Prematurity and High-Risk Infants: Difference between revisions

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=== Complications ===
=== Complications ===


* 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 systems disorders throughouta life. <ref name=":1" /><ref name=":0" />  Pravia et al., (2020) details below the risk and management of a preterm birth on each body system:<ref name=":1" />
* 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 systems disorders throughout life. <ref name=":1" /><ref name=":0" />  Pravia et al., (2020) details below the risk and management of a preterm birth on each body system:<ref name=":1" />
{| class="wikitable"
{| class="wikitable"
|+<ref name=":1" />
|+<ref name=":1" />
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|Risk
|Risk
|
|
* Obstructive disease, 
* Obstructive disease
* Pulmonary hypertension  
* Pulmonary hypertension  
|-
|-
|Management
|Management
|
|
* Evaluate previous asthma diagnosis  
* Evaluate previous [[asthma]] diagnosis


* Consider baseline pulmonary function testing
* Consider baseline pulmonary function testing
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* Avoid nephrotoxins
* Avoid nephrotoxins


* Control blood pressure (consider an angiotensin-converting enzyme inhibitor if a hypertension medication is needed)
* Control blood pressure (consider an angiotensin-converting enzyme inhibitor if [[Hypertension in Pregnancy|hypertension]] medication is needed)


* Limit salt intake
* Limit salt intake
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|Risk
|Risk
|
|
* Hypertension
* [[Hypertension in Pregnancy|Hypertension]]
* Ischemic heart disease
* Ischemic heart disease
* Congestive heart failure
* Congestive heart failure
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|Risk
|Risk
|
|
* Diabetes
* [[Diabetes]]
* Metabolic syndrome
* Metabolic syndrome
* Obesity
* [[Obesity]]
* Osteoporosis
* [[Osteoporosis]]
|-
|-
|Management
|Management
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|Risk  
|Risk  
|
|
* Autism
* [[Autism Spectrum Disorder|Autism]]
* Mood disorders
* Mood disorders
* Intellectual disabilities
* Intellectual disabilities
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* Tocolytics to slow down labor
* Tocolytics to slow down labor
* Antenatal corticosteroids to reduce mortality in the newborn
* Antenatal corticosteroids to reduce mortality in the newborn
* Antibiotics to prevent infection
* [[Antibiotics]] to prevent infection
* Provision of magnesium sulphate for neuro-protection of the newborn
* Provision of magnesium sulphate for neuro-protection of the newborn<ref name=":3" />
* Promote antenatal and skilled delivery care for all women
* Smoking cessation and reducing exposure to secondhand smoke and other pollutants
* Policies to support safe motherhood and universal access to antenatal care
* Workplace policies regulating working hours and strenuous working conditions
* Professional and hospital policies to regulate infertility treatments and to reduce cesarean birth rates and early induction of labor<ref name=":3" />
 
=== Management of Preterm Labor ===
Preterm labor may still occur despite all of the precautions above.  In this scenario, there are several ways to manage preterm labor to promote the best possible outcome:
 
# Tocolytics to slow down labor
# Antenatal corticosteroids
# Antibiotics<ref name=":3" />


=== Care of the Premature Baby ===
=== Care of the Premature Baby ===
Managing preterm birth with various techniques can help improve the outcome for the newborn child.  Some of these strategies are listed below:
* Essential and extra newborn care, especially feeding support  
* Essential and extra newborn care, especially feeding support  
* Neonatal resuscitation  
* Neonatal resuscitation  
* Kangaroo Mother Care  
* Thermal care (maintain baby's body temperature)
* Chlorhexidine cord care
* Kangaroo Mother Care (skin-to-skin contact with mother or another family member to provide stable warmth and to encourage frequent and exclusive breastfeeding)
* Comprehensive neonatal intensive care, where capacity allowsDespite taking preventions for preterm labor<ref name=":3" />
* Chlorhexidine cord care (umbilical cord cleaning)
* Comprehensive neonatal intensive care, where capacity allows<ref name=":3" />


*
== Resources ==


=== Management of Pregnant Women at Higher Risk of Preterm Birth ===
* [[Understanding Newborn Behaviour]]
 
* [[Infant Development]]
* Identification and treatment of hypertensive disease in pregnancy
* [[Infant Terminology and Reflexes]]
* Monitoring multiple pregnancies
* Administration of progesterone to prolong pregnancy 
* Identification and treatment of structural abnormalities (e.g., cervical cerclage, cervical pessary)
* Management of women in preterm labor including:
* Tocolytics to slow down labor
* Antenatal corticosteroids to reduce mortality in the newborn
* Antibiotics to prevent infection
* Provision of magnesium sulphate for neuro-protection of the newborn
* Promote antenatal and skilled delivery care for all women
* Smoking cessation and reducing exposure to secondhand smoke and other pollutants
* Policies to support safe motherhood and universal access to antenatal care
* Workplace policies regulating working hours and strenuous working conditions
* Professional and hospital policies to regulate infertility treatments and to reduce cesarean birth rates and early induction of labor<ref name=":3" />


== References ==
== References ==
<references />
[[Category:ReLAB-HS Course Page]]
[[Category:Rehabilitation]]
[[Category:Paediatrics]]
[[Category:Course Pages]]

Revision as of 15:21, 10 January 2023

Introduction[edit | edit source]

Prematurity is a significant healthcare problem with estimates of 15 million preterm births annually according to the World Health Organization (WHO).[1][2] Preterm births are further 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. Developing neurological sequelae from prematurity includes 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 are at a higher risk for complex medical conditions, recurrent hospitisations and neurodevelopmental impairments. Developmental delays and chronic diseases that result from preterm birth may persist into adulthood and consequently, require a heavy burden on the patients, 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 systems disorders throughout life. [3][1] Pravia et al., (2020) details below the risk and management of a preterm birth on each body system:[3]
[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


[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
[3]
Body System Cardiovascular
Risk
  • Hypertension
  • Ischemic 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
[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
[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 if 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
  • Administration of 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 regulating working hours and strenuous working conditions
  • Professional and hospital policies to regulate infertility treatments and to reduce cesarean birth rates and early induction of labor[6]

Management of Women in Preterm Labor:[edit | edit source]

  • Tocolytics to slow down labor
  • 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).
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