Premature Baby

Dr. Md. Masudur Rahman

Medical Officer (SCANU)
Cox’s Bazar Sadar
Hospital
 Premature Baby:

-A baby born before 37 weeks of

gestation calculating from the first day of
last menstural period is defined as
preterm baby/ premature baby.

-These babies are known as preemies.

Types Weeks of
Gestation
Extremely Preterm <28 wks

Very Preterm 28 to 31 wks

Preterm <37 wks

Late Preterm 34 to 36 wks

LBW of a newborn baby is related to-

a. Prematurity- Apropriate for

Gestational Age

b. Intrauterine growth retardation

(IUGR)- Inappropriate/ Small for
gestational age(SGA).
Parameters Preterm IUGR
Alertness: Less alert alert

Movement: Usually less

Comperatively
more.
Skin: Thin,Shiny May have
cracks or
peeling of
epidermis.
Parameters Preterm IUGR
Sole Crease: Less
More

Labia majora: Widely separated

Normal

Limbs : Limp Semi

flexed

Abdomen: Distended with Usually

Age of Viability:

-Most neonatologist define the age

of viability as being about 24 weeks of
gestation.
Result:
A total of 19.4% of newborn infants were preterm
-13.5% late preterm (34 and 36 weeks )
-3.3% moderate preterm (32 to 33 weeks)
-2.6% extremely preterm (28 to 31 weeks).

Preterm babies experienced 46% of all neonatal

deaths. Among them-
-40% in late preterm
-20% in moderate preterm
-40% in very preterm infants.
 OUR SCANU IN 2020……

Preterm baby - Admission - Death - NMR

1.5-2.5 kg 212 34 16.04 %

<1.5 kg 215 87 40.46 %

Expected Birthweight (50th percentile)

Gestational Age(wks) Birthweight(g)

24 700
26 900
28 1100
30 1350
32 1650
34 2100
 Why do premature newborns
need special care?

•A premature newborn is not fully

ready to deal with our world.

• Their little bodies still have areas

that need to mature and fully develop.
 Some of these areas include
the-

Digestive system
 Lungs
 Immune system
Skin
 Causes
Maternal factor :–
-Pre eclampsia
-Heart or kidney disease
-Infections: such as-
.Group B streptococcus
.Urinary tract infections
.Vaginal infections
.Infections of the fetal/placental
tissues
 –Drug use (such as cocaine)

–Abnormal structure of the uterus

–Cervical incompetence (inability of

the cervix to stay closed during
pregnancy)

–Previous preterm birth

•Factors involving the pregnancy:
–Abnormal or decreased function of
the placenta
–Placenta previa
–Placental abruptia
–Premature rupture of membranes
–Polyhydramnios
Fetal factor:

–Multiple pregnancy
–IUGR
–Congenital malformation
–Rh incompatibility
 Characteristics

Posture :

–hypotonic
–assume extended posture due to
poor muscle tone
 Skin:
–thin, gelatinous, shiny and
excessive pink with abundant lanugo.

–very little vernix edema may be

present.

–breast nodules are small or absent

-Hair appears wooly and fuzzy.
Face and head :
-face is small and head is large as per
body.
-Sutures are widely separated and
fontanelles are large.
-Protuding eye due to shallow orbit
and absent of buccal pads of fat.
-Ear cartilage is deficient with poor
recoil.
 •Planter creases; not so dark and very
few in number

•Nails: Bright pink colored nail beds

and very soft nails

•Activity : less activity of limbs

•Sucking : poor sucking ability
•Cry : weak cry
•Breast : no breast tissue palpable
•Central Nervous system :

–poor reflexes

–Reflexes : moro, sucking and other

reflexes are absent or poor.

–Uncoordinated sucking
swallowing leads to feeding difficulties.
Respiratory system:
–Period of apnea usually less that
20 seconds.

–Poor cough reflex leads to increase

risk of infection.

–Deficiency of surfactant leads to

respiratory distress syndrome.
•Gastro intestinal system:
–Functional immaturity of liver
cause hyperbilirubinaemia,
hypoglycemia and poor detoxification
of drug.

–Tendency to regurgitate due to an

incompetent cardio-esophageal
sphincter and small capacity of the
stomach.
• Abdominal distension
Necrotizing entercolitis
Temperature regulation:
–Loose more heat due to large area so
cause hypothermia

–Subcutaneous fat is less, less brown

fat

–Inadequate thermal response

Cardio-vascular system
–Delayed closure of ductus arteriosus
 –Inadequate peripheral circulation
–Intra cranial hemorrhage due to poor
auto regulation of cerebral blood flow
Renal System:

–GFR and urine concentration are

reduced due to renal immaturity.
Metabolic disturbance:
–Hypoglycemia

–Hypocalcemia

–Hypoproteinemia

–Hypoxia
Nutritional deficiency:

–Prone to develop anemia at 6-8

weeks because of low iron storage.
Susceptibility of infection:

–3 to 10 times more vulnerable to

infection than term babies.

–Low level of IgG.

