Premature

Question 1

Definition of Premature Birth

Answer 1

WHO,AAP, and ACOG define premature
birth as the delivery of an infant before
37 weeks of gestation.
• NCHS of the CDC generally reports
data on three categories of preterm
birth: • 1. Overall preterm, less than 37
weeks • 2. Moderately preterm, 32 and 36
weeks • 3.Very preterm births, less than 32
weeks

Question 2

Causes of Premature Labour

Answer 2

Causes of Premature Labour
• The exact pathogenesis of premature labor is not well understood, but it is associated
with certain risk factors.
• High risk factors
• History of preterm birth.
• Cervical insufficiency
• Multiple gestation

Question 3

Antenatal steroid

Answer 3

Antenatal steroid
• (IM betamethasone or IM dexamethasone ) • Indication: 24–34 weeks gestation with a risk of delivery within the
next 7 days • Improves fetal lung maturity and surfactant production • Repeat the course if the last dose of corticosteroids was > 14
days previously

Question 4

Bronchopulmonary Dysplasia (BPD)

Answer 4

Bronchopulmonary Dysplasia (BPD)
also known as Chronic Lung Disease (CLD)
• Abnormal alveolar formation/injury in premies
who had RDS, from mechanical ventilation/high
oxygen concentration • Defined as requiring oxygen at 36 weeks post-
conceptual age

Bronchopulmonary Dysplasia (BPD)
Symptoms: – Increased work of breathing – Oxygen requirement – Growth failure – Can result in pulmonary hypertension and heart failure Treatment: - Respiratory support - Diuretics - Bronchodilators (albuterol), inhaled steroids - Systemic steroids (though worsens neurodevelopmental
outcomes) - Maximize nutrition (often have high caloric needs)

Question 5

Apnea of Prematurity

Answer 5

• Premature infants may stop breathing for 20
seconds or more, may be followed by drop in
heart rate and oxygen saturation • May be treated with caffeine • Typically, but not always, resolves by term

Question 6

Necrotizing enterocolitis (NEC)

Answer 6

Necrotizing enterocolitis (NEC)
• Bacterial infection of intestines leading to inflammation &
necrosis • Occurs in 6-7% of VLBW infants • Presents with feeding intolerance, blood in stools, apnea,
and other nonspecific signs. • Can result in bowel perforation, septic shock • Management:
– Medical: antibiotics, supportive – Surgical: resection with ostomy placement or placement of
peritoneal drain
• Complications: death (20-30%), stricture formation, short
gut syndrome (9%), frequent/loose stools, impaired
growth, worse neurodevelopmental outcome

Question 7

Retinopathy of Prematurity (ROP)

Answer 7

Retinal blood vessels are sensitive to
stress, which can cause them to stop
growing
– When they start growing again it is
abnormal, excessive growth called ROP – Eyes need to be examined until retina
are completely vascularized
– Abnormal vessels may regress, or can
progress to retinal detachment, vision
loss
– Treated with laser ablation if severe

Question 8

Intraventricular Hemorrhage (IVH)

Answer 8

Bleeding in the periventricular germinal matrix (a
layer of neuronal precursor cells) – Classification (Grades)
• Supportive • Shunting for hydrocephalus
• I: germinal matrix hemorrhage • II: IVH without ventricular dilation • III: IVH with ventricular dilation • IV: IVH with parenchymal involvement
– Treatment:

Question 9

Periventricular Leukomalacia (PVL)

Answer 9

• Necrosis of periventricular white
matter resulting from cerebral
hypoperfusion and
oligodendrocyte vulnerability • Ocurs in 6% of VLBW babies on
ultrasound. • More than half of patients with
cystic PVL develop cerebral palsy,
classically spastic diplegia  (affecting
the lower extremities)

Question 10

Treatment of preterm labour

Answer 10

Bed rest and sedation  Antenatal steroids
• (IM betamethasone or IM dexamethasone )
 Indication: 24–34 weeks gestation with a risk of delivery within the next 7
days  Improves fetal lung maturity and surfactant production  Repeat the course if the last dose of corticosteroids was > 14
days previously
Treatment of preterm labour
 Tocolysis:
 administration of tocolytics to inhibit uterine contractions and prolong pregnancy
 Recommended for up to 48 hours to enable administration of antenatal corticosteroids in
preterm labor 
 Antibiotics