Prematurity and Low Birth Weight

Definitions & Classifications - Tiny Terms, Big Impact

• Gestational Age (GA):
  • Preterm: < 37 weeks
  • Late Preterm: 34 ⁰/₇ to 36 ⁶/₇ weeks
  • Term: 37 ⁰/₇ to 41 ⁶/₇ weeks
  • Post-term: ≥ 42 weeks
• Weight for GA:
  • Appropriate (AGA): BW 10th-90th percentile
  • Small (SGA): BW < 10th percentile
  • Large (LGA): BW > 90th percentile

⭐ WHO: Preterm <37 wks; Low Birth Weight (LBW) <2500g; Very LBW (VLBW) <1500g; Extremely LBW (ELBW) <1000g.

Etiology & Risk Factors - Why So Early?

• Spontaneous Preterm Labor/PPROM (Pathological):
  • Maternal: Infections (UTI, GBS, chorioamnionitis), multiple gestation, uterine/cervical issues (anomalies, short cervix), chronic illness (HTN, DM), preeclampsia, substance use, extremes of age (<18/>35), low SES, short interpregnancy interval (<18 mo).

  ⭐ Previous preterm birth is the strongest risk factor for subsequent preterm birth.

  • Fetal: Congenital anomalies, IUGR, polyhydramnios.
  • Placental: Abruptio placentae, placenta previa, placental insufficiency.
• Iatrogenic (Indicated) Preterm Birth:
  • Maternal or fetal conditions necessitating early delivery (e.g., severe preeclampsia, fetal distress, IUGR with absent/reversed end-diastolic flow).

Complications - Preemie Perils Parade

• Respiratory System

  • ⭐ Respiratory Distress Syndrome (RDS) due to surfactant deficiency is the most common immediate complication in preterm infants.

  • Apnea of Prematurity: Pause >20s or with O₂ desat/bradycardia.
  • Bronchopulmonary Dysplasia (BPD): Chronic O₂ dependency at 36 wks PMA.
• Central Nervous System (CNS)
  • Intraventricular Hemorrhage (IVH): Germinal matrix bleed; Grades I-IV. Cranial US screen.
  • Periventricular Leukomalacia (PVL): White matter injury, ↑CP risk.
• Gastrointestinal (GIT)
  • Necrotizing Enterocolitis (NEC): Bowel inflammation/necrosis. Key sign: pneumatosis intestinalis.
  • Feeding intolerance.
• Cardiovascular
  • Patent Ductus Arteriosus (PDA): Persistent shunt, risk of heart failure/pulmonary edema.
  • Hypotension.
• Metabolic & Thermal
  • Hypoglycemia, Hypothermia, Hypocalcemia.
  • Osteopenia of prematurity.
• Hematologic
  • Anemia of Prematurity.
• Infections
  • Sepsis: High vulnerability due to immature immunity.
• Sensory Organs
  • Retinopathy of Prematurity (ROP): Abnormal retinal vascular growth. Screen <32 wks GA or <1500g.
  • Hearing impairment.
• Long-term Outcomes
  • Neurodevelopmental Impairment (NDI), Cerebral Palsy (CP).
  • Chronic Lung Disease (CLD), Growth failure.

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Management - Nurturing Tiny Warriors

• Golden Hour: Stabilize ABCs, ensure thermoregulation (DR 25-28°C), gentle handling.
• Thermoregulation: Radiant warmers, incubators. Promote Skin-to-skin (KMC). Target axillary temp 36.5-37.5°C.

  ⭐ Kangaroo Mother Care (KMC) significantly reduces mortality, sepsis, and hypothermia in LBW infants.

• Respiratory Support: Oxygen (target SpO2 90-95%). Nasal CPAP. Early surfactant for RDS. Caffeine for apnea.
• Nutrition & Fluids: Early EBM/donor milk. Trophic feeds (10-20 mL/kg/d). Human Milk Fortifiers (HMF). IV fluids & PN as indicated.
• Infection Prevention: Strict hand hygiene, aseptic techniques. Judicious use of antibiotics.
• Developmental Care: Minimal stimulation, supportive positioning (nesting), pain management.
• Monitoring: Vitals, glucose, electrolytes, bilirubin, growth. Screen for ROP, IVH, hearing loss.

Prevention - Guarding Gestation

• Quality ANC; good maternal nutrition.
• Infection screening & treatment.
• Avoid smoking, alcohol.
• Progesterone (high-risk); cervical cerclage.

⭐ Antenatal corticosteroids (e.g., Betamethasone) administered to mothers at risk of preterm delivery (24-34 weeks) significantly improve neonatal outcomes by accelerating fetal lung maturity.

High‑Yield Points - ⚡ Biggest Takeaways

• Preterm is <37 weeks; LBW <2500g, VLBW <1500g, ELBW <1000g.
• RDS, from lung surfactant deficiency, is a major neonatal morbidity.
• Antenatal corticosteroids critically boost fetal lung maturity, improving survival.
• Key complications include IVH, NEC, ROP, PDA, and sepsis.
• Kangaroo Mother Care (KMC) is vital for stable LBW infants, aiding growth.
• Screen for ROP in infants <1500g or ≤32 weeks gestation.
• Apnea of prematurity is common; manage effectively with caffeine.