Prematurity

Question 1

What is prematurity?

Answer 1

when a baby is born before 37 completed weeks of gestation

Question 2

What is a viable fetus?

Answer 2

when is born after 28 weeks gestation
Note: Birth before 28 weeks is a miscarriage or abortion

Question 3

What is a low birth weight baby?

Answer 3

one with a birth weight of less than 2500g

Question 4

What are the categories of low birth weight?

Answer 4

1. low birth weight <2500g
2. very low birth weight <1500g
3. extremely low birth weight <1000g

Question 5

Maternal predisposing factors of prematurity?

Answer 5

1. Teen pregnancy
2. Hard labour
3. Poor nutrition
4. Infections: Malaria, TORCHES
5. Anaemia

Question 6

What are the TORCHES infections?

Answer 6

1. Toxoplasmosis
2. Others (gonorrhea, hepatitis B, varicella-zoster virus, parvovirus B19, HIV)
3. Rubella
4. Cytomegalovirus
5. Herpes Simplex
6. Syphilis

Question 7

Consequences of the TORCH infections?

Answer 7

1. premature birth
2. intrauterine growth restriction
3. miscarriage
4. stillbirth (loss of pregnancy after 20 weeks of gestation)

Question 8

Fetal predisposing factors of prematurity?

Answer 8

1. congenital anomalies
2. genetic conditions

Question 9

Complications of prematurity?

Answer 9

1. apneic attacks
2. respiratory distress syndrome
3. anaemia
4. jaundice
5. infection
6. food intolerance
7. necrotising enterocolitis
8. cerebral and intraventricular haemorrhage
9. heart failure and pulmonary edema
10. poor mental and intellectual development years
11. retinopathy of prematurity

Question 10

What causes apneic attacks?

Answer 10

The baby is prone to these attacks because of immaturity of the lungs and the respiratory centre

Question 11

What causes RDS?

Answer 11

• Atelectasis can develop with the possibility of developing hyaline membrane disease
• Notice that all these lead to respiratory distress syndrome
• Frequent apnoec attacks leads to cyanosis and signify very poor chance of survival

Question 12

What causes anemia?

Answer 12

1. The immature bone marrow
2. iron stores in the foetus are laid in the last four weeks of intra-uterine life make premature baby is prone to anaemia

Question 13

What causes jaundice?
Complications of jaundice?

Answer 13

Due to immaturity of the liver, bilirubin cannot be conjugated
- Sometimes the level of unconjugated bilirubin rises to as high as 20mg/100ml and causes kernicterus
- Kernicterus is neurological sequelae that comes as a result of the bilirubin crossing the blood brain barrier.

Question 14

What causes infection?

Answer 14

common complication since the immune system is immature

Question 15

What causes NEC?

Answer 15

immaturity of the childs digestive system
- NEC involves infection and inflammation in the childs gut which may stem from the growth of dangerous bacteria in parts of the intestine they don usually live

Question 16

What causes food intolerance?

Answer 16

digestive system may not be fully developed

Question 17

What causes cerebral and intraventricular haemorrhage?

Answer 17

The fragile capillaries and small veins easily rupture and the baby may display abnormal neurological function

Question 18

What causes heart failure and pulmonary edema?

Answer 18

1. the poor muscular tone of the baby may prevent adequate venous return causing accumulation of the blood in the extremities
2. Asphyxia adds to the circulatory problems and later the baby goes into heart failure and pulmonary oedema

Question 19

What causes poor mental and intellectual development in later years?

Answer 19

1. prolonged asphyxia to which the premature baby is prone can lead to mental retardation and low intelligence later in life.
2. Neurological conditions like Kernicterus and Intracranial haemorrage

Question 20

What causes retinopathy?

Answer 20

The immature retina is at risk of further destruction that may or may not lead to permanent visual impairment, especially with exposure to high concentrations of oxygen

Question 21

Management of a preterm/LBW?

Answer 21

1. Routine care of the newborn is applicable to a preterm baby
2. Checking respirations of the baby, heart rate, colour, tone/grimance, cry
3. Provide warmth
4. If the baby is stable, she/he is kept on skin to skin contact with the mother and a comprehensive assessment is done after ninety minutes of birth
5. Observe for the complications of LBW and Prematurity e.g. respiratory problems - give O2 if need arises and monitor
6. Comprehensive care
7. elimation problems
8. feeding
9. growth monitoring

Question 22

What is comprehensive care in the newborn?

Answer 22

1. Cord care with 7.1% chlohexidine
2. Eye care with TEO (tetracycline eye ointment)
3. Administration of Vitamin K according to birth weight intramuscular injection to prevent haemorrhagic disease of the new-born (to form blood clots)

Question 23

What are elimination problems?

Answer 23

to observe if the baby is passing stools and urine
- Frequency of stools should be noted and loose stools could be associated with infection

Question 24

Feeding management?

Answer 24

1. The maximum amount is normally 200-220 ml/kg per day divided in eight feeds.
2. Very small babies (< 1500 grams) should be fed every two hours.
3. Larger babies (> 1500 grams) should be fed every three hours.
4. As the baby grows and reaches 40 weeks gestation or reaches a weight or 2500 grams), gradually replace scheduled feeding with feeding on demand.
5. Observe for signs of food intolerance which include; vomiting of feeds tinged with bile, abdominal distension and bloody stool
   - These should be reported, investigated and managed promptly

Question 25

Growth monitoring?

