High risk infants complications



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HIGH RISK INFANTS – COMPLICATIONS





RDS/HMD

BPD

(GM)-IVH

PVL

ROP

NEC

TERM

Respiratory Distress Syndrome/

Hyaline Membrane Disease



Bronchopulmonary Dysplasia

(Germinal Matrix) -Intraventricular Hemorrhage

Periventricular Leukomalacia

Retinopathy of Prematurity

Necrotizing Enterocolitis

PATHO-PHYSI-OLOGY

Poor surfactant production leads to alveolar collapse and respiratory distress ;

Pulmonary immaturity & deficiency of surfactant



Caused by incomplete or abnormal repair of lung disease during neonatal period

Bleeding into the subependymal germinal matrix (prominent from 26-34 wks of gestation; typically gone by term)

Symmetric, non-hemorrhagic, ischemic lesion to the brain of the premature infant; characteristic necrosis of white matter dorsal & lateral angles of lateral ventricles; Affects white matter thru which cortico-spinal tract travels

Retina is incompletely vascularized, constriction occurs, leading to hypoxic damage of the retina; capillaries multiply in hypoxic area, leading the retina swells, small bleeds occur, retina detaches

Inflammation of the bowel during the first 6 weeks of preterm life; possible pathogenesis includes intestinal ischemia, infectious agents or toxins, and enteral alimentation

IMPAIR-

MENTS

  • Prone to developing cor pulmonale, CHF, pulmonary edema

  • Hydrocephalus

  • Germinal matrix destruction

  • Cyst formation

  • Hypoxic-ischemic lesions

  • Seizures

  • Spastic diplegia (most common)

  • Spastic quadric-plegia

  • Visual deficits

  • Vomiting

  • Abdominal distention

  • Bloody stools

  • Retention of stools

  • Lethargy

  • Decreased urine output

  • Altered respiratory status

OTHER INFO

Most common single cause of respiratory distress in neonates;

Prognosis varies;

10% mortality rate; leading cause of neonatal death & morbidity; frequent hospitalization for URTI & increased incidence of neurologic sequelae with severe RDS


Dx at 28 days chronological age if requires oxygen, has tachypnea, wheezes, retractions, abnormal chest radiograph;

Boys>girls;

Incidence of developmental disability, i.e. MR & CP 29-34%


Most common type of neonatal intracranial hemorrhage; characteristic of premature infant of < 32 weeks w/<1,500g;

90% occur during first 72 hrs of birth; 4 grades; unusual to occur after 7 days



Reduction in cerebral blood flow; often associated with IVH; head cooling at 6 hrs or less of life to reduce risk of disabling neuro-developmental injuries to basal ganglia

Virtually eliminated in 1950s and 70s due to decreased use of oxygen; recurred as one of the major causes of disability in preterm infants as a result of the increased survival of VLBW infants

Most common cause of death in neonates undergoing surgery; most frequent and lethal GI disease of premature infants

RISK

FACTORS

Prematurity, LBW, low APGAR score at 1 and 5 min; maternal age over 34 years, neonatal transport

Prematurity, barotraumas from high pressures used in assisted ventilation, etc

Prematurity (<32 weeks)

Prematurity; hypoxia or ischemia particularly b/w 28-32 gestational weeks

Lower gestational age, LBW, BPD





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