PREMATURE SEXUAL MATURATION
P
PREMATURITY
A premature baby may need to be
nursed in an incubator where the
temperature and humidity are
carefully controlled and the baby
can be closely observed. If breathing
difficulties develop, they may be
treated by artificial ventilation. Very
small babies cannot suck so they
must be fed intravenously or via a
tube passed into the stomach. If
jaundice develops, they may be
treated by phototherapy (light
therapy), which breaks up the
bilirubin that causes the yellow
discoloration of the skin.
FEATURES AND COMPLICATIONS OF PREMATURITY
Physical features
Low birthweight (often less than 2.5kg)
Small size
Relatively large head and hands
Thin, smooth, shiny skin
Veins visible under the skin
Little fat under the skin
Wizened, wrinkled features
Soft, flexible ear cartilage
Short toenails (but normal length
fingernails)
Complications
• Increased risk of birth injury
• Hypoglycaemia (low blood sugar level)
and other disturbances of body
• Respiratory distress syndrome
chemicals
• Recurrent episodes of breathing
stoppage
• Jaundice
• Rickets
• Increased bleeding tendency
• Infection
• Brain haemorrhage
• Necrotizing enterocolitis (severe
• Poor temperature control
intestinal inflammation that may lead
• Anaemia
to death of intestinal tissue)
Downy (lanugo) hair
Reduced vernix (greasy substance that
covers the newborn)
Protuberant abdomen
Enlarged clitoris (girls)
Small scrotum (boys)
Feeble, whining cry
Irregular breathing
Poor sucking and swallowing ability
Tendency to regurgitate
Premature infant
This baby was born several weeks prematurely and
is being fed via a flexible tube that passes through
the nose and oesophagus into the stomach.
p re m a tu re s e x u a l m a tu ra tio n
S e e
p r e c o c io u s p u b e rty .
p re m a tu rity
T h e b i r t h o f a b a b y t h a t o c c u r s b e f o r e
3 7
w e e k s ’
g e s t a t io n .
T h e
p r e m a t u r e
i n f a n t
m a y
n o t
b e
s u f f i c i e n t l y
d e v e l -
o p e d
t o
c o p e
w i t h
i n d e p e n d e n t
l i f e
a n d n e e d s s p e c i a l c a r e .
CAUSES
N e a r l y 5 0 p e r c e n t o f p r e m a t u r e d e l i v -
e r i e s o c c u r f o r n o k n o w n r e a s o n . T h e
r e m a i n d e r a r e d u e t o c o n d i t i o n s s u c h a s
p re - e c la m p s ia , h y p e rt e n s io n , d ia b e t e s m e l-
litu s ,
l o n g - s t a n d i n g k i d n e y d i s e a s e , a n d
h e a r t d i s e a s e . O t h e r c a u s e s a r e
a n te p a r-
tum h a e m o rrh a g e ,
i n t r a u t e r i n e i n f e c t i o n ,
o r
p r e m a t u r e
r u p t u r e
o f
t h e
m
e m
-
b r a n e s . A c o m
m o n c a u s e o f p r e m a t u r e
b i r t h i s m u l t i p l e p r e g n a n c y
( s e e
p r e g -
n a n cy , m u lt ip le ).
FEATURES AND COMPLICATIONS
A
p r e m a t u r e
i n f a n t
i s
s m a l l e r
t h a n
a
f u l l - t e r m b a b y . H e o r s h e l a c k s s u b c u t a -
n e o u s f a t , i s c o v e r e d w i t h d o w n y h a i r
(
la n u g o
) , a n d h a s v e r y t h i n s k i n .
T h e
b a b y ’s
i n t e r n a l
o r g a n s
a r e
a l s o
i m m a t u r e .
