1. The premature newborn infant
Ola Didrik Saugstad
Department of Pediatric Research
Rikshospitalet University Hospital
University of Oslo, Norway
Student lecture 9th semester

2. Prematurity GA < 259 days (37 weeks)
Norway: 5.6% (1988) and 6.5% (1996)
< 1.5 kg % (528 = 0.9% in 1996)
< 1.0 kg 0.3 % (200 =0.3% in 1996)
USA: 7% among caucasians 18% among black

3. Preterm infants Slight 32-36 weeks
Feeding and temperature problems, some have immature lungs
Moderate weeks
Immature lungs, temperature control, feeding problems, apneas
Severe < 28 weeks
Immature organ systems, intensive care
Slight and moderate approx 3000, severe 200 ( %) per year

4. Terminology Low birth weight < 2.5 kg
Very Low Birth Weight < 1.5 kg
Extremely Low birth Weight < 1.0 kg
Premature < 37 weeks
Immature < 28 weeks
ELGAN: Extremely Low Gestational Age Newborn < 26 weeks
Small for gestational age < 2.5 percentile

5. General problems in premature infants
Feeding: (IV – Gavage)
Temperature control: (incubator-heated bed)
Respiratory control: apneas, Respiratory support CPAP, Artificial ventilation
Immature lungs – lack of surfactant: Oxygen suppl, Respiratory support (CPAP, ventilator)
Immature brain: brain hemorrhage and cysts
Immunology: risk of infections (antibiotics)
Organ injury (Brain, Eye, Lung, Intestine, Skin
Long term consequences

6. Survival 1940: 50% with BW1500 gram survive
Birth weight % Survival after 1 year g g
g _______________
Medical Birth Registry

7. Survival Gestational age weeks Survival % 21 0-4 22 0-12 23 8-36
NFR’s Consensus report 1999

8. Sequels
From to survival among preterm infatns with BW gr increased from 20 to 59%.
The percentage of children with severe neurosensory injury was however, unchanged
(O’Shea 1997)

9. Injury of ELGANs 1972-1990 < 26 uker < 800 gram
Mental retardation % %
Cerebral palsy % %
Blindness % %
Deafness % %
”Major disability” % %
Survival increased, however rate of injury was constant
Lorents JM et al 1998, (meta-analysis including > 4000 children)

10. Injury of preterm infants
Eye ( Retinopathy of prematurity ROP
Stage 1-5)
Brain injury (Intracranial hemorrhage (grade 1-4) Periventricular leukomalacia PVL). Immature capillaries (plexus Choroides), hemodynamic changes, intrauterine inflammation
Pulmonary ( Bronchopulmonary dysplasia - BPD, Chronic lung disease - CLD)
Intestinal (necrotizing enterecolitis - NEC)

11. Development and pathogenesis of ROP

12. Impact of BPD, Brain Injury & ROP on 18 m Outcome of ELBW Infants
Overall probability of a poor 18 m (35%)
“ A simple count of 3 common neonatal morbidities strongly predicts the risk of later death or disability ”
Schmidt B et al. JAMA. March 2003;289:

13. School problems
A Dutch study showed that > 50% with BW < 1500 gram needed extra support at school
No relation between Gestational age and injury
Preterm infants have to be followed-up at least till school age because these problems have a late debut. Learning problems picked up around 8 years
ADHD
Hyperactivity
Intellectual problems (arithmetics, solving problems, cognitive functions)
Short term memory
Coordination problems
Behavioral problems (shy, sport performance, sosialise )
Boys> girs
Low Socioeconomic conditions

14. Future challenges Prevent preterm birth
Understand relation between intrauterine conditions and postnatal injury
Improved nutrition
Improved technology
New drugs (antioxidants, anti inflammatory, etc)
New insight into the needs and the psychological development