the premature infant dr husain alsaggaf. بسم الله الرحمن الرحيم
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The Premature infant
DR Husain alsaggaf
الرحيم الرحمن الله بسم
THE PREMATURE INFANT
DEFINITION : NEWBORN BABY LESS THAN 37 weeks.
Physical characteristic
Length related to weight. Head circumference>chest
circumference. Weak cry. In active and sleep most of the time. Ears are floppy and respiration is.
irregular labia minora covered labia majora. Testicles are incompletely descended.
The premature
Birth asphyxia weak respiratory muscles Weak thoracic cage
Hypothermia
Increased heat loss Lack of insulation. Increase surface area to weight
Decreased heat production Decrease activity. Lack of brown fat
Respiratory difficulties decrease amount of
surfactant. Poor gag and cough
reflex. In coordination o
swallowing and sukingaspiration of food.
Soft thoracic cage and weak respiratory muscle-ineffective ventilation.
Immature respiratory centerapnea.
High incidence of bronchopulmonary dysplasia.
Gastrointestinal and nutrition
Poor sucking and swallowing<35 weeks decrease intestinal motilityabdominal
distension Decrease gastric volume and gastric
emptying time Decrease digestion and absorption of fat
and fat soluble vitamins,cetain minerals High incidence of necrotizing colitis
Gastrointestinal problems
gastrointestinal problems
Hepatic problems
Impaired conjugation and excretion of bilrubin jaundice.
Deficiency of vitamin k dependant factorsbleeding.
Decrease glycogen storageHypoglyceamia.
Renal problems
The concentration and delution ability is reduced.
The kidneys are unable to hold large solute load.
Increased lose of salt. Increased lose of sodium bicarbonate.
Neurological problems
Defective sucking and swallowing.Recurrent apnoea.Increase incidence of intracranial
haemorrhage.
Blood and cardiovascular problems
Delayed closure of the ducts. Weak capillary. High haemoglobin at birth and then law
level at 6 weeks .
Immunological problems
Decrease level of antibodies. Decrease ability to produce antibodies. Relative impairment of cellular
immunity.
Metabolic problems
Liability to rickets.Hypoglycaemia.Hypocalcaemia.
Other problems
Retinopathy of prematurity. Increase incidence of non
accidental injuries. Congenital malformations.
Management
PREVENTION: Rest. Adrenergic drugs. Steroid to prevent (IRDS).
During labour and delivery
Paediatrician should be informed. Delivery in well equipped hospital. Analgesia to mother should be withheld. Prompt Resuscitation with endotracheal
intubations.
Monitoring
Temperature. Apnoea monitor. Heart and respiratory rate. Oxygen saturation. Blood sugar and calcium.
Temperature management
Incubators in thermonuetral range.
Head caps and heat shield.
Suitable Room temperature.
Humidification.
Feeding
Early feedings at (2-3 hours). Less than 34 weeks tube feeding. Less than 1750 gm / hourly. Between 1750-2000 gm two hourly. More than 2000 gm 3 hourly.
Feeding
Breast milk, premature formula. Cal 110-130/kg cal day. 50ml / kg increase by 25ml / kg / day. Weight increase 30 gm / day.
Vitamins
Vit D 800 iu day. Vit C 50 mg day. Vit E 10mg day. Folic acid 50 mg day if less than 2kilo. Vit K at birth.
Management
Oxygen: No oxygen except for hypoxia. Keep PO2 50-80 mmg. Surfactants and Mechanical Ventilation. Encourage mother to visit the baby.
Small for date infant
Physical characteristics Lack of subcutaneous fat. Wasting of soft tissues. Skin is lose with peeling. Scalp hair is spare, skull bone is
hard. Vigorous and active. Eager to feed.
Small of date. Special Hazards Conception---Malformation. Anti-natal------Intrauterine death. Labour and delivery----Asphyxia…
Neonatal---Meconium aspiration. Hypoglycaemia . Hypothermia. Polycythemia. Pulmonary haemorrhage. Infection