PREEMIES:

DEVELOPMENT
PROBLEMS, MEDICAL
NEEDS AND
EXPECTATIONS
• A normal pregnancy lasts nine
months, or about 38 to 42 weeks.

• The current World Health

Organization definition of
prematurity is a baby born before
37 weeks of gestation, counting
from the first day of the last
menstrual period
 Risk factors that can increase a premature delivery

• Multiple gestation

• Maternal malnutrition and maternal smoking or use of illicit drugs

• Having delivered a previous premature baby

• Maternal medical problems such as Diabetes or Hipertension,

specially if they aren’t well controlled
• Uterine or cervical problems such as uterine infections

• Lack of prenatal care

• Age: mothers under 18 and over 30 have a greater risk of being in

labour earlier than other mothers

Although there are many risk factors that can help to

predict which pregnancies are at risk for premature
delivery, in most cases, no cause is found.
 Interventions to reduce the morbidity and mortality of
preterm birth

• Primary (directed to all women)

Problems of social deprivation, poor maternal nutrition and substance
abuse must all be addressed. Smoking should cease and alcohol
consumption should be avoided

• Secondary (aimed at eliminating or reducing risk) Antenatal care is

important and should be easily accessible to all women.

• Terciary ( intended to improve outcomes for preterm infants)

Interventions when complications arise e.g. regionalised care,
treatment with antenatal corticosteroids, tocolytic agents and
antibiotics
 Common Health Problems of Premature babies
Premature infants are prone to a
number of problems, mostly
because their internal organs
aren't completely ready to function
on their own.

•Hyperbilirubinemia

•Apnea

•Anemia

•Gastroesophageal reflux disease

•Pneumonia

•Sepsis

•Long-therm problems
 Many premature infants have medical problems that continue into
childhood or permanently. As a rule, the more premature an infant
and the smaller the birth weight, the greater the risk of complications.

It is impossible to predict the long-term outcome for an individual

baby just on the basis of gestational age or birth weight.

Severe problems such as cerebral palsy, blindness and deafness

may affect 10 to 15% of premature babies.

Cognitive and neuromotor impairments at 5 years of age increase

with decreasing gestational age. Many of these children need a high
level of specialised care.
 Premature infants have many special needs which is why they
often begin their lives after delivery in a neonatal intensive care
unit that provides the basic needs to assure proper growth and
development:

 Warmth

 Nutrition

 Protection
 Warmth

Premature babies lack the body fat

necessary to maintain their body
temperature.

Therefore,incubators or radiant
warmers are used to keep the
babies warm

In some units it is used a method

called “kangaroo care”:
holding babies skin to skin with a
parent that can be done with any
infant who is medically stable.
 Nutrition

Premature babies have special nutritional needs because they grow at a faster rate
than full-term babies and their digestive systems are immature.

Breast milk is an excellent source of nutrition, but premature

infants are too immature to feed directly from the breast or bottle
until they're 32 to 34 weeks gestational age
• Special fortifiers may be added to
breast milk (or to the formula if
breastfeeding isn't desired), because
premature infants have higher vitamin
and mineral needs than full-term
infants

• Nearly all premature babies receive

additional calcium and phosphorus

• The baby's blood chemicals and

minerals, such as blood glucose
(sugar), salt, potassium, calcium,
phosphate, and magnesium, are
monitored regularly, and the baby's
diet is adjusted to keep these
substances within a normal range.
 Protection

• In the unit of intensive care the neonatology team includes

experienced neonatal nurses, respiratory therapists, and
neonatologists.

• A multi-disciplinary team of experts involved in each child’s case

may include pulmonologists, intensivists, cardiologists, cardiac
surgeons, endocrinologists, radiologists and others focused on
delivering the best treatment plan for each infant.

• Family suport is very important, to explain and show what are the
improvements, expectations and problems related with the baby.

Before NICU discharge, premature babies need to be able to

breathe, eat, and keep their temperatures stable
• Often, premature infants require
special care after leaving the
hospital. In addition to the regular
well-child visits and immunizations
that all infants receive, premature
infants receive periodic hearing
and eye examinations

• Careful attention is paid to the

development of the nervous
system, including the achievement
of motor skills like smiling, sitting,
and walking, as well as the
positioning and tone of the muscles

• Speech and behavioral

development are also important
areas during follow-up visits.
• Morbidity is inversely related to gestational age

• A premature infant's development may be slower than babies who

were born full-term

• However, premature babies can become extremely productive, as

shown by some famous premature babies...
Albert Einstein Isaac Newton Charles Darwin
 Ethical issue

When should neonatologists decide that the quality of

life of those they save is not worthy the effort? When
would it be better to let babies die?

This is an intense and rather polemic subject that

always causes passionate, argumentative but
fundamental discussion. We cannot escape it.