Pediatric Fundamentals

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Pediatric Fundamentals Prematurity
Drs. Greg and Joy Loy Gordon January 2005
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Pediatric Fundamentals - Prematurity
Definitions premature gestational age less than
37 weeks or 259 days moderately premature 31-36
weeks severely premature 24-30 weeks postterm
greater than 41 weeks low birth weight (LBW) lt
2,500 Gm (only a bit over half of LBW infants
are premature)very low birth weight (VLBW) lt
1,500 Gm newborn first day of life neonate
first month of life infant first year of life
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Pediatric Fundamentals - Prematurity
5-10 of live births High morbidity and mortality
due to immature organ systems Responsible for 75
of perinatal deaths Immediate/early
complications hypoxia/ischemia intraventricular
hemorrhage sensorineural injury respiratory
failure necrotizing enterocolitis cholestatic
liver disease nutrient deficiency social stress
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Pediatric Fundamentals - Prematurity
Early complications and associated sequelae
Hypoxia/ischemia mental retardation spastic
diplegia microcephaly seizures poor school
preformance
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Pediatric Fundamentals - Prematurity
Early complications and associated sequelae
Intraventricular hemorrhage mental retardation
spasticity seizures hydrocephalus
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Pediatric Fundamentals - Prematurity
Early complications and associated sequelae
Sensorineural injury hearing
impairment visual impairment retinopathy of
prematurity strabismus myopia
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Pediatric Fundamentals - Prematurity
Early complications and associated sequelae
Respiratory failure bronchopulmonary dysplasia
(BPD) cor pulmonale bronchospasm malnutriti
on iatrogenic cleft palate recurrent
pneumonia
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Pediatric Fundamentals - Prematurity
Early complications and associated sequelae
Necrotizing enterocolitis short bowel
syndrome malabsorption malnutrition infectio
us diarrhea
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Pediatric Fundamentals - Prematurity
Early complications and associated sequelae
Cholestatic liver disease cirrhosis hepatic
failure carcinoma malnutrition
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Pediatric Fundamentals - Prematurity
Early complications and associated sequelae
Nutrient dificiency osteopenia fractures ane
mia vitamin E deficiency growth failure
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Pediatric Fundamentals - Prematurity
Early complications and associated sequelae
Social stress child abuse/neglect failure to
thrive
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Pediatric Fundamentals - Prematurity
Organ system complications
Respiratory respiratory distress syndrome
(RDS) hyaline membrane disease bronchopulmonary
dysplasia pneumothorax pneumomediastinum congen
ital pneumonia pulmonary hypoplasia pulmonary
hemorrhage apnea
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Pediatric Fundamentals - Prematurity
Organ system complications
Cardiovascular patent ductus arteriosus
(PDA) hypotension hypertension bradycardia
(with apnea) congenital malformations
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Pediatric Fundamentals - Prematurity
Organ system complications
Neurologic intraventricular hemorrhage periventr
icular leukomalacia hypoxic-ischemic
encephalopathy seizures retinopathy of
prematurity (retrolental fibroplasia) hypotonia
congenital malformations kernicterus (bilirubin
encephalopathy)
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Pediatric Fundamentals - Prematurity
Organ system complications
Hematologic anemia hyperbilirubinemia (direct
or indirect) subcutaneous or organ hemorrhage
(liver, adrenal) disseminated intravascular
coagulopathy vitamin K deficiency hydrops
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Pediatric Fundamentals - Prematurity
Organ system complications
Gastrointestinal necrotizing enterocolitis poor
gastrointestinal function or motility
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Pediatric Fundamentals - Prematurity
Organ system complications
Metabolic/endocrine hypocalcemia hypoglycemia h
yperglycemia late metabolic acidosis hypothermia
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Pediatric Fundamentals - Prematurity
Organ system complications
Renal hyponatremia hypernatremia hyperkalemia
renal tubular acidosis renal glycosuria edema
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Pediatric Fundamentals - Prematurity
Organ system complications
Other Infections congenital perinatal n
osocomial
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Pediatric Fundamentals - Prematurity
Special considerations
Respiratory breathing may initially be
exclusively nasal spontaneous neck flexion may
cause airway obstruction and apnea diaphragm
is most important respiratory muscle fewer
diaphragmatic type I fibers (10 vs
25) maternal betamethasone or
dexamethasone 48 hours before
delivery increases surfactant production and
decreases mortality after 30 weeks gestation
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Pediatric Fundamentals - Prematurity
Special considerations
Respiratory
apneas 25 of all prematures alleviated with
caffeine or theophylline PEEP stimulation
may be exacerabated by general anesthesia especi
ally infants lt 50 weeks postconceptional age
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Pediatric Fundamentals - Prematurity
Special considerations
Cardiovascular
PDA - treatment fluid restriction diuretics ind
omethacin surgical ligation Cardiac output
relatively dependent on heart rate Immature
sympathetic innervation
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Pediatric Fundamentals - Prematurity
Special considerations
Renal urine flow begins 10-12 weeks
gestation decreased in premature (compared to
full term) GFR renal tubular Na
threshold glucose threshold bicarbonate
threshold relative hypoaldosteronism with
increased risk of hyperkalemia tubular
function develops significantly after 34 weeks
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Pediatric Fundamentals - Prematurity
Special considerations
Nervous system
Brain has 2 growth spurts 1. neuronal cell
multiplication 15-20 weeks gestation 2. glial
cell multiplication 25 weeks to 2 years of
life Blood vessels more fragile increased risk
of intracerebral hemorrhage Periventricular
leukomalacia ischemic cerebral
complication 12-25 of LBW infants increase
risk of mental handicap Retinopathy of prematurity
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Pediatric Fundamentals - Prematurity
Special considerations
Thermal problems
Immature thermoregulation system Body heat loss
by conduction convection evaporation
radiation