Genitalia :
in male : testes are undescended,
scortum poorly pigmented
 -in female: labia majora are
widely separated exposing labia
minora and clitoris.
Management:
Antenatal management:
Antenatal injectable
corticosteroid to mother- 12mg
I/M 2 doses 12 hours interval in
preterm labour to prevent
complications of prematurity.
 Management
•Optimal management at birth:
–Promptly dry and keep warm with
gentle handling.
–The cord is to be clamped quickly
to prevent hypervolemia and
development of hyperbilirubinaemia.
–Give vitamin-K to prevent
hemorrhage.
 Management

Maintain body temperature :

–Keep the baby under radiant

warmer with temperature monitoring.
 Management
Kangaroo Mother
Care:
–Encourage KMC and
exclusive breastfeeding.
 Management
Benefits of KMC:

*Maintain body temperature

*Facilitates weight gain
*Easy access to breasfeed
*Increases intimacy and
attatchment
Oxygen therapy:
–It should be administered only
when indicated .

–O2 should administer with head

box when O2 saturation falls below
 Feeding and nutrition:
When to start?
-Haemodynamically stable.
-Normal abdominal Examination.
-No sign of
Respiratory Distress.
-Having no risk
factor for NEC.
 Management
Risk Factors for NEC:
-Severe IUGR
- Severe PNA
-Preterm (<32 wks, the lower the
gestational age, the greater the risk of
NEC).
-Sepsis
-Hypotension requiring Inotrops.
-Polycythaemia requiring exchange
 Management
When to stop/withheld Feeding:
-Blood/bile stained gastric aspiration.
-Systemic signs (Respiratory distress,
lethargy, apnoea,convulsion)
- Evidence of feeding intolerance:
*Vomiting (altered
milk/bile/blood )
*Abdominal Distension
*Reduced/ absent bowel sound
Minimal Enteral Nutrition (MEN) /
Trophic Feeding:
• This is a practice where in small
volumes of feeds are given to the baby in order
to stimulate the development of the immature
gastrointestinal tract of the preterm infant.
• Begin as soon after birth as possible,
ideally by postnatal day 2 to 3.
• It is not used in infants with severe
hemodynamic instability, suspected or
confirmed NEC, evidence of ileus, or clinical
signs of intestinal pathology.
 • These feeds are of small volume
ranging from 10-15 ml/kg/day.
• Trophic feeds decrease duration to
reach full enteral feeds and duration of
hospital stay without increasing the risk of
NEC.
To start with minimal enteral nutrition
(MEN):
.For the babies weight <1200 gm –
0.5ml 4 hourly
.For the babies weight >1200 gm – 1ml 4
 Management
Goals of feeding: -Start Feed: 60ml/kg/day
(>1.5kg) and 80ml/kg/day(<1.5kg).
-Daily increment 10-20ml/kg/day
-Full Feeds: 150-180/200ml/kg/day
-Calories:110-130 kcal/kg/day
-Anthropometry:
*Weight gain between 15-25
g/kg/day
*Length: 1cm/week
*Head Circumference: 0.5-0.7
 Management
Nutritional supplement:
*Multivitamins paed. Drop: 0.3ml
OD from 2wks till 6 months.
*Folic Acid:50mcg/day(1/4tab) every
alternate day till 6 months.
*Iron drop (1ml=50mg):
1drop OD - 4wks
1drop BD – 6wks
2drop BD – 6month
 Management
Gentle rhythmic stimulation:
–Gentle tactile stimuli by the mother.
–Soothing auditory
stimuli as family
voice,music.
–Eye to eye contact,
colored object
provide
visual inputs.
 Management
Prevention of nosocomial
infection:

-Strict hand washing or sanitizing

before and after touching the baby.

-Minimal handling.
Phototherapy:
–Early phototherapy is adviced to keep
the serum bilirubin level within safe limit
to prevent need for exchange transfusion.
Usually premature baby develops
hyperbilirubinaemia.
When to Plan for discharge:
-Able to maintain body temperature.
-Neither apnoea nor bradycardia for 5
days
-Able to take and tolerate full feeding
from breast or cup-spoon without
respiratory discomfort.
-Parents confident enough to take care
of the baby at home.
-Has crossed birth weight and shows a
Follow up:
-During follow up visit following
parameters should be addressed-
-Growth monitoring(weight,
length,OFC)
-Anemia
-Rickets and metabolic bone disease
-ROP (between 20-30 days of post
natal days)
-Hearing assessment
Possible Complications:
Early:
-Hypothermia (<95 F)
-Hypoglycaemia (<2.2 mmol/l)
-Respiratory distress syndrome
-Apnoeic spells (caesation of
respiration for >_20 sec)
-More chance of acquiring
infections
 -Haemorrhage (minor or fatal intra-
ventricular, GI, pulmonary
haemorrhage)

-Feeding Difficulty.
-Problems of gut: NEC, GERD
-Exaggeration of physiological
jaundice
-Anemia of prematurity
Late:
-Metabolic bone disease. e.g. rickets
of prematurity, osteopenia of prematurity)
- Retinopathy of prematurity(ROP)
-Delayed growth and development.
-Cerebral palsy or other
neurological deficit.
Prevention:
-Identifying mothers at risk for
preterm labor.
-Prenatal education of the symptoms
of preterm labor.
-Avoiding heavy or repetitive work or
standing for long periods of time that
can increase the risk of preterm labor.
-Early identification and treatment of
preterm labor.
Their future is in our hands !

THANK YOU!