PREMATURE

Issue in premature

1. Respiratory distress syndrome

2. Hypothermia - Mostly during transportation

3. Hypoglycemia

4. Intraventricular Haemorrhage - eg cause hypercarbia

Grade 1, 2?

5. ROP (Retina of Prematurity)  - check by opthal about 4 to 5 weeks before discharge

6. Jaundice

7. PDA (Patent Ductus Artery) - sebab tu kita jarang bagi fluid bolus, takut open up the PDA. Feature - Murmur, pulse, wide pulse pressure 

Need restriction of fluid.  

Sign PDA open - urea will be high
Prem usually self closed (functional), unless kalau DM, which is anatomical

8. NEC (Necrotizing Enterocolitis) - Xray , what to look?

9. Rickets of prematurity

Planned to discharge baby premature? What to do?

1. Teach mother for Basic Life Support (sign of apnea)
2. Biweekly weight monitoring.
3. Immunization - some advice to take extra - Pneumococcal
4. Avoid sick contact, avoid crowd, restrict visitor
5. Hand hygiene

OTHERS :

1. When we need to do Ballard Score?

➢ As soon as possible

➢ Not valid to assess if patient on sedation

2. How to know baby is anemic? Level Hb?

➢ Hb less than 15. If anemia, check?

Reticulocyte, Mother Blood Group/ Baby BG, DCT – Direct Coombs Test

Infection? - Hemolysis. Any history cord round neck?

What is placenta weight? (usually 1/5th baby weight)

If huge? What significance?

3. What is Kleirhour test? Check mother blood.

What we want to see?

4. Definition hypotension?

➢ Depend on BP chart)

➢ Small baby we rarely give bolus. Howevet if really needed start 10 cc/kg...Then need to consider inotropic support.

5. Choice of antibiotic

➢ C. Penicillin - more on gram positif  (group B streptococcus)

➢ Gentamicin - more on gram negative  (E coli)

6. Why some patient given Aminophyline? 

- to stimulate baby to prevent apnea

- not given in ventilated patient        

7. When to off caffeine in premature with PDA? 

- Given if patient can tolerate orally

- Its is long acting medication – need  off 3 days before discharge, if

- usually given after CGA 34 weeks