PREMATURITY

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PREMATURITY Causes, Concerns Management Omyma
Dawood, R.N. Head of Nursing, NICU NN Jordan
Hospital, Amman
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What is prematurity? A baby born before 37
weeks of pregnancy is considered premature, that
is, born before complete maturity. Other terms
often used for prematurity are preterm and
"preemie." Preterm generally refers to the
pregnancy (as in preterm labor), while premature
is more often used to describe the baby. Many
premature babies also weigh less than 2,500 grams
(5.5 pounds) and may be referred to as low birth
weight (LBW).
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What causes prematurity?

• 1- Maternal factors
• Infection (such as group B streptococcus, urinary
  tract infections, vaginal infections, infections
  of the fetal or placental tissues).
• Drug abuse (such as cocaine).
• Abnormal structure of the uterus.
• Cervical incompetence (inability of the cervix to
  stay closed during pregnancy).
• Previous preterm birth.

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2- Factors involving the pregnancy

• Abnormal or decreased function of the placenta.
• Placenta previa (low lying position of the
  placenta).
• Placental abruption (early detachment from the
  uterus).
• Premature rupture of membranes (amniotic sac).
• Polyhydramnios (too much amniotic fluid).
• 3- Factors involving the fetus
• When fetal behavior indicates the intrauterine
  environment is not healthy.
• Multiple gestation (twins, triplets or more).

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Why prematurity is a concern?

• Premature babies are born before their bodies and
  organ systems have completely matured.
• These babies are often small, with low birth
  weight (less than 2,500 grams or 5 ½ pounds), and
  they may need help breathing, eating, fighting
  infection, and staying warm.

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Problems in Premature Infants1. Respiratory
problems.2. Cardiovascular problems.3. Blood
and metabolic problems.4. Gastrointestinal
problems.5. Neurologic problems.
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• Respiratory problems
• Immediate such as hyaline membrane disease
  (condition in which the air sacs cannot stay open
  due to lack of surfactant in the lungs).And type
  II RDS ( Wet lung increased fluid in the lungs)
• Apnea which occurs in about half of babies born
  at or before 30 weeks.
• Chronic lung disease/bronchopulmonary dysplasia -
  long-term respiratory problems caused by injury
  to the lung tissue.

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• Cardiovascular problems
• Patent ductus arteriosus (PDA) ( heart condition
  that cause blood to divert away from the lungs).
• Low or high blood pressure.
• Low heart rate ( often occurs with apnea).

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Blood and metabolic problems

• Anemia ( may require blood transfusion).
• Jaundice ( due to immaturity of liver and
  gastrointestinal function)
• Very low or high levels of minerals and other
  substances in the blood such as calcium and
  glucose (sugar).
• immature kidney function.
• Temperature instability (inability to stay warm
  due to low body fat).

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Gastrointestinal problems

• Difficulty in feeding ( many are unable to
  coordinate suck and swallow before 35 weeks
  gestation).
• Poor digestion.
• Necrotizing enterocolitis (NEC) ( serious disease
  of the intestine common in premature babies).

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Neurologic problems

• Intraventricular hemorrhage ( bleeding in the
  brain).
• Periventricular leukomalacia (softening of
  tissues of the brain around the ventricles which
  are the spaces in the brain containing
  cerebrospinal fluid).
• Poor muscle tone.
• Seizures.
• Retinopathy of prematurity.

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Premature infants are more susceptible to
infection and may require antibiotics !!
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Characteristics of prematurity

• Each baby may show different characteristics
  which
• may include

• Small baby, usually the weight less than 2,500
  grams (5 pounds or 8 ounces).
• Thin, shiny, pink or red skin.
• Little body fat.
• Little scalp hair, but may have lanugo (soft body
  hair).
• Weak cry and body tone.
• Genitals may be small and underdeveloped.

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Care of premature babies

• Temperature-controlled beds.
• Monitoring of temperature, blood pressure, heart
  and breathing rates, and oxygen levels.
• Mechanical ventilators.
• Giving extra oxygen by a mask or with a breathing
  machine.
• Intravenous (IV) fluids when feedings cannot be
  given, or for medications.

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Care of premature babies cont.

• Placement of catheters (small tube) into the
  umbilical cord to give fluids and medications and
  to draw blood.
• Radiological studies (for diagnosing problems and
  checking the placement of the tubes ).
• Feedings care.
• Kangaroo Care ( method of caring for premature
  babies using skin-to-skin contact with the parent
  to provide contact and aid parent-infant
  attachment).

