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Fifth stage
Pediatric
Lec-6-7
.د
بسام
21/12/2015
Prematurity
Premature (preterm) baby:
Birth before 37 completed weeks of gestation. 8% of all births. Most problems seen in with
infants born <32 completed weeks.
Predisposing factors:
Idiopathic (40%).
Previous preterm birth.
Multiple pregnancy.
Maternal illness, e.g. chorioamnionitis, polyhydramnios, pre-eclampsia,
Diabetes mellitus.
Premature rupture of membranes.
Uterine malformation or cervical incompetence.
Placental disease, e.g. dysfunction, antepartum haemorrhage.
Poor maternal health or socio-economic status
Complications of prematurity:
Respiratory: surfactant deficiency causing respiratory distress syndrome, apnea of
prematurity, chronic lung disease / Broncho pulmonary dysplasia.
CNS: intraventricular hemorrhage, periventricular leucomalacia, retinopathy of
prematurity.
GIT: necrotizing enterocolitis, inability to suck, and poor milk tolerance.
Hypothermia.
Immuno-compromise resulting in recurrent infections.
Impaired fluid/electrolyte homeostasis skin water loss, poor renal function.
Patent ductus arteriosus.
Anaemia of prematurity.
Jaundice liver enzyme immaturity.
Birth trauma.
Perinatal hypoxia.
Later: increased risk of adverse neurodevelopmental outcome, behavioral problems
and sudden infant death syndrome (SIDS).
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Signs of prematurity:
Thin gelatinous skin and dark red in color.
Poorly developed breast tissue, no palpable breast tissue or it is flat and less than 1cm
in diameter.
The ear auricle is soft, no cartilage and there is slow or no recoil.
Genitalia
o Male: the testes are not descended in the scrotum and no creases on the
scrotum.
o Female: labia majora are not covering completely labia minora.
Plantar creases are absent or only seen on the anterior 2/3 of the sole
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Neonatal Seizures
About 2–4/1000 live births suffers of seizure disorder. Usually occur 12–48hr after delivery.
Can be generalized or focal, and tonic, clonic, or myoclonic.
Subtle seizure patterns (lip-smacking, limb-cycling, eye deviation, apnoeas, etc.) can be
difficult to identify or differentiate from other benign conditions that may mimic seizures
as:
Startle or Moro reflexes, normal jittery’ movements (fine, fast limb movements that are
abated by holding affected limb), Sleep myoclonus (REM movements).
Causes:
-Brain injury as:
hypoxic ischaemic encephalopathy (HIE).
intracranial haemorrhage.
cerebral infarction (ischaemic or haemorrhagic).
cerebral oedema.
birth trauma.
-CNS infection:
meningitis (e.g. GBS, coliforms).
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encephalitis (e.g. HSV, CMV).
-Cerebral malformations.
-Metabolic:
Hypoglycaemia.
hypo- or hypernatraemia.
hypocalcaemia, hypomagnesia.
pyridoxine dependent seizures.
non-ketotic hyperglycinaemia.
-Neonatal withdrawal from maternal medication or substance abuse.
-Kernicterus.
-Rare syndromes:
benign familial neonatal seizures (autosomal dominant).
early myoclonic encephalopathy.
With improved access to neuroimaging, fewer infants are being categorized as ‘benign’ or
‘idiopathic’ seizures. Neonatal stroke is increasingly recognized.
Treatment of neonatal seizures:
Immediate: give oxygen,maintain airway, insert IV canula.
When to start anticonvulsants?
usual indication is >3seizures/hr or single seizure lasting >3–5min
particularly if evidence of cardio-respiratory compromise.
First-line anticonvulsant:
IV phenobarbital (10–20mg/kg bolus; give further 10–15mg if seizures persist after 30min;
maintenance dose 5mg/kg/day).
Then treat the underlying cause.