an early start to life ….. the preterm baby march... · polyhydramnios. 7 aetiology 4 aetiology 4...
Post on 18-Mar-2020
4 Views
Preview:
TRANSCRIPT
1
An early start to life …..An early start to life …..The Preterm BabyThe Preterm Baby
Dr Faeza Soobadar
Paediatrician/Neonatologist
SSRNH NICU
2
Definitions (1)Definitions (1)
Term 37 41+6 wks Term 37-41+6 wks Post-Term 42 wks Preterm <37 wks Moderately PT 32-36+6 wks Severely/Very PT 28 31+6 wks Severely/Very PT 28-31 6 wks Extremely PT <28 wks
3
Definitions (2)Definitions (2)
Low Birth Weight <2 5kg Low Birth Weight <2.5kg(LBW)
Very Low Birth Weight <1.5kg(VLBW)
Extremely Low Birth Weight <1kg Extremely Low Birth Weight <1kg(ELBW)
4
Aetiology 1 Aetiology 1 -- (Maternal)(Maternal)
Idiopathic Low socio-economic statusLow socio economic status Malnutrition Age <16 or >35 Smoking & drug abuse Stress Malformations of uterus & cervix Malformations of uterus & cervix Previous preterm delivery or late
miscarriage
5
Aetiology 2 Aetiology 2 -- (Maternal)(Maternal)
Maternal illnessesUTI & asymptomatic bacteriuriaUTI & asymptomatic bacteriuriaBacterial vaginosisAnaemiaDiabetesHypertension or PETHypertension or PET
6
Aetiology 3 Aetiology 3 -- (Fetal)(Fetal)
Multiple gestation Multiple gestation Congenital malformation Fetal distress Polyhydramnios
7
Aetiology 4 Aetiology 4 -- (Iatrogenic)(Iatrogenic)
Fetal distress IUGR IUGR Uncontrolled PIH/ Eclampsia APH Diabetes Maternal cardiac disease Chorioamnionitis Incorrect estimate of gestational age
8
Prevention & Obstetric Prevention & Obstetric managementmanagement Health promotion programmes Antenatal care PIH diabetes Antenatal care – PIH, diabetes Cervical cerclage Detection & treatment of infection Tocolytics Optimising outcome for baby: Optimising outcome for baby:Steroids; IUT.
9
PROBLEMS OF PROBLEMS OF PREMATURITY & PREMATURITY & POSTPOST--NATAL NATAL MANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENT
1 0
ResuscitationResuscitation
Difficulty in extra- Delivery in level 3 Difficulty in extra-uterine adaptation.
Delivery in level 3 NICU.
Appropriate planning & immediate availability of qualified personnel & equipment.
Prompt resuscitation & Prompt resuscitation & stabilization.
PNT
1 1
Temperature regulationTemperature regulation
Inability to shiver Large SA Decreased
subcutaneous fatR d d b f
Servo-controlled incubator
Humidity Easy access to infant
H d f f Reduced brown fat stores
Humidification of ventilator gases
1 3
Respiratory (1)Respiratory (1)
Pulse oxymetry, Cardio-
RDS Apnoea of
prematurity
Pulse oxymetry, Cardioresp monitoring & ABG.
Oxygen
Respiratory support –mechanical ventilation, NCPAP.
S f h Surfactant therapy
Respiratory stimulant
2 3
Respiratory (2)Respiratory (2)
Pneumothorax Thoracocentesis
Pulmonary haemorrhage
↑Ventilation Blood transfusion FFP/Vitamin K
2 4
CardiovascularCardiovascular
Hypotension BP monitoring Hypotension
PDA
BP monitoring Volume expansion Inotropic support
Cardiac echo Diuretics Indomethacin Ibuprofen
2 6
Renal/MetabolicRenal/Metabolic
Regular U’s&E’s Electrolyte
disturbances Hypocalcaemia Hypo/hyper-glycaemia
Regular U s&E s Urine output Dextrostix Careful fluid
management & administrationadministration
Insulin infusion
2 8
GIT/NutritionGIT/Nutrition
Feed intolerance Gavage feeding TPN
High requirements
TPN
EBM+Fortifier Pre-term formulas
Gastric NEC
Gastric decompression, NBM, iv antibiotics, surgical opinion.
