AKT · Child health/Neonatal & surgical

Prematurity

Birth <37 weeks gestation

Overview

Birth before 37 completed weeks. Complications are organ-immaturity driven: RDS (surfactant deficiency), IVH, NEC, retinopathy of prematurity, PDA, apnoea, hypothermia and chronic lung disease.

Recognise

Respiratory distress syndrome (surfactant deficiency) — ground-glass CXR
Apnoea of prematurity, temperature instability, hypoglycaemia
Risk of IVH, NEC, ROP, PDA, anaemia of prematurity

Red flags

RDS with worsening hypoxia; IVH; NEC; sepsis

Differentials & how to tell them apart

Transient tachypnoea of the newbornterm/near-term, fluid in fissure, self-resolves

Congenital pneumonia/sepsisrisk factors, CRP, cultures

Meconium aspirationterm/post-term, meconium-stained liquor

Investigations

CXR (RDS ground-glass + air bronchograms), gases, glucose, cranial USS (IVH), ROP screening, septic screen as needed.

Management

Antenatal steroids (mother) + surfactant + neonatal supportive care

1Antenatal corticosteroids to the mother before anticipated preterm birth (lung maturation); magnesium sulfate for neuroprotection <30 weeks.
2Neonatal: surfactant for RDS, respiratory support, caffeine for apnoea, thermoregulation, cautious feeding, ROP screening.

Antenatal corticosteroids — given to mother to mature fetal lungs before preterm birth

Surfactant — endotracheal for RDS

Caffeine — apnoea of prematurity

Key points

ROP screening is essential in very preterm/low-weight infants (treatable cause of childhood blindness). Antenatal steroids are the highest-yield preventive.

Monitor & prognosis

Growth, neurodevelopment, ROP, hearing; CLD.

Improves with gestation; very preterm carry neurodevelopmental risk.

Source: NICE NG25 (preterm labour); neonatal guidance