Complications of Prematurity Dr Ghada Ramadan Head of

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Complications of Prematurity Dr Ghada Ramadan Head of Neonatal Services Associate Medical Director (Quality

Complications of Prematurity Dr Ghada Ramadan Head of Neonatal Services Associate Medical Director (Quality & Safety) Medway Hospital NHS Foundation Trust, Kent, UK Associate Lecturer in Child Health, Canterbury Christ Church University, Kent, UK E-mail: [email protected] net Twitter: gramadan_ghada

CONTENTS • • Definition of prematurity Acute complications Chronic complications Prevention

CONTENTS • • Definition of prematurity Acute complications Chronic complications Prevention

CLASSIFYING PREMATURITY • Delivery prior to 37 weeks gestation. • Preterm birth is the

CLASSIFYING PREMATURITY • Delivery prior to 37 weeks gestation. • Preterm birth is the leading cause of death in children younger than 5 years worldwide. 1 million deaths in 2015. • Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising. • Incidence worldwide is 5 -18% of all births. • 81% in Asia and Africa. • Pakistan, ranked 4 th among 10 countries with high number of preterm births [748 100].

CAUSES OF PREMATURE BIRTH • Maternal factors – Infection, cervical incompetence, uterine anomalies, placental

CAUSES OF PREMATURE BIRTH • Maternal factors – Infection, cervical incompetence, uterine anomalies, placental insufficiency, placental abruption, placenta praevia, PPROM, PET, diabetes, renal disease, heart conditions, smoking, drugs. • Foetal factors – Twin pregnancy, foetal distress, syndromes, polyhydramnios, hydrops foetalis. • Induced for maternal or foetal wellbeing • Iatrogenic trauma

Acute Complications of Prematurity

Acute Complications of Prematurity

ACUTE COMPLICATIONS OF PREMATURITY • • • Increased mortality Neonatal infections Cardio-respiratory complications Gastrointestinal

ACUTE COMPLICATIONS OF PREMATURITY • • • Increased mortality Neonatal infections Cardio-respiratory complications Gastrointestinal problems Neurological complications Haematological/Metabolic complications

NEONATAL INFECTIONS • • • High risk due to immaturity of immune system Lack

NEONATAL INFECTIONS • • • High risk due to immaturity of immune system Lack of maternal Ig. G transfer at 3 rd trimester Inadequate skin barrier Repeated blood sampling Invasive lines and tubes Humid environment

CARDIO-RESPIRATORY COMPLICATIONS • • • Hypotension PDA, heart failure Respiratory distress syndrome (SDLD) Air

CARDIO-RESPIRATORY COMPLICATIONS • • • Hypotension PDA, heart failure Respiratory distress syndrome (SDLD) Air Leak Bronchopulmonary dysplasia (CLD)

GASTROINTESTINAL COMPLICATIONS • Feed intolerance, GORD, aspiration pneumonia • Prolonged jaundice, kernicterus • Delay

GASTROINTESTINAL COMPLICATIONS • Feed intolerance, GORD, aspiration pneumonia • Prolonged jaundice, kernicterus • Delay in establishing full feeds • Gut immaturity • Necrotising enterocolitis ; lack of breast milk and umbilical catheters

NEUROLOGICAL COMPLICATIONS • Intracranial haemorrhages • Cystic periventricular leucomalacia • Acquired hydrocephalus

NEUROLOGICAL COMPLICATIONS • Intracranial haemorrhages • Cystic periventricular leucomalacia • Acquired hydrocephalus

HAEMATOLOGICAL/METABOLIC COMPLICATIONS • • Poor temperature regulation Bone marrow depression Anaemia, low platelets, low

HAEMATOLOGICAL/METABOLIC COMPLICATIONS • • Poor temperature regulation Bone marrow depression Anaemia, low platelets, low white cell count Clotting disorders ↓BM, Ca++ Metabolic bone disease of prematurity Electrolyte disturbances

Chronic Complications of Prematurity

Chronic Complications of Prematurity

CHRONIC COMPLICATIONS OF PREMATURITY • • • Increased long term morbidity Neonatal infections Cardio-respiratory

CHRONIC COMPLICATIONS OF PREMATURITY • • • Increased long term morbidity Neonatal infections Cardio-respiratory complications Gastrointestinal problems Neurological complications

NEONATAL INFECTIONS CARDIORESPIRATORY COMPLICATIONS • Bronchiolitis (RSV) • Recurrent hospital admissions • Propensity for

NEONATAL INFECTIONS CARDIORESPIRATORY COMPLICATIONS • Bronchiolitis (RSV) • Recurrent hospital admissions • Propensity for wheeze and asthma like symptoms • Home oxygen therapy (Bi. PAP, LFNC) • Tracheostomy • Pulmonary hypertension

BRONCHO-PULMONARY DYSPLASIA • • Hyperinflation Fibrosis Atelectasis Cystic changes

BRONCHO-PULMONARY DYSPLASIA • • Hyperinflation Fibrosis Atelectasis Cystic changes

GASTROINTESTINAL COMPLICATIONS • • • NEC surgery Stomas, gastrostomy management Sub-optimal growth Home NGT,

GASTROINTESTINAL COMPLICATIONS • • • NEC surgery Stomas, gastrostomy management Sub-optimal growth Home NGT, NJT feeding Bone fractures, splinting, surgery

NEUROLOGICAL COMPLICATIONS • • Cognition, learning disability Movement disorder (Cerebral palsy) Global developmental delay

NEUROLOGICAL COMPLICATIONS • • Cognition, learning disability Movement disorder (Cerebral palsy) Global developmental delay Behavioural and psychological issues Retinopathy of prematurity (oxygen therapy) Blindness (partial or complete) Deafness

NEUROLOGICAL COMPLICATIONS

NEUROLOGICAL COMPLICATIONS

COMORBIDITIES ASSOCIATED WITH CP

COMORBIDITIES ASSOCIATED WITH CP

Henry’s Story

Henry’s Story