Prematurity Year 4 Paediatrics Notes OmpathStudy

Prematurity Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.3 / Munge / NEONATOLOGY -- Slide 1 Prematurity Dr Rose Munge Slide 2 Prematurity is a term for the broad category of neonates born at less than 37 weeks' gestation.\n Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization. For premature infants born with a weight below 1000 g, the three primary causes of mortality are respiratory failure, infection, and congenital malformation. Slide 3 Confirmation of gestational age is based on physical and neurologic characteristics. \nThe Ballard Scoring System remains the main tool clinicians use after delivery to confirm gestational age by means of physical examination. Slide 4 Pathophysiology Before birth, the placenta serves three major roles for the fetus: provision of all the nutrients for growth, elimination of fetal waste products, and synthesis of hormones that promote fetal growth. In addition, the placenta acts as a barrier to infection through mucosal macrophages and by allowing transfer of maternal immunoglobulins (immunoglobulins such as immunoglobulin G [IgG]) to the fetus beginning at 32-34 weeks' gestation.\n Placental dysfunction is involved in the transfer of IgG. Antibacterial activity of the amniotic fluid improves as gestational age advances. Each of the immature organs of a premature infant has functional limitations. Slide 5 Aetiology Premature delivery can be the result of preterm labor and preterm premature rupture of the membranes (PPROM), or it can be due to maternal indications (eg, pregnancy-induced hypertension). Chorioamnionitis Rates of perinatal mortality, neonatal infection, and respiratory distress syndrome (RDS) increase in the presence of maternal fever and chorioamnionitis. Intrauterine growth restriction (10th percentile for birth weight) Intrauterine growth restriction is significantly associated with perinatal mortality and long-term morbidity. Low socioeconomic status Maternal diabetes Pregnancies complicated by diabetes and poor glycemic control are associated with a high incidence of prematurity, macrosomia, malformation, fetal death, and neonatal death. The rate of preterm birth (<37 weeks' gestation) is 20-22% of persons with insulin-dependent diabetes Slide 6 Multiple gestation pregnancies Women with multiple gestation pregnancies are at high risk of preterm labor and delivery Maternal age In women aged 13-15 years, the rate of preterm birth is 5.9%. This rate declines to 1.7% in women aged 18-19 years and 1.1% in women aged 20-24 years. The rate of preterm births increases in pregnancies in which the mother is older than 40 years. Tobacco or marijuana use Tobacco use is a risk factor for placental abruption and accounts as a factor for 15% of preterm births and 20-30% of ELBW infants. Maternal marijuana use appears to be associated with an increased risk of neonatal morbidity (eg, infection and neurologic morbidity) or death. Slide 7 Prognosis Mortality and morbidity are inversely proportional to gestational age and birth weight. Infants with extremely low birth weight (ELBW) who are born at tertiary care centers have outcomes more favorable than those who are born at level I or II centers and then transferred. Preterm births account for approximately 70% of neonatal deaths and 36% of infant deaths, as well as 25-50% of cases of long-term neurologic impairment in children. Slide 8 Confirmation of gestational age in the newborn is based on physical and neurologic characteristics. Dubowitz scoring system for determining gestational age based on neurologic and physical parameters The Ballard Scoring System, remains the main tool clinicians use after delivery to confirm gestational age by means of physical examination. The major parts of the anatomy for physical characteristic markers are ear cartilage, sole creases, breast tissue, and genitalia. The physical examination and evaluation should be performed immediately after stabilization and before the expected weight loss occurs on the first day. Slide 9 Management Can be divided roughly into\nInitial stabilization Catch up\nLong term follow up Slide 10 Management Respiratory management -CPAP, Oxygen, Surfactant Thermoregulation- Radiant warmers, incubators Fluid and Electrolyte Management- Dextrose, sodium potassium, calcium Skin Care Diet- breast milk Prevention of infection Slide 11 Kangaroo mother care A multistakeholder group of newborn health advocates proposed accelerating global kangaroo mother care (KMC) as the standard of care for preterm infants. KMC consists of various preterm infant care practices that include skin-to-skin contact, breastfeeding, and close post discharge follow-up. Achieving universal KMC coverage could potentially save an estimated 450,000 preterm newborns annually, but current global coverage of KMC is lower than 1%. With a goal of achieving 50% coverage of KMC by the year 2020, the group plans a series of