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Prematurity: Complications

Prematurity: Complications. Respiratory distress syndrome Bronchopulmonary dysplasia Apnea of prematurity Patent ductus arteriosus Intraventricular hemorrhage Periventricular leukomalacia Necrotizing enterocolitis Sepsis Anemia Retinopathy of prematurity. Respiratory Distress Syndrome.

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Prematurity: Complications

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  1. Prematurity: Complications Respiratory distress syndrome Bronchopulmonary dysplasia Apnea of prematurity Patent ductus arteriosus Intraventricular hemorrhage Periventricular leukomalacia Necrotizing enterocolitis Sepsis Anemia Retinopathy of prematurity

  2. Respiratory Distress Syndrome Etiology Anatomic immaturity of the lung Increased interstitial and alveolar lung fluid Surfactant deficiency

  3. 17 Weeks Courtesy of Professor Louis De Vos http://www.ulb.ac.be/sciences/biodic/index.html

  4. 22 Weeks Courtesy of Professor Louis De Vos http://www.ulb.ac.be/sciences/biodic/index.html

  5. 25 Weeks Courtesy of Professor Louis De Vos http://www.ulb.ac.be/sciences/biodic/index.html

  6. CXR: poor aeration, ground-glass appearance, homogenous, air bronchograms

  7. Respiratory Distress Syndrome Management: Prevention - antenatal steroids Positive pressure ventilation Oxygen +/- Surfactant (requires intubation)

  8. Volume (ml) Pressure (cmH20)

  9. Bronchopulmonary Dysplasia Respiratory symptoms, x-ray abnormalities, and O2 req’t for > 28 d and persisting at 36 wks corrected GA Pathophysiology: Disturbed alveolarization with increased alveolar-to-capillary distance and decreased alveolar-to-capillary ration Secondary to: Lung inflammation Mucociliary dysfunction Airway narrowing Hypertrophied airway smooth muscle Alveolar collapse Constriction of pulmonary vascular bed

  10. Bronchopulmonary Dysplasia Management: Prevention: IM Vitamin A, Caffeine NUTRITION Oxygen +/- ventilation +/- Diuretics +/- Steroids: systemic, inhaled +/- Bronchodilators Prognosis: Increased respiratory illnesses in childhood Decreased long-term lung function BUT, fine in the playground by pre-school age (usually …)

  11. Apnea of Prematurity Central, obstructive, or mixed Majority of <32 weeks Treat with: Adequate positioning Oxygen Methylxanthines (i.e. Caffeine) CPAP Ventilation if necessary

  12. Patent ductus arteriosus Seen in >60% of <1000 g babies Management strategies: Preload/afterload reduction Adequate oxygenation Optimize pH Indomethacin/Ibuprofen Surgery (PDA ligation) Conservative management Prognosis: Multiple associations (NEC, CLD, etc …) but no proven causation

  13. Metabolic Problems of Prematurity Hypoglycemia Fluid/electrolyte imbalance Hypocalcemia/hypomagnesemia Hyperbilirubinemia Hypothermia

  14. Intraventricular hemorrhage Common in < 1500 gm babies Usually evident in 1st week of life Reasons: highly vascularized germinal matrix less basement membrane to capillaries abnormal cerebral autoregulation Prognosis: Good - small amounts of bleeding in the ventricles Poorer - large amount intraparenchymally or if post-hemorrhagic hydrocephalus

  15. Periventricular leukomalacia Pathophysiology: Ischemic lesion to watershed area around ventricles in premature infants Link to inflammation? Most often shows up 3-4 wks after delivery Prognosis: Correlated with cerebral palsy

  16. Necrotizing Enterocolitis 1-5% NICU admissions Multi-factorial etiology: Feeds, Prematurity, Ischemia, Infection Diagnosis: clinical and radiologic Treatment: Decompression (NPO, NG tube) Antibiotics Surgery prn Prognosis: 30% mortality if <1500 g

  17. Sepsis Suboptimal immune function in preemies plus poor skin barrier, indwelling catheters GBS and coliforms cause early onset sepsis < 5-7 days of life Nosocomial sepsis common in prems Most common = coagulase negative staphylococcus Fungi can also be problematic in > 1 week of life

  18. Anemia of Prematurity Reasons: decreased hemoglobin at delivery decreased RBC survival blunted erythropoietin response IATROGENIC Treatment: prevention iron supplementation transfusion EPO

  19. Retinopathy of Prematurity 40-70% NICU survivors < 1000 g Etiology: vasoconstriction leading to abnormal vascular proliferation Diagnosis: Screening Treatment: Close monitoring, laser if necessary

  20. Long Term Outcomes – 24 weeks Local survival (2006-2008) ~ 60% Risk of severe disability: very low IQ, unable to walk, blindness and/or deafness ~ 15-20% of survivors Risk of moderate disability: low IQ, walk with aid, impaired vision and/or correctable hearing loss ~ 20-30% of survivors Deafness ~ 2% of survivors Blindness 1-10% of survivors Overall, chance of being ‘normal’ or mildly impaired ~ 50-65% of survivors

  21. Disorders of gestation length or of growth • Small for gestational age: <2SD below • Large for gestational age: >2SD above • Prematurity: <37 weeks gestation • Postmaturity: >42 weeks gestation

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