Low-weight babies are those who weigh less than 2500g at birth without depending on gestational age. Classification of low-weight babies is divided into 3 groups: Premature babies; The child is retested from development in the uterus; Premature babies combined with in-uterus development delay.
1. Definition and classification of babies
Full-month babies: Those with gestational age from 37 – 42 weeks
Premature babies (premature babies): Those who give birth ahead of time, have a gestational age of less than 37 weeks.
Babies born under 22 weeks are called miscarriages.
Older babies: Those with gestational age over 42 weeks
Low birth weight (low weight during childbirth): Those who have a low weight at birth <2500g mà không phụ thuộc vào tuổi thai. Classification of low-weight babies (according to Luchenco) is divided into the following 3 groups:
- Premature babies: As babies develop in the uterus normally, but the calving occurs before 37 weeks, has a weight commensurate with the gestational age (the weight at birth of the child is in the middle of the cypress line 10-90%)
- Children with intra-uterus developmental delay (fetal malnutrition), including full-month babies, old months but weight at birth <2500g
- Premature babies combined with intra-uterus developmental delays (premature babies with fetal malnutrition or premature babies): Those born before 37 weeks of gestation and with low birth weight <10% độ bách phân (cân nặng thấp hơn so với tuổi thai).
Real age: The real age of premature babies is equal to the age according to the date of birth minus the difference between the gestational age of the full-month baby and the gestational age at birth. Specifically calculated according to the following formula:
Real age = age by date of birth – (40 weeks – gestational age at birth)
2. Gestational age
How to calculate gestational age
There are many ways to calculate gestational age:
- Step 1: Based on the first day of the last period. Normally about 280 days (day +10, month -3).
- Way 2: Rely on pregnancy ultrasound about 10-12 weeks old. Gestational age can be predicted based on the head ring, head index = dipolar diameter/apized forehead diameter, chest ring, femur length
- Way 3: Clinical examination after the child has been born
Classification of gestational age
- Premature babies are babies of gestational age < 260 ngày tức là < 37 tuần.
- Full-month babies are babies with a gestational age of 260 – 294 days i.e. from 37 – 42 weeks.
- Older children are children with a gestational age of > 294 days i.e> 42 weeks.
Calculate gestational age on Dubowitz's scale
Based on the total number of points of external body characteristics and nervous system characteristics.
- Calculation of gestational age according to Finnström (1977)
- Calculates gestational age according to the new Ballard (New Ballard)
3. Causes of childbirth
3.1 Causes of mother
Obstetric and gynecology causes:
- Uterine malformation, uterine tumors, ovarian cysts, inflammation
- sub-sections, …
- Pregnancy intoxication, vegetable striker, multiple amniotic fluid, disagreement Rh.
- Chronic diseases: heart, lungs, kidneys, diabetes,…
- Infections: pneumonia, influenza, hepatitis, listeriose.
Causes of obstetrics:
- Direct injury: fall
- Indirect injury: surgery during pregnancy.
Genital endal disorders : historyof miscarriage, repeated premature calving.
3.2 Causes of child
Multiple pregnancy, deformity.
30% of cases did not find the cause. There are also a number of favorable factors such as:
- Mother is too young (younger than 15 years old), too old (older than 40 years old).
- Hard working conditions.
- Difficult economic conditions, little pregnancy monitoring.
4. Features of recognition of premature babies
- Weight at calving below 2500g
- Body length at calving less than 45cm
- Skin: The younger the baby, the more red, berry, blood vessels under the skin are clear, on the skin there is a lot of fluff, especially on the shoulders and back. Thin subcutaneous fat layer
- Muscles, muscle movements decrease, the child is in the position of stretching the limbs, less movement.
- The bones are soft, the head is large compared to the body ratio (1/4), the density is wide, the ears are soft, the ear cartilage is not developed.
- Short hair under 2cm is especially in the top forehead area, curly hair like wool. Nails, soft toenails, not covered to the tip of the fingers.
- Underdested external genitals: testicle boys have not yet descended to lower follicles; big-liped girl who hasn't covered her small lips and tinged with a penis
- Neurological: Sleeping babies, little response, weak crying, weak or unpromasced newborn reflexes
5. Common diseases in premature babies
5.1 Lowering the temperature
In babies that have not yet produced heat by muscle contraction, they can produce heat only by decomposing the brown fat organization. This form of heat-insity does not fully compensate for the loss of heat after calving. As a result, the child increases energy consumption, oxygen and glucose, causing acid metabolism due to the release of free fatty acids and lactates. Especially in premature babies, the layer of fat is thin, brown fat reserves are low, while the area of large skin (babies born full months the ratio of skin area / body weight is 2.7 times that of adults, in premature babies under 1000 g, this rate is 4 times that of adults), causing an increase in post-calving heat loss.
