Preterm baby

 Preterm baby(Immature, truly premature ,born

early)
 About 10-12 %of the babies are born premature in
India
 These babies are anatomically and functionally
immature and therefore neonatal mortality is high
Causes of prematurity
 1 spontaneous onset of premature labour
.2 induced by the obstetrician to safeguard the interests of the
mother and baby
 Spontaneous
 Poor socioeconomic status
 Low maternal weight
 Chronic and acute maternal disease
 Antepartum haemorrhage
 Cervical incompetence
 Cigarate smoking during pregnancy
 Thetaened abortion
 Acute emotional stress
 Physical exertion
 Trauma
 Bicornuate uterus
 Multiple pregnancy
 Congenital malformations
 Past history of premature labour is associated with 3-4
times more risk with subsequent pregnancies
 Induced
 Labour is induced before term when ther is impeding
danger to mother or fetal life in the uterus
 Eg: maternal diabetes mellitus
 Placental dysfunction- eclampsia, fetal hypoxia,
antepartum haemorrhage and severe Rhesus iso
immunisation
Clinical features/ characyteristics

 Measurements
 Size is small with relatively large head , crown to heel
length is less tha 47 cm
 Head circumference is less than 33cm
 Chest circumference is 3 cm less than head circumference
 Activity and posture
 General activity is poor reflexes are sluggish
 Baby assumes an extended postue due to poor tone
 Face and head
 Face appears small and disappropriate
 Large head size
 Sutures are separated and the fontanels are large
 Small chin ,protruding eyes due to shallow orbit and
absence of buccal pad of fat
 Often nerve is unmyelinated
 Ear cartilage is absent with poor reoil
 Hair appear wooly and fuzzy and individual hair fibers can
be seen separately
 Skin and subcutaneous tissue
 Skinis thin, gelatinous, shiny and
excessively pink with abundant lanugo and
very little vernix caseosa
 Edema may be present
 Breast nodule is small or absent
 Deep sole ceases are often not present
 Genitals
 Male : testes are undescended and scrotum is
poorly developed
 In female: labia majora widely separated
exposing labia minora and hypertrophied clitoris
Physiological handicaps/ hazards of
prematurity
 Central nervous system
 Immaturity of the nervous system is expressed as
inactivity and lethargy . Poor cough reflex and
incordinated suckng and swallowing , recurrent apneic
attacks are common
 Prone to get retrolental fibroplasia when o2 is
administered due to o2 toxicity
 Blood brain barriers are inefficient and due to that they
are quite prone to get brain damage due to kernicterus
 Respiratory system
 Respiatory system is also immature they have deficient
surfactant (found in lung alveoli) (surfactant causes the
expansion of the lung ), it causes resuscitation difficulty
as well as atelectasis of the lung
 Breathing is diaphragmatic , periodic and associated with
intercostal resection due to soft rib
 Pulmonary atelectasis and aspiration is very commomnly
seen in them
GI system
 Due to poor incordinated sucking and swallowing there are
difficulty in self feeding although their digestive ability is
good
 Regurgitation and aspiration are common due to in
coordinated sucking small capacity of stomach,
incompetence of cardioesophageal junction and poor
cough reflex
 Abdominal distension and functional intestinal obstruction
is common due to hypotonia
 Liver is immature it is unable to deal with protein
metabolism and due to that thee is
hyperbilirubinemia which may be aggravated
 Deficiency of vit K dependent coagulation factors
causes capillary fragility results in haemorrhage
Thermoregulation

 Hypothermia commonly seen in them

 Excessive heat lose due to large surface area and
poor generation of heat due to paucity of brown
fat in a baby who s equipped with un efficient
thermostat
Infection

 Infections are an important cause of neonatal

mortality in low birth weight babies ,because of
low levels of IgG antibodies and inefficient
cellular immaturity predispose them to infection
(after 8 months mothers Ig G will cross to baby)
 Excessive handling , humid and warm atmosphere
,contaminated incubators, and resuscitators
expose them to infecting organisms, this
contribute to high incidence of infection
 Renal immaturity
 Due to low glomerular filtration rate blood urea nitrogen
is high. Ability to concentrate urine very poorbecause of
renal immaturity . Preterm baby has to pass 4to 5 ml of
urine to excrete one milliosmole of solute as compared to
0.7ml by an adult for the same purpose.
 Therefore baby cannot conserve water and gets
dehydrated readily . The solute retention and low serum
proteins explain occurrence of edema in some preterm
babies
 Toxicity of drugs
 Poor hepatic detoxification and reduced
clearance make a preterm baby vulnerable to
toxic effects of drugs unless caution is expressed
during their administration.
 Ntritional handicaps
 Preterm babies are prone to develop anaemia around 6 to
8 weeks of age . This is due to diminished store of iron
due to short gestation
 Hey may also manifest deficiency of folic acid and vit E
 these infants are prone to develop haemolytic anaemia
,thrombocytopenia, and edema at 6 to 10 weeks of age
 Biochemical disturbances
 these babies are prone to develop hypoglycaemia,
hypocalcemia, hypoprotenemia and hypoxia