Prematurity & Low Birth Weight PDF

PREMATURITY & LOW BIRTH WEIGHT Dr.Sijal Fadhil Farhood FICMS MSc MBChB Objectives: 1-To introduce students to the main concept of Prematurity and LBW, and elaborate on specific determinants of LBW. 2-To explain the classification of LBW. 3-To explain epidemiology and rate of prematurity...

PREMATURITY & LOW BIRTH WEIGHT Dr.Sijal Fadhil Farhood FICMS MSc MBChB Objectives: 1-To introduce students to the main concept of Prematurity and LBW, and elaborate on specific determinants of LBW. 2-To explain the classification of LBW. 3-To explain epidemiology and rate of prematurity and LBW in Iraq and worldwide. 4-To outline the immediate and late clinical impact of prematurity. 5-to outline preventive measures to reduce mortality and morbidity Preterm birth is when a baby is born too early before.weeks of gestation have been completed 37 In 2022 preterm birth affected about 1 of every 10 infants born in the US, preterm birth rate is declined 1% in 2022 to following an increase of 4% from, 10.5% to 202115 million babies are preterm each 2020 year (5% to 18% of all deliveries). In many countries rates of premature births have increased between the 1990s and 2010s. Complications from preterm births resulted in 0.74 million deaths in 2013 down from 1.57 million in 1990. The chance of survival at fewer than 23 weeks is close to zero, while at 23 weeks it is 15%, 24 weeks 55% and 25 weeks about The chances of survival without long term.80% difficulties are lower.th is the most common cause  Racial and ethnic differences in preterm births is remain The rate of preterm birth in African- American women (14.6%) was higher than the rate of preterm birth among white or Hispanic women (9.4% and 10.1%) respectively.  : Definition What is preterm birth?  The delivery of a baby before 37 completed weeks'  :Definition ii What is Birth Weight?  Birth weight is the body weight of a baby at its birth  Determinants of birth weight There is a relation between birth weight and gestational age. 28 weeks : 900 g 36 weeks : 2750g  :Definition ii What is Low Birth Weight?  Low birth weight Either by a preterm birth (low gestational age at birth) or of the infant being small for gestational age (slow prenatal growth rate), or a combination of both. Epidemiology of Low Birth Weight Epidemiology of prematurity Epidemiology The current preterm birth rate globally is 10.5% and in 2020 15% of all preterm births occurs before 32 weeks of gestation. RATES IN IRAQ In Iraq 15-16% of births are low birth weight just over one third is born premature  5 countries Reports reveals that India,Pakistan,Nigeria,C hina and Ethiopia accounted for over half of all preterm births in 2020 Several factors have contributed to the overall rise in the incidence of preterm birth. These factors include increasing rates of multiple births, greater use of assisted reproduction techniques, and more obstetric intervention. Part of the apparent rise in the incidence of preterm birth, may reflect changes in clinical practice. Increasingly, ultrasonography rather than the last menstrual period date is used to estimate gestational age.. Mortality and morbidity Worldwide, prematurity accounts for 10% of neonatal mortality.  TYPES OF DELIVERIES 1-Spontaneous preterm births : 40–45% preterm births that follow preterm labour 2- 25–30% are induced preterm births i.e premature rupture of membranes. 3- (30–35%) are preterm births via Cesarean section for obstetrical reasons; (i.e. infection, intrauterine growth retardation)  Clinical impact of prematurity Immediate : :Respiratory -1 One of the main organs greatly affected by premature birth is the lungs. The lungs are one of the last ;organs to develop in the womb because of this, premature babies typically spend the first days/weeks of their life on a ventilator suferring from such conditions as apnoea, RDS and..asphyxia :Neurological -2 The other main system greatly affected by premature birth is the CNS… because of this, premature babies may suffer from intracranial.heamorrhage :Cardio vascular-3 Bradycardia and hypotension :Haematological-4 Anaemia and bleeding tendency Gastrointestinal-5 Metabolic: Hypoglycaemia-6 Renal Reduced G Filtration-7 Temperature regulation-8 Immunity-9 Opthalmic-10  Clinical impact of prematurity Late: Chronic lung diseaes CNS especially cerebral palsy Poor growth  LIMIT OF VIABILITY The earliest gestational age at which the infant has at least a 50% chance of survival is referred to as the limit of viability.  PRETERM PATHWAYS 4 different pathways can result in preterm birth : 1-Precocious fetal endocrine activation. 2-Uterine over distension..3-Decidual bleeding 4- Intrauterine inflammation/infection. Kangaroo Care Implications of low birth weight & perinatal infant mortality Increasing incidence globally Human wastage Emotional suffering Very high cost of NICU care PREVENTION  PREVENTION A- Direct Intervention: 1- Identification of women at risk: a- maternal malnutrition b- heavy work load c- medical illnesses d- infections especially urinary e- raised blood pressure  PREVENTION A- Direct Intervention: 1- Identification of women at risk: f- too many pregnancies g- close spacing between births h- multiple pregnancy i- under 18 & over 35  PREVENTION A- Direct Intervention: 1- Identification of women at risk: J- Short stature k- Poor weight gain in pregnancy l- ethnicity m- pscychological stress n- Rural residence  PREVENTION B- Indirect Intervention: 1- Family planning 2- Sanitation 3- Avoid smoking 4- Nutritional care 5- Combating poverty and deprevation  SMOKING & LBW Decreases-1 maternal appetite Direct toxic-2 effect Nicotine is a-3 vasoconstrictor leading to placental insufficiency raised carbon-4 monoxide levels  :Leading Causes of Death 1- Atelectasis,Hyaline membrane disease and surfactant deficiency. 2- Life threatening malformations 3- Pulmonary heamorrhage 4- Intracranial bleeding following anoxia and trauma 5- Pneumonia and infections  Research Studies shows that climate change exacerbates risk for expectant mothers with higher preterm birth and stillbirth linked to extreme weather in Australia  Research The main analysis found that higher maternal autistic traits correlated with increase risks of preterm birth and small for gestational age.  Latest Recommendations It is recommended that labor not be medically induced before 39 weeks unless required for other medical reasons. The same recommendation applies to cesarean section There is significant evidence that long term (> one year) use of folic acid supplement preconceptionally may reduce premature birth About 75% of nearly a million deaths due to preterm delivery would survive if provided warmth, breastfeeding, treatments for infection, and breathing support. If a baby has cardiac arrest at birth and is before 23 weeks or less than 400 gms attempts at resuscitation are not indicated  Iraq A high percentage of LBW in the Iraqi community points to deteriorating health status of pregnant women, younger age at marriage,inadequate prenatal care.  Harvard Report Today levels of LBW in Iraq has reached unprecedented rates, ranging from 31-50% of all births have been recorded by international bodies in Dyala , Anbar and suburbs of Baghdad due to war at that time.  Historical Figuers Johannes Kepler (born at 7 months gestation). Isaac Newton small enough to fit into a mug) Winston Churchill (7 months gestation).  Contemporary Figures Stevie Wonder Who is blind due to retinopathy of prematurity Winston Churchill Newton Thank You  References Maternal and child health nursing ,care of the childbearing and childbearing family seventh edition Adele Pillitteri ,2022 #Park’s text book of preventive and social disease 2021