Complications of Prematurity

Dr Tamara Keith discuss the most important complications of prematurity, including RDS and NEC.

 

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Video Duration: 15 minutes

  • Necrotising Enterocolitis
    Created by EveRobertson
    General
    Epidemiology

    Infection and inflammation of the bowel leading to cell death

    More common in preterm

    50% mortality

    Pathology

    Commonly terminal ileum and proximal ascending colon

    Unknown cause but probably vulnerable intestinal mucosal barrier (inflammation+immunological dysfunction+immunologocal immaturity) --> gut flora transit across bowel wall --> necrosis

    Top three causes
    1. Exclusively formula fed
    Clinical Features
    Symptoms

    General: off feeds, apnoea

    Specific (comes later): vomiting, bloody stools

    Signs

    General: bradycardia, temperature instability

    Specific (comes later): abdominal distension, bile stained aspirates, abdominal tenderness, ascites, sepsis

    On abdominal xray: dilated bowel loops, pneumonitis coli, portal gas, free gas

    Investigations
    Cultures

    Septic screen = urine culture, stool sample, lumbar puncture and CSF culture

    (baby non-specifically unwell)

    Bloods

    FBC, CRP (?infection)

    Clotting (?DIC)

    U+E (?dehydration--> compromised kidneys)

    ABG (respiratory compromise from distended abdomen = respiratory acidosis)

    Imaging

    Abdominal USS (when NEC first suspected)

    CXR (as part of septic screen)

    Abdominal xray (look for NEC signs)

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    NONE - must treat, as high mortality rate.

    Medical

    Nil by mouth

    Remove umbilical catheters

    Broad spectrum antibiotics

    Circulatory and respiratory support

    Surgical

    Indicated when:

    1. deterioration/failed medical management
    2. stricture formation/abdominal mass
    3. intestinal perforation

    Drain/aspirate tense peritoneum causing respiratory compromise (neonatal unit)

    Bowel resection --> anastomosis or stoma formation