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Prematurity
Julia Petty
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PREMATURITY� Below 37 weeks gestational age
�Different degrees of prematurity determine OUTCOME
� Extreme prematurity (<26 weeks gestation)
� Borderline of viability 24 weeks
� Increase in survival rate means an inevitable increase in long-term developmental problems.
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Problems of Prematurity
�Respiratory:
� Respiratory Distress Syndrome -Surfactant deficiency.
� Chronic lung disease of prematurity –oxygen dependency & imfalmmatroy changes of the lungs persisiting past 28 days or 36 weeks corrected gestation
� Apnoea of Prematurity – due to immature brain stem
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Other systems
�Cardiovascular :
� Low circulating blood volume and blood pressure
� ‘Patent Ductus Arteriosus’ – fetal duct remains open
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Other systems
�Hepatic :
� Jaundice due to immature liver
� Reduced clotting factors
� Reduced metabolism of drugs
�Renal and fluid balance:
� Renal tubule immaturity
� Reduced filtration rate
� Fluid and Electrolyte imbalance
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Other systems
� Immune:
� Low levels of immunoglobulins
� Limited defences
�Metabolic:
� Increased metabolic rate, oxygen and energy demands
� Poor glycogen stores -hypoglycaemia is common
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Other systems
�Haematological:
� Anaemia of Prematurity
�Differences in values
�Nervous system:
� Intraventricular haemorrhage –bleeding into the ventricles of the brain
� Periventricular leukomalacia – damage to the area around the brain ventricles
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Intra ventricular haemorrhage
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Sensory deficits–eyes and ears
� Stages of Retinopathy of Prematurity (ROP)
� 1= Demarcation line between retina & non-vascularised area
� 2= Scar tissue seen & new vessels form a ridge
� 3= Ridge (vascular) increases with growth of extra retinal tissue
� 4= Partial retinal detachment
� 5= Full detachment
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Other systems
�Gastro-intestinal-
�Necrotising Enterocolitis – an inflammatory disease of the bowel common in extreme prematurity
�Gastro-oesophageal reflux is common
�Delays in enteral feeding
�Weight loss / poor weight gain
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Other systems
� Thermoregulation;
� Immature thermal control
� Limited brown fat stores and inability to perform ‘thermogenesis’ (heat production)
� Rapid heat loss through the skin
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Other systems
�Skin;
� Thin, immature skin with no or underdeveloped waterproofing layer
� Skin fragile and easily damaged
�Muscle;
� Lack of muscular tone before 34 weeks
�Weak, floppy limbs requiring support
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Further Reading
� Chatterjee J, Gullam J, Vatish M and Thornton S (2007) The Management of preterm labour, Archives of disease in Childhood; Fetal and Neonatal edition, 92,2, F88-93
� Hale, R (2007) Monitoring fetal and maternal wellbeing British Journal of Midwifery 15, 2 , 107-110
� Hollier LM (2005) Preventing Preterm birth – what works, what doesn’t’, Obstetrical and Gynecological Survey, 60, 2, 124- 131
� McGuire W, McEwan and Fowlie PW (2004) ABC of preterm birth : Care in the early newborn period, BMJ, 329, 1087-1089
� Tucker J and McGuire W (2004) ABC of Preterm Birth: Epidemiology of preterm birth, BMJ, 329, 675-678
� For further detail & more resources go to the online resource…. Unit 3E
� http://www.cetl.org.uk/learning/neonatal/unit_3e/player.html