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The Premature infant

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  1. The Premature infant • DR Husain alsaggaf

  2. بسم الله الرحمن الرحيم The Premature Infant

  3. THE PREMATURE INFANT DEFINITION : NEWBORN BABY LESS THAN 37 weeks.

  4. 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.

  5. The premature • Birth asphyxia • weak respiratory muscles • Weak thoracic cage

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

  7. Respiratory difficulties • decrease amount of surfactant. • Poor gag and cough reflex. • In coordination o swallowing and sukingaspiration of food. • Soft thoracic cage and weak respiratory muscle-ineffective ventilation. • Immature respiratory centerapnea. • High incidence of bronchopulmonary dysplasia.

  8. Gastrointestinal and nutrition • Poor sucking and swallowing<35 weeks • decrease intestinal motilityabdominal 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

  9. Gastrointestinal problems

  10. gastrointestinal problems

  11. Hepatic problems • Impaired conjugation and excretion of bilrubin jaundice. • Deficiency of vitamin k dependant factorsbleeding. • Decrease glycogen storageHypoglyceamia.

  12. 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.

  13. Neurological problems • Defective sucking and swallowing. • Recurrent apnoea. • Increase incidence of intracranial haemorrhage.

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

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

  16. Metabolic problems • Liability to rickets. • Hypoglycaemia. • Hypocalcaemia.

  17. Other problems • Retinopathy of prematurity. • Increase incidence of non accidental injuries. • Congenital malformations.

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

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

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

  21. Temperature management • Incubators in thermonuetral range. • Head caps and heat shield. • Suitable Room temperature. • Humidification.

  22. 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.

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

  24. 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.

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

  26. 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.

  27. Small of date. Special Hazards • Conception---Malformation. • Anti-natal------Intrauterine death. • Labour and delivery----Asphyxia… • Neonatal---Meconium aspiration. • Hypoglycaemia . • Hypothermia. • Polycythemia. • Pulmonary haemorrhage. • Infection