Complications of Prematurity Dr Ghada Ramadan Head of

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

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 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 • • • 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 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 Leak Bronchopulmonary dysplasia (CLD)

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

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 • • • Increased long term morbidity Neonatal infections Cardio-respiratory complications Gastrointestinal problems Neurological complications

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

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 Behavioural and psychological issues Retinopathy of prematurity (oxygen therapy) Blindness (partial or complete) Deafness

NEUROLOGICAL COMPLICATIONS

COMORBIDITIES ASSOCIATED WITH CP

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