Premature Baby

• Babies born at less than 37 completed weeks of gestation(258 days).
• 10-12% of babies born in India are Premature.
• 35% of the neonatal deaths in India is due to Prematurity.
• These babies are structurally and physiologically immature and thus their death rate is high.

PHYSIOLOGICAL DISADVANTAGES:-

1. CENTRAL NERVOUS SYSTEM:- The premature babies have immature central nervous system.They are inactive, lethargic and inco-ordinated sucking and swallowing process. So, they have difficulty in feeding.They are vulnerable to have intraventricular-periventricular hemorrhage and harmful effect of jaundice on brain.
2. EYE:- Retinopathy of Prematurity (ROP) is a preventable potentially blinding disorder that mainly affects both eyes of premature babies.
3. RESPIRATORY SYSTEM:- Respiration is prone to be irregular in rate and depth and are likely to have apneic spells resulting in bluish discoloration of body and decreased heart rate.They have poor cough reflex increasing the risk of pneumonia.
4. GASTROINTESTINAL SYSTEM:- Regurgitation and aspiration are common because of incordinated sucking, small capacity of stomach, incompetence of cardioesophageal junction and poor cough reflex.Due to intestinal immaturity they are prone to have abdominal distention and feed intolerance.Immaturity of liver leads to exaggerated jaundice.They have poor glycogen store.They are more likely to have hypoglycemia.
5. TEMPERATURE REGULATION:- Brown fat and subcutaneous fat are less in immature baby.The heat loss is more and the heat production is less.Hence they are more prone to develop hypothermia.
6. CARDIOVASCULAR SYSTEM:- The closure of ductus arteriosus (blood vessel communication between main artery sending blood to whole body with artery sending blood to lungs, which is patent in womb) may be delayed in premature infant.The peripheral circulation is inadequate.Intracranial hemorrhage may occur due to poor autoregulation of cerebral blood flow.
7. IMMATURE KIDNEY FUNCTIONS:- The glomerular filtration rate and the concentrating ability of kidney tubules are reduced.The babies are more vulnerable to develop acidosis.
8. METABOLIC DISADVANTAGES:- The immature babies are more likely to develop hypoglycemia, hypocalcemia, hypoproteinemia, acidosis and hypoxia.
9. PRONE TO NUTRITIONAL DEFICIENCY:- The nutritional requirements of premature infants are higher as the need for postnatal catch-up growth can be upto 10 times. A 1 kg preterm baby may increase the weight by 10 times to achieve 10 kg at 2 years similar to a baby born at normal gestational age.Since intrauterine acquiring of nutrients occurs mainly in the later part of third trimester, immature babies have low body stores at birth.Hence, they require supplementation of various nutrients along with iron.
10. INCREASED CHANCE OF INFECTIONS:- Immature babies have 3-10 times more chances of getting infections as compared to normal newborn.They have lower level of IgG antibodies, inadequate mucosal complement and some aspects of cellular immunity.