Prematurity and High-Risk Infant

Original Editor - Robin Tacchetti based on the course by Krista Eskay
Top Contributors - Robin Tacchetti and Jess Bell

Introduction[edit | edit source]

There are an estimated 15 million preterm births every year and prematurity is considered a significant healthcare problem.[1][2] Preterm births are categorised by gestational period:

  • extremely preterm (< 28 weeks)
  • very preterm (28–32 weeks)
  • moderate to late preterm (32–36 weeks)[3]

Risk of Preterm Birth[edit | edit source]

Preterm infants are at an increased risk for neurodevelopmental disorders and delayed growth. Neurological sequelae associated with prematurity include cerebral palsy, decreased intelligence and delayed neurodevelopment.[4] The rate of neurodevelopment and growth in preterm infants can be affected by:

  • gestational age
  • birth weight
  • length of hospitisation
  • Apgar score
  • cardiopulmonary resuscitation (CPR)
  • ventilation
  • breastfeeding[4]

Infants born at an earlier gestational age have a higher risk of complex medical conditions, recurrent hospitisations and neurodevelopmental impairments. Developmental delays and chronic diseases that result from preterm birth may persist into adulthood and consequently, have a heavy burden on the individual, families and healthcare system.[4][5]

Complications[edit | edit source]

The third trimester of pregnancy is marked by rapid organ maturation and growth. Without proper organ development, preterm infants are at an increased risk for chronic respiratory, cardiac, renal and endocrine system disorders throughout their life.[3][1] Pravia and Benny[3] detail the risks and management of a preterm birth on each body system:

Risks and management of preterm birth on the pulmonary system[3]
Body System Pulmonary
Risk
  • Obstructive disease
  • Pulmonary hypertension
Management
  • Evaluate previous asthma diagnosis
  • Consider baseline pulmonary function testing
  • Avoid smoking, maintain healthy weight, promote exercise
  • Keep current on influenza and Pneumococcus vaccinations


Risks and management of preterm birth on the renal system[3]
Body System Renal
Risk Chronic kidney disease
Management
  • Monitor blood pressure regularly
  • Avoid nephrotoxins
  • Control blood pressure (consider an angiotensin-converting enzyme inhibitor if hypertension medication is needed)
  • Limit salt intake
  • Consider periodic urine microalbumin screening, renal ultrasonography
Risks and management of preterm birth on the cardiovascular system[3]
Body System Cardiovascular
Risk
  • Hypertension
  • Ischaemic heart disease
  • Congestive heart failure
  • Peripheral vascular disease
Management
  • Monitor blood pressure regularly
  • Avoid smoking
  • Maintain healthy weight
  • Promote exercise
  • Consider baseline echocardiogram with appropriate cardiovascular risk assessment
Risks and management of preterm birth on the endocrine system[3]
Body System Endocrine
Risk
Management
  • Monitor blood glucose
  • Body mass composition, lipids
  • Maintain healthy body weight and abdominal girth
  • Ensure appropriate calcium and vitamin D supplementation
  • Promote weight-bearing exercise
  • Limit medications associated with causing metabolic abnormalities, dyslipidemia, worsening bone density
Risks and management of preterm birth on the central nervous system[3]
Body System Central Nervous System
Risk
  • Autism
  • Mood disorders
  • Intellectual disabilities
Management Be alert to need for early evaluation and support

Prevention[edit | edit source]

Knowing all of the potential sequelae of preterm birth, prevention where possible is key. When prevention is not possible, understanding the best ways to handle preterm birth and care for the newborn are essential to attain the best possible outcome. Below are suggestions by the Global Action Report on Preterm Birth to reduce the risk, manage and care for premature birth.[6]

Management of Pregnant Women at Higher Risk of Preterm Birth[edit | edit source]

  • Identify and treat hypertensive disease in pregnancy
  • Monitor multiple pregnancies
  • Administer progesterone to prolong pregnancy
  • Identify and treat structural abnormalities (e.g., cervical cerclage, cervical pessary)
  • Promote antenatal and skilled delivery care for all women
  • Smoking cessation and reducing exposure to secondhand smoke and other pollutants
  • Workplace policies to regulate working hours and strenuous working conditions
  • Professional and hospital policies to regulate infertility treatments, reduce cesarean birth rates and early induction of labour[6]

Management of Women in Preterm Labour[edit | edit source]

  • Tocolytics to slow down labour
  • Antenatal corticosteroids to reduce mortality in the newborn
  • Antibiotics to prevent infection
  • Provision of magnesium sulphate for neuro-protection of the newborn[6]

Care of the Premature Baby[edit | edit source]

  • Essential and extra newborn care, especially feeding support
  • Neonatal resuscitation
  • Thermal care (maintain baby's body temperature)
  • Kangaroo Mother Care (skin-to-skin contact with mother or another family member to provide stable warmth and to encourage frequent and exclusive breastfeeding)
  • Chlorhexidine cord care (umbilical cord cleaning)
  • Comprehensive neonatal intensive care, where capacity allows[6]

Resources[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 Kamity R, Kapavarapu PK, Chandel A. Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management. Children. 2021 Dec 8;8(12):1158.
  2. Pusdekar YV, Patel AB, Kurhe KG, Bhargav SR, Thorsten V, Garces A, Goldenberg RL, Goudar SS, Saleem S, Esamai F, Chomba E. Rates and risk factors for preterm birth and low birthweight in the global network sites in six low-and low middle-income countries. Reproductive Health. 2020 Dec;17(3):1-6.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Pravia CI, Benny M. Long-term consequences of prematurity. Cleveland Clinic journal of medicine. 2020 Nov 23;87(12):759-67.
  4. 4.0 4.1 4.2 Kang SR, Cho H. Research trends of follow-up care after neonatal intensive care unit graduation for children born preterm: a scoping review. International journal of environmental research and public health. 2021 Mar 22;18(6):3268.
  5. Grunberg VA, Geller PA, Bonacquisti A, Patterson CA. NICU infant health severity and family outcomes: a systematic review of assessments and findings in psychosocial research. Journal of Perinatology. 2019 Feb;39(2):156-72.
  6. 6.0 6.1 6.2 6.3 Jawaid SA. The global action report on preterm birth. Pulse International. 2012 May 31;13(10).