Neurological, retinal, hearing, and growth problems in preterm infants
THE CONTEXT
Preterm infants are vulnerable to complications of immature organ systems. The passage describes preventive measures for intraventricular hemorrhage, retinopathy, and hearing impairment, along with causes of inadequate weight gain.
Intraventricular hemorrhage
•
Preterm infants have a fragile, highly vascular germinal matrix near the lateral ventricles.
•
Respiratory distress, mechanical ventilation, or vigorous resuscitation can rupture these vessels and lead to adverse neurological sequelae.
•
Prevention includes antenatal steroids, minimal and gentle handling, avoidance of rapid fluid boluses and hyperosmolar infusions, and avoidance of high ventilation pressures.
Retinopathy of prematurity
•
Retinal vessels grow from the optic disc toward the periphery between 18 and 44 weeks of gestation.
•
High or low oxygen saturation, sepsis, blood transfusions, sickness, and poor postnatal nutrition may injure retinal vascular growth. This injury can induce pathological vessel proliferation and retinopathy of prematurity.
•
Retinopathy regresses over time in most neonates, but untreated disease can progress to retinal detachment and blindness in some.
•
Risk reduction includes rational oxygen use with oxygen saturation maintained at 91–95%, avoiding unnecessary transfusions, and regular eye screening for early detection.
•
Advanced retinopathy requires peripheral retinal ablation by laser.
Hearing impairment
•
Preterm infants have an increased risk of hearing loss.
•
Rational use of ototoxic drugs, prevention of hypoxia, optimal treatment of jaundice, and routine early screening can minimize this complication.
Causes of inadequate weight gain
•
In breastfed infants, inadequate intake can result from improper positioning or attachment, infrequent breastfeeding, or omission of night feeds.
•
In spoon- or paladai-fed infants, inadequate intake can result from incorrect technique with excess spilling, incorrect measurement or calculation, or infrequent feeding.
•
Failure to fortify milk in very-low-birth-weight infants can contribute to inadequate intake.
•
Increased demands associated with hypothermia or cold stress, chronic illnesses including bronchopulmonary dysplasia, and medications such as corticosteroids can contribute to inadequate weight gain.