Main causes of heat loss:
- Re luuation: depends on the temperature difference between the environment and the child and the air velocity. To limit heat loss through convecation we must: keep the temperature in the room at least 280C, close the door to avoid air circulation, wrap the child when placed on the emergency table, heat oxygen.
- Heat transfer: depends on the temperature difference and thermal conduction of the contact object. Heat transfer increases when using glass tables, metal tools: film containers.
- Radiation: caused by cold objects in the environment (windows, ceramics) and depends on the 4th power of the temperature difference. Therefore, we have to use a 2-layer incubator, a plastic blanket …
- Evaporation: mainly lost through the skin and respiratory mucosa. In the post-calving period every 1 g of evaporated water will entail the loss of 0.58 kCal. This phenomenon occurs especially strongly in premature babies under 32 weeks. Therefore, we need to pay attention to moisten the air.
5.2 Respiratory failure
Common and severe respiratory manifestations. The disease ranks first in pathology in the newborn department.
Membrane diseases in:
- Caused by a lack of sulfuric substances.
- Diagnosis is based on respiratory distress syndrome that occurs on premature babies under 35 weeks, acute on the first or second day after calving, the symptoms of respiratory muscle contraction are very clear. Symptoms to confirm the diagnosis are XQ imaging: less hatched lungs, dimming nodules spreading 2 bronchial fields, decreased brightness of lung cuticles, gas retention in the bronchial branches.
- Treatment: respiratory aid immediately + surfactan substance.
- Common consequences are preliminary pulmonary condition, or retinal eye due to high and prolonged oxygen use.
Delayed absorption of alveolar solution leads to respiratory failure that lasts several hours after calving. Common in low-weight babies.
The respiratory center is incomplete, causing "pioneering" apnea that lasts from a few seconds to 20 seconds. May cause slow and cyanosis if the apnea persists.
Stop breathing "second- line" in the following diseases: cerebral hemorrhage, which membrane, purulent meningitis, hypoth glucose reduction, hypoth glucose reduction.
5.3 Digestive diseases
There are many manifestations of clinical digestion. It should be noted that premature babies with stools last longer than full months, and they often have to eat with sonde.
Gastric milk residues and do not: common in children under 34 weeks. It is necessary to pay attention to assess the properties of milk residue before each meal to decide:
- Use to re-pump into the stomach if the juice is small, white.
- Remove if the quantity is large, it must be fed with gastric drip sonde.
Duodenal stagnation syndrome:stagnant fluid in the yellow, blue, numerous stomachs, often seen in babies weighing less than 1500 g. Intravenous nourishment, or feeding in the small intestine will avoid this complications.
Abdominal obstruction :due to stagnation in the intestinal meds. X-rays are not prepared to see images of dilated bowels. Attention is paid to the exclusion of necrotizing enteritis. May be accompanied by symptoms of gastric juice, green stools. Intravenous nourishment is in dinhment for 2-3 days.
"Coin node" syndrome: commonin premature babies. Clinically, it is common to slow down the penny, abdominal obstruction, normal condition.
An unmedied abdominal X-ray shows images of dilated bowels. Colon indentation with physiological saline helps the child to excrete dense tendencies.
Necrotizing enteritis: often there are serious, varied complications and can lead to death. Accounting for 1 – 2 % of the percentage of premature babies admitted to the hospital.
Necrotizing inflammation, bleeding, ulcers in the intestines (2/3 of cases in the ileum area), accompanied by gas penetration in the lower part of the mucosa.
- Common in the first week after calving. Clinically, yellow or green vomiting is common, stools with blood clots, abdominal obstructions. The whole body is in a very severe condition, the skin is blue left, the skin is purple, the child is neglected, there is a bout of apnea, bradycardia.
- Uns prepared abdominal X-ray: the typical image is the vapor shadow in the intestinal wall.
- Possible complications are perforation of the intestines, peritonitis.
- Medical treatment is mainly, 10% of medical treatment in the exception of complications of perforation of the intestines, peritonitis.
- Mortality rate of 10 – 25 % depending on statistics.
Anemia when Hb levels < 13g/dl ở trẻ ≥ 28 tuần tuổi và < 12 g/dl ở trẻ < 28 tuần tuổi
Clinical symptoms :50% of babies under 32 weeks present with clinical anemia.
- Anemia: tachycardia. rapid breathing – shallow, weak or lost peripheral vessels, lower arterial blood pressure, lower central venous blood pressure, stunting, metabolic acidosis.
- Chronic anemia: blue skin, rapid breathing, tachycardia, normal pulse, enlarged liver, heart failure, normal arterial blood pressure.
