The Premature infant  DR Husain alsaggaf

بسم الله الرحمن الرحيم

THE PREMATURE INFANT DEFINITION : NEWBORN BABY LESS THAN 37 weeks.

Physical characteristic  L Length related to weight. HHead circumference>chest circumference. WWeak cry. IIn active and sleep most of the time. EEars are floppy and respiration is. irregular llabia minora covered labia majora. TTesticles are incompletely descended.

The premature  Birth asphyxia weak respiratory muscles Weak thoracic cage

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

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.

Gastrointestinal and nutrition  Poor sucking and swallowing<35 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

Gastrointestinal problems

gastrointestinal problems

Hepatic problems  Impaired conjugation and excretion of bilrubin  jaundice.  Deficiency of vitamin k dependant factors  bleeding.  Decrease glycogen storage  Hypoglyceamia.

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.

Neurological problems DDefective sucking and swallowing. RRecurrent apnoea. IIncrease incidence of intracranial haemorrhage.

Blood and cardiovascular problems  Delayed closure of the ducts.  Weak capillary.  High haemoglobin at birth and then law level at 6 weeks.

Immunological problems  Decrease level of antibodies.  Decrease ability to produce antibodies.  Relative impairment of cellular immunity.

Metabolic problems  Liability to rickets.  Hypoglycaemia.  Hypocalcaemia.

Other problems  Retinopathy of prematurity.  Increase incidence of non accidental injuries.  Congenital malformations.

Management  PREVENTION:  Rest.  Adrenergic drugs.  Steroid to prevent (IRDS).

During labour and delivery  Paediatrician should be informed.  Delivery in well equipped hospital.  Analgesia to mother should be withheld.  Prompt Resuscitation with endotracheal intubations.

Monitoring TTemperature. AApnoea monitor. HHeart and respiratory rate. OOxygen saturation. BBlood sugar and calcium.

Temperature management  Incubators in thermonuetral range.  Head caps and heat shield.  Suitable Room temperature.  Humidification.

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

Feeding  Breast milk, premature formula.  Cal /kg cal day.  50ml / kg increase by 25ml / kg / day.  Weight increase 30 gm / day.

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.

Management  Oxygen: No oxygen except for hypoxia.  Keep PO mmg.  Surfactants and Mechanical Ventilation.  Encourage mother to visit the baby.

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.

Small of date. Special Hazards  Conception---Malformation.  Anti-natal------Intrauterine death.  Labour and delivery----Asphyxia…  Neonatal---Meconium aspiration.  Hypoglycaemia.  Hypothermia.  Polycythemia.  Pulmonary haemorrhage.  Infection