3 0
NeurologicalNeurological
IVH Vitamin E Ethamsylate IVH Vitamin E, Ethamsylate Good ventilation
management & control of BP
Regular cranial USS
3 3
OthersOthers
Haematological – Multiple blood Haematological –anaemia/ thrombocytopenia
Immunological –infection
Multiple blood transfusions
Multiple courses of antibiotics; antifungalinfection
Psychological
antibiotics; antifungal.
Parental support NIDCAP
3 5
Criteria for home discharge Criteria for home discharge
Clinically stable Clinically stable Stable temperature Good weight gain Mother’s ability to care for baby Social circumstances Social circumstances
3 7
RespiratoryRespiratory
CLD Dexamethasone CLD Recurrent respiratory
infections
Dexamethasone
Nebulized/Inhaled therapy
Chest physio
Long term oxygen & prolonged hosp stay
Recurrent re-admissions
Immunization
3 9
Nutrition & Growth Nutrition & Growth
Poor growth Growth charts High-calorie formula
Anaemia
High calorie formula & vits
Hb monitoring Iron supplementation
Rickets of prematurity Phosphate supp
4 0
NeurologicalNeurological
PVL & Cerebral palsy PreventionPVL & Cerebral palsy
Convulsions
Hydrocephalus
Prevention
Neuro-developmental follow-up
PT & OT
Anticonvulsants
Neurosurgical opiniony p
ROP
Hearing impairment
Ophthalmology r/v
Hearing assessment
4 2
PsychoPsycho--socialsocial
Learning difficulties Developmental Learning difficulties
Behavioural problems Family/social impact
Developmental psychologist
Special educational programme
PsychotherapyParent support groups Family/social impact Parent support groups
4 4
Incidence of prematurityIncidence of prematurity
SSRNHSSRNH
2003 5.5%
2004 9.2%
2005 5.5%
2006 4.4%
Other countries
USA (2006) 12.7%
UK (2007) 8.6%
France 7%
2007 7.5%
2008 9.0%Australia (2002) 7%
4 5
Admissions to NICU2002 2003 2004 2005 2006 2007 2008
Admissions 226 235 225 200 208 201 163
Mortality % 21 17 27 27 27 24 28
Preterm % 72 71 72 67 57 62 61
Moderately PT(survival)
58%(92%)
51%(91%)
53%(84%)
44%(80%)
37%(89%)
49%(79%)
42%(79%)
Severe PT(survival)
30%(63%)
42%(79%)
34%(65%)
46%(79%)
49%(55%)
36%(71%)
33%(64%)
Extreme PT(survival)
12%(26%)
7%(55%)
12%(45%)
10%(8%)
14%(44%)
14%(50%)
24%(71%)
4 6
20
25
19.4
14 8
21.919.4
12 4
15.414.6
NMR & IMR – SSRNH & MRU
5
10
15
6.28.5
11.8
14.8
910.98.8
10.2
14.212.4
NMR SSRN
NMR MRU
IMR SSRN
IMR MRU
NMR SSRN
NMR MRU
IMR SSRN
IMR MRU
0
5
19982003
20072008
4 7
150
200184.4
NMR & IMR WORLDWIDE
2004
0
50
100
1 1 2 3 3 4 10 18 17
542.3 3.2 3.4 4.6 5 6.4 15.4 22.1
59.4 NMR 2004
IMR 2007
NMR 2004
4 8
Survival of a 16Survival of a 16--oz. baby (450g)oz. baby (450g)DOB 30.01.1949; GA 26 wksDOB 30.01.1949; GA 26 wks
Case report; Dr H Fakim; RMO; Civil Hospital; MauritiusHospital; Mauritius
BMJ 19.08.1950 31 y old mother At birth the infant was
very feeble & did not cry…nikethamide….
Wrapped up in cotton ool cot lined ithwool …cot lined with
blankets & kept warm with hot water bottle
Fed on glucose water ..EBM…condensed milk
3.06kg at 5½m
4 9
Acknowledgements
My grateful thanks to:
•Dr A G Mohamedbhai, Consultant Paediatrician, for laboriously over the years compiling the statistics for SSRN Hospitalover the years, compiling the statistics for SSRN Hospital.
•Dr Oochita Jhummun, NICU RMO, for computerizing the data.
•All the children for performing in front of the camera.
•All b t t i i f k i t ll th ti•All obstetricians for keeping us on our toes all the time.
•And of course to all Paediatricians & NICU nursing staff & RMO’s, past & present, without whose dedication the NICU would not exist & these children would not be alive today.
top related