- Bleeding in the fetal stage (vegetable cake bleeding, amniotic fluid puncture, cesarean section, mother-mother blood transfusion, fetal blood transfusion) and in the newbornstage (cerebral hemorrhage – meninges, digestive bleeding, peritoneal bleeding, umbilical bleeding …)
- Hematoma: blood type disagreement, thalasemie.
- Blood is tested several times, especially in children weighing too low.
- Lack of raw materials for the synthesis of red blood cells in late anemia.
- Erythropoiétine synthesis disorder in the first weeks after calving is the main cause of early anemia.
- Erythropoiétine synthesis is associated with intravenous hypoxia. Immediately after calving the amount of erythropoiétine increases, decreasing rapidly in the first weeks after calving, much lower than adults explaining the above phenomenon. But there are a few studies that find that the amount of erythropoietine does not decrease, so it has been assumed that anemia is caused by the response disorder of erythropoietine.
Red blood cells infusion in the following cases:
- Hematocrit < 40 %, Hb < 11g/dl, khi trẻ có suy hô hấp và/hoặc suy tim.
- Hematocrit < 25%, Hb < 8g/dl, khi trẻ nhịp tim nhanh > 180 times/min, rapid breathing > 80 times a minute, dependent on o xy for more than 48 hours.
- Anemia in premature babies with apnea, abdominal obstruction, slow weight gain, poor feeding. Blood transfusion when taking the test exceeds 10% of the child's blood volume (about 8 – 9 ml/kg).
- Anemia hemolyxes after 1 week when hemoglobin < 10 g/dl
- Pay attention to the daily supply of iron to premature babies from the 2nd week after calving at a dosage of 2 mg/kg/ day in full-month babies, 2-4 mg/kg/day in premature babies. Vitamin E 15-25/ day to 38 weeks.
- Erythropoiétine is in order for children under 30 weeks of age at a dose of 250 units/kg x 3 times/week intravenously or subcutaneously, from the end of the first week after calving, within 4-6 weeks.
5.5 Neurological complications
Common are brain haemorrhage and white matter brain puree, which can be combined or separately.
Cerebral hemorrhage :common in the first 3 days of life, pre-birth bleeding may occur. Brain haemorrhage on the 5th, 6th day is rare.
- All factors deaction of brain circulation, excessive increase in brain perfusation.
- Increased carbon dioxide in the blood, blood acidity leads to dilated cerebral blood vessels.
- Rupture of cerebral vessels and incomplete coaulation leads to bleeding.
Diagnosis by ultrasound via encephalox, CRANIAL CT
The higher the rate of brain haemorrhage in young children: 60% of brain haemorrhage is seen in children under 28 weeks.
Is is is an issyphaly brain damage: white matter brain puree leads to long-term neurological consequences.
- Common location: front and back of the lateral erbular brain horn, next to the lateral brain trunk, frontal region and occipital horn. These are areas with few arc-shaped arteries. In premature babies this area is up to several millimeters wide.
- All the causes of cerebral is anemia are the causes of white matter brain necrosis.
- Occurs before calving: intoxication of pregnancy, bleeding forward vegetables, vegetable peeling.
- Occurs after calving: especially vascular depravity.
- Diagnosis by ultrasound via sysent, Cranial Ct.
- The location, size, number of lesion drives will help the next toe.
- The rate of white matter brain necrosis is 12-15 % in children under 1500g, 8% in children older than 34 weeks.
- Premature calving can be caused by an amniotic infection, or an early amniotic rupture causes a second amniotic infection.
- Post-calving infection at the stage of hospitalization is a matter of anxiety for biomedies because the child's resistance is very weak.
- Common hospital infections: gastroenteritis, which can cause necrotizing enteritis, lung infections, skin infections …
- Prevention: wash your hands before and after each examination, thoroughly sterilize incubators, fabrics, absolutely ensure the principle of sterile when performing procedures, infusions.
5.7 Arterial tubes
Common in premature babies under 32 weeks. The younger the child, the less immature the muscles of the arteries, the harder it is to shrink after birth, so the arterial tube in premature babies lasts much longer than the full-month baby. Moreover, increased cruiser mass makes the arterial tube reopen on day 3-6.
Symptoms of arterial tubes are:
- Increased respiratory distress (must be respiratory aid on day 2 – 5, increase oxygen demand …)
- Sysysy sysys, rarely constantly, may not be heard. Must check several times a day.
- The pulse is fast and fast.
- XQ lung sees images of pulmonary blood retention.
- Cardiac ultrasound clearly sees the arterial tube.
