premature Baby, etiology, complications and chances of survival

Preterm or Premature Baby: A baby born before 37 weeks of gestation age (from first day of last menustral period) is termed as preterm baby, such babies have weight less than 2.5kg. They constitute two third of low birth weight babies.Etiology of Preterm:1. Smoking habits2. Low socio economic and nutrition status3. Recurrent urinary tract infections.4. Pregnancy complications like pre-eclampsia, antepartum haemorrhage, premature rupture of membranes, polyhydroamnios.5. Genital Tract infections6. Medical and Surgical illnesses.7. Fetal causes like multiple pregnancy, congenital causes, intrauterine death.8. Placenta - infarction, thrombosisDiagnosis of Preterm labour: is done on the basis of 1. regular uterine contractions with or without pain at least one in every 10 minutes, 2. dilatation (>2cms) and effacement of cervix.Baby looks: skin is red, thin and shiny, lack of subcutaneous fat, covered by plentiful lenugo and vernix caseosa. Muscle tone is poor, planter creases are not visible beyond 34 weeks, testicles are undescended, labia minora are exposed, and nails are not grown upto fingertips.Complications of Preterm Baby1. Asphyxia: Babies are likely to be asphyxiated due to anatomical and functional immaturity.2. Hypothermia: because of reduced subcutaneous fat and brown fat.3. Pulmonary Syndromes: it includes pulmonary oedema, intra-alveolar haemorrage, and idiopathic respiratory distress syndromes which is one of the major cause of death in preterm babies.4. Cerebral Haemorrhage: soft skull bones allowing high degree of moulding leading to subdural and subarachnoid haemorrages, Fragile subependymal capillaries causing bleeding due to hypoxia.5. Fetal shock: it may happen due to improper resuscitation6. Heart Failure: due to asphyxia and pulmonary oedema.7. Oliguria, anuria- due to immature kidneys8. Infection- since both humoral and cell mediated immune response is poor, common infection are bronchopneumonia, meningitis, gastro-enteritis.9. Jaundice- because of hepatic insufficiency, bilirubin produced by excessive haemolysis cannot be conjugated adequately for excretion of bile, leading to rise in unconjugated bilirubin , causing physiological jaundice.10. Dehydration and Anaemia11. Retinopathy of prematurity.Chances of Survival of preterm baby:It depends upon the birthweight of baby, vigour at birth is more important than weight of baby, a baby weighing more than 1.5kg is have 95% chances of survival. Bany having weight in range of 750-1000gm have 85% chances of survival by intensive neonatal care. If gestational age is less than 23 weeks chances of death are more than 97%. Most of death occurs with in 48 hours ;