Complications of prematurity

Question 1

Definition of prematurity

Answer 1

less than 37 weeks of completed gestation

Question 2

Definition of extremely preterm

Answer 2

<28 weeks

Question 3

Definition of very preterm

Answer 3

28 to 32 weeks

Question 4

Definition of moderate to late preterm

Answer 4

32-37 weeks

Question 5

What is the neonatal period?

Answer 5

first 28 days of life

Question 6

Low birth weight cut off

Answer 6

<2.5kg

Question 7

Very low birth weight cut off

Answer 7

<1.5kg

Question 8

Extremely low birth weight cut off

Answer 8

<1kg

Question 9

Levels of care for premature babies

Answer 9

intensive care
high dependency
special care
transitional care

Question 10

Risk factors for preterm birth

Answer 10

previous premature birth
pregnancy with twins, triplets or other multiples
IVF
problems with uterus, cervix or placenta
smoking cigarettes, drinking alcohol or using illicit drugs
poor nutrition
some infections eg. group B strep
some chronic conditions eg. BP and diabetes
being underweight or overweight before pregnancy
multiple miscarriages or abortions
no or late antenatal care
under 17 or over 35

Question 11

Features of babies born <28 weeks

Answer 11

all require respiratory support (most need period of ventilation)
eyelids fused <24 weeks
thin, red skin
difficult fluid management
high risk of hypotension, infection
unable to suck, need TPN
risk of IVH
central access
long admission
500-1000g

Question 12

Features of babies born 28-32 weeks

Answer 12

many still need respiratory support - non-invasive
may be able to feed via OG/NG tube
still at risk of complications such as NEC, infection
usually 900-1800g

Question 13

Roughly when does the suck, swallow and breathe coordination kick in?

Answer 13

~34 weeks

Question 14

Features of babies born 33-36 weeks

Answer 14

most able to feed if no respiratory distress
may require oxygen
better able to control temperature
weigh 1500-2200g

Question 15

Why do babies develop hypothermia easily?

Answer 15

surface area:volume ratio
fat stores
energy demand
losses: conduction, convection, radiation + evaporation

Question 16

What does BAPM stand for?

Answer 16

british association of perinatal medicine

Question 17

Why are babies (particularly prem or sick babies) at increased risk of hypoglycaemia?

Answer 17

high demands
poor intake
poor reserves
lack of alternative fuels

Question 18

What causes respiratory distress syndrome in preterm babies?

Answer 18

surfactant deficiency + structural immaturity

Question 19

What does surfactant do?

Answer 19

helps keep alveoli open

Question 20

When is surfactant produced?

Answer 20

bursts during pregnancy
last as ~32 weeks

Question 21

Pathophysiology of respiratory distress syndrome

Answer 21

alveolar collapse
reduced compliance
increased dead space
inflammation

Question 22

What cells produce surfactant?

Answer 22

type 2 alveolar cells

Question 23

Characteristic clinical course of respiratory distress syndrome in preterm babies

Answer 23

immediate onset from birth
increased distress
low oxygen
high carbon dioxide
fatigue –> apnoea, respiratory failure, death

Question 24

Characterstic xray changes of respiratory distress syndrome in babies

Answer 24

ground glass
air bronchograms
under-aerated

Question 25

Respiratory distress syndrome in preterm babies treatment

Answer 25

exogenous surfactant (replacement therapy)

Question 26

Other than respiratory distress syndrome, what other resp condition can preterm babies develop?

Answer 26

pulmonary interstitial emphysema

Question 27

What causes pulmonary interstitial emphysema?

Answer 27

complication of mechanical ventilation too much pressure/hyperinflation damages alveoli + allows air leakage alveoli hyperinflate --> rupture air escapes into interstitium

Question 28

What does respiratory distress syndrome become if it is a chronic condition?

Answer 28

bronchopulmonary dysplasia (BPD)

Question 29

When can palivizumab be useful?

Answer 29

in preterm babies in their first winter RSV monoclonal antibody helps protect them from ending up back on ventilator from RSV

Question 30

What scan can be done to look for IVH in babies?

Answer 30

coronal section cranial ultrasound looking for bleeding around ventricles looks bright

Question 31

What is IVH?

Answer 31

intraventricular haemorrhage

Question 32

What is NEC?

Answer 32

necrotising enterocolitis

Question 33

How is IVH graded?

Answer 33

1 = bleeding limited to small area of ventricles 2 = bleeding in ventricles but not enough to cause expansion 3 = blood presses on brain tissue, ventricle enlargement 4 = bleeding in tissues around ventricles (parenchymal)

Question 34

IVH sequelae

Answer 34

post-haemorrhagic ventricular dilatation porencephalic cyst

Question 35

What is periventricular leukomalacia?

Answer 35

underperfusion of watershed regions surrounding ventricles ischaemic insults caused by lack of oxygen or blood flow to brain

Question 36

What is retinopathy of prematurity?

Answer 36

Abnormal blood vessel growth in the retina, Bleeding, Scarring, Retinal detachment, and Vision loss

Question 37

Most common cause of retinopathy of prematurity?

Answer 37

oxygen use

Question 38

Retinopathy of prematurity treatment

Answer 38

monitoring laser treatment cryotherapy