Cold stress, preterm, posterm (CP102)

• Preterm birth


  Any birth before 37 completed weeks of gestation or fewer than 259 days since the first day of the woman's last menstrual period (LMP)
• Preterm birth classification by Gestational Age (GA)


  • Extremely preterm (<28 weeks)
  • Very Preterm (28-<32 weeks)
  • Moderate of late preterm (32-<37 completed weeks of gestation)
• Pregnancy duration classification


  • Pre-term: Less than 259 days(37 weeks)
  • Term: 259-293 days (37-41 weeks)
  • Post-term:294 days (42 weeks) or more
• Contributing factors for Preterm birth

  • Antepartum Hemorrhage
  • Cervical incompetence
  • Hormonal changes
  • Bacterial infection
• Preventing deaths and complications from preterm births

  • Starts with a healthy pregnancy
  • WHO antenatal care guidelines include key interventions to help prevent preterm birth, such as: Counselling on health diet, Optimal nutrition, Tobacco and substance use
• WHO antenatal care guidelines

  • Early ultrasound to determine GA and detect multiple pregnancies
  • Minimum of 8 contacts with health professional starting before 12 weeks to identify and manage risk factors
• Treatment available for Preterm Labor

  • Antenatal steroids
  • Tocolytics treatments to delay labor
  • Antibiotics for preterm prolabor rupture of membranes (PPROM)
• WHO new recommendations on the care of the preterm infant

  • Simple Interventions such as: Kangaroo mother care immediately after birth, Early initiation of breastfeeding
• Post-term birth


  Birth that occurs after 42 completed weeks (294 days) of gestation
• Maternal complications associated with Post-term births

  • Postpartum haemorrhage
  • Dystocia
  • Caesarean deliveries
• Cold stress


  A condition that occurs when the body can no longer maintain its normal temperature, defined as axillary or rectal temperature of 36.0 ˚C-36.4 ˚C with term "Mild Hypothermia"
• Simple method and second lesser choice of Cold Stress detection

  • Cold stress can be detected by monitoring peripheral temperature, hand and foot temperature
• Measurements to confirm or detect

  • Hypothermia ( <36.5 ˚C) WHO
  • Hyperthermia (>37.5 ˚C)
  • Temperature normally ranges from (36.7 ˚C to 37.2 ˚C)
• Clinical Manifestations of Cold Stress

  • Pale
  • Mottled skin
  • Central cyanosis
  • Apnea
  • Bradycardia
  • Lethargy
  • Poor muscle tone
  • Weak cry and weak suck
• Prevention of Hypothermia in Neonates


  • Maintaining an appropriate environmental temperature is the most important step
  • The WHO recommends the delivery room temperature be at least 25 ˚C to 28 ˚C
  • Neonates be dried immediately and placed in skin to skin contact with the mother and covered
• Adequate Nutrition


  • Early initiation of breastfeeding within 1 hour of birth
  • Exclusive breastfeeding for the first 6 months of life
  • Introduction of nutritionally adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond
• Average term baby needs in the first year of life

  • Fluid 100-150ml/kg
  • Calories 100-120 kCal/kg
  • Protein 1.5-2g/kg
• Micronutrients and foods for babies

  • IRON - First micronutrient the baby received in supplementary feeding
  • CARBOHYDRATES - First food received by the baby
  • BREAST MILK - Primary food of an 0-6 months