prematurity
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prematurity
من طرف ghonem الثلاثاء ديسمبر 08, 2009 9:53 pm
Prematurity
What is prematurity?
A baby born before 37 weeks of pregnancy is
considered premature, that is, born before complete maturity. Slightly
fewer than 12 percent of all babies are premature. Overall, the rate of
premature births is rising, mainly due to the large numbers of multiple
births in recent years. Twins and other multiples are about six times
more likely to be premature than single birth babies. The rate of
premature single births is slightly increasing each year.
According to the March of Dimes, about 12 percent
of babies born in the US are born preterm, or before 37 completed weeks
of pregnancy. Of the babies born preterm:
- 84 percent are born between 32 and 36 weeks of gestation (the time from conception to birth)
- about 10 percent are born between 28 and 31 weeks of gestation
- about 6 percent are born at less than 28 weeks of gestation
Other terms often used for prematurity are preterm
and "preemie." Many premature babies also weigh less than 2,500 grams
(5.5 pounds) and may be referred to as low birthweight (LBW).
Premature infants born between 34 and 37 weeks of
pregnancy are often called late preterm or near-term infants. Late
preterm infants are often much larger than very premature infants but
may only be slightly smaller than full-term infants.
Late preterm babies usually appear healthy at
birth but may have more difficulties adapting than full-term babies.
Because of their smaller size, they may have trouble maintaining their
body temperature. They often have difficulty with breastfeeding and
bottle feeding, and may need to eat more frequently. They usually
require more sleep and may even sleep through a feeding, which means
they miss much-needed calories.
Late preterm infants may also have breathing
difficulties, although these are often identified before the infants go
home from the hospital. These infants are also at higher risk for
infections and jaundice, and should be watched for signs of these
conditions. Late preterm infants should be seen by a care provider
within the first one or two days after going home from the hospital.
What causes prematurity?
There are many factors linked to premature birth.
Some directly cause early labor and birth, while others can make the
mother or baby sick and require early delivery. The following factors
may contribute to a premature birth:
- Maternal factors:
- preeclampsia (also known as toxemia or high blood pressure of pregnancy)
- chronic medical illness (such as heart or kidney disease)
- infection (such as group B streptococcus, urinary tract infections,
vaginal infections, infections of the fetal/placental tissues) - drug use (such as cocaine)
- abnormal structure of the uterus
- cervical incompetence (inability of the cervix to stay closed during pregnancy)
- previous preterm birth
Why is prematurity a concern?
Premature babies are born before their bodies and
organ systems have completely matured. These babies are often small,
with low birthweight (less than 2,500 grams or 5 ½ pounds), and they
may need help breathing, eating, fighting infection, and staying warm.
Very premature babies, those born before 28 weeks, are especially
vulnerable. Many of their organs may not be ready for life outside the
mother's uterus and may be too immature to function well.
Some of the problems premature babies may experience include:
- temperature instability - inability to stay warm due to low body fat.
- respiratory problems:
- hyaline membrane disease/respiratory distress syndrome - a
condition in which the air sacs cannot stay open due to lack of
surfactant in the lungs. - chronic lung disease/bronchopulmonary dysplasia - long-term respiratory problems caused by injury to the lung tissue.
- air leaking out of the normal lung spaces into other tissues
- incomplete lung development
- apnea (stopping breathing) - occurs in about half of babies born at or before 30 weeks
around the ventricles (the spaces in the brain containing cerebrospinal
fluid).
Premature babies can have long-term health
problems as well. Generally, the more premature the baby, the more
serious and long lasting are the health problems.
What are the characteristics of prematurity?
The following are the most common characteristics
of a premature baby. However, each baby may show different
characteristics of the condition. Characteristics may include:
- small baby, often weighing less than 2,500 grams (5 pounds 8 ounces)
- thin, shiny, pink or red skin, able to see veins
- little body fat
- little scalp hair, but may have lots of lanugo (soft body hair)
- weak cry and body tone
- genitals may be small and underdeveloped
The characteristics of prematurity may resemble
other conditions or medical problems. Always consult your baby's
physician for a diagnosis.
Treatment of prematurity:
Specific treatment for prematurity will be determined by your baby's physician based on:
- your baby's gestational age, overall health, and medical history
- extent of the disease
- tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Treatment may include:
- prenatal corticosteroid therapy
One of the most important parts of care for premature babies is a
medication called a corticosteroid. Research has found that giving the
mother a steroid medication at least 48 hours prior to delivery greatly
reduces the incidence and severity of respiratory disease in the baby.
