A Clinical Atlas of Chinese Infants

Section 2. The Preterm Baby (Photos 28-40)

SECTION 2 THEP RETERM BABY (photos 28-40) 29 16 .!Ii Lanugo hair is the soft, woolly hair that can be seen a.ll over the body in preterm babies after 30 weeks of gestation, especially over the back. CIS: This is less commonly seen in the very premature, or in babies over 36 weeks of gestation, the notable exception being the mature baby of a d.iabetic mother. 29-a. Physical/t;'atures of the pretenn baby. (Compare with features in the tenn baby, photos 4-6.) 29 Breast areolae are inconspicuous if <35 weeks. 30 Smooth scrotal sac if <33 weeks. 31 .n Little skin crease over the sole if <34 weeks. 17 32 18 a2 Hypotonia is evident in this 3D-week prelcrrn baby who is unable to maintain the head in the same plane as the trunk (head lag) on the pull-la-sit manoeuvre. Most term newborn babies can do this momentarily. ~IS Hyaline membrane disease (or respiratory distress syndrome, RDS), the commonest cause of respiratory distress in preterms of <32 weeks' gestation, presents wi th respiratory problems within 4 hours of birth. The baby has tachypnoea, retraction of chest wall on inspiration, and expiratory grunting. Xray chest film (33) shows the characteristic air bronchogram, ground glass appearance, or 'while out' lung fields. Assisted ventilation, e.g. continuous positive airway pressure (CPAP), or mechanical ventilation, is required in severe cases (34). CIS: The progressive respiratory difficulty is due to surfactant deficiency in the immature lung, and replacement therapy can bring about marked improvement (35, film taken 4 hours after surfactant therapy; same baby as 33). Other conditions such as Group B streptococcal pneumonia and massive pulmonary haemorrhage may closely mimic RDS. 33 34 3 3 19 3G 37 20 36 Bronchopulmonary dysplas ia is Ihe sequelae seen in babies, typically preterrns, who require prolonged oxygen therapy and mechanical ventilation for severe respiratory disorders. This chest film shows honey-comb appearance of the lung fields with penhi!ar fibrosis. CIS: The eventual outcome varies from respiratory failure, chronic lung disease, recurrent 'wheezy bronchitis', or apparent recovery. The use of dexamethasone appears to improve prognosis. 37 Nec roti zing enterocolitis (NEe) is more commonly seen in preterm baby of less than 1.8 kg birth weight, but it can also occur in term babies with severe sepsis. This plain abdominal X-ray film shows the typical findings of pneumatosis intestinalis (air in the bowel wall), sandy-foamy appearance of bowels, and marked abdomina l dis tension. Clinical signs include a distended abdomen,blood in stools, and vomiting. CIS : The aetiology is probably related to ischaemic bowel injury and infection. Surgeons should be consulted if surgical complications arise. 38 39 38 Intraventricu.lar haemorrhage (lVH) is a serious complication in the prelerm who is <32 weeks' gestation. This 24-week-old baby had sudden clinical deterioration after being stabilized on the ventilator for 1-2 days. This ultrasonogram (coronal view) shows blood dot in the Lventricle with shifting of the midline, and bleeding into the R ventricle. CIS: Hydrocephalus and neurological sequelae are common among survivors. as Jaundice is usually more prolonged due to immature liver function, and made worse in the presence of other factors like respiratory distress syndrome, perinatal hypoxia, and sepsis. This prelerrn baby is receiving phototherapy and the eyes are shielded and protected from light. CIS; Unconjugated bilirubin levels considered harmless for term babies can cause kernicterus or death in the pretenn. 21 40 40 Cellulitis developed quickly (within hours) al the site of a minor skin abrasion over the lumbosacral region in this baby because of impaired resistance to bacterial infections. CIS: Prompt medical treatment must be instituted on theslighlesl suspicion of infection. ...