Prematurity

1. Prematurity By Cody Sacquitne

2. What is Prematurity • Prematurity is cut off at 37 weeks in gestation • Prior to 32 weeks is considered a very premature birth • Less than 28 weeks is extremely premature

3. Not prematurity • Weights aren’t truly a part of determining prematurity • Weights of infants are associated different problems but just because a baby is smaller doesn’t mean they are preterm • Some uterine restriction prevents additional growth so infants remain small • Organ maturity is different in preterm infants

4. Conditions associated with prematurity • Inadequate fetal growth • Pre-eclampsia • Prelabor rupture of the membranes • Multiple Pregnancy • Placenta Praevia • Placental Abruption • Fetal congenital malformations • Abnormal fetal lie • Severe disease of the mother

5. Vaginal Infections • Associated with higher levels of premature births • Treatment of things like Chlamydia, Ureaplasma, and group B strep. showed no reduction to risk of prematurity • Bacterial Vaginosis • 60% increase of preterm birth

6. Types of Prematurity • Antepartum death and lethal malformations • Multiple Pregnancy • Elective Delivery • Maternal and fetal pathology

7. Antepartum death and lethal malformations • 10-15% of all premature births • Almost 50% of total perinatal mortality • This form is unsavable • Infant dies before labor or has malformations that are incompatible with life • Maternal well-being is a large factor • Ethical problems come in to play

8. Multiple Pregnancy • Almost half of multiple births occur prematurely • Multiple births are 15 times more likely • Babies make up 20% of all premature infants

9. Elective Delivery • Planned obstetric decision • Complications during pregnancy within the mother or the fetus • Not necessarily premature infants

10. Maternal and Fetal Pathology • Eclampsia • Antepartum Hemorrhage • Intra-uterine growth restriction • Spontaneous preterm labor • Nature

11. Delivery Location • Must be in an environment ready to handle a premature infant • Monitoring of infant 24-hr • Possible risk to diseases if not proper location • Similar in animals- the cleaner the environment the better chance they would have

12. Route for Delivery • Main decision for premature infants • Vaginal or Cesarean Section • Breech much more common in preterm • Safer for premature infants to use C-section • Mostly planned deliveries • Premature baby is more susceptible to compress from the pelvic region than a term baby • They have a softer skull

13. Prevention of Prematurity • Social Interventions • Women’s social and economic circumstance • How well informed she is • Physical measures • Pay attention to uterine activities • Enough Bed-Rest • Pharmacological • Betamimetic drugs • Calcium • Overall proper nutrition is essential

14. Effects on Newborn • Respiratory • Circulatory • Renal • Neurological • Thermoregulation • Intestinal • Growth and Development • Immunological • Long term problems

15. Pulmonary System • Respiratory Distress Syndrome • Affects over 50% of premature infants • One of leading cause or mortality and morbidity • Ventilator needed in some cases • Use different methods to mature or help lungs

16. Pulmonary Cont. • Corticosteroids • Betamethasone and Dexamethasone • Reduce risk of RDS by 40-60% • Helps with lung maturation • Max effect more than 24 hrs prior to birth within 7 days of administration • Risks to Corticosteroids • Increased susceptibility to infection • Delayed response recognition

17. Circulatory System • Different results depending on birthing method • Umbilical Cord Clamping • Delayed much better • Increased blood volume • Patent DuctusArteriosus • Takes more time closing ductusvenosus • Low Blood Pressure • Oxygen vital at young stages of infants life

18. Renal System • Decreased ability to maintain their blood pressure • Difficult time regulating salt and water balances

19. Neurological • Developmentally behind slightly • More risk • Intraventricular hemorrhaging • Blood vessels of brain not fully developed • Premature infants at a much higher risk • Smaller and earlier • Increase chances if other problems • 4 different grades • No way to stop • Hydrocephalus • Fluid accumulation in the brain

20. Thermoregulation • Tend to lose body heat rapidly • Don’t have as much stored fat • At high risk to hypothermia • Leads to breathing problems and low blood sugars • Use up energy just to stay warm • Hypoglycemia • Smaller stores of glycogen

21. Gastrointestinal and Metabolism • Immature systems • Necrotizing Enterocolitis • Cells in bowel are injured • Only breast milk have lower risk • Spontaneous intestinal perforation • Bowel perforations

22. Growth and Development • Start out behind • Likely to have other problems • One problem will lead to another • Likely to develop long term disease • Developmental slower

23. Immunity • Increased susceptibility to infection through childhood • Risk of bacterial infection • Prolonged intensive care • NICU environment • Less functionality • Immunoglobulin • General deficiency at birth

24. Immunity cont. • Development of Innate immune defense • Results in immediate defense system • Prematurity acts on many levels of defense • Immune signaling • Link between adaptive and innate immunity • Limited neutrophil precursor pool • Neutropenia • Increase bacterial infections

25. Long Term • Cerebral Palsy • 40-50% of patients were born prematurely • Movement and muscle tone • Effects the brain • Poor Circulation • Insufficient oxygen supply • Undernourishment or neural infection • Impaired Cognitive Skills • Lag behind term babies in mental development • More likely to have a learning disability

26. Long Term Cont. • Vision problems • Retinopathy of prematurity • Blood vessels swell and overgrow in the light sensitive layer of the nerves of the retina • Retinal scaring • Retinal detachment • Possible blindness • Hearing problems • Increased risk of hearing loss

27. Long term cont. • Dental problems • Delayed tooth eruption • Tooth discoloration • Improper alignment of teeth • Behavioral and psychological problems • More likely to develop problems • Attention deficit hyperactivity disorder (ADHD) • Depressed or anxiety • Interaction problems with other kids

28. Long term cont. • Chronic health issues • Infections • Asthma • Feeding problems • Sudden infant death syndrome • Possible risk to diabetes and cardiovascular disease

29. Conclusion • Prematurity puts the infant as well as mother at more risk for complications at birth • The infants immune system is compromised leading to many problems in different systems of the body

30. Questions ???

31. References • http://www.anslab.iastate.edu/Class/AnS536w/17%20Prematurity/7211429a.pdf. • http://www.anslab.iastate.edu/Class/AnS536w/17%20Prematurity/Carey2003.pdf • http://www.anslab.iastate.edu/Class/AnS536w/02%20Circulatory%20Physiology/Itoh2001.pdf • Murray Enkin, Marc J.N.C. Keirse, James Neilson, Caroline Crowther, LeliaDuley, Ellen Hodnett, and Justus Hofmeyr. A Guide to Effective Care in Pregnancy and Childbirth, 3rd ed. Oxford, UK: Oxford University Press, 2000 • http://www.anslab.iastate.edu/Class/AnS536w/02%20Circulatory%20Physiology/Saigal1972.pdf • http://eds.b.ebscohost.com.proxy.lib.iastate.edu/ehost/pdfviewer/pdfviewer?sid=9f598ed2-1281-40f2-9569-6e35b4b97b69%40sessionmgr115&vid=2&hid=105 • http://www.nlm.nih.gov/medlineplus/ency/article/007301.htm • http://www.mayoclinic.org/diseases-conditions/premature-birth/basics/complications/con-20020050