Neonatal Pathology Flashcards
Define Small for Gestational age?
- Newborns are those who are smaller in size than normal for the gestational age
- most commonly defined as a weight below the 10th percentile for the gestational age.
What is Intra-uterine Growth Restriction?
Intrauterine growth restriction (IUGR) refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb
- IUGR (<10th cent)
- Severe IUGR (<0.4th cent)
What are some of the causes of a baby being “small for dates”?
- Maternal
- such as pre-eclampsia
- Foetal
- Such as chromosomal abnormalities and infection (CMV)
- Placental
- such as placental abruption
- Other
- Twin pregnancy
What are some of the common problems with babies that are small for dates?
- Perinatal Hypoxia
- Hypoglycaemia
- Hypothermia
- Polycythaemia
- Thrombocytopenia
- Hypoglycaemia
- Gastrointestinal problems
What are some of the long term problems expereinced by babies who were small for dates?
Unconfirmed but some link thought to the following:
- Hypertension
- Reduced growth
- Obesity
- Ischaemic heart disease
What are the week cutoffs for premature and extremely premature?
Premature
- <37 weeks
Extremely Premature
- <28 weeks
What are the weights which can classify children as Low, Very Low and Extremely Low Birth weights?
- Low birth weight - <2500g
- Very low birth weight - <1500g
- Extremely low birth weight - <1000g
What is Respiratory Distress Syndrome?
Prevention
Early Treatment
Respiratory disorder of premature babies, when the lungs are not fully developed, so there are issues getting oxygen.
Prevention - antenatal steroids
Early treatment - surfactant - (then as little treatment as possible)
- Early extubation
- Non-invasive support (N-CPAP)
- Minimal ventilation (low tidal volume & good inflation)
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What is Broncho-Pulmonary Dyplasia?
Issues?
Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns (mostly premature) and infants. It results from damage to the lungs caused by mechanical ventilation (respirator) and long-term use of oxygen .
Issues include:
- Overstretched by volu-baro-trauma
- Atelectasis - collapse of lung.
- Infection via ETT
- O2 Toxicity
- Inflammatory changes & scarring
Treatment
- Patience
- Nutrition and Growth
- Steroids
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What are the more common respiratory problems of the new born?
Treatment?
Minor more common problems
- Apnoea
- Irregular breathing
- Desaturations
Treatment
- Caffeine
- N-CPAP - nasal continous positive airway pressure
What is Intra Ventricular Haemorrhage (IVH)?
Prevention
Treatment
IVH is bleeding into the fluid-filled areas (ventricles) inside the brain. This is because blood vessels in the brain of premature infants are not yet fully developed.
Prevention
AN Steroids
Treatment
Symptomatic
What is a Patent Ductus Arteriosus?
Pathophysiolog
- Ductus Arteriosus fails to close after birth.
- Pressure in aorta is greater than Pulmonary artery resulting in a Left to Right Shunt.
- Causing over perfusion of the lungs (lung oedema)
- The blood here is thereby being stolen form the systemic circulation, resulting in systemic ischaemia.
Can lead to worsening respiratory symptoms, retention of fluid(due to poor renal perfusion) and GI ischaemia.
What is necrotising enterocolitis?
Treatment
Condition seen in premature babies where part of the bowel dies. There is ischaemic and inflammatory changes, necrosis of the bowel.
Surgical intervention is often required.
COnservative management is sometimes possible with antibiotics and parenteral nutrition.
Basically, outline the importance of nutrition in preterm babies?
Very important.
The nutritional requirements are unparalleled anywhere else in medicine.
Patients often triple their size during hospital stay.
Building new functional tissues from compounds provided artificially.
What are the outcomes of extreme prematurity?
- Unpredictable at birth, and even on discharge home.
- USS of brain at 1 week can be indicative.
- There can be surprising deterioration between years 2 to 6 , or some unexpected imporvemnt here too.
- 1/3 dies
- 1/3 normal life / moderate diasbility
- 1/3 moderate or severe disability for life
