Updated: 12/28/2021

Complications of Prematurity

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  • Snapshot
    • A 1-day-old newborn boy is being evaluated in the neonatal intensive care unit for dyspnea. The patient was born to a 16-year-old girl at 29 weeks of gestation by spontaneous vaginal delivery. The patient’s mother did not attend any prenatal appointments. Her medical history is significant for cocaine use. On exam, the patient appears cyanotic and tachypneic. There is grunting, nasal flaring, and accessory muscle use. A chest radiograph is obtained. (Neonatal respiratory distress syndrome)
  • Introduction
    • Overview
      • clinical definition
        • preterm infants are defined by gestational age less than 37 weeks
      • demographics
        • 5-18% of births worldwide
        • preterm birth complications are a leading cause of death for patients < 5 years of age worldwide
      • risk factors
        • morbidity and mortality in preterm infants increase with decreasing birth weight and gestational age
  • Neonatal Respiratory Distress Syndrome
    • Neonatal respiratory distress syndrome (NRDS)
      • demographics
        • > 50% of infants born at < 28 weeks of gestation
        • < 5% of infants born at > 37 weeks of gestation
      • pathogenesis
        • deficiency of pulmonary surfactant
          • sufficient pulmonary surfactant concentration not reached until 35-36 weeks of gestation
        • causes alveolar collapse
    • Presentation
      • symptoms usually present soon after birth
        • tachypnea
        • nasal flaring
        • grunting
        • accessory muscle use
        • cyanosis
    • Imaging
      • chest radiograph
        • atelectasis
          • increased linear densities/opacities
        • air bronchograms
          • tubular outline of airways
    • Studies
      • arterial/venous blood gas
        • respiratory and metabolic acidosis
        • hypoxia
    • Treatment
      • prevention
        • antenatal glucocorticoids
          • stimulates infant lung maturation
          • recommended for pregnant women < 34 weeks of gestation at risk of preterm delivery within 7 days
      • first-line
        • nasal continuous positive airway pressure (CPAP) with positive end-expiratory pressure (PEEP)
      • if severe
        • intratrachael surfactant and intubation
    • Complications
      • bronchopulmonary dysplasia
      • patent ductus arteriosus (PDA)
  • Bronchopulmonary Dysplasia
    • Bronchopulmonary dysplasia (BPD)
      • demographics
        • infants born < 32 weeks of gestation who required prolonged mechanical ventilation
          • especially consider if still requiring oxygen past original due date
      • pathogenesis
        • barotrauma
        • oxygen toxicity
    • Presentation
      • persistent symptoms of NRDS
      • increasing oxygen demand
    • Imaging
      • chest radiograph
        • atelectasis
    • Studies
      • arterial/venous blood gas
        • respiratory and metabolic acidosis
        • hypoxia
      • echocardiogram
        • monitor for development of pulmonary hypertension (i.e., increased pulmonary artery pressure or right heart strain)
    • Treatment
      • controlled oxygenation
    • Complications
      • pneumothorax
  • Anemia of Prematurity
    • Anemia of prematurity
      • pathogenesis
        • erythropoiesis normally decreases after birth due to increased tissue oxygenation following the onset of breathing and ductus arteriosus closure
        • in preterm infants, this occurs earlier (~3-12 weeks post-birth) and with more severity
          • impaired production of erythropoietin
          • reduced red blood cell life span
          • blood loss from iatrogenic blood sampling
    • Presentation
      • often asymptomatic
      • poor weight gain
      • tachycardia
      • increased episodes of apnea
    • Studies
      • labs
        • low hemoglobin
        • low hematocrit
        • low reticulocyte count
        • normal mean corpuscular volume (MCV)
      • peripheral smear
        • normocytic and normochromic RBCs
    • Treatment
      • iron supplementation
      • blood transfusions as needed
  • Intraventricular Hemorrhage
    • Intraventricular hemorrhage (IVH)
      • demographics
        • majority are newborns who
          • have a birth weight < 1500 g
          • are born at < 32 weeks of gestation
      • pathogenesis
        • fragile germinal matrix
          • increased risk of bleeding into the ventricular system of the brain
    • Presentation
      • symptoms appear usually 0-5 days of birth
        • lethargy
        • seizure
        • cranial nerve abnormalities
        • hypotonia
        • apnea
        • bulging anterior fontanelle
        • head circumference enlargement
          • does not increase until severe
    • Imaging
      • cranial ultrasound
    • Treatment
      • supportive care
      • if severe
        • serial lumbar punctures
        • diuretics
        • ventriculo-peritoneal shunt
    • Complications
      • cerebral palsy
      • developmental delay
  • Hypothermia
    • Hypothermia
      • pathogenesis
        • large body surface relative to size
        • inability to produce enough heat
    • Presentation
      • temperature < 37°C
      • cyanosis
      • lethargy
    • Treatment
      • slowed warming
  • Other Complications
    • Patent ductus arteriosus (PDA)
    • Retinopathy of prematurity (ROP)
    • Necrotizing enterocolitis (NEC)
    • Neurological disorders
      • cerebral palsy
      • developmental delay
    • Hypo- and hyperglycemia
    • Increased risk of infections
    • Growth impairment

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