Common complications in the late preterm infant Tamara Kerbelker - PowerPoint PPT Presentation

Common complications in the late preterm infant Tamara Kerbelker

Talk overview  Definitions  Epidemiology  Short term complications  Long term complications  Prevention  Recommendations for outpatient management

Definitions  Prematurity  Birth before 37 completed weeks

Classification according to gestational age  Late preterm birth – GA between 34 and less than 37 weeks  Very preterm (VPT) birth – GA less than 32 weeks  Extremely preterm (EPT) birth – GA at or below 28 weeks

Classification according to birth weight  Low birth weight (LBW) – Birth weight less than 2500 g  Very low birth weight (VLBW) – Birth weight 1000-1499g  Extreme low birth weight (ELBW) – birth weight <999g

Epidemiology Western Cape PPIP data 2016

Epidemiology Western Cape PPIP data 2016

Short term complications  Hypothermia  Respiratory distress syndrome  Apnoeas of prematurity  Patent ductus arteriosus  Hypotension  Intraventricular haemorrhage  Glucose anomalies  Infection  Retinopathy of Prematurity

Hypothermia  Rapid heat loss  large body surface area  inability to produce enough heat  Heat is lost by conduction, convection, radiation, and evaporation  Contributes to metabolic disorders - hypoglycaemia or acidosis.  Increased mortality  Intraventricular haemorrhage (IVH),pulmonary insufficiency, haemorrhage

Prevention of hypothermia  Drying the baby thoroughly immediately after birth  Removal of any wet blankets  Plastic bags  Kangaroo mother care (KMC) – skin-to-skin

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Respiratory distress syndrome  Surfactant deficiency  Early CPAP

Apnoeas of prematurity  More common in the patients with lower gestational age  Stimulation  Helping Babies Breathe (HBB)

Glucose anomalies  Keep warm  Feed early

Interventions to improve short term 15 complications and outcome  Helping Babies Breathe (HBB)  Management of the sick and small newborn (MSSN)  CPAP to all district facilities

Long term complications 18

Long term complications  Recurrent hospitalisation  Increased risk of SIDS  Neurodevelopmental outcomes  Chronic health conditions  Growth impairment  Impaired lung function  Effect on adult health

Recurrent hospitalisation  Respiratory  RSV (any viral infection)  Asthma  Gastrointestinal  GORD  Gastroenteritis

Prevention of recurrent hospitalisation  Promote breastfeeding  Ensure vaccinations  Influenza vaccine  No tobacco smoke exposure  Vitamin A supplementation  Limit contact with sick people  Limit crowded environments (if possible) – malls, taxis  RSV immunoglobulin

Growth impairment  Lower weight for age  Lower height for age  Lower BMI  Smaller head circumference

Growth impairment 23  Plot the child at every visit  Head circumference  Height  Weight  Weight for height  Supplemental iron  Multivitamins  Vit D  Wean at 6 months

Neurodevelopmental outcomes  Impaired cognitive skills  Motor deficits including mild fine or gross motor delay, and cerebral palsy (CP)  Sensory impairment including vision and hearing losses  Behavioural and psychological problems

Neurodevelopmental outcomes Infant neurological assessment (INA)  Neurodevelopmental paediatrician  or general paediatrician School placement  ADHD management  Sensory screening  Vision  Hearing  Allied health  Physiotherapy  Occupational therapy  Speech therapy  Educational psychologist 

Chronic health conditions  Cerebral palsy  Cognitive deficit  Asthma  Decreased exercise capacity  Increased respiratory symptoms  Chronic kidney disease  Smaller kidneys  Higher blood pressure  Microalbuminuria

Effect on adult health  Insulin resistance  Hypertension  Lower reproduction rate

Primary prevention Prevent the pregnancy  Female empowerment  Contraception  Planned pregnancy  Teenage pregnancy

Other prevention 29  Educate expecting moms BANC sites and the importance of antenatal care  Maternal nutrition  Treatment of STIs, TB  HIV testing and prevention during pregnancy  Alcohol and drug use during pregnancy

What can we do 30  Supplements at discharge  Encourage any breastfeeding  Educate moms on basic life support  Educate moms about risk factors for SIDS  Apnoea monitors  Synagis motivation  Vigilance with any ARI  Encourage immunisation  Follow up visits  Monitor growth and development  Facilitate allied health visits

31 Questions? 2017-08-08