Makindo Medical Notes

Premature infants (born before 37 weeks of gestation) face a spectrum of acute and chronic complications due to immature organ systems. Survival rates have improved with neonatal intensive care, but morbidity remains significant. A multidisciplinary approach is key: neonatology, nursing, nutrition, physiotherapy, psychology, and family support.

🫁 Respiratory Complications

• Problems:
  • Respiratory distress syndrome (RDS)
  • Bronchopulmonary dysplasia (BPD)
  • Apnoea of prematurity
  • Chronic lung disease, ↑ infection risk
• Why: Immature alveoli & ↓ surfactant → alveolar collapse + impaired gas exchange.
• Management: Antenatal corticosteroids, CPAP, oxygen, surfactant therapy; long-term pulmonary follow-up.

❤️ Cardiovascular Complications

• Problems:
  • Patent ductus arteriosus (PDA)
  • Hypotension, poor perfusion
  • Pulmonary hypertension
• Why: Failure to close fetal shunts; immature myocardium.
• Management: Fluid balance, diuretics, indomethacin/ibuprofen for PDA, surgery if persistent; cardiac echo monitoring.

🧠 Neurological Issues

• Problems:
  • Intraventricular haemorrhage (IVH)
  • Periventricular leukomalacia (PVL)
  • Seizures, cerebral palsy
  • Neurodevelopmental delay
• Why: Fragile germinal matrix, impaired autoregulation of cerebral blood flow.
• Management: Cranial USS screening, neuroprotective strategies, developmental follow-up, physio/OT/speech therapy.

🍽️ Gastrointestinal Complications

• Problems:
  • Necrotising enterocolitis (NEC)
  • Feeding intolerance
  • Gastro-oesophageal reflux
• Why: Immature gut barrier, poor motility, altered microbiome.
• Management: Breast milk preferred, careful feed advancement, antibiotics for NEC, surgical intervention if perforation.

🛡️ Immunological Immaturity

• Problems: High risk of sepsis (esp. GBS, E. coli), late-onset infections, poor vaccine response initially.
• Why: ↓ maternal IgG transfer (esp. if <32 weeks), impaired neutrophil function.
• Management: Strict infection control, early antibiotics, immunisations, RSV prophylaxis in high-risk infants.

⚖️ Metabolic & Endocrine Problems

• Problems:
  • Hypoglycaemia
  • Electrolyte imbalances (Na, Ca, Mg)
  • Poor thermoregulation
  • Hypothyroxinaemia of prematurity
• Management: Frequent glucose checks, electrolyte monitoring, incubator/skin-to-skin thermoregulation, thyroid function testing.

👁️ Ophthalmic Complications

• Problems: Retinopathy of prematurity (ROP), strabismus, visual impairment.
• Why: Abnormal retinal vascular development, exacerbated by high oxygen exposure.
• Management: Regular retinal screening, laser therapy or intravitreal anti-VEGF in severe cases.

👂 Hearing Problems

• Problems: Sensorineural hearing loss.
• Why: Immaturity, infections, ototoxic drugs (e.g., aminoglycosides).
• Management: Newborn hearing screen, ENT/audiology follow-up, early hearing aids if needed.

🦴 Growth & Nutritional Concerns

• Problems:
  • Failure to thrive
  • Osteopenia of prematurity
  • Micronutrient deficiencies (iron, vitamin D)
• Management: Fortified breast milk/formula, iron & vitamin D supplements, monitoring growth charts.

📚 Long-Term Developmental & Social Issues

• Problems: Motor delay, learning difficulties, behavioural issues, chronic health problems.
• Management: Multidisciplinary developmental clinics, early years interventions, special educational support, psychological services for families.

🤝 Parental & Family Support

• Challenges: Emotional stress, anxiety, guilt, practical difficulties caring for a high-needs infant.
• Support: Counselling, parental education, peer support groups, social work input, continuity of care through community neonatal nurses.

💡 Teaching Pearls

✔️ The earlier the gestation, the greater the risk of multi-system complications. ✔️ “Preterm = immature organs” → every system may be affected. ✔️ Complications span immediate survival → long-term neurodevelopment. ✔️ Family-centred care is as important as medical intervention.