Prematurity

-Prematurity

-Small for gestational age
-Large for gestational age

Premature (preterm) baby:

Birth before 37 completed weeks 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, apnoea of prematurity, chronic lung disease / bronchopulmonary dysplasia.

CNS: intraventricular haemorrhage, 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.

Hypoglycemia.

Anaemia of prematurity.


Jaundice liver enzyme immaturity.

Birth trauma.

Perinatal hypoxia.

Later: increased risk of adverse neurodevelopmental outcome,

behavioural problems and sudden infant death syndrome (SIDS).

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:-

male: the testes are not descended in the scrotum and no creases
on the scrotum.

Female: labia majora are not covering completely labia minora.

-Plantar creases are absent or only seen on the anterior 2/3 of the

sole:-






Small for gestational age (SGA):
SGA is birth weight <10th centile for gestational age.

Causes:

-Constitutional: small parents (commonest).
-Restricted foetal oxygen or glucose supply, e.g. placental dysfunction,
maternal hypertension, multiple pregnancy, maternal illness.
-Foetal abnormality as chromosomal disorders, congenital anomalies
and syndromes, congenital infection.
-Maternal substance exposure, e.g. alcohol, smoking, therapeutic or
other drugs

Complications:

-Hypoglycaemia
-Hypothermia
-Polycythaemia
-Necrotizing enterocolitis and/or intolerance of feeds.
-Thrombocytopenia/neutropenia/coagulopathy.
-Meconium aspiration syndrome.


Large for Gestational Age (LGA):
Defined as birth weight >90th centile for gestational age.

Causes:

-Most frequently constitutional, large parents.
-Infant of diabetic mother.
-Foetal hyperinsulinism, pancreatic islet cell hyperplasia.
-Hydrops foetalis.
-Beckwith–Wiedemann syndrome.

Complications:

Perinatal asphyxia, nerve palsies, shoulder dystocia, fractures.
Hypoglycaemia, especially if due to maternal diabetes or in BWS.
Problems associated with the underlying cause LGA.