The Premature infant • DR Husain alsaggaf
بسم الله الرحمن الرحيم 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. • 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
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