Prematurity-An Overview
Murila FV
Prematurity
• GA < 259 days (37 weeks)
• 15 million every year worldwide
• More than 1 in 10 babies are born
preterm
• Over 1 million children die each year due
to complications of preterm birth.
• Rates of preterm birth are rising in almost
all countries
CLASSIFICATIONS
BIRTH WEIGHT
Borderline LBW 2000-2499g
PREMATURITY
Borderline preterm 34-36wks
Mild LBW
1500-1999g
Mildly Preterm
32-34 wks
Very LBW
1000-1499g
Very preterm
28-32 wks
Extremely LBW
<1000g
Extremely preterm
<28wks
Causes of Under 5 Mortality in Kenya
Distribution of causes of deaths among under fives in
kenya, 2000-2003
3%
5%
Neonatal causes
24%
HIV/AIDS
Diarrhoeal diseases
20%
measles
malaria
15%
14%
pneumonia
injuries
3%
16%
(WHO, Kenya Country Fact Sheet, 2006)
0thers
Why are 4 million newborn dying in the world?
Source: Lawn JE, Cousens SN, Zupan J Lancet 2005. based on cause specific mortality data and estimates for 192 countries
Leading causes of mortality in
NBU 2010
Number
Prematurity
648
Respiratory distress syndrome
257
Neonatal sepsis
206
Asphyxia
138
Total number of deaths
913
Early Complications; Mx
RESPIRATORY DISTRESS SYNDROME
Due to Immature Lungs
Mx -O2 supplementation
-Intravenous Fluids
-Antibiotics
CPAP
Ventilator
CARDIOVASCULAR ANOMALIES
-Dehydration
Monitoring and replacement
-PDA of pre-maturity
Prostaglandin inhibitors
INTRA-VENTRICULAR BLEEDS
-Stringent management of respiratory
METABOLIC DERRANGEMENTS
•
•
•
Hypoglycemia
Acid base imbalances
Electrolyte Abnormalities
NEONATAL INFECTION
Prevention-strict hand washing policy
GIT
NEC
and cardiovascular complications
ASPHYXIA
-Effective resuscitation at birth
Later Complications
INTERMEDIATE
• Anaemia of Pre-maturity
Iron, folate and Vit A
• Rickets of Prematurity
Vitamin D and Calcium
• Post-Haemorrhagic
Hydrocephalus
V-P shunting
• Retinopathy of
prematurity
laser therapy
LATE
• Mental & physical
development delay
Rehabilitation
• Failure to thrive
Nutritional support
• Increased morbidity and
mortality
Late Complications
•
ADHD
• Intellectual problems (arithmetics, solving problems,
cognitive functions)
•
Short term memory
• Coordination problems
• Behavioral problems (shy, delinquency )
Prevention of mortality
• 50% of babies born at 32 weeks die
• 75% of premature babies could be saved
with feasible, cost-effective care , such as
warmth, breastfeeding support, basic care
for infections and breathing difficulties.
• Further reductions are possible through
intensive neonatal care.