The Preterm Infant

Preterm: a birth that occurs before 37 completed weeks of gestation

Risk factors of a preterm birth

• >2 preterm deliveries increases the risk of another premature baby by 70%

• Abnormally shaped uterus increases the risk of giving birth early by 19%

• Women are 9 times more likely to give birth early if they have a multiple pregnancy

• Interval of < 6 months between pregnancies

• Conceiving through IVF

• Smoking, drinking alcohol, using illicit drugs

• Poor nutrition, some chronic conditions (high BP, diabetes), multiple miscarriages or abortions

Management of a preterm infant at birth

Issues in early life

• Need more help to stay warm

• Have more fragile lungs

• Don't breathe effectively

• Have fewer reserves

Altered approach to care

• Delay cord clamping if possible

• Keep baby warm - plastic bag and radiant heater and hat

• Gentle lung inflation - PEEP important

• Use of saturation monitor - careful use of oxygen

Common problems in preterm infants

Hypothermia

• Low admission temperature is an independent risk factor for neonatal death

• Increases severity of all preterm morbidities

• In the newborn is due more to a lack of knowledge than lack of equipment

• Low BMR

• Minimal muscular activity

• Subcutaneous fat insulation is negligible

• High ratio of surface area to body mass

• Wrap or bags

• Skin-to-skin care

• Transwarmer mattress

• Prewarmed incubator

Growth and nutrition

• Limited nutrient reserves

• Gut immaturity

• Immature metabolic pathways

• Increased nutrient demands

System immaturity/dysfunction

• Neonatal sepsis

• Respiratory distress syndrome

• Apnoea of prematurity

• Bronchopulmonary dysplasia

• Patent ductus arteriosus

• Intraventricular haemorrhage

• Necrotising enterocolitis

Other complications

• Retinopathy of prematurity - usually 6-8 weeks after delivery

• Metabolic
• Early - hypoglycaemia, hyponatraemia
• Late - osteopenia of prematurity