEarly 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.

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

  • VitaminsVit 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.

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

  • Small for date infantPhysical characteristicsLack 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----AsphyxiaNeonatal---Meconium aspiration.Hypoglycaemia .Hypothermia.Polycythemia.Pulmonary haemorrhage.Infection

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