8. Associated Factors
• Maternal
– Low socioeconomic status
– Lack of prenatal care
– Substance abuse, smoking
– Maternal age < 16yrs or > 35yrs
– Maternal illness e.g. renal, heart, lung, HPT, DM, etc
– Multiple gestation
– Prior preterm delivery
– Obstetric factors e.g. uterine malformations, cervical
incompetence, polyhydramnios, premature rupture of
membranes, infection (e.g. chorioamnionitis), placenta
praevia, abruptio, etc
– Abdominal trauma / surgery
• Foetal
– Foetal distress, IUGR, etc
9. Problems of Prematurity
• Related to difficulty in extrauterine
adaptation due to immaturity of organ
systems
• Degree of immaturity
– Appearance, behaviour, problems, clinical course
– Mildly preterm (35 - 36 wks)
– Moderately preterm (32 - 34 wks)
– Severely preterm (< 32 wks)
10. Management
• Prevention
– Obstetric Mx: maternal illness, infection
– Inhibition of preterm labour
– Steroids to facilitate lung maturation
Problems & Management:
• Initial, acute
• Long term
13. Temperature Regulation
• Poor temperature control
– Hypothermia, hyperthermia
1. Immature heat regulatory centre
2. Impaired heat production
∀ ↓ brown fat, poor muscular activity, poor 02
consumption
3. Increased heat loss
∀ ↓ subcutaneous fat, ↑ surface area (large
surface area to body weight, extended position)
14. Management
• Achieve neutral thermal zone
i.e. environmental T0 at which O2
consumption is minimal yet sufficient to
maintain body T0
• Yet exposed to facilitate observation
• Heat shield, plastic wrap, cap
• Overhead radiant warmer
– Infant accessibility, rapid T0 response
• Closed incubator
↓ insensible H2O loss, barrier to infection
29. Management
– Specific attention to type (expressed breast
milk & human milk fortifiers, preterm formula),
amount & route of feeding
– Gavage feeding
– Parenteral nutrition
– Multivitamin
43. Long Term Problems
• Preterm infants are vulnerable to wide
spectrum of morbidity
• Severe impairment occurs in a small
population
• Prevalence of lesser morbidities less
clearly defined
47. Social
• Increased risk of child abuse & neglect
• Financial
• Psychosocial & Emotional
• Marital discord
• Parent support groups
• Light Weight Club
• Club Rainbow
49. Management
• Multidisciplinary team
– Neonatologists
– Nurses
– Therapists
– Psychologists
– Medical specialists: ophthalmologist,
otolaryngologist, cardiologist, paediatric
surgeon, plastic surgeon
– Medical social worker
50.
51. Extremes of
Birth Weight
Neonatal
Hypoglycaemia
Prematurity
Notas do Editor
Ultrasound estimation of gestational age - 14-20wks: 10-11dys - 20-28wks: 14dys - 29-40wks: 21dys Direct ophthalmoscopy of the lens - Before 27 weeks: cornea too opaque to allow visualisation - After 34 weeks: atrophy of vessels of lens occurs Reliable to 2 weeks Pupils must be dilated Assessment must be performed within 48 hrs of birth before the vessels atrophy Grading system