Dr. Roberto J. Murgas Torrazza Pediatra - Neonatólogo
507-204-8311 (Español) 507-66183605 (English/Español) dr.robmurgastorrazza@gmail.com
Pediatrics&Neonatology
Children's and Premature Infant Specialist
Ciudad de Panamá, Panamá
Panama city, Panama
Care of the Premature Infant
Any infant born at less than 37 weeks gestation is by definition "premature." Elective c-section should not be done earlier than 39 weeks of gestation per recommendation of the ACOG (American Congress of Obstetricians and Gynecologists. Babies born younger than 34 weeks of gestation are at increased risk of preterm infant related problems.
Before birth
Prenatal care should be sought with a Neonatologist who is up to date and comfortable with the management of a mother who is at risk for a preterm delivery.
Lung Problems
Premature babies born before 32 weeks of gestation are at increased risk of respiratory problems because the lack of a substance called surfactant. Surfactant is a substance that allows the lungs to expand and to oxigenate the blood. We have surfactant available as a medication that we can use in case your infant needs it.
Brain
The immature internal structures of the brain in a preterm infant are at risk for hemorrhage, especially in less than 32 weeks premature infants. The bleeding is usually the result of changes in the blood flow, and most bleeding occurs in the first three days of life. Diagnosis of the bleeding is performed with bedside ultrasound exams. The degree of bleeding is graded from 1 to 4. Grade 1 and 2 bleeds are small, and they often resolve without any complication. Babies with grade 3 and 4 bleeds may suffer severe neurologic injury. Another complication is called periventricular leukomalacia (PVL), which can cause cerebral palsy.
Nutrition
Most premature infants are given nutrition into their veins. Feeds are started in the first days and advanced slowly. Breast milk is the milk of choice and it has all the goodies that your baby needs to be healthy. It is important that you start pumping your milk as soon as you recover from the delivery.
Infection
Some preterm deliveries are the result of an infection in the uterus, which also can lead to an infection in the baby. In addition, infants in the intensive care nursery are at an increased risk for infection due to indwelling lines and tubes, as well as a compromised immune ("infection fighting") system. Thus, the risk of infection is high. If there is concern that an infant might be infected or there is a proven infection, the infant is treated with antibiotics an event that is likely to occur more than once during the nursery stay. Most infant will receive on average 2 to 7 days of antibiotics.
Eyes
The retina of the preterm infant is not fully "vascularized"(i.e., the blood vessels are not fully developed) at birth. The infant is at risk for a process called retinopathy of prematurity (ROP), which, in its worst form, can lead to detachment of the retina and blindness. In babies born at less than 30 weeks or 1,500 grams, an ophthalmologist will perform a screening exam at 6 weeks of age.
Most Frequent Complications
The premature infant is at increased risk of complications secondary to his immaturity and the need for critical care therapy.
In summary the most frequent complications are:
- Respiratory: chronic lung disease, respiratory distress
- Nutrition: feeding intolerance, necrotizing enterocolitis
- Infection: bloodstream infection, pneumonia, meningitis
- Neuro: intracraneal bleeding, hydrocephaly, PVL
- Eyes: retinopathy of prematurity
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