Premature and Small-for-Dates Infants
SIDS
**Occurs more than twice as frequently in premature infants as in full-term infants **Usually between 2-5 months of age Apnea of prematurity is NOT a major predisposing factor for SIDS
Intraventricular Hemorrhage
- immaturity in the CNS places the infant at risk for IVH, PVL, and hydrocephalus
Bronchopulmonary dysplasia (BPD)
- infants who requires oxygen and/or ventilation 4 weeks post natal age or corrected age of 36 weeks
Bradycardia
--> Very low heartrate May be symptom of underlying medical condition If all serious underlying causes ruled out, infant said to have apnea of prematurity Risk of apnea of prematurity declines with advancing postnatal maturation Treatment involves use of caffeine which reduced incidences of AOP
Incidence of Preterm Births
-13% of all pregnancies -->> Responsible for majority of neonatal deaths Responsible for nearly ½ of all cases of neonatal-onset neurodevelopmental disabilities, including cerebral palsy (CP) Risk is highest in those infants born before 32 weeks' gestation, representing 2% of all births
Ophthalmologic Problems
-Abnormalities of retinal vascular development after preterm birth lead to retinopathy of prematurity (ROP) -ELBW infants are at the greatest risk of developing ROP -An eye exam should be performed at 4-6 weeks post natal or at 32-33 weeks gestational age.
Care After Discharge from hospital
-Discharge based on weight and maturity of body organs -May be more irritable and have poor sleep wake cycles -Require more frequent feedings -Specialized formula and/or breast milk supplements are available
Early-intervention program
-Often start prior to discharge until 3 years old -Corrected age is calculated by first determining how premature the baby was, then subtracting that from 40 weeks -Then that number is subtracted from the child's current chronological age (CA) -EI uses multi-disciplinary, family- centered approach
Immunological Problems
-Premature infants are born with an immature immune system -This results in increased risk for infection in the first months of life -Premature infants who remain in the NICU for extended time should receive their vaccinations according to their chronological age
Apnea of Prematurity
-Respiratory pause lasting 15-20 seconds associated with decrease in heart rate to below 80-100 beats per minute -Most common disorder of respiratory control found in neonatal intensive care unit (NICU) -Related to immaturity of the central nervous system (CNS) -Roughly 10% of all LBW infants and more than 40% of VLBW infants have apnea
Gastrointestinal Problems
-The premature infant often has an immature gastrointestinal system -Impacts the ability to digest nutrients -Places them at risk for serious condition called necrotizing enterocolitis (NEC) which can be life threatening -NEC results from decreased blood supply to body organs start to die from lack of blood
Risk Factors for Premature Births
1. Inadequate prenatal care 2. Poverty 3. Acute and chronic maternal illness 4. Multiple-gestation bites 5. History of previous premature pregnancies 6. Placental bleeding 7. Preeclampsia very high blood pressure (could be fatal) 8. Smoking 9. Substance abuse
Causes of Premature Birth
1. Increased obstetric intervention 2. Use use of assisted reproduction techniques 3. High number of multiple pregnancies 4. Increased prevalence of substance abuse in urban areas 5. Rise in ideopathic preterm delivery rates due to adverse effect of low socioeconomic (SES) factors 6. Maternal infections 7. Adolescence
Complications of Prematurity
1. Respiratory problems 2. Neurologic problems 3. Hearing impairment 4. Apnea and bradycardia 5. Sudden infant death syndrome (SIDS) 6. Cardiovascular problems 7. Gastrointestinal problems 8. Opthalmologic problems 9. Immunologic problems 10. Other physiologic abnormalities
Corrected age
40- week of gestation (i.e. 40-30 if baby was born at 30 weeks) month at assessment - answer from above
Gastroesophageal reflux (GER)
A syndrome in which the contents of the stomach are regurgitated back into the esophagus Aspiration pneumonia An infection precipitated by the aspiration of food into the lung
Hearing Impairment
ELBW infants at increased risk for hearing loss due to multisystem illness and frequent use of meds with toxic side effects to auditory system
Hyaline membrane disease (HMD)
Also called respiratory distress syndrome (RDS) RDS is caused by decreased production of surfactant in the lungs This causes deflation of the alveoli in the lungs Alveoli appear dense and hazy in comparison to those of full term infants
VLBW (very low birth weight)
Birth weight less than 1500 grams (3 1/3 pounds)
LBW (low birth weight)
Birth weight less than 2500 grams (5 ½ pounds)
Extremely low birth weight (ELBW)
Birth weight lower than 1000 grams (2 ¼ pounds)
Micro preemie
Birth weight lower than 800 grams (1 ¾ pounds)
Respiratory Problems
Hyaline membrane disease (HMD) Bronchopulmonary dysplasia (BPD) **Occurs in infants born at less than 32 weeks gestational age
Neurological Problems
Intraventricular Hemorrhage Periventricular leukomalacia (PVL)
Reasons for SGA
Maternal illness Smoking Malnutrition In-utero exposure to alcohol In-utero exposure to infections such as cytomegalovirus (CMV) Certain chromosomal and other genetic disorders
Small-for-Dates Infants other terms
Small-for-Gestational-Age (SGA) Infants Dysmature
Periventricular leukomalacia (PVL)
Spastic diplegia --> lower body Hemiplegia--> one side Spastic quadriplegia --> all limbs, both sides Inadequate kidney functioning--> makes fluid and metabolic management challenging
Survival of LBW
Survival of LBW infants has increased to more than 90% ELBW survival rates have increased from 49% to 67%
Nagele rule
add 7 days and subtract 3 months from onset date of last menstrual period
Patent ductus arteriosus (PDA)
most common cardiovascular problem in LBW infants. About 30% of premature infants and roughly 50% of LBW premature infants will have an open ductus arteriosis leading to decreased blood flow and oxygenation to the lungs and rest of body
