The premature newborn infant Ola Didrik Saugstad

Sana26.01.2018
Hajmi466 b.


The premature newborn infant

  • Ola Didrik Saugstad

  • Department of Pediatric Research

  • Rikshospitalet University Hospital

  • University of Oslo, Norway

  • Student lecture 9th semester


Prematurity

  • GA < 259 days (37 weeks)

  • Norway: 5.6% (1988) and 6.5% (1996)

  • < 1.5 kg 0.7-1.0% (528 = 0.9% in 1996)

  • < 1.0 kg 0.3 % (200 =0.3% in 1996)

  • USA: 7% among caucasians 18% among black



Preterm infants

  • Slight 32-36 weeks

  • Feeding and temperature problems, some have immature lungs

  • Moderate 28-31 weeks

  • Immature lungs, temperature control, feeding problems, apneas

  • Severe < 28 weeks

  • Immature organ systems, intensive care



Terminology

  • Low birth weight < 2.5 kg

  • Very Low Birth Weight < 1.5 kg

  • Extremely Low birth Weight < 1.0 kg

  • Premature < 37 weeks

  • Immature < 28 weeks

  • ELGAN: Extremely Low Gestational Age Newborn < 26 weeks

  • Small for gestational age < 2.5 percentile



General problems in premature infants

  • Feeding: (IV – Gavage)

  • Temperature control: (incubator-heated bed)

  • Respiratory control: apneas, Respiratory support CPAP, Artificial ventilation

  • Immature lungs – lack of surfactant: Oxygen suppl, Respiratory support (CPAP, ventilator)

  • Immature brain: brain hemorrhage and cysts

  • Immunology: risk of infections (antibiotics)

  • Organ injury (Brain, Eye, Lung, Intestine, Skin

  • Long term consequences



Survival

  • 1940: 50% with BW1500 gram survive

  • 2000: 50% with BW 600 gram survive

  • Birth weight % Survival after 1 year

  • 350-499 g 14

  • 500-799 g 47

  • 750-999 g 76_______________

  • Medical Birth Registry 1992-96



Survival

  • Gestational age weeks Survival %

  • 21 0-4

  • 22 0-12

  • 23 8-36

  • 24 12-62

  • 25 31-79

  • 26 53-85

  • NFR’s Consensus report 1999



Sequels

  • From 1979 to 1994 survival among preterm infatns with BW 501-800 gr increased from 20 to 59%.

  • The percentage of children with severe neurosensory injury was however, unchanged

  • (O’Shea 1997)



Injury of ELGANs 1972-1990

  • < 26 uker < 800 gram

  • Mental retardation 14% 14%

  • Cerebral palsy 12% 8%

  • Blindness 8% 8%

  • Deafness 3% 3%

  • ”Major disability” 22% 24%

  • Survival increased, however rate of injury was constant



Injury of preterm infants

  • Eye ( Retinopathy of prematurity ROP

  • Stage 1-5)

  • Brain injury (Intracranial hemorrhage (grade 1-4) Periventricular leukomalacia PVL). Immature capillaries (plexus Choroides), hemodynamic changes, intrauterine inflammation

  • Pulmonary ( Bronchopulmonary dysplasia - BPD, Chronic lung disease - CLD)

  • Intestinal (necrotizing enterecolitis - NEC)



School problems

  • A Dutch study showed that > 50% with BW < 1500 gram needed extra support at school

  • No relation between Gestational age and injury

  • Preterm infants have to be followed-up at least till school age because these problems have a late debut. Learning problems picked up around 8 years

  • ADHD

  • Hyperactivity

  • Intellectual problems (arithmetics, solving problems, cognitive functions)

  • Short term memory

  • Coordination problems

  • Behavioral problems (shy, sport performance, sosialise )

  • Boys> girs

  • Low Socioeconomic conditions



Future challenges

  • Prevent preterm birth

  • Understand relation between intrauterine conditions and postnatal injury

  • Improved nutrition

  • Improved technology

  • New drugs (antioxidants, anti inflammatory, etc)

  • New insight into the needs and the psychological development


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