PREMATURITY & THE COMMON PROBLEMS

Definition 1.

 A preterm neonate is one whose birth occurs

trough the end of the last day of the 37 week
(36,6/7 weeks) following onset of the last
menstrual period
 Have more problems than term babies who are small
( less than 2,5 kg at birth)
 The more preterm the baby is, the more likely the baby
is to have problem
 Preterm baby may have a problem that is specific 
jaundice of prematurity, but may have any other problem
that a full-size, term baby can have( jaundice
associated with sepsis)
 Regardless of what other problems they may have
 all preterm babies require special considerations for
feeding, fluid management and maintenance of normal
body temperature (ideally using kangaroo mother care)
 Problems
1. Respiratory:
a. Perinatal depression
b. RDS  surfactant deficiency
c. Apnea  immaturity in mechanisms controlling
breathing
d. Bronchopulmonary dysplasia

2. Neurologic, high risk for:

a. Intracranial hemorrhagic
b. Periventricular white matter & other neural injury
 Problems
3. Cardiovascular:
a. Hypotension, this may be due to the following:
a. Hypovolemia
b. Cardiac dysfunction
c. Vasodilatation due to sepsis
b. Patent ductus arteriosus is common and may lead to
congestive heart failure
4. Hematologic :
a. Anemia
b. Hyperbilirubinemia
 Problems

5. Gastrointestinal:
a. Difficult Feeding & feeding intolerance
b. Necrotizing Enterocolitis
6. Eye :
c. Retinopathy of Prematurity (ROP)
d. Others (myopia, amblyopia, etc)
Feeding and Fluid Management of
Preterm Babies
General principles of feeding preterm babies
 Difficulty feeding  the babies are not mature
enough to feed well.
 Good feeding  established by 34 – 35 weeks post-
menstrual age.
 Provide special support & attention to the mother
during this difficult period
Explain to the mother that :
 Her breast milk is the best food for the baby
 Breastfeeding is especially important for preterm baby.
 It is usually normal if the baby :

 Tires easily & suckles weakly at first

 Suckles for shorter periods of time before resting

 Falls asleep during feeding

 Pause for long periods between suckling

 Problems
If the baby is vomiting / had the abdominal distension/
episodes of apnoea/ > 20 % of the previous feed is retained
in the stomach (gastric residual) just before the next feed :

 Established an IV line
 Reassess the baby after 12 hours :
 If the baby’s condition is improving  restart feeds,

observing carefully
 If the baby’s condition is not improving  IV fluid at

maintenance volume for another 12 hours

Feed and Fluid Volume

 Preterm babies  require different feed and fluid

volumes based on their condition and weight

Babies without major illness:

 1,75 – 2,5 kg
 Allow the baby to begin breastfeeding.

 If the baby cannot be breastfed  expressed breast

milk using an alternative feeding method

 1,5- 1,749 kg
GiveVolumes
Table expressed breastmilk
of breast milkforusing
a by an alternative
weighing 1,5-1,748 kg
without
feedingmajor illness
method every 3 hours until the baby is able to
breastfeed.

Day of life
1 2 3 4 5 6 7
Feed volume every 12 18 22 26 30 33 35
3 hours (ml/feed)
• 1,25 – 1,49 kg
- Give expressed breast milk by gastric tube every 3 hours

- Progress to feeding by cup/ spoon as soon as the baby

can Volumes
Table swallow without
of breast milkcoughing or spitting
for a by weighing 1,25-1,49 kg
without major illness
Day of life
1 2 3 4 5 6 7
Feed volume every 10 15 18 22 26 28 30
3 hours (ml/feed)
If the baby weighs 1,25 – 1,5 kg  at least 8 times in
24 hours
If the baby weighs less than 1,25 kg  at least 12 times
in 24 hours

Ensure the baby is receiving enough milk by assessing

the baby’s growth