Answer 25

babies have to be weighed on a daily basis - The baby might lose 10 % of their birthweight by 7- 10 day, and therefore a slight drop in weight is normal - The baby regains the weight within the first 2 weeks

Question 26

Management of hematological problems?

Answer 26

Hemoglobin is estimated weekly to exclude anaemia

Question 27

Management of temperature instability?

Answer 27

premature and low birthweight babies require prolonged and continuous skin to skin contact for more than twenty hours per day to maintain a normal body temperature, failure of which requires a heater

Question 28

Management of neurological problems?

Answer 28

1. monitor general behaviour of the baby with particular attention to its activity- they may be inactive or hyper alert. 2. Also look for seizures - Remember that neonatal seizures may not be so obvious as they tend to be subtle and may be missed ( usually focal seizures due to the poorly myelinated nerves)

Question 29

What is physiological jaundice? Treatment?

Answer 29

- appears after 48 hours: maximum by 4th and 5th day in term and 7th day in preterm - generally disappears without any treatment but some will require photoherapy

Question 30

What is pathological jaundice?

Answer 30

- starting on the first day of life - associated with fever - deep jaundice: palms and soles

Question 31

Causes of pathological jaundice?

Answer 31

1. hemolysis 2. congenital infection 3. neonatal sepsis

Question 32

What is prolonged/pathological jaundice? Clinical features?

Answer 32

- jaundice lasting for longer than 14 days in term infants and 21 days in preterm infants - stool clay coloured - urine dark colour

Question 33

Causes of prolonged jaundice?

Answer 33

1. hypothyroidism 2. neonatal hepatitis 3. biliary atresia

Question 34

Management of jaundice?

Answer 34

after 24 hours and is visible in the palms of the hands and soles of the feet, that's regarded severe jaundice 1. Jaundice should be managed in hospital under phototherapy 2. Where available, the bilirubin levels should be assessed and these will guide management. 3. Those who develop jaundice after 24 hours need to be  closely monitored and advised on exclusive breast feeding as this is physiological and clears on its own

Question 35

What is a jaundice Kramer chart?

Answer 35

for all babies who are jaundiced in the first 24 hours of life 1. area 1 + 2 (head + trunk) - if preterm, low birth weight, or sick 2. area 1-5 (head, trunk, pelvis, legs + arms, feet + hands) - all babies including healthy term babies

Question 36

Management of infections?

Answer 36

1. Babies must be monitored for  signs of infection which are;- rash, discharge from the eyes, moist umbilical cord, grey color and temperature instability. 2. Frequent hand washing is encouraged to both the mother and the care giver 3. The immune system of premature babies is underdeveloped which makes them susceptible to infections. 4. In addition babies could be born preterm or with low birthweight as a result of intrauterine infections > These neonates are often initiated on antibiotics to treat infections

Question 37

Management of metabolic disorders?

Answer 37

1. Preterm and Low birthweight babies are also prone to hypoglycaemia and it is very important to maintain proper nutrition for the baby 2. Proper nutrition also assists in preventing hypothermia

Question 38

What is Kangaroo mother care?

Answer 38

- is early, prolonged continuous skin-to-skin contact between mother (or her surrogate) and her low birth weight infant - the baby is placed skin-to-skin against the mother’s chest wearing only a nappy, hat and socks, and secured in an upright position between the mother’s breasts by wrapping a cloth around both mother and baby

Question 39

Benefits of KMC?

Answer 39

1. It has proven benefit in decreasing neonatal mortality 2. It decreases morbidity by decreasing risk of neonatal infections, improves cardio-pulmonary circulation, and improves brain development 3. KMC has psychosocial benefits in that it improves bonding between the child and the mother. 4. KMC encourages exclusive breastfeeding

Question 40

Types of KMC?

Answer 40

1. continuous 2. intermittent

Question 41

What is continuous KMC?

Answer 41

- It takes place when the baby is in  skin-to-skin position for 24 hours every day (except for very short periods when the mother has to bath or use the toilet) - It is initiated in the hospital and as soon as baby is stable and other criteria are met, this is continued at home - It requires the support from family members. - Although there are will known benefits, continuous KMC is labour intensive and not very well done because of this.

Question 42

What is intermittent KMC?

Answer 42

- It is when the baby is put in skin-to-skin contact for a few hours each day - When not in KMC position, the  baby is kept warm in an incubator or warmly wrapped - It is mostly used for very small and sick babies, and/or for mothers who do not want to or are not yet ready or able to practice continuous KMC

Question 43

Danger signs taught in KMC?

Answer 43

1. Hypothermia 2. Fever 3. Red, swollen eyelids and pus discharge from eyes 4. Red swollen and/or pus around the cord or umbilicus 5. Convulsions/fits 6. Jaundice/ yellow skin 7. Convulsions 8. Breathing problems – apnea, chest in-drawing, grunting, flaring, cyanosis 9. Lethargy (excessive sleepiness, reduced activity).