The Premature infant

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The Premature infant

• DR Husain alsaggaf

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The Premature Infant
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THE PREMATURE INFANT

• DEFINITION NEWBORN BABY LESS THAN 37 weeks.

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Physical characteristic

• Length related to weight.
• Head circumferencegtchest circumference.
• Weak cry.
• In active and sleep most of the time.
• Ears are floppy and respiration is. irregular
• labia minora covered labia majora.
• Testicles are incompletely descended.

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The premature

• Birth asphyxia
• weak respiratory muscles
• Weak thoracic cage

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Hypothermia

• Increased heat loss
• Lack of insulation.
• Increase surface area to weight
• Decreased heat production
• Decrease activity.
• Lack of brown fat

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Respiratory difficulties

• decrease amount of surfactant.
• Poor gag and cough reflex.
• In coordination o swallowing and
  suking?aspiration of food.
• Soft thoracic cage and weak respiratory
  muscle-?ineffective ventilation.
• Immature respiratory center?apnea.
• High incidence of bronchopulmonary dysplasia.

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Gastrointestinal and nutrition

• Poor sucking and swallowinglt35 weeks
• decrease intestinal motility?abdominal distension
• Decrease gastric volume and gastric emptying time
• Decrease digestion and absorption of fat and fat
  soluble vitamins,cetain minerals
• High incidence of necrotizing colitis

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Gastrointestinal problems
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gastrointestinal problems
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Hepatic problems

• Impaired conjugation and excretion of bilrubin?
  jaundice.
• Deficiency of vitamin k dependant
  factors?bleeding.
• Decrease glycogen storage?Hypoglyceamia.

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Renal problems

• The concentration and delution ability is
  reduced.
• The kidneys are unable to hold large solute load.
• Increased lose of salt.
• Increased lose of sodium bicarbonate.

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Neurological problems

• Defective sucking and swallowing.
• Recurrent apnoea.
• Increase incidence of intracranial haemorrhage.

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Blood and cardiovascular problems

• Delayed closure of the ducts.
• Weak capillary.
• High haemoglobin at birth and then law level at
  6 weeks .

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Immunological problems

• Decrease level of antibodies.
• Decrease ability to produce antibodies.
• Relative impairment of cellular immunity.

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Metabolic problems

• Liability to rickets.
• Hypoglycaemia.
• Hypocalcaemia.

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Other problems

• Retinopathy of prematurity.
• Increase incidence of non accidental injuries.
• Congenital malformations.

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Management

• PREVENTION
• Rest.
• Adrenergic drugs.
• Steroid to prevent (IRDS).

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During labour and delivery

• Paediatrician should be informed.
• Delivery in well equipped hospital.
• Analgesia to mother should be withheld.
• Prompt Resuscitation with endotracheal
  intubations.

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Monitoring

• Temperature.
• Apnoea monitor.
• Heart and respiratory rate.
• Oxygen saturation.
• Blood sugar and calcium.

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Temperature management

• Incubators in thermonuetral range.
• Head caps and heat shield.
• Suitable Room temperature.
• Humidification.

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Feeding

• Early feedings at (2-3 hours).
• Less than 34 weeks tube feeding.
• Less than 1750 gm / hourly.
• Between 1750-2000 gm two hourly.
• More than 2000 gm 3 hourly.

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Feeding

• Breast milk, premature formula.
• Cal 110-130/kg cal day.
• 50ml / kg increase by 25ml / kg / day.
• Weight increase 30 gm / day.

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Vitamins

• Vit D 800 iu day.
• Vit C 50 mg day.
• Vit E 10mg day.
• Folic acid 50 mg day if less than 2kilo.
• Vit K at birth.

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Management

• Oxygen No oxygen except for hypoxia.
• Keep PO2 50-80 mmg.
• Surfactants and Mechanical Ventilation.
• Encourage mother to visit the baby.

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Small for date infant

• Physical characteristics
• Lack of subcutaneous fat.
• Wasting of soft tissues.
• Skin is lose with peeling.
• Scalp hair is spare, skull bone is hard.
• Vigorous and active.
• Eager to feed.

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Small of date.
Special Hazards

• Conception---Malformation.
• Anti-natal------Intrauterine death.
• Labour and delivery----Asphyxia
• Neonatal---Meconium aspiration.
• Hypoglycaemia .
• Hypothermia.
• Polycythemia.
• Pulmonary haemorrhage.
• Infection

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