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Apnea of Prematurity
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What is apnea of prematurity?.

• It is a term for the absence of breathing for
  more than 20 seconds.
• It can occur in full-term babies, but is more
  common in premature babies. The more premature
  the baby, the greater the chances that apnea will
  occur.
• Apnea may be followed by bradycardia, a decreased
  heart rate. When breathing slows, the heart rate
  also slows. A common term for apnea with
  bradycardia is As and Bs.

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I- What causes apnea of prematurity?

• Disturbance in the brains breathing control
  center, called central apnea.
• Obstructive apnea, breathing stops because
  something is blocking the airway.
• Problems in other organs can also affect the
  breathing control center.

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II- What causes apnea of prematurity?

• Apnea of prematurity may not have an identifiable
  cause other than immaturity of the central
  nervous system.
• Bleeding or tissue damage in the brain.
• Respiratory disease.
• Infections.

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III- What causes apnea of prematurity?

• Gastrointestinal problems such as reflux (when
  the stomach contents move back up into the
  esophagus).
• Very low or high levels of chemicals in the body,
  such as glucose or calcium.
• Heart or blood vessel problems.
• Immature neurologic system.

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IV- What causes apnea of prematurity?

• Stimulation of reflexes that can trigger apnea
  such as with feeding tubes or suctioning, or when
  a babys neck is very flexed.
• Unstable temperature.
• Unknown.

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Who is affected by apnea of prematurity

• Most babies who develop apnea are prematures.
• It appears to be more common during sleep,
  especially during active sleep a period when
  the baby has rapid eye movement (REM) while
  sleeping.
• About half of all premature babies have apnea of
  prematurity.

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What are the symptoms of apnea of prematurity?

• Apnea of prematurity may be different from
  another breathing pattern that can occur in both
  premature and full term newborns, called periodic
  breathing, a pattern of short pauses followed by
  a burst of faster breaths. While periodic
  breathing is a normal type of breathing in
  babies, apnea of prematurity can be a symptom of
  a more serious condition.

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What are the symptoms of apnea of prematurity? /
continue

• The following are the most common symptoms
  of apnea of prematurity. However, each baby may
  experience symptoms differently. Symptoms may
  include
• Periods of absent breathing for 20 seconds or
  more.
• Apnea of prematurity beginning in the first week
  of life or later.

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What are the symptoms of apnea of prematurity? /
continued

• Symptoms of the more serious forms of
  apnea of prematurity may include
• Longer periods of absent breathing.
• Apnea beginning right after birth or after the
  second week.
• Blue coloring.
• Severe decrease in heart rate ( bradycardia).
• May resemble other conditions or medical
  problems.

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How is apnea of prematurity diagnosed?

• It is important to find out if the apnea is due
  primarily to prematurity or if it is caused by
  another problem.
• So the physician will check many of the babys
  body systems to find out what might be causing
  the apnea.
• Diagnostic procedures may include
• Physical examination.
• Blood tests (checking for blood counts,
  electrolyte levels, and infection).

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How is apnea of prematurity diagnosed?/ continoue

• Measurement of the level of oxygen in the babys
  blood.
• X-ray (to check for problems in the lungs, heart,
  or gastrointestinal system) a diagnostic test
  which uses invisible electromagnetic energy beams
  to produce images of internal tissue, bones, and
  organs onto film.
• Apnea study monitoring breathing effort, heart
  rate, and oxygenation.

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Treatment for apnea of Prematurity

• When apnea occurs, stimulation of the baby by
  rubbing the skin or patting can help the baby
  begin breathing again.
• Any problems that might be causing the apnea need
  to be identified and treated.
• Many premature babies will outgrow apnea of
  prematurity by the time they reach 36 weeks
  gestation.

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Specific treatment for apnea of prematurity will
be determined by physicians based on

• Gestational age, overall health, and medical
  history of the baby.
• Extent of the condition.
• Baby tolerance for specific medications,
  procedures, or therapies.
• Expectations for the course of the condition.

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Treatment for apnea of prematurity may include

• Monitoring of breathing and heart rates.
• Medications Caffeine or theophylline to
  stimulate CNS.
• Continuous positive airway (CPAP) a
  mechanical breathing machine that pushes a
  continuous flow of air or oxygen to the airways
  to help keep tiny air passages in the lungs open.
• Apnea not due to prematurity may require other
  treatments.

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THANK YOU ALL