Preterm Infant PDF

World Health Organization ( WHO) Preterm Infant Is defined as the babies born alive before 37 weeks of pregnancy are completed. Full term gestation is 40 weeks ( range 37 to 42 weeks) A preterm infant is traditionally...

World Health Organization ( WHO) Preterm Infant Is defined as the babies born alive before 37 weeks of pregnancy are completed. Full term gestation is 40 weeks ( range 37 to 42 weeks) A preterm infant is traditionally defined as a live- born infant born before the end of week 37 of gestation.  Factors to Determine Gestational Age Neonatal assessment (Ballard Scoring). Inspection for sole creases, skull firmness, ear cartilage and neurologic development plus the mothers’ report of date of her last menstrual period along with sonographic estimation of age all can be helpful to determine gestational age. Newborns should be evaluated immediately after birth to determine their weight, height, head circumference, and gestational age to determine their immediate healthcare needs and to help anticipate possible future problems. Preterm birthoccurs in approximately 11% of live births worldwide, with the United States having one of the highest rates of preterm births (Martin et al., 2019).  All preterm infants need Limited glycogen and fat stores, inability to generate intensive care from the new glucose. moment of birth to give them their best chance of survival without neurologic Blood vessels are not fully aftereffects because they are developed and extremely more prone than others to fragile. hypoglycemia, intracranial hemorrhage, and RDS. Lack of lung surfactant ( form until 34th week of pregnancy. ( Dumpa & Bhandari, 2018) Birth weight is90% Approximately normally of all live Term neonates are births fall those born after the plotted oninto this category. a growth chart Newborns beginning of week 38 such as theborn before term Colorado and before week 42 of (before the beginning of the (Lubchenco) Intrauterine pregnancy (calculated 38th week of pregnancy) are Growth classifiedChart, a special as preterm from the first day of the chart for newborns regardless. of birth weight last menstrual period). (Quinn et al., 2016).  Categories of Preterm Birth Late Early Preterm Preterm born between 34 born between 24 and 34 weeks and 37 weeks  Sub-Categories of Preterm Birth Moderate premature Extremely premature < 37 weeks < 34 weeks < 32 weeks < 28weeks Late preterm Very premature  Non-premature infants are categorized as: Early Term Full Term Late Term Post Term 37 to 38 6/7 weeks 39 to 40 6/7 weeks 41 to 41 6/7 weeks ≤42 weeks  The exact cause of TRUE FALSE premature labor and early birth is exactly known.  ETIOLOGY Unknown cause of premature labor and delivery Proceeded by premature rupture of mem branes. Gestational age is a major determinant of neonatal death rates (Cnattingius et al., 2020).  ETIOLOGY Infant mortality could be reduced dramatically if However , Preterm infant death even with the the causes of preterm accounts for 80% to examples of birth could be possible causes, 90% of infant discovered and the exact cause of mortality in the first corrected, and all premature labor year of life. and early birth is pregnancies could be rarely exactly brought to term. known.  ETIOLOGY Elective Preterm Delivery The American College of Obstetricians and Gynecologists (ACOG) recommends late preterm delivery in conditions such as multiple gestation with complications, preeclampsia, placenta previa, placenta accreta, and premature rupture of membranes.  ETIOLOGY Elective Preterm Delivery ACOGrecommends delivery as early as 32 weeks in selected cases involving multiple gestation with complications. Quasi-elective (almost but it depends) delivery earlier than 32 weeks is done on a case- by-case basis to manage severe maternal or fetal complications.  ETIOLOGY Spontaneous Preterm Delivery Patient has spontaneous preterm delivery may or may not have an obvious immediate trigger (e.g. infections like intra–amniotic infection, infectious disease in pregnancy, and placental abruption. Toxoplasmosis is an infection caused by a single-celled parasite calledToxoplasma gondii. Chorioamnionitis is an infection of That causes miscarriage the placenta and the amniotic and still birth. fluid. Risk Factors  Prior Premature Prior Multiple Prior Multiple Births Pregnancies Abortions (biggest risk factor) (twins, triplets, or more) (therapeutic/spontaneous) G5 P5 (1405) G3 P6 (2406) G6 P3 (0332) Past Obstetric History  Current Pregnancy Related Factors Pregnancy Younger or