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COMPLICATIONS OF PREMATURITY

Mona Khattab, MD
Neonatal-Perinatal Fellow
Yale University Childrens Hospital

I am not just a Small baby I am a Preterm


baby.
I am a Unique Baby with Unique
Problems!!

Definition-Magnitude of Problem
Prematurity < 37 completed weeks
Accounts for 1/3 of infant deaths in USA,
45% cerebral palsy, 35% vision impairment,
and 25% cognitive or hearing impairment.
Risk of complications increases with
increasing immaturity

Classification based upon GA:


oLate preterm birth GA between 34 and < 37
weeks
oVery preterm birth GA < 32 weeks
oExtremely preterm birth GA 28 weeks

Classification by BW
oLow birth weight (LBW) < 2500 g
oVery low birth weight (VLBW) < 1500 g
oExtremely low birth weight (ELBW) < 1000 g

YOUR TURN
Short-term complications
Long-term complications
Proper stabilization in the DR is important to
reduce risk of short-term complications
decrease long term complications.

SHORT-TERM COMPLICATIONS
o
o
o
o
o

Hypothermia
Respiratory abnormalities: RDS, pneumothorax
Cardiovascular abnormalities: PDA, hypotension
Central nervous system: IVH, PVL
Metabolic: Hypo/ hyperglycemia,
hypo/hypernatremia, hypo/hyperkalemia
o Gastrointestinal: NEC, perforations
o Immune system: Sepsis, meningitis, UTI
o Eyes: Retinopathy of prematurity

EPIDEMIOLOGY
NICHD 8515 VLBW study:
oRespiratory distress: 93%
oRetinopathy of prematurity: 59%
oPatent ductus arteriosus: 46%
oBronchopulmonary dysplasia: 42%
oLate-onset sepsis: 36%
oNecrotizing enterocolitis: 11%
oGrade III and Grade IV IVH: 7 and 9%
oPeriventricular leukomalacia: 3%

HYPOTHERMIA
o Relatively large body surface area and
inability to produce enough heat.
o Heat loss by conduction, convection,
radiation, and evaporation.
o Sequale: hypoglycemia, acidosis, apnea
o Greatest risk for hypothermia immediately
after birth in the delivery room.
o Admission temperature is inversely related to
mortality and late-onset sepsis.

Standard care in DR to prevent


hypothermia

oMaintain the delivery room temperature


oDrying the baby thoroughly immediately after
birth
oRemoval of any wet blankets
oUse of prewarmed radiant heaters
o Polyethylene/polyurethane body wrap or bags,
and polyethylene or stockinet caps) or
oExternal heat sources ( skin to skin care and
transwarmer mattress)

RESPIRATORY COMPLICATIONS
o RDS: incidence and severity increase with
decreasing gestational age.
o Bronchopulmonary dysplasia, CLD, defined
as oxygen dependency at 36 weeks
postmenstrual age (PMA)
o Apnea of prematurity: 25% of preterm
infants. Incidence increases with decreasing
gestational age

CARDIOVASCULAR COMPLICATIONS
PDA: Symptomatic 30% VLBW
Shunts blood flow from left-to-rightincrease
pulmonary flow and decreased systemic
circulation.
Severity depends upon size and response of the
heart and lungs.
oSignificant shunting hypotension, oligurea,
apnea, respiratory distress, or heart failure

CARDIOVASCULAR COMPLICATIONS
Systemic hypotension : in the immediate postnatal
period significant morbidity (IVH) and mortality.
oVolume expansion: crystalloid (eg, normal saline)
and colloid (eg, fresh frozen plasma)
oInotropic therapy: (dopamine, epinephrine)
oSystemic glucocorticoid therapy: refractory
hypotension or those who required high dose
inotropic therapy (adverse effects: intestinal
perforation and long-term poor neurodevelopment
outcome (eg, cerebral palsy)

CNS COMPLICATIONS
Intraventricular hemorrhage: in the fragile
germinal matrix and increases with decreasing
BWbirth. Incidence of severe IVH (Grades III
and IV) 12-15%in VLBW
Preventive measures: prompt and appropriate
resuscitation, avoid hemodynamic instability
and conditions that impair cerebral
autoregulation (eg, hypoxia, hypercarbia,
hyperoxia, and hypocarbia).

METABOLIC COMPLICATIONS
Glucose abnormalities:
hypoglycemia or hyperglycemia
Blood glucose concentration should be
monitored routinely starting immediately after
birth and continued until feedings are well
established and glucose values have normalized
Other metabolic abnormalities will be discussed separately

GI COMPLICATIONS

Necrotizing enterocolitis (NEC):


2-10 percent of VLBW infants. associated with
increase in mortality.
Survivors are at increased risk for growth delay
and neurodevelopmental disabilities.

INFECTION
Classification:
o Early onset sepsis
o Late-onset sepsis
Risk factors for infection: Prolonged
intubation, BPD, prolonged intravascular
access, PDA, and NEC.
Neonatal sepsis is associated with increased
likelihood of poor neurodevelopmental
outcome and growth impairment.

EYE
Retinopathy of prematurity (ROP):
oDevelopmental vascular proliferative disorder
occurs in the incompletely vascularized retina of
premature infants.
oIncidence & severity of ROP increases with
decreasing gestational age or birth weight.
oTypically begins about 34 weeks(PMA), but may
be seen as early as 30 to 32 weeks.
oNext to cortical blindness, ROP is the most
common cause of childhood blindness in the USA.

Pathogenesis of ROP
Hypotension, hypoxia, or hyperoxia, with free
radical formation, injures newly developing blood
vessels and disrupts normal angiogenesis
neovascularization retinal edema, hemorrhage
and abnormal fibrovascular tissue development.

LONG-TERM COMPLICATIONS
o Neurodevelopmental outcome: Impaired
cognitive skills
o Motor deficits including mild fine or gross
motor delay, and cerebral palsy
o Sensory impairment including vision and
hearing losses
o Behavioral and psychological problems
o Poor growth compared to those born full-term
o Impairment of lung function

EFFECT ON ADULT HEALTH

oInsulin resistance
oHypertension and vascular abnormalities
oReproduction: Prematurity has been associated
with decrease reproduction in adulthood.

THANK YOU