Prematurity-An Overview Murila FV

Prematurity GA < 259 days (37 weeks) 15 million every year worldwide More than 1 in 10 babies are born preterm Over 1 million children die each year due to complications of preterm birth. Rates of preterm birth are rising in almost all countries

CLASSIFICATIONS BIRTH WEIGHT Borderline LBW g Mild LBW g Very LBW g Extremely LBW <1000g PREMATURITY Borderline preterm 34-36wks Mildly Preterm wks Very preterm wks Extremely preterm <28wks

Causes of Under 5 Mortality in Kenya (WHO, Kenya Country Fact Sheet, 2006)

Why are 4 million newborn dying in the world? Source: Lawn JE, Cousens SN, Zupan J Lancet based on cause specific mortality data and estimates for 192 countries

Leading causes of mortality in NBU 2010 Number Prematurity648 Respiratory distress syndrome257 Neonatal sepsis206 Asphyxia138 Total number of deaths913

Early Complications; Mx RESPIRATORY DISTRESS SYNDROME Due to Immature Lungs Mx -O2 supplementation -Intravenous Fluids -Antibiotics CPAP Ventilator METABOLIC DERRANGEMENTS Hypoglycemia Acid base imbalances Electrolyte Abnormalities NEONATAL INFECTION Prevention-strict hand washing policy GIT NEC CARDIOVASCULAR ANOMALIES -Dehydration Monitoring and replacement -PDA of pre-maturity Prostaglandin inhibitors INTRA-VENTRICULAR BLEEDS - Stringent management of respiratory and cardiovascular complications ASPHYXIA - Effective resuscitation at birth

Later Complications INTERMEDIATE Anaemia of Pre-maturity Iron, folate and Vit A Rickets of Prematurity Vitamin D and Calcium Post-Haemorrhagic Hydrocephalus V-P shunting Retinopathy of prematurity laser therapy LATE Mental & physical development delay Rehabilitation Failure to thrive Nutritional support Increased morbidity and mortality

Late Complications ADHD Intellectual problems (arithmetics, solving problems, cognitive functions) Short term memory Coordination problems Behavioral problems (shy, delinquency )

Prevention of mortality 50% of babies born at 32 weeks die 75% of premature babies could be saved with feasible, cost-effective care, such as warmth, breastfeeding support, basic care for infections and breathing difficulties. Further reductions are possible through intensive neonatal care.