PRETERM BABY
Q&A COUNT: 14*
Q&A COUNT: 14*
Steps to look for, when you assess the weight of a preterm baby?
1. Plot the weight in the SGA/LGA chart
2. Look if the baby comes under SGA or LGA or AGA and comment on it
3. YOU CANNOT COMMENT "LOW BIRTH WEIGHT" in a preterm baby case!
SGA - Small for Gestational age
LGA - Large for Gestational age
Term and Preterm Baby - Differences
1) Moro reflex, Sucking and swallowing reflex are incomplete in a preterm baby
2) Posture - Extended in preterm (due to poor tone) (A term baby keeps its hands and legs flexed)
3) Preterm baby has large head, widely seperated sutures with large fontanelles, small chin, protruding eyes
4) Preterm's hair appears wooly and fuzzy, individual hair fibres can be appreciated seperately
5) Preterm's hair is shiny, thin, gelatinous, bright pink with very little vernix caseosa
6) Breast Bud is absent in preterm
7) Lack of subcutaneous fat in preterm. Small vessels clearly visible underneath epidermis
8) Preterm males - Undescended testis, scrotum poorly developed and less pigmented; Preterm females - labia majora widely seperated exposing labia minora
9) Soles and palms have minimal creases in preterm
10) Soft and pliable ear cartilage
11) Scarf sign - Elbow can be easily brought across the chest with little or no resistance
1. Plot the weight in the SGA/LGA chart
2. Look if the baby comes under SGA or LGA or AGA and comment on it
3. YOU CANNOT COMMENT "LOW BIRTH WEIGHT" in a preterm baby case!
SGA - Small for Gestational age
LGA - Large for Gestational age
AGA - Appropriate for Gestational age
How can one say a baby as LGA and SGA baby?
Using charts
>90th percentile - LGA (Large for Gestational age)
<10th percentile - SGA (Small for Gestational age)
Between 10-90 percentile - AGA (Appropriate for Gestational Age)
Between 10-90 percentile - AGA (Appropriate for Gestational Age)
Term and Preterm Baby - Differences
1) Moro reflex, Sucking and swallowing reflex are incomplete in a preterm baby
2) Posture - Extended in preterm (due to poor tone) (A term baby keeps its hands and legs flexed)
3) Preterm baby has large head, widely seperated sutures with large fontanelles, small chin, protruding eyes
4) Preterm's hair appears wooly and fuzzy, individual hair fibres can be appreciated seperately
5) Preterm's hair is shiny, thin, gelatinous, bright pink with very little vernix caseosa
6) Breast Bud is absent in preterm
7) Lack of subcutaneous fat in preterm. Small vessels clearly visible underneath epidermis
8) Preterm males - Undescended testis, scrotum poorly developed and less pigmented; Preterm females - labia majora widely seperated exposing labia minora
9) Soles and palms have minimal creases in preterm
10) Soft and pliable ear cartilage
11) Scarf sign - Elbow can be easily brought across the chest with little or no resistance
Expressed Breast Milk?
EBM is breast milk expressed by mother in a clean wide mouthed container - and give it to the baby, when the mother is not in a position to feed the baby.
EBM can be stored at room temperature for 6-8 hours, in refrigerator for 24 hours and in freezer for 3 months (at -20°C)
Method to express EBM:
1. Massage breast gently towards nipples
2. Place the thumb and index finger opposite to each other, just outside the areola
3. Press back towards the chest and gently squeeze to release milk
4. Repeat step 3 in different positions of areola
EBM is breast milk expressed by mother in a clean wide mouthed container - and give it to the baby, when the mother is not in a position to feed the baby.
EBM can be stored at room temperature for 6-8 hours, in refrigerator for 24 hours and in freezer for 3 months (at -20°C)
Method to express EBM:
1. Massage breast gently towards nipples
2. Place the thumb and index finger opposite to each other, just outside the areola
3. Press back towards the chest and gently squeeze to release milk
4. Repeat step 3 in different positions of areola
Feeding algorithm in a Preterm baby?
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| This picture is taken from OP Ghai textbook of Paediatrics |
Human Milk Fortifier
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| This picture is taken from Aruchamy textbook of Paediatrics |
Sources of Milk in a case of Preterm baby:
- EBM from mother
- Breast milk from breast bank
- No formula feeds and no cow milk (Cow milks are highly NEC prone)
Put socks, cap for a preterm with "hypothermia" under warmers - Why?
To prevent insensible water loss
Antenatal corticosteroids - purpose, drug name, how many doses given, when is the last dose given
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| This picture is taken from OP Ghai textbook of Paediatrics |
ADDITIONAL VITAMIN TO BE GIVEN FOR PRETERM BABY:
VITAMIN E (Vitamin E deficiency may manifest if not given)
Apnea of prematurity - management:
Stimulate if persistent using Caffeine or aminophylline (till 34 weeks)
Nasal CPAP and Mechanical ventilation (if not responding)
Criteria for INCUBATION
<30 weeks
<1.2 kg baby
What are the HANDICAPS of PRETERM child? (Long term complications)
1. Hearing disturbances
2. Visual loss or blindness
3. Speech disabilities
4. Learning disabilities
5. Physical disabilities
6. Delayed growth and poor co-ordination
2. Visual loss or blindness
3. Speech disabilities
4. Learning disabilities
5. Physical disabilities
6. Delayed growth and poor co-ordination
Risk of putting BCG vaccine in a PRETERM CHILD
There will be no adequate subcutaneous tissue. So, there are chances of disseminated BCG due to invasion of periosteum