Prematurity

Prematurity is birth before 37 completed weeks gestation.

Classification:

• Extremely preterm: below 28 weeks
• Very preterm: 28 to below 32 weeks
• Moderate to late preterm: 32 to below 37 weeks

Prematurity affects virtually every organ system because physiological maturation is incomplete.

Complications include:

• Respiratory distress syndrome
• Apnoea
• Hypothermia
• Hypoglycaemia
• Feeding intolerance
• Necrotising enterocolitis
• Sepsis
• Intraventricular haemorrhage
• Anaemia
• Retinopathy of prematurity
• Chronic lung disease

Confirm gestational age using:

• Reliable obstetric dating
• Early pregnancy ultrasound where available
• Postnatal gestational assessment when dating is uncertain

Assess birth weight and determine whether the infant is appropriate, small or large for gestational age.

• Maintain thermal stability, preferably with kangaroo mother care for stable low birth weight infants.

• Provide breast milk as the preferred nutrition.

• Use expressed breast milk by cup or nasogastric tube when direct breastfeeding is ineffective.

• Monitor glucose, temperature, oxygen saturation and feeding tolerance.

• Provide CPAP early when respiratory distress develops.

• Use caffeine for clinically significant apnoea of prematurity.

• Minimize unnecessary invasive procedures because infection risk is high.