Born too early too small

Question 1

what is classed as a small baby and why does this occur?

Answer 1

The most common reason why a baby is smaller than average — weighing less than 2.5kg at birth — is prematurity (being born before 37 weeks’ gestation). The earlier the baby is born, the smaller they are likely to be. This is because the baby will have had less time in the womb to grow

Question 2

what is small for gestational age?

Answer 2

Small for gestational age (SGA) fetuses or newborns are those smaller in size than normal for their gestational age, most commonly defined as a weight below the 10th percentile for the gestational age

Question 3

what are the causes of small for gestational age (SGA) or small for dates (SFD)?

Answer 3

Maternal

Foetal

Placental

Other

Question 4

what are maternal causes for small for dates?

Answer 4

smoking - known to cause tailoring of foetal growth, smoking leads to smaller babies

Maternal Pre-Eclamptic Toxemia (PET) - Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn’t get enough blood, your baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction, low birth weight or preterm birth

Question 5

what are foetal causes for small for dates?

Answer 5

chromosomal (e.g. Edwards Syndrome - trisomy 18)

infection (e.g. CMV)

Question 6

what are placental causes for small for dates?

Answer 6

Abruption of placenta

Question 7

what are other causes for small for dates?

Answer 7

twin pregnancy

Question 8

Many babies with SGA have a condition called ____________________ (IUGR)

Answer 8

intrauterine growth restriction

Intrauterine growth restriction, or IUGR, is when a baby in the womb (a fetus) does not grow as expected. The baby is not as big as would be expected for the stage of the mother’s pregnancy

Question 9

whata re some common problems with being small for dates?

Answer 9

Perinatal Hypoxia (lack of oxygen to an unborn child during labor and delivery)

Hypoglycaemia

Hypothermia

Polycythaemia (increased red cell production due to hypoxia)

Thrombocytopenia

Gastrointestinal problems (feeds, NEC)

Question 10

what are long term problems seen in babies that were bron small?

Answer 10

Hypertension

Reduced growth

Obesity

Ischemic heart disease

Question 11

what is classed as preterm and what is classed as low weight?

Answer 11

Question 12

what is the Prematurity incidence

Answer 12

5-12%

Question 13

Common problems of preterm babies - what system can be affected?

Answer 13

Any system…

Respiratory

Circulation

Metabolic / Nutrition

Immune / Infection

Brain

Gastrointestinal

Haematology

Renal

Skin

• Still havnt developed all the function of the organs

Question 14

what is respiratory distress syndrome in preterms?

Answer 14

Newborn respiratory distress syndrome (NRDS) happens when a baby’s lungs are not fully developed and cannot provide enough oxygen, causing breathing difficulties. It usually affects premature babies

Surfactant deficiency on the lungs

Question 15

how do you manage repsiraotry distress syndrome?

Answer 15

If thought to be at risk of giving birth before week 34 of pregnancy, treatment for NRDS can begin before birth

You may have a steroid injection before your baby is delivered, second dose is usually given 24 hours after first

The steroids stimulate the development of the baby’s lungs. It’s estimated that the treatment helps prevent NRDS in a third of premature births

treatment after birth - If ,ild symptoms, may only need extra oxygen. It’s usually given through an incubator or tubes into their nose. If symptoms are more severe then baby may be put on vetilator

Question 16

what is BPD/CLD?

Answer 16

Bronchopulmonary dysplasia (BPD) can affect babies born prematurely, whose lungs have not developed fully in the womb. It’s sometimes called chronic lung disease of prematurity or chronic neonatal lung disease

usually had breathing problems from birth. These usually get better with time

Question 17

what damaged may BPD reuslt in?

Answer 17

Overstretch by volu-baro-trauma

Atelectasis

Infection via ETT

O2 toxicity

Inflammatory changes

Tissue repair - scarring

Question 18

what is the treatment of BPD?

Answer 18

If you are at risk of premature labour, you may be given steroids to help mature your baby’s lungs

• patience
• nutrition & growth

Question 19

what minor repsiratory problems are commonyl seen in preterm babies? and how are they managed?

Answer 19

Apnoea/irregular breathing/desaturations

• caffeine
• N-CPAP (Nasal continuous positive airway pressure (CPAP) therapy is a nonsurgical treatment that provides a steady flow of air to the lungs through the nose)

Question 20

what is IVH?

Answer 20

Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles in the brain. The ventricles are the spaces in the brain that contain the cerebral spinal fluid. Bleeding in the brain can put pressure on the nerve cells and damage them. Severe damage to cells can lead to brain injury

most common limiting factor for good long term prognosis

grades I-IV

grade Iv = 75% adverse outcome

Question 21

what is the prevention and treamtent of IVH?

Answer 21

Prevention - AN steroids (give mum steroids before birth)

Treatment - Sympthomatic

Question 22

what is PVL?

Answer 22

Periventricular leukomalacia (PVL) is a type of brain injury that is most common in babies born too soon (premature) or at low birthweight. The white matter (leuko) surrounding the ventricles of the brain (periventricular) is deprived of blood and oxygen leading to softening (malacia). The white matter is responsible for transmitting messages from nerve cells in the brain so damage to the white matter can cause problems with movement and other body functions

Injury of white matter in watershed area

Lead to disruption of the connectivity between the cortex and the lower part of our muscles

Question 23

what is PHH (post haemorrhagic hydrocephalus)?

Answer 23

Major complication of IVH is PHH

Blood products of sludge block draining system of CSF system in the brain and it has no way to go out and leads to increase cranial pressure

When a child is born prematurely, areas inside the brain (called “lateral ventricles”) that contain many small, thin, and fragile blood vessels are easily injured during the stress of shock of birth and the period of intense care afterward. These vessels burst and bleeding starts within those areas.

Unfortunately, the areas where the bleeding occurs are also those where cerebrospinal fluid forms. The blood may plug the drainage holes, causing the fluid to build within the brain, pushing on surrounding brain tissue, causing further brain damage.

In some cases, the posthemorrhagic hydrocephalus will subside on its own. In other cases, medications and sometimes placing of permanent shunts within the brain to drain the fluid may be necessary.

Question 24

what is PDA?

Answer 24

Patent ductus arteriosus (PDA) is a medical condition in which the ductus arteriosus fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta, which has a higher pressure, to the pulmonary artery

Question 25

what is the circulation in PDA? and what problems does it cause?

Answer 25

Consequences:

Worsening of respiratory symptoms

+

Retention of fluids (low renal perfusion)

Gastrointestinal problems (GE ischemia)

Question 26

what is Necrotising entero-colitis (NEC) and what does it cause?

Answer 26

Necrotising Enterocolitis (NEC) is an inflammation of the bowel (intestines) that may damage the bowel to a variable extent

Ischemic and inflammatory changes

Necrosis of bowel

Surgical intervention is often required

Conservative management is sometimes possible
- antibiotics and parenteral nutrition

Question 27

what is the outcomes of extreme prematurity?

Answer 27

1/3 dies

1/3 have normal life or mild disability

1/3 have moderate or severe disability for lifetime

1 in 6 is entirely normal at 6 years of age

Subjective quality of life was not different in ex-preterm compared to ex-term controls