Dr Faeza Soobadar Paediatrician/Neonatologist SSRNH NICU
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1 An early start to life The Preterm Baby.. Dr Faeza Soobadar Paediatrician/Neonatologist SSRNH NICU 1
2 Definitions (1) Term wks Post-Term 42 wks Preterm <37 wks Moderately PT wks Severely/Very PT wks Extremely PT <28 wks 2
3 Definitions (2) Low Birth Weight (LBW) Very Low Birth Weight (VLBW) Extremely Low Birth Weight (ELBW) <2.5kg <1.5kg <1kg 3
4 Aetiology 1 - (Maternal) Idiopathic Low socio-economic status Malnutrition Age <16 or >35 Smoking & drug abuse Stress Malformations of uterus & cervix Previous preterm delivery or late miscarriage 4
5 Aetiology 2 - (Maternal) Maternal illnesses UTI & asymptomatic bacteriuria Bacterial vaginosis Anaemia Diabetes Hypertension or PET 5
6 Aetiology 3 - (Fetal) Multiple gestation Congenital malformation Fetal distress Polyhydramnios 6
7 Aetiology 4 - (Iatrogenic) Fetal distress IUGR Uncontrolled PIH/ Eclampsia APH Diabetes Maternal cardiac disease Chorioamnionitis Incorrect estimate of gestational age 7
8 Prevention & Obstetric management Health promotion programmes Antenatal care PIH, diabetes Cervical cerclage Detection & treatment of infection Tocolytics Optimising outcome for baby: Steroids; IUT. 8
9 PROBLEMS OF PREMATURITY & POST-NATAL MANAGEMENT 9
10 Resuscitation Difficulty in extrauterine adaptation. NICU. Delivery in level 3 Appropriate planning & immediate availability of qualified personnel & equipment. Prompt resuscitation & stabilization. PNT 10
11 Temperature regulation Inability to shiver Large SA Decreased subcutaneous fat Rd Reduced d brown fat stores Servo-controlled incubator Humidity Easy access to infant Humidification df of ventilator gases 11
12 12
13 Respiratory (1) RDS Apnoea of prematurity Pulse oxymetry, Cardio- resp monitoring & ABG. Oxygen Respiratory support mechanical ventilation, NCPAP. Surfactant therapy Respiratory stimulant 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 Respiratory (2) Pneumothorax Thoracocentesis Pulmonary haemorrhage Ventilation Blood transfusion FFP/Vitamin K 23
24 Cardiovascular Hypotension BP monitoring Volume expansion Inotropic support PDA Cardiac echo Diuretics Indomethacin Ibuprofen 24
25 25
26 Renal/Metabolic Electrolyte disturbances Hypocalcaemia Hypo/hyper-glycaemia Regular U s&e s s Urine output Dextrostix Careful fluid management & administration Insulin infusion 26
27 27
28 GIT/Nutrition Feed intolerance High requirements NEC Gavage feeding TPN EBM+Fortifier Pre-term formulas Gastric decompression, NBM, iv antibiotics, surgical opinion. 28
29 29
30 Neurological IVH Vitamin E, Ethamsylate Good ventilation management & control of BP Regular cranial USS 30
31 31
32 32
33 Others Haematological anaemia/ thrombocytopenia Multiple blood transfusions Immunological infection Psychological Multiple courses of antibiotics; antifungal. Parental support NIDCAP 33
34 34
35 Criteria for home discharge Clinically stable Stable temperature Good weight gain Mother s ability to care for baby Social circumstances 35
36 LONG TERM PROBLEMS & FOLLOW-UP 36
37 Respiratory CLD Recurrent respiratory infections Dexamethasone Nebulized/Inhaled therapy Chest physio Long term oxygen & prolonged hosp stay Recurrent re-admissions Immunization 37
38 38
39 Nutrition & Growth Poor growth Anaemia Rickets of prematurity Growth charts High-calorie formula & vits Hb monitoring Iron supplementation Phosphate supp 39
40 Neurological PVL & Cerebral palsy Convulsions Hydrocephalus ROP Hearing impairment Prevention Neuro-developmental follow-up PT & OT Anticonvulsants Neurosurgical opinion Ophthalmology r/v Hearing assessment 40
41 41
42 Psycho-socialsocial Learning difficulties Behavioural problems Family/social impact Developmental psychologist Special educational programme Psychotherapy Parent support groups 42
43 STATISTICS 43
44 Incidence of prematurity SSRNH % % % % % % Other countries USA (2006) 12.7% UK (2007) 8.6% France 7% Australia (2002) 7% 44
45 Admissions to NICU Admissions Mortality % Preterm % Moderately PT (survival) 58% (92%) 51% (91%) 53% (84%) 44% (80%) 37% (89%) 49% (79%) 42% (79%) Severe PT (survival) 30% (63%) 42% (79%) 34% (65%) 46% (79%) 49% (55%) 36% (71%) 33% (64%) Extreme PT (survival) 12% (26%) 7% (55%) 12% (45%) 10% (8%) 14% (44%) 14% (50%) 24% (71%) 45
46 NMR & IMR SSRNH & MRU NMR MRU NMR SSRN IMR MRU IMR SSRN NMR SSRN NMR MRU IMR SSRN IMR MRU 46
47 NMR & IMR WORLDWIDE NMR IMR NMR
48 Survival of a 16-oz. baby (450g) DOB ; GA 26 wks Case report; Dr H Fakim; RMO; Civil Hospital; Mauritius BMJ y old mother At birth the infant was very feeble & did not cry nikethamide. Wrapped up in cotton wool cot lined with blankets & kept warm with hot water bottle Fed on glucose water..ebm condensed milk 3.06kg at 5½m 48
49 Acknowledgements My grateful thanks to: Dr A G Mohamedbhai, Consultant Paediatrician, for laboriously over the years, compiling the statistics for SSRN Hospital. Dr Oochita Jhummun, NICU RMO, for computerizing the data. All the children for performing in front of the camera. All obstetricians t i for keeping us on our toes all the time. And of course to all Paediatricians & NICU nursing staff & RMO s, past & present, without whose dedication the NICU would not exist & these children would not be alive today. 49
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