Neonatology: Prematurity and Complications

Prematurity and Complications

• A neonate is a newborn child less than 1 month old.
• Prematurity is defined as birth at a gestational age (GA) of less than 37 weeks.
• Appropriate for Gestational Age (AGA) refers to a newborn with a birth weight (BW) and birth length appropriate for their GA.
• Small for Gestational Age (SGA) describes a newborn with a birth weight and birth length below the 10th percentile for their GA.
• Large for Gestational Age (LGA) refers to a newborn with a birth weight above the 90th percentile for their GA.
• Extreme immaturity is defined as birth at a GA of less than 28 weeks.

Low Birth Weight

• Low Birth Weight (LBW) is defined as a birth weight of 1500-2499g.
• Very Low Birth Weight (VLBW) is a birth weight of 1000-1499g.
• Extremely Low Birth Weight (ELBW) is a birth weight of less than 1000g or 50% of the ventricular area.

Intraventricular Hemorrhage (IVH)

• IVH is a primary concern in premature management.
• Prevention of prematurity and improved perinatal management are key to preventing IVH.
• Postnatal management includes skilled resuscitation, circulatory support, and correction of coagulation abnormalities and hemoglobin levels.
• Grade IV IVH represents periventricular hemorrhagic infarction.

Periventricular Leukomalacia (PVL)

• PVL is brain damage that involves the periventricular white matter of the brain.
• PVL results in the death of injured cells, leaving empty areas in the brain that fill with fluid.
• 60-100% of infants with PVL are diagnosed with Cerebral Palsy, leading to intellectual impairment and spasticity.
• PVL typically occurs between 26 and 34 weeks of gestation, with premature birth being a high-risk factor.
• Severe IVH may also result in the formation of cysts.

Routine Examinations

• Systematic routine examinations include assessments of respiration, circulation, neurology, hematology, nutrition, growth, infections, and informing the mother.
• Routine examinations around 32 weeks GA are recommended to reveal injuries and complications.

Patent Ductus Arteriosis (PDA) and Retinopathy of Prematurity (ROP)

• PDA is a common complication in premature infants.
• Routine ophthalmology examinations are recommended to detect ROP.
• ROP stages include:
  • Stage 1: Demarcation line
  • Stage 2: Ridge with height and width
  • Stage 3: Extraretinal fibrovascular proliferation
  • Stage 4A: Extrafoveal retinal detachment
  • Stage 4B: Subtotal retinal detachment involving fovea
  • Stage 5: Total retinal detachment

Necrotizing Enterocolitis (NEC)

• NEC is a serious gastrointestinal complication in premature infants.
• Symptoms of NEC include:
  • Vomiting
  • Diarrhea
  • Delayed gastric emptying
  • Abdominal distention and tenderness
  • Ileus/decreased bowel sounds
  • Abdominal wall erythema (advanced stages)
  • Fresh red blood in stool
• Systemic signs of NEC include:
  • Apnea
  • Lethargy
  • Decreased peripheral perfusion
  • Shock (in advanced stages)
  • Cardiovascular collapse
  • Bleeding diathesis (consumption coagulopathy)