MANAGEMENT OF

PRETERM
 Preterm -- < 37 weeks of gestation
SGA -- <10th percentile
AGA 10th to 90th percentile
LGA -- > 90th percentile
NEONATAL PROBLEMS ASSOCIATED
WITH PREMATURE INFANTS

RESPIRATORY : Respiratory distress syndrome

Apnea
BPD
pneumothorax
pneumo mediastinum
interstitial emphysema
congenital pneumonia
 CARDIOVASCULAR -
Patent ductus arteriosus
Hypotension
Bradycardia
HEMATOLOGIC
Anemia
GASTROINTESTINAL

Poor gastrointestinal function

Necrotising Enterocolitis
GERD
Hyperbilirubinemia
Spontaneous perforation
METABOLIC-ENDOCRINE

Hypocalcemia
Hypoglycemia
Hyperglycemia
Late metabolic acidosis
Hypothermia
Euthyroid but low thyroxine status.
CNS

Intraventricular hemorrage
Periventricular leukomalacia
Seizures
Retinopathy of prematurity
Deafness
Hypotonia
RENAL

Hyponatremia
Hypernatremia
Hyperkalemia
Renal tubular acidosis
Renal glycosuria
Edema
OTHER INFECTIONS
SUPPLEMENTS
Minerals elemental calcium: 160mg/kg
phosphorus: 80mg/kg.
vitamins vit A :1000-1500IU
vit D: 400IU
vit E: 25IU
vit C: 40-50mg
vit B1: 1000micrograms
vit B12: 3-5 micrograms
niacin: 5-10 mg
folicacid: 50 micrograms
Iron -2-4mg/kg/day
HYPOTHERMIA

Higher ratio of skin surface area to

weight.
Highly permeable skin leads to
increased transepidermal water loss.
Decreased subcutaneous fat, with
less insulative capacity.
Less developed stores of brown fat.
 Hypothermia leads to increased oxygen
consumption, metabolic acidosis, hypoglycemia.
HYPOGLYCEMIA

Preterm babies are more prone for hypoglycemia due

to low hepatic glycogen stores, high incidence of
hypoxia, hypothermia, respiratory distress
syndrome.
RESPIRATORY DISTRESS
SYNDROME

It is due to surfactant deficiency.

Assessed by Silverman Anderson
score
X ray low volume lungs
-reticulogranular pattern
-air bronchogram
-whiteout lungs
RESPIRATORY DISTRESS
SYNDROME

Management: maintain spo2 85 to 92%

CPAP
surfactant replacement
therapy
mechanical ventilation
supportive therapy
APNEA

Cessation of breathing more than 20 sec

associated with cyanosis, bradycardia.

Due to immaturity of CNS, chemoreceptor

response, protective airway reflexes and lung
mechanics.
 Apnea of prematurity is a diagnosis of exclusion
and should be considered only after secondary
causes have been ruled out.
 apnea

check position of neck

Gentle tactile stimulation, oropharyngeal suction

Improved not improved

Maintain spo2 > 92% bag & mask ventilation

CPAP

intubation and IPPV

 Baby kept on NBM and maintain the
temperature & blood glucose levels.

Keep hematocrit > 30% and screen

the baby for underlying cause.
 Indications of drug therapy :
1. Recurrent apnea--
> 2 episodes in 1 hr
>3 episodes in 2 consecutive
hours.
2. apnea requiring BMV
Drugs : caffeine citrate
aminophylline
NECROTISING ENTEROCOLITIS
preterm baby

hypovolemia

diving reflex

reduced intestinal perfusion

functional intestinal obstruction

delayed gastric emptying
bilious vomiting
abdominal distension
 Investigations: thrombocytopenia
hyponatremia
metabolic acidosis
X-ray : dilated fixed loops of bowel
pneumatosis intestinalis
portal vein gas
pneumo peritoneum
 Treatment: early recognition of NEC.
NBM for 7-14 days
continuous NG aspiration
maintain adequate hydration
Antibiotics
FFP
Surgery
PATENT DUCTUS ARTERIOSUS

Decrease sensitivity of oxygen induced

contraction of smoothmuscle.

Increased PG E2 due to increased production &

decreased degradation.

Increased dilator response of PG E2.

PATENT DUCTUS ARTERIOSUS

Associated with RDS,NEC, after treatment

of RDS especially after surfactant therapy.

X ray : pulmonary plethora

cardiac enlargement.
2d echo.
PATENT DUCTUS ARTERIOSUS

MEDICAL MANAGEMENT: Indomethacin

Ibuprofen
HYPERBILIRUBINEMIA

Due to immaturity of glucuronyl transferase

system in the liver leads to hyperbilirubinemia
which may be aggravated by dehydration , delayed
feeding , hypoglycemia.
HYPERBILIRUBINEMIA

Relatively low serum albumin , acidosis ,

hypoxia predispose to development of
kernicterus at low serum bilirubin level.
OSTEOPENIA OF PREMATURITY

> 80% of skeletal uptake of calcium, phosphorus

occur during last trimester of pregnancy.
Poor intestinal absorption of calcium.
Impaired conversion of vitamin D into its active
metabolites.
Breast milk is a poor source of calcium &
phosphorus.
 Serum calcium within normal range.
Hypophosphatemia
Increased alkaline phosphatase.(>1000IU)
Hypercalciuria
Vitamin D levels usually low or normal range.
 Prevention:
-daily oral supplementation of calcium 160 mg/kg
-Phosphorus 80 mg/kg
-Vit D -200 IU
Treatment:
vit D 400 800 IU
calcium
phosphorus
gentle massage & passive movement of
limbs.
INTRA VENTRICULAR
HEMORRAGE

Rapid fluid infusion, hyper osmolar solutions

of glucose, sodium bicarbonate.

Immaturity of cerebral vasculature, peri

ventricular area is more prone to hemorrage
due to structural deficient in smooth muscle,
collagen & elastin
 Clinical features:
-sudden unexplained fall in hematocrit
-changes in muscle tone (hypotonia)
- anemia
- hyperbilirubinemia.
Anaemia of prematurity

Due to decrease RBC mass and iron stores in

premature babies
Haemoglobin nadir occurred earlier and at
lower levels .
Due to rapid growth of preterm babies
Treatment :

Iron supplementation 2-4 mg / kg /day

Vit E -15-25 IU /day

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