Pediatrics: Preterm and Postterm Infants

Question 1

What is prematurity

Answer 1

Birth before 37 weeks

Question 2

What is Late preterm

Answer 2

34 to 37 weeks

Question 3

What is extremely preterm

Answer 3

<28 weeks

Question 4

How to analyze milestones in premature infant

Answer 4

Use corrected age until 2 years old

Question 5

How to calculate Corrected age

Answer 5

Actual age - weeks premature (before 40)

Question 6

What are the Immediate Newborn Complications in prematurity

Answer 6

Hypothermia
Hypoglycemia
Hypotension
Hyperbilirubinemia
Hypocalcemia

Question 7

What causes Neonatal Respiratory Distress Syndrome (RDS)

Answer 7

Surfactant Deficiency
-high surface tension
-atelectasis
-decreased lung compliance

Question 8

How does Neonatal RