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Nasterea Prematura
Nasterea Prematura
Sarcina prelungita
Nou-nscutul prematur
Definition
By Mayo Clinic staf Most pregnancies last about 40
weeks. By definition, a premature birth takes place
more than three weeks before the due date.
A premature birth gives a baby less time to develop
and mature in the womb. The result is an increased
risk of various medical and developmental
problems, including trouble breathing and bleeding
in the brain. If you go into labor too early, your
doctor may try to delay your baby's birth. Even if
premature birth is inevitable, a few extra days in
the womb can promote significant development.
Although the rate of premature birth seems to be
on the rise, there's good news. A healthy lifestyle
can go a long way toward preventing preterm labor
and premature birth.
Symptoms
By Mayo Clinic staf Prompt recognition of preterm
labor may help you prevent premature birth. Even
months before your due date, be on the lookout
for:
Contractions that occur more than six times each
hour (You'll feel a tightening sensation in your
abdomen, often reminiscent of menstrual cramps.)
Low, dull backache
Pelvic pressure or pain
Diarrhea
Vaginal spotting or bleeding
Watery vaginal discharge (This may be amniotic
fluid, which surrounds your baby in the uterus.)
If you're concerned about what you're feeling,
contact your health care provider. Don't worry
about mistaking false labor for the real thing.
Risk factors
By Mayo Clinic staf Often, the specific cause of preterm labor or
premature birth isn't clear. Many factors may increase the risk of
early labor and premature birth, however. The most common risk
factors include:
Having a previous preterm labor or premature birth
Pregnancy with twins, triplets or other multiples
Problems with the uterus, cervix or placenta
Smoking cigarettes, drinking alcohol or using illicit drugs
Some infections, particularly of the amniotic fluid and lower
genital tract
Some chronic conditions, such as high blood pressure and
diabetes
Being underweight or overweight before pregnancy
Stressful life events, such as the death of a loved one or domestic
violence
Multiple miscarriages or abortions
For unknown reasons, black women are more than twice as likely
to experience preterm labor and premature birth than are women
of other races. But preterm labor and premature birth can happen
to anyone. In fact, many women who have a premature birth have
no known risk factors.
Complications
By Mayo Clinic staf Preterm labor and premature birth may have various complications.
For mothers
Aside from starting too early, preterm labor typically resembles normal labor. Treatments used to
delay delivery may carry risks, however. Medications that halt uterine contractions may cause fluid
to collect in your lungs, which can make it difficult to breathe. Other side efects depend on the
medication used to stop labor. Some medications can lead to fatigue and muscle weakness. Others
may cause a rapid heartbeat, blood sugar abnormalities, headaches, dizziness or nausea.
Your health care provider will weigh the potential risks from medications used to stop labor against
the risks for your baby if he or she is born too soon.
For babies
The risks of premature birth vary depending on how soon a baby is born. Although survival is
possible for babies born as early as 23 to 26 weeks, the risks are greatest for the youngest babies.
Complications of premature birth may include:
Difficulty breathing
Episodes of stopped breathing (apnea)
Bleeding in the brain (intracranial hemorrhage)
Fluid accumulation in the brain (hydrocephalus)
Cerebral palsy and other neurological problems
Vision problems
Intestinal problems
Developmental delays
Learning disabilities
Less serious complications may include:
Yellowing of the skin and whites of the eyes (jaundice)
Lack of red blood cells (anemia)
Low blood pressure
For some premature babies, difficulties may not appear until later in childhood or even adulthood.
Not performing well in school is often a prime concern. Some studies suggest that premature babies
may face an increased risk of type 2 diabetes and cardiovascular disease in adulthood.
But not all preemies have medical or developmental problems. By 28 to 30 weeks, the risk of
serious complications is much lower. And for babies born between 32 and 36 weeks, most medical
problems
For newborns
Hospital neonatal intensive care units (NICUs) are designed
to provide round-the-clock care for premature babies and fullterm babies who develop problems after birth. In the NICU,
your baby will probably be kept in an incubator an
enclosed plastic bassinet that's kept warm to help your baby
maintain normal body temperature. Because preemies have
immature skin and very little body fat, they often need such
care to stay warm.
Sensors may be taped to your baby's body to monitor blood
pressure, heart rate, breathing and temperature. Caregivers
may also use ventilators to help your baby breathe. This
high-tech equipment may seem overwhelming at first, but it's
all designed to help your baby.
At first your baby may receive fluids and nutrients through an
intravenous tube. Breast milk may be given later through a
tube passed through your baby's nose and into his or her
stomach. When your baby is strong enough to suck, breastfeeding or bottle-feeding is often possible. The antibodies in
breast milk are especially important for preemies.
Your baby's caregivers will help you learn how to touch and
eventually hold and feed your baby. Talk or sing softly to your
baby, or simply provide quiet company.
Prevention
By Mayo Clinic staf A healthy lifestyle can go a long way toward preventing preterm
labor and premature birth.
Seek regular prenatal care. Prenatal visits can help your health care provider
monitor your health and your baby's health. Mention any signs or symptoms that
concern you, even if they seem unimportant.
Eat healthy foods. During pregnancy, you'll need more folic acid, calcium, iron,
protein and other essential nutrients. A daily prenatal vitamin that contains at least 1
milligram of folic acid ideally starting a few months before conception can help
fill any gaps.
Manage chronic conditions. Remember, uncontrolled diseases such as diabetes
and high blood pressure increase the risk of preterm labor. Work with your health care
provider to keep any chronic conditions under control.
Follow your health care provider's guidelines for activity. If you develop signs
or symptoms of preterm labor, your health care provider may suggest working fewer
hours or spending less time on your feet. Sometimes it makes sense to scale back
other physical activities, too.
Avoid risky substances. If you smoke, quit. Smoking may trigger preterm labor.
Alcohol and recreational drugs are of-limits, too. Even over-the-counter supplements
and medications deserve caution. Get your health care provider's OK before taking
any medications or supplements.
Ask your health care provider about sex. It's not a concern for women who have
healthy pregnancies. But sex may be of-limits if you have certain complications,
such as vaginal bleeding or problems with your cervix or placenta.
Limit stress. Set reasonable limits and stick to them. Set aside some quiet time
every day. Ask for help when you need it.
Take care of your teeth. Brush and floss daily, and visit your dentist for regular
cleanings and dental care. Some studies suggest that gum disease may be
associated with preterm labor and premature birth.
If you have a history of premature birth or significant risk factors for premature birth,
your health care provider may suggest weekly shots of the hormone progesterone.
Although much remains to be learned about progesterone therapy, initial studies
suggest that progesterone may help prevent preterm labor and premature birth in
some women.
Nou-nscutul prematur
Particulariti morfofuncionale comparativ cu nou nscutul la termen:
Nou-nscutul prematur
Nou-nscutul prematur
Definiie. Prematurul = nou-nscutul cu o vrst gestaional sub 37
de sptmni n momentul naterii (< 256-260 zile).
Clasificare. Prematurii pot fi mprii, n funcie de maturitate i de
concordana cu vrsta gestaional, n:
prematur cu greutate la natere corespunztoare cu vrst
gestaional (prematur AGA - appro-priate size for gestational age);
prematur cu greutate la natere mai mare dect cea
corespunztoare vrstei gestaionale (prematur LGA - large for
gestational age);
prematur cu greutate la natere mai mic dect cea
corespunztoare vrstei gestaionale (prematur SGA smallforgestational age).
Nou-nscutul prematur
Elemente morfologice.
La natere,
pielea-acoperit de vernix caseosa,
Marii prematuri - aspect asemntor cu cel al malnutriilor,
cu esut celular subcutanat absent, tegumente subiri,
uscate, largi i un craniu ceva mai voluminos fa de talie.
Alte cauze ale afectrii respiratorii : dezvolarea insuficient a reelei capilaroalveolare, fora sczut a musculaturii toracice, osificarea mai slab a cutiei toracice,
atelectazia secundar prin aspiraia secreiilor nazofaringiene sau a lichidelor
alimentare.
Analgezicele i anestezicele care trec prin placent inhib respiraia mai mult la
prematuri dect la maturi.
Neurologic
risc crescut pentru afeciunile neurologice acute, cum sunt:
hemoragia intracranian i depresia perinatal.
Caracteristic pentru prematur este hemoragia
intraventricular i subarahnoidian, care este precedat
frecvent de hipoxie i manifestat prin semne de oc
circulator cu tulburri neurologice
Cardiovascular
poate fi hipotensiv prin hipovolemie (pierderile sunt
exagerate datorit dimensiunilor reduse ale prematurului)
sau prin disfuncii cardiace i/sau vasodilataie produs de
sepsis.
Hematologic
Este vorba n special de anemia de diferite etiologii. La
prematuri apare frecvent hiperbilirubinemia.
Nutriional
Prematurul necesit ngrijiri speciale - absena reflexului de
supt i capacitatea gastric limitat impune alimentaia n
gavaj, completat n primele zile cu alimentaia
parenteral.