- Limit the amount of alcohol introduced: Less than 1000g: 100 ml/kg/day; 1001 – 1500 g: 80 ml/kg/day; over 1500g: 60 ml/kg/day
- If the child is still fit, furosemide of 1mg/kg can be used, reducing the amount of water introduced.
- Ensure your child's oxygen needs.
- Indomethacine to inhibit the prostaglandine system. Prevention dose: 0.1 mg/kg/intravenous dose 12, 24, 48 and 72 hours after calving. The therapeutic dose is 0.2 mg/kg/dose x 3 doses 12 hours apart. Slow intravenous injection.
- Ibuprofène: 10 mg/kg then 5 mg/kg 24 and 48 hours. Intravenously.
- Common complications when taking the drug are VRHT, renal failure, hemorrhage.
- If the arterial tube does not close after drug treatment, the arterial tube is tightened by a non-medical method.
5.8 Conversion disorders
- Hypoth glucose: due to increased consumption (ensuring body temperature, maintaining respiration), poor glycogen reserves. Symptoms: tremor, cyanosis, respiratory failure, apnea, breastfeeding, convulsions, hypothermia …). Use: 3-4 ml/kg Gluco se 10% intravenously slowly, then sugared at a concentration of 0.3-0.6g/kg/hour.
- Hyponatremia: < 130 mmol/l do các ống lượn chưa trưởng thành, mất Na, thiếu hormon và/hoặc không tác dụng với ống lượn. Dehydration enters the cell cavity, so it is necessary to limit the amount of water introduced.
- Hypocalcemia: < 2 mmol/l do hoạt động của calcitonin, tăng phospho máu, thiếu VTM D và Ca của mẹ trong quá trình mang thai. Children often increase irritation, tremors, increased sysentary, In severe cases children convulsions, cyanosis, apnea, big heart, tachycardia, about prolonged QT. Calcium room 0.3g/kg/day, VTM D 1500 units/day. Treatment with calcium 1000-1500 units/m2/day intravenously then taken orally, in combination with VTM D. In case of seizures, TM injections are slow to calcium chloride 10-20 mg/kg/day.
- Vitamin K deficiency: causes a decrease in the incidence of prothrombin, the risk of hemorrhage. VTM K injection tape room for all infants 1-2 mg
- Jaundice: seen in 60% of premature babies. Causes of lack of glucoronyl transferase in combination with protein reduction, hypoglycemia, intestinal-hepatic cycle. The most common complications are cerebral gold. Prevent complications by monitoring blood bilirubin levels and shining lights.
5.10 Retinopathy in premature babies
The vessel city is highly permeable and fragile due to the lack of carboxylic esterase yeast, especially with oxygen deficiency. When blood oxygen is too high (PaO2 >150 mmHg) and prolonged, blood vessels in some places such as the visual nerve area, retina can shrink, nourish cells poorly, can cause cell damage. Therefore, when giving babies mechanical ventilators with high and prolonged oxygen levels or babies giving birth<1500g) nằm="" trong="" lồng="" ấp="" với="" nồng="" độ="" ôxy="">too young (40% prolonged, can cause blindness because of retinal</1500g)> atrophy and the back of the lens
6. The future of premature babies
Mortality :10 – 20 % depending on statistics.
Neurological complications in premature babies : long-termmonitoring is required. Monitoring in the time before school age we experience the following complications:
- Temporary neurological abnormalities: increased a irritation, abnormal muscle edict in the back and 2 lower 3 ents. It can be lost at the school stage.
- Neurological and mental relics: paralysis of 2 3 esttres, 2 3 2 20s, mental retardation, blindness, deafness. Symptoms of brain haemorrhage and white matter brain necrosis. Damage to the forehead area is good, peak area lesions often have movement disorders, occipital areas affect vision.
- Neurological relics: as above.
- During school we may encounter children who are too hyperactive, increase stimulation, and lose focus in 24% of premature babies. Difficulties in pronunciation, sysy sysy orientation, coordination between and movement.
Therefore, premature babies need special education, there needs to be a combination of pediatricians and psychiatrists, psychiatrists to detect and treat the smallest disorders early, limiting the risk at the school stage.
Caring for premature babies does not stop only when the child is born out of the newborn resuscitation room. Share99 International Health Hub has successfully performed many life-saving cases for premature babies. In particular, there are premature births at 26 weeks of age with a high mortality rate but after being treated at Share99, the babies were discharged without any risk of long-term complications.
The Newborn Department of Share99 Health Hub is equipped with modern equipment such as regular ventilators, high frequency ventilators, CPAP ventilators, incubators, good infection control, ensuring a safe environment for children, a team of highly specialized doctors and nurses has been bringing many opportunities for premature babies to be cured and healthy.
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