Another major benefit of steroid treatment is lessening of
intraventricular hemorrhage (bleeding in the baby's brain). Although
studies are not clear, prenatal steroids may also help reduce the
incidence of NEC and PDA. Mothers may be given steroids when preterm
birth is likely between 24 and 34 weeks of pregnancy. Before that time,
or after, the medication usually is not effective.
Premature babies usually need care in a special nursery called the
Neonatal Intensive Care Unit (NICU). The NICU combines advanced
technology and trained health professionals to provide specialized care
for the tiniest patients. The NICU team is led by a neonatologist, who
is a pediatrician with additional training in the care of sick and
premature babies.
Care of premature babies may also include:
- temperature-controlled beds
- monitoring of temperature, blood pressure, heart and breathing rates, and oxygen levels
- giving extra oxygen by a mask or with a breathing machine
- mechanical ventilators (breathing machines) to do the work of breathing for the baby
- intravenous (IV) fluids - when feedings cannot be given, or for medications
- placement of catheters (small tube) into the umbilical cord to give fluids and medications and to draw blood
- x-rays (for diagnosing problems and checking tube placement)
- special feedings of breast milk or formula, sometimes with a tube
into the stomach if a baby cannot suck. Breast milk has many advantages
for premature babies as it contains immunities from the mother and many
important nutrients. - medications and other treatments for complications, such as antibiotics
- Kangaroo Care - a method of caring for premature babies using
skin-to-skin contact with the parent to provide contact and aid
parent-infant attachment. Studies have found that babies who "kangaroo"
may have shorter stays in the NICU.
When can a premature baby go home from the hospital?
Premature babies often need time to "catch up" in
both development and growth. In the hospital, this catch-up time may
involve learning to eat and sleep, as well as steadily gaining weight.
Depending on their condition, premature babies often stay in the
hospital until they reach the pregnancy due date.
If a baby was transferred to another hospital for
specialized NICU care, he/she may be transferred back to the "home"
hospital once the condition is stable.
Consult your baby's physician for information
about the specific criteria for discharge of premature babies at your
hospital. General goals for discharge may include the following:
- serious illnesses are resolved
- stable temperature - able to stay warm in an open crib
- taking all feedings by breast or bottle
- no recent apnea or low heart rate
- parents are able to provide care including medications and feedings
Before discharge, premature babies also need an
eye examination and hearing test to check for problems related to
prematurity. Parents need information about follow-up visits with the
pediatrician for baby care and immunizations. Many hospitals have
special follow-up healthcare programs for premature and low birthweight
babies.
Even though they are otherwise ready for
discharge, some babies continue to have special needs such as extra
oxygen or tube feedings. With instruction and the right equipment,
these babies are often able to be cared for at home by parents. A
hospital social worker can often help coordinate discharge plans when
special care is needed.
Ask your baby's physician about a "trial run"
overnight stay in a parenting room at the hospital before your baby is
discharged. This can help you adjust to caring for your baby while
healthcare providers are nearby for help and reassurance. Parents may
also feel more confident taking their baby home when they have been
given instructions in infant CPR (cardiopulmonary resuscitation) and
infant safety.
Prevention of prematurity:
Because of the tremendous advances in the care of
sick and premature babies, more and more babies are surviving despite
being born early and being very small. But prevention of early birth is
the best way of promoting good health for babies.
Prenatal care is a key factor in preventing
preterm births and low birthweight babies. At prenatal visits, the
health of both mother and fetus can be checked. Because maternal
nutrition and weight gain are linked with fetal weight gain and
birthweight, eating a healthy diet and gaining weight in pregnancy are
essential. Prenatal care is also important in identifying problems and
lifestyles that can increase the risks for preterm labor and birth.
Some ways to help prevent prematurity and to provide the best care for
premature babies may include the following:
- identifying mothers at risk for preterm labor
- prenatal education of the symptoms of preterm labor
- avoiding heavy or repetitive work or standing for long periods of time which can increase the risk of preterm labor
- early identification and treatment of preterm labor
ghonem- ..
- العمر : 34
العمل/الترفيه : القراءة
المزاج : يتغير دائما
تاريخ التسجيل : 05/07/2009
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