Gastrointestinal
Prematuritatea este cel mai important factor de risc pentru
enterocolita necrozant.
Metabolism
Sunt afectate metabolismele calciului i ale glucozei
Nou-nscutul prematur
Renal
Imaturitatea renal=filtrare glomerular sczut i instabilitate
n economisirea apei i n meninerea echilibrului acido-bazic.
Se produce ncrcare cu radicali acizi prin alterarea eliminrilor
de uree, cloruri i fosfai.
Imunologic
deficit n rspunsul umoral i celular -risc crescut la infecie
La acesta se adaug:
Oftalmologie
Retinopatia prematurilor poate aprea prin imaturitatea
retiniana. Examinarea vaselor capsulei anterioare a
cristalinului arat dispariia lor, progresiv, n sptmnile 2734.
Nou-nscutul prematur
Ingrijirea prematurului
Ingrijirea neonatal n
secia de nou-nscui:
Pentru marii prematuri- adugarea unui radiant (incubator deschis) deasupra nounscutului sau utilizarea unui incubator nchis .
Nou-nscutul prematur
Terapia hidroelectrolitic
contracareaza potenialul crescut de pierderi sensibile de ap, cu
meninerea unei hidratri corespunztoare i o concentraie
normal de glucoza i electrolii plasmatici.
Scderea fiziologic permis la prematuri este de 5-15% n
primele 5-6 zile.
Rspunsul la terapia hidroelectrolitic trebuie evaluat frecvent n
primele dou zile de via.
Nutriia - limitat prin inabilitatea multor prematuri de a avea reflex eficient de supt i de nghiire sau
de a tolera alimentaia enteral, astfel nct s fie necesar gavajul sau alimentaia parenteral.
Alimentaia precoce la 4-8 ore de la natere scade riscul de hipoglicemie, hiperbiliru-binemie i
catabolismul excesiv.
Complicaiile prematuritii
Sindrom de detres respiratorie idiopatica (boala membranelor
hialine);
Hemoragia intraventricular;
Retinopatia prematuritii (fibroplazia retro-lental);
Hiperbilirubinemia;
Anemia precoce a prematurului.
Nou-nscutul prematur
Prognostic i supravieuire
Sunt n funcie de gradul prematuritii (vrst gestaional i
greutate la natere), de afeciunile respiratorii, malformaii
congenitale majore i de prezena depresiei perinatale, a
infeciilor, hemoragiei intracraniene, displaziilor sanguine.
Cei mai afectai sunt nou-nscuii care sunt i prematuri i
dismaturi.
Prematuritatea reprezint cauza principal de deces neonatal:
prematuri gr. I -5-10% mortalitate;
prematuri gr. II - 10-40%;
prematuri gr. III-IV -30-100%.
Sunt cunoscute trei vrfuri de mortalitate:
Primele 24 h (cel mai mare), prin insuficien respiratorie;
Urmtoarele 24 h (mai redus), prin boli pulmonare i
hemoragie ventricular;
Al treilea vrf, mai mic i mai tardiv, prin infecie.
Nou-nscutul prematur
Criterii de externare
Iniial, s-a considerat c greutatea este cel mai important criteriu de externare. La nceput
se vorbea de 2.500 g, mai trziu de 2.250 g, iar mai nou, n majoritatea serviciilor,
greutatea nu mai este considerat un element determinant de externare. Mult mai
important dect greutatea specific este considerat acum starea general a nounscutului.
n general, un nou-nscut care nu este dependent de oxigen, care poate fi alimentat la sn,
care poate tolera temperatura normal din ncpere i care prezint o cretere ponderal
progresiv, fr apnee, este, din punct de vedere medical, pregtit pentru externare.
Majoritatea nou-nscuilor cu greutate foarte mic la natere pot fi mutai din incubator la
1.750-1.800 g, iar unii, care sunt mici pentru vrsta gestaional, dar cu aproximativ 36 de
sptmni de gestaie, pot fi mutai din incubator la greuti chiar mai mici.
Sunt unele circumstane n care nu toate criteriile de externare sunt ndeplinite, dar
externarea este posibil. De exemplu, unii nou-nscui cu bronho-displazie pulmonar, care
sunt oxigenodependeni, dar care au n rest o adaptare normal. Externarea cu administrare
de oxigen acas are multe beneficii (nu n ultimul rnd reducerea costului ngrijirii medicale
spitaliceti).
Nou-nscutul prematur
Probleme, acas, dup externare
Nou-nscutul postmatur
Prognosticul imediat i tardiv sunt rezervate i mortalitatea este de 24 ori mai crescut fa de celelalte categorii de nou-nscui.