achieved by Older Artificial inseminationorintrauterine in-vitro- insemination(IUI), sperm maternal ageis placed Cigarette directly into the uterus using a Smoking fertilization (e.g. 35) speculum. In-vitro fertilization(IVF), eggs are surgically removed using a needle that goes through the back of the vagina, and those eggs are fertilized Poor nutrition Untreated outside of the body. during gestation Infections Little or (and perhaps (e.g. UTI, bacterial No vaginosis, before) chorioamnionitis) prenatal care  Current Pregnancy Related Factors Order of birth Race (People of Age (highest (highest in first Color has higher incidence in younger Closely spaced pregnancy and incidence than than 20 years old. pregnancies. those fourth and White People) beyond. Abnormalities of birthing parent’s Pregnancy Early induction of Elective cesarian reproductive system, complications, such labor. section. (iatrogenic- such as intrauterine as PROM healthcare caused) septum  Current Pregnancy Related Factors Certain Cervical Placental Preeclampsia congenital insufficiency abruption defects (fetuses with structural The placenta Incompetent cervix High blood congenital heart defects (weakness of cervical separatesearly pressureduring arenearly twiceas likely tissue that contributes in the uterus. pregnancy. to be delivered to cause premature prematurely as fetuses delivery) without congenital heart defects). Current Pregnancy Related Factors Certain Congenital Defects  Certain Congenital Defects Acyanotic Defects Patent Ductus Ventricular Septal Coarctation of Atrial Septal Defect Arteriosus Defect Aorta  Certain Congenital Defects cyanotic Defects Total Anomalous Pulmonary Hypoplastic Left Venous of the Great Tetralogy of Fallot Transposition HeartVessels Syndrome Truncus Arteriosus Return Socioeconomic Factors  Low socioeconomic status.  Mothers with less formal education. It is unclear how much risk these socioeconomic factors contribute independently or effect on other risk factors (e.g. nutrition, access to medical care). Important among these is a high correlation between low socioeconomic level and early birth. In birthing parents from middle and upper socioeconomic groups, for example, only 4% to 8% of pregnancies are not carried to term. In birthing parents from low socioeconomic levels, as many as 10% to 20% end before term (Brink et al., 2020).  Signs and Symptoms The skin is generally Head appears unusually ruddy and may High degree of disproportionately be translucent; thin, pink, acrocyanosis may be Lesser activity and large (≥3 cm greater underlying veins are easily present. tone. than chest size). seen, and little subcutaneous fats. Late Preterm: Late Preterm: Delivered at greater Lanugo are extensive, Both anterior and than 28 weeks of Extremities are not held in covering the back, posterior fontanelles gestation are covered flexed. forearms, forehead, will be small. with vernix caseosa. and sides of the face.  Signs and Symptoms Preterm infant at 28 weeks’ gestation has a A term infant has well- small amount of ear developed cartilage cartilage and/or with instant recoil. flattened pinna. The ears appear large in The cartilage of the ear is The level of the ears should be relation to the head. immature and allows the pinna to carefully inspected to rule out fall forward. chromosomal abnormalities.  Signs and Symptoms Preterm infant at Preterm infant at 33 Term gestation. 28 weeks' weeks' gestation. Note Note the gestation. Note the presence of only an multiple creases. the flat sole. anterior crease.  Signs and Symptoms Undescended Testes Female labia do not Scrotum have few Needs repair to prevent cover labia minor. rugae. sterility (ORCHIOPEXY) if it is still present until 6 years old.  Signs and Symptoms Although difficult to elicit, apupillaryreaction ispresent. An ophthalmoscopic examination is extremely difficult and often uninformative because the EYES vitreous humormay behazy. Varying degrees ofmyopia(nearsightedness) because of alack of eye globe depth. Spontaneous or provoked muscle movements can be as important as formal reflex testing. Suckingwith coordinatedswallowingand breathing will beabsentif the newborn is≤33 weeks Reflex Deep tendonreflexes such as Achilles tendon reflex will also be markedlydiminished. Neurologic function is often difficult to evaluate because theneurologic system is still immature. Less activethan a mature neonate andrarely cries. Neuro If the neonate does cry, thecry is weakand may behigh-pitched. Potential Complications A NEMIA OF PREMATURITY A CUTE BILIRUBIN ENCEPHALOPATHY P ERSISTENT PATENT DUCTUS ARTERIOSUS P ERIVENTRICULAR HEMORRHAGE  ANEMIA OF PREMATURITY < 32 weeks AOG Immaturity of the Destruction of red blood Excessive Blood Drawing hematopoietic system cells(low levels of Vit. E) (Electrolytes, CBC, Blood Gas) Normochromic, Normocytic Anemia PREVENTIVE MEASURE PREVENTIVE MEASURE Delaying cord clamping at Blood draws are birth to allow a little more Pale, Lethargic, and Anorectic coordinated to the fewest blood from the placenta to possible and a record of the enter the newborn. blood loss for these are tallied.  