Complications arising from Prematurity
The immature organs of a pre-term infant have structural and functional limitations; as a result they are at risk for numerous medical problems affecting different organ systems.
Neurological
- Intraventricular haemorrhage - (bleeding into the brain which may sometimes also lead to fluid accumulation in the brain (hydrocephalus).
- Periventricular Leucomalacia (PVL) - is thought to be caused by infection/inflammation and/or a lack of blood flow and oxygen to areas in the brain leading to permanent damage. It is closely associated with the development of cerebral palsy.
- Retinopathy of prematurity - is a disease that affects the immature blood vessels in the eyes of premature babies. It can be mild and may resolve on its own with no effects on vision or in more serious cases leads to blindness if untreated.
- Meningitis
- Hearing impairment
Respiratory
1. Respiratory distress syndrome - is a syndrome in premature infants caused by immaturity of the lungs. Insufficient surfactant (a naturally occurring substance which is a mixture of lipids and proteins) is produced by the immature lungs, and this is essential to help prevent collapse of the air sacs in the lung.
2. Chronic lung disease (also called bronchopulmonary dysplasia) - is most common among extremely premature and very low birth weight babies who received prolonged mechanical ventilation and/or supplemental oxygen therapy to treat respiratory distress syndrome.
Gastrointestinal Problems
1. Necrotising enterocolitis (NEC) - is a serious condition in which the large or small intestine becomes inflamed. In severe cases this results in intestinal obstruction or perforation and peritonitis. Symptoms include feeding intolerance, abdominal distension and rectal bleeding. It is treated by intravenous fluids and antibiotics, but more severe cases may require surgery.
2. Gastroesophageal reflux - is a malfunction of the junction that separates the stomach from the oesophagus. This causes food to return to the oesophagus, and may result in vomiting. Treatment involves using feed thickeners and antacids. In most babies, the symptoms improve with time, although occasionally an operation is required.
Cardiovascular
Patent Ductus Arteriosus
After birth the ductus arteriosus, a small blood vessel connecting two of the major arteries in the heart, normally closes and disappears. In some premature infants, the hole remains open (patent) for weeks or months. If the opening is small, the baby may not have any symptoms; however, if it is large, blood flow to the lungs increases and the heart must pump harder to compensate. This can lead to heart failure. If treatment is necessary, medicines may be prescribed, but for some babies, surgery may be needed to permanently close it.
Jaundice
High levels of bilirubin a by-product from the breakdown of red blood cells, causes jaundice (yellowing of the skin and whites of the eyes). In premature babies, red blood cells breakdown more easily and the liver may take longer to get rid of bilirubin as well. If untreated, very high levels of bilirubin can lead to neurodisability (including cerebral palsy), thus prompt treatment is essential. A special kind of light therapy, phototherapy, is used to treat jaundice. Occasionally a baby’s blood needs to be exchanged to remove bilirubin (an exchange transfusion).
Infections
Sepsis, pneumonia, and urinary tract infection.
Longer Term Complications
Outcomes for premature babies have significantly improved; however a significant proportion suffers long term chronic medical problems. Some of these complications may appear early on, however many may only become apparent later, sometimes years later. In general the risks are increased with lower birth weight and lower gestational age. There are many conditions, some of the most important include:
- Cerebral Palsy
- Learning Disability
- Vision or hearing impairment
- Developmental delay
- Poor school performance
- Behavioural/psychological problems such as ADHD
- Epilepsy
