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 complications and outcome

 Helping Babies Breathe (HBB)  Management of the sick and small newborn (MSSN)  CPAP to all district facilities

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Long term complications

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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

 Plot the child at every visit

 Head circumference  Height  Weight  Weight for height

 Supplemental iron  Multivitamins  Vit D  Wean at 6 months

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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

• r 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

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 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

 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

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Questions?

2017-08-08

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