T h e
m a j o r
c o m p l i c a t i o n
i s
r e s p ir a t o r y d is t re s s s y n d ro m e ,
w h i c h m a y
o c c u r b e c a u s e t h e l u n g s a r e i n s u f f i c i e n t l y
d e v e l o p e d . T h e r e a r e a l s o i n c r e a s e d r i s k s
o f
b r a i n
h a e m o r r h a g e ,
ja u n d ic e ,
a n d
h y p o g ly c a e m ia
( l o w
b l o o d
s u g a r ) . T h e
b a b y h a s a l i m i t e d a b i l i t y t o s u c k a n d t o
m a i n t a i n
a
n o r m a l b o d y t e m p e r a t u r e ,
a n d h e o r s h e i s a l s o p r o n e t o i n f e c t i o n
d u e
t o
a
p o o r l y
d e v e l o p e d
i m m u n e
s y s t e m . T h e e a r l i e r a b a b y i s b o r n , t h e
m o r e l i k e l y i t i s t h a t h e o r s h e w i l l h a v e
s u c h p r o b l e m s .
TREATMENT AND OUTLOOK
P r e m a t u r e i n f a n t s a r e u s u a l l y n u r s e d i n
a s p e c i a l b a b y u n i t t h a t p r o v i d e s i n t e n -
s i v e
c a r e .
T h e
b a b y
i s
p l a c e d
i n
a n
in c u b a t o r.
H e o r s h e m a y h a v e a r t i f i c i a l
v e n tila tio n
t o
a s s i s t
b r e a t h i n g ,
a r t i f i c i a l
f e e d i n g t h r o u g h a s t o m a c h t u b e o r i n t o
a
v e i n ,
a n d
t r e a t m e n t
w i t h
a n tib io tic
d ru g s
a n d
iro n
a n d
v ita m in s u p p le m e n t s
.
T h e
b a b y
i s
u s u a l l y
k e p t
i n
h o s p i t a l
u n t i l h e o r s h e h a s r e a c h e d a w e i g h t o f
a t l e a s t 2 . 2 5 k g , i s g r o w i n g s u f f i c i e n t l y ,
a n d i s f e e d i n g w e l l .
W
i t h t h e m o d e r n t e c h n i q u e s t h a t a r e
n o w
g e n e r a l l y
a v a i l a b l e ,
s o m e
i n f a n t s
s u r v i v e e v e n i f t h e y a r e b o r n a s e a r l y a s
2 4 w e e k s ’ g e s t a t i o n . M o s t b a b i e s t h a t a r e
b o r n a f t e r 2 8 w e e k s , a n d g i v e n s p e c i a l i s t
c a r e , s u r v i v e . T h e m a j o r i t y o f p r e m a t u r e
b a b i e s c a t c h u p w i t h f u l l - t e r m b a b i e s , i n
t e r m s o f t h e i r d e v e l o p m e n t , b e f o r e t h e
e n d o f t h e i r f i r s t y e a r .
p re m e d ic a tio n
T h e
t e r m
a p p l i e d
t o
d r u g s
t h a t
a r e
g i v e n , u s u a l l y b y i n j e c t i o n , o n e t o t w o
h o u r s b e f o r e a n o p e r a t i o n i n o r d e r t o
p r e p a r e a p e r s o n f o r s u r g e r y . T h e p r e -
m e d i c a t i o n i n j e c t i o n u s u a l l y c o n t a i n s a n
o p i o i d
a n a lg e s ic d ru g
( p a i n k i l l e r ) ,
a n d
o f t e n
a n
a n tic h o lin e rg ic d ru g
( w h i c h
r e d u c e s
t h e
s e c r e t i o n s
i n
t h e
a i r w a y s
a n d p r o t e c t s t h e h e a r t ) .
p re m e n s tru a l s y n d ro m e
T h e c o m
b i n a t i o n o f p h y s i c a l a n d e m
o -
t i o n a l s y m p t o m s
t h a t
o c c u r s
i n
m a n y
w o m
e n i n t h e w e e k o r s o r u n n i n g u p
t o
m e n s tru a tio n .
P r e m e n s t r u a l s y n d r o m e
( c o m m
o n l y k n o w n a s P M S )
b e g i n s a t
o r a f t e r
o v u la tio n
( t h e m
i d - p o i n t o f t h e
m e n s t r u a l
c y c l e ,
w h e n
a n
e g g
i s
r e l e a s e d f r o m a n o v a r y )
a n d c o n t i n u e s
u p u n t i l t h e o n s e t o f m e n s t r u a t i o n . I n
626
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