PREMATURITY AND ITS

COMPLICATIONS
INTRODUCTION
 Definition
 Incidence
 Appropriate birth weight at different gestational ages
 Etiology
DEFINITION

It is defined as live born infant delivered before 37 weeks from the

first day of the last menstrual period.
INCIDENCE
 The exact incidence in Pakistan is not known.
 Estimated 11 to 13%.
 It includes both small for gestational age (SGA) and appropriate for gestational age
(AGA).
ETIOLOGY
 Maternal causes
 Uterine causes
 Fetal causes
 Others
MATERNAL CAUSES
 Malnutrition and Anemia
 Teenage pregnancy or multiparity
 Twin pregnancy
 Pre eclampsia
 Chronic illness (diabetes, renal disease , heart disease, hypertension)
 Infection(malaria, UTI, chorioamnionitis)
 Lower socioeconomic status
 Smoking or drug abuse
 Illegitimate birth
UTERINE CAUSES
 Bicornuate uterus
 Incompetent cervix
 Placenta previa, abruptio placenta, placental dysfunction
FETAL CAUSES
 Fetal distress
 Multiple gestation
 Chromosomal disorders(down’s syndrome)
 Intrauterine Infections (syphilis, TORCH)
 Erythroblastosis, non immune hydrops
OTHERS
 Polyhydramnios
 Trauma
 Premature rupture of membranes
 Itrogenic
COMPLICATIONS OF PREMATURITY
 Immediate
 Long term
IMMEDIATE (ACUTE) COMPLICATIONS
 Hypothermia
 Hypoglycemia
 Hypocalcemia
 Respiratory difficulties
 Intra ventricular hemorrhage
 Liver Immaturity
 Increased susceptibility to infections
 Necrotizing enterocoloitis
 Patent ductus arteriosus
 Feeding Problems
 Anemia of prematurity
 Retinopathy of prematurity
 Matabolic bone disease of prematurity
LONG TERM COMPLICATIONS
 Chronic lung disease (bronchopulmonary dysplasia
 Poor growth
 CNS dysfunctions
Cerebral palsy
Post hemorrhagic hydrocephalus Learning problems
Deafness
Mental subnormality
ASSESSMENT OF GESTATIONAL AGE
 Gestational age can be assessed appropriately in weeks by simple visual assessment of
certain physical signs and more accurately by using Ballard scoring system.
BALLARD SCORING SYSTEM
 Physical and neuromuscular criteria of maturity are given in Expanded New Ballard
score (NBS) .
 In this score physical and neurological scores are added and by this added score
gestational age is calculated.
 The score is accurate within 2weeks of gestation in infants weighing >999g at birth and
is most accurate at 30-42hours of age.
MANAGEMENT
 The management of preterm baby is based upon proper anticipation and prevention of
complications.
DELIVERY ROOM CARE
 Every preterm delivery should be attended by a pediatrician.
 Proper Resuscitation at birth early stabilization of vital signs ,prevention of hypothermia
and hypoglycemia in delivery room is related with ggod outcomes with minimal
complications.
AFTER BIRTH CARE
 Maintain thermos neutral environment
 Maintaince of fluid and electrolyte balance
 Oxygen administration
 Feeding
 Supplementation of iron and vitamins
 Protection from infection
 Early detection and management of complications of prematurity
 Immaturity of drug metabolism
PROGNOSIS
 It is related to gestation and birth weight
 In developed countries in NICU survival rate for 24weeks gestation is 25%. But there is
marked disability in survivors.
 5-10% of babies with birth weight less than 1500gm have major handicap.
 Risk increases with decreasing gestational age andweight.