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Complications of prematurity
Each system in the preterm infant has its own "disease of prematurity" — intraventricular haemorrhage in the first days, PVL leading to cerebral palsy, retinopathy of prematurity, bronchopulmonary dysplasia, PDA and apnoea of prematurity — and each is checked at a fixed time.
Why it matters in the exam
Questions ask when and how each complication is screened: cranial ultrasound for intraventricular haemorrhage in infants born before 32 weeks, an eye examination for retinopathy in infants born at 30 weeks or less or weighing 1500 g or less, and diagnosis of BPD by oxygen need at 36 weeks' postmenstrual age. A common distractor is "wait until discharge" — but the first eye examination is set by age, not by discharge status.
Apnoea of prematurity is treated with caffeine citrate (loading 20 mg/kg and maintenance 5–10 mg/kg per day), after excluding sepsis, hypoglycaemia and anaemia. A haemodynamically significant PDA in a preterm infant is treated with ibuprofen, indomethacin or paracetamol. In pregnancy, antenatal steroids before preterm birth (24–34 weeks) reduce RDS, brain haemorrhage and NEC, and magnesium before delivery under 32 weeks reduces cerebral palsy.
Another important trap is age: developmental milestones and growth charts are assessed by corrected age until 2 years, but vaccines are given by chronological age and at the same doses. PVL (periventricular leukomalacia) appears later as spastic diplegic cerebral palsy, because the fibres to the legs pass close to the ventricles.
Key points
- IVH — cranial ultrasound in infants under 32 weeks.
- ROP — screen at 30 weeks or less, or 1500 g or less.
- BPD — oxygen need at 36 weeks' postmenstrual age.
- Apnoea of prematurity — caffeine citrate after excluding sepsis.
- Development by corrected age until 2 years; vaccines by chronological age.
Summary table
| Complication | Who and when | Diagnosis | Treatment or prevention |
|---|---|---|---|
| Intraventricular haemorrhage (IVH) | Born before 32 weeks; most bleeds in the first 72 hours | Cranial ultrasound, grades I–IV | Prevention: antenatal steroids, gentle care; follow for hydrocephalus |
| PVL | Small preterm infants, after hypotension or infection | Ultrasound: periventricular cysts | Developmental follow-up; risk of spastic diplegia |
| Retinopathy of prematurity (ROP) | 30 weeks or less, or 1500 g or less | First eye exam at 31 weeks' postmenstrual age or 4 weeks of age, whichever is later | Laser or anti-VEGF; avoid excess oxygen |
| BPD | Born before 32 weeks | Oxygen need at 36 weeks' postmenstrual age | Gentle ventilation, caffeine, nutrition; steroids in selected cases |
| Apnoea of prematurity | Under 34 weeks | Pauses over 20 seconds or with bradycardia | Caffeine citrate; exclude sepsis |
| PDA | Small preterm infants | Continuous murmur, bounding pulses, echocardiography | Ibuprofen, indomethacin or paracetamol; invasive closure if needed |
A free exam question
בן 3 ( שנים, חולה לוקמיה ALL), כשבוע לאחר טיפול כ י מותרפי באמצעות ליין מרכזי, לא ידועה רגישות יתר לתרופות. מתייצג במיון עם ח ו ם 38.7˚c . סימנים חיוניים תקינים, מצב כללי טוב. לא ידועה נשאות לחיידקים עמידים, ללא טיפול אנטיביוטי מונע. בבדיקה גופנית – מדדים חיוניים תקינים. ללא ממצא מכוון לחום, צילום חזה תקין. במעבדה- ABSOLUTE NEUTROPHIL COUNT -50 cell/mm3 מהו שילוב הטיפול האמפירי המומלץ ביותר ? (the question as examined, in Hebrew)
- א. IV VANCOMYCIN+ IV PIPERACYLIN-TAZOBACTAM
- ב. IV AMPICILLIN+ IV AMIKACIN
- ג. IV PIPERACYLIN-TAZOBACTAM+/- AMIKACIN
- ד. IV VANCOMYCIN+ IV MEROPENEM
In the full version for subscribers
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Sources
- AAP Policy Statement: Screening Examination of Premature Infants for Retinopathy of Prematurity, 2018 — Screening criteria and timing
- NICHD/NHLBI Workshop definition of bronchopulmonary dysplasia, 2001 (with 2018 refinements) — Oxygen need at 36 weeks postmenstrual age
- Nelson Textbook of Pediatrics, 22nd edition (2024) — The High-Risk Infant; Nervous System Disorders of the newborn
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.