Neonatology

Prematurity

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.

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.

-soft auricle no cartilge slow 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:-