ACUTE BILIRUBIN ENCEPHALOPATHY PREMATURITY Excessive breakdown of red blood Acidosis that occurs from poor respiratory cells at birth Less serum exchange albumin High concentrations of indirect Jaundice Brain cells to be more bilirubin form in the susceptible to the effect of bloodstream occurs indirect bilirubin Invasion of indirect or PREVENTIVE PREVENTIVE unconjugated bilirubin MEASURE MEASURE Exchange Phototherapy Transfusion Destruction of brain cells  Persistent patent PREMATURITY ductus arteriosus PREVENTIVE MEASURE Lack surfactant In term neonates, indomethacin or ibuprofen may be used to cause closure of a PDA, making ventilation more efficient; however, it is given cautiously to premature neonates because it has been associated Difficult to move blood from the with adverse effects such as decreased renal function, pulmonary artery into the lungs decreased platelet count, and gastric irritation. Leads to PREVENTIVE PREVENTIVE MEASURE MEASURE pulmonary artery hypertension Administer Carefully monitor intravenous therapy urine output and cautiously to observe for bleeding, Interferes with closure premature neonates especially at injection because increasing of the ductus sites, if this is blood pressure could prescribed. arteriosus further compound this problem. Ventricular System  Periventricular/ PREMATURITY intraventricular hemorrhage Fragile capillaries and immature cerebral vascular development. PREVENTIVE MEASURE Rapid change in cerebral blood pressure Premature neonates usually have a cranial ultrasound performed after the first few days of Capillary rupture life and again at different intervals based on the gestational age of the infant to detect if a hemorrhage has occurred. Infants with grade 1 or 2 bleeds have a good long-term prognosis; the Periventricular hemorrhage /bleeding into prognosis of those with more intense bleeds is the tissue surrounding the ventricles. guarded until further complications are ruled out. Grade 1 or Grade 2 or Grade 3 or Grade 4 Brain anoxia occurs distal to the rupture.  Intraventricular hemorrhage occurs most often in VLBW (less than 1500 grams) infants and is classified as: Grade 1 Grade 2 Grade 3 Grade 4  Grade Grade Grade Grade 1 2 3 4 The germinal matrix ( where bleeding originates) is a transient, highly vascularized region (blood- Bleeding in the rich area) of the brain that produces Bl eeding within periventricular germinal neurons and glial cells, and is present the lateral Bleeding in the fetal brain during Bleeding in matrix regionsor germinal the early gestation. matrix, occurring in one ventricle causing al ventricle. dilatation ofgerminal The the matrix 32 without matures atand theventricles ventricles. to 34 weeks. hemorrhage. A long-term effect of hemorrhage ventricle. 34 weeks, it becomes After a watershed enlargement of area may be the development of (there is no intraparenchym direct blood supply hydrocephalus if there is bleeding into to this area). the narrow aqueduct. The significance of IVH decreases after 32 weeks of gestations. PREVENTIVE MEASURE THERE IS VARIATIONS PER AGENCY/HOSPITAL Ultrasonography Scheduling of cranial ultrasound For babies born at When is cranial less than 32 weeks gestation or less than 1,500 gm ultrasound done in --- head ultrasounds 7 to 10 days after birth ---for high risk pretermthree days after birth prematurely born ---50% of IVH occur within the first day neonate? ---90% of IVH occur within the first three days For babies less than 2 kg --40% of IVH occur within 8 hours --25% of IVH occur within 24 hours --35% of IVH occur within 1 week According to Paneth et al, about 100% of IVH cases occurone week after delivery. Nathan was born at 30 weeks AOG and weighing 1200gm and a high- risk preterm. When is the best time for baby Nathan to have cranial ultrasound? head ultrasounds head head 8 hours ultrasounds ultrasound head after birth 7 to 10 days s 3 days ultrasound after birth after birth s within the first day