Prematurity and Neonatal Issues PDF

# Prematurity ### Definition A live born infant who is delivered before 37 completed weeks of gestation calculated from the first day of the last menstrual period. ### Physical characteristics: - Decreased - **Body measurements**: - Birth weight < 2500 gm. - Crown-heel length < 47 cm. -...

# Prematurity ### Definition A live born infant who is delivered before 37 completed weeks of gestation calculated from the first day of the last menstrual period. ### Physical characteristics: - Decreased - **Body measurements**: - Birth weight < 2500 gm. - Crown-heel length < 47 cm. - Head circumference < 33 cm. - Chest circumference < 30 cm. - The head is disproportionately large relative to the body size but the neck and extremities are relatively short and the abdomen is protruding. - **Signs of physical immaturity**: - **Cry**: feeble and infrequent with poor suckling. - **Behavior**: sleeps more or less continuously with infrequent muscular movements. - **Skin**: Thin, smooth and red skin. Little subcutaneous fat: triangular face and loose skin over the limbs. Abundant lanugo hair that may cover the whole body. Frequent occurrence of edema hands and feet. - **Chest**: soft chest wall with weak respiratory muscles. Irregular respiration with periodic spells of apnea. - **Abdomen**: prominent with thin wall and visible peristalsis. - **Breast**: not palpable nodule, with diminished areola and nipple formation. - **Ear**: soft, easily folded with absent cartilage. - **Genitalia**: - **Male**: light colored, smooth scrotum with absent rugae, and undescended testes. - **Female**: widely separated labia majora with prominent labia minora and clitoris. - **Signs of neuromuscular immaturity**: # Problems of prematurity: 1. **Respiratory**: Respiratory distress syndrome (RDS) 2. **Neurologic**: intracranial hemorrhage 3. **Cardiovascular**: A patent ductus arteriosus is a common problem that may result in congestive heart failure. 4. **Hematological problems**: There is increased hemorrhagic tendency due to: Increased vascular fragility 5. **Anemia of prematurity**: 6. **Nutritional and Feeding problems due to**: - Impaired suckling and swallowing. 7. **Gastrointestinal problems**: Prematurity is the single greatest risk factor for necrotizing enterocolitis. 8. **Metabolic problems**: disorder in glucose and calcium metabolism, are more common in premature infants. 9. **Renal**: The immature kidney is characterized by a low glomerular filtration rate and an inability to handle water, solute, and acid loads. 10. **Temperature regulation**: Premature infants are especially susceptible to hypothermia and hyperthermia. 11. **Immunologic**: Because of deficiencies in both humoral and cellular immune response, premature infants are a greater risk for infection than are full-term infants. 12. **Ophthalmologic**: Retinopathy of prematurity may develop in the immature retina. # Neonatal Respiratory Distress - **Signs**: - Tachypnea (more than 60 min). - Retraction (intercostal and subcostal). - Expiratory grunting. - Cyanosis - **Causes**: - **Pulmonary diseases**: - Hyaline membrane disease and transient tachypnea of the newborn. - Aspiration syndrome. - Pneumonia. - Airleak syndromes: pneumothorax, pneumomediastinum. - **Obstruction or abnormality of air Passages.** - Nasal or nasopharyngeal: choanal atresia. - Laryngeal: Laryngomalacia. - **Impaired respiratory center and nerve Pathway function**: - Immaturity. - Neuromuscular disorders. - **Extrapulmonary causes.** - Diaphragmatic hernia. - Metabolic acidosis. - Cardiac: congenital heart disease, heart failure. # Neonatal Hyperbilirubinemia - **Types**: - **Unconjugated hyperbilirubinemia (indirect)** - physiological - Pathological like: - Hemolytic anemia of newborn - Hemorrhage - Breast milk jaundice - Others - **Conjugated hyperbilirubinemia (direct)** - Hepatitis. - Biliary obstruction. - Others - **Physiologic Jaundice**: In almost every newborn infant, elevation of serum unconjugated bilirubin develops during the first week of life and resolves spontaneously. - **Exclusion criteria for physiologic jaundice**: - Unconjugated bilirubin level > 12.9 mg/dl in term infants - Unconjugated bilirubin level > 15mg/dl in preterm infants - Bilirubin level increasing at a rate > 5 mg/dl/day. - Jaundice in the first day of life - Conjugated bilirubin > 2 mg/dl - Clinical jaundice persisting > 1 week in full-term or > 2 weeks in preterm infants. - **Pathological jaundice criteria**: the reverse of physiological jaundice # Rh hemolytic disease of the newborn (Rh-HDN): If an Rh-ve mother get pregnant to an Rh +ve fetus, leakage of fetal RBCs across the placenta into the maternal circulation may lead to formation of maternal IgG antibodies directed against fetal antigens. It occur in 2nd and third pregnancy. # ABO-hemolytic disease of the newborn: ABO-HDN is caused by the reaction of maternal anti-A or anti-B antigens on the RBCs of the fetus or newborn infants. It is usually seen in A or B infants born to type O mothers. # Breast milk jaundice: It is characterized by high peak (10-30 mg/dl), peaking by days 10-15 of life and slower decline in the serum bilirubin concentration. - **Treatment:** - Phototherapy - Exchange transfusion - Phenobarbital # Kernicterus (Bilirubin encephalopathy) ### Definition: Is a pathologic diagnosis refers to yellow staining of the brain by bilirubin together with evidence of neuronal injury. ### Treatment: If kernicterus is suspected, treatment is immediate exchange transfusion, preceded by phototherapy until exchange starts.