Immature newborn

An immature (premature) newborn is a newborn born before the end of the 37th week of pregnancy (< 37+0 weeks+days of pregnancy). Degrees of prematurity:

• slight immaturity: 32-36 weeks of pregnancy; ("late preterm": 34+0 to 36+6 weeks+days);
• intermediate immaturity: 28-32 weeks of pregnancy;
• severe immaturity: 26-28 weeks of pregnancy;
• extreme immaturity: < 26 weeks of gestation.

Morphological manifestations of immaturity:

• • skin – thin, delicate, rose-red, thick lanugo;
  • thin and long limbs;
  • fine and sparse hair, absence of sebum;
  • ears slightly curved, soft;
  • the nipple is almost impalpable;
  • there are usually edemas on lower limbs;
  • testes not ascending, protruding clitoris;
  • faintly visible furrowing of the feet.

Maturity assessment

• In neonatology, the assessment of gestational age according to the Ballard scoring system is most often used - it evaluates the system of somatic signs, developmental functional responses of the newborn, and by combining them with a certain probability we arrive at the determination of gestational age.
• Less often, the Petrussa index is used to assess maturity:
  • maturity (g. t.) = 30 + number of index points according to Petrussa

Petrussa-Index

Criteria	0	1	2
Ear shape	not formed	soft	firm
Skin	translucent	thin	pink, firm
Testicles	impalpable	high in the scrotum	descended
Labia	labia majora < labia minora	labia majora = labia minora	labia majora > labia minora
Lanugo	everywhere	not in face	missing
Feet	without creasing	creased distally	all creased

Complications of immaturity

Premature newborn on ventilatory support.

Premature baby in incubator

• Thermolability, risk of perinatal asphyxia.
• Respiratory system:
  • respiratory distress syndrome – treatment: respiratory support, surfactant
  • Apnea of immaturity - in 50-60%, main cause is immaturity of respiratory control center in trunk and immaturity of receptors, treatment: methylxanthines;
  • bronchopulmonary dysplasia,
  • SIDS.
• Cardiovascular system:
  • hypotension – more often in severely premature babies, treatment: volume adjustment, dopamine, adrenaline.
  • persistence of an open duct - in 40-60% of low birth newborns with PH below 1500 g. Closure is inhibited by increased production of PGE2 and PGI1. We observe a systolic murmur over the base of the heart, a hyperactive precordium, increased vascular pulsation. Treatment: ibuprofen, indomethacin.
• Metabolic deviations:
  • hypoglycemia (low glycogen stores), hyperglycemia (low tolerance of intravenous glucose intake),
  • hypocalcemia,
  • hyponatremia,
  • metabolic bone disease of immaturity.
• Anemia of immaturity.
• Hyperbilirubinemia from immaturity.
• Poor food tolerance, failure to thrive, risk of necrotizing enterocolitis.
• Intraventricular/intraparenchymal bleeding - in the smallest up to 30-40% risk (under 1000 g up to 60%); periventricular leukomalacia.
• Retinopathy of prematurity – a disorder of the development of the vessels of the immature retina with the risk of irreversible damage to the retina. Hearing damage.
• Cerebral palsy, epilepsy, ADHD, short stature.

Sources

Related articles

• Characteristics of the newborn period •Treatment of the newborn after birth

External links

• Ballard Score Calculator

Zdroj

• BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2009]. <http://www.jirben.wz.cz/>.