Prematurity

Definition

A premature infant is one born before 37 weeks of gestation.

Main concerns

Essentially there are two bigs things that you need to worry about:

• Respiratory distress syndrome
• Stabilising the neonate

Other conditions

These are conditions with a higher incidence in premature babies but are less common than RDS:

• Pneumothorax - more common in RDS. Treated by insertion of chest drain.
• Apnoea, bradycardia and desaturation - all common. Usually treated by physical stimulation. Stimulants and CPAP can be used if more serious.
• PDA
• Infection
• Brain inury - haemorrhages occur in 25% of preterm infants, usually with asphyxia or severe RDS.
• Necrotising enterocolitis (NEC) - bacterial infection of ischaemic bowel. Abdomen is distend, stool sometimes contains fresh blood. Bowel distended on X-ray. Treat with parenteral nutrition and broad-spectrum antibiotics.
• Retinopathy of prematurity (ROP) - basically, they get a retinopathy because the blood vessels to the retina are not fully blood vessels.
• Bronchopulmonary dysplasia (BPD) - infants who still need O₂ after the date of 36 weeks gestation. X-ray can be abnormal. Steroids, oxygen and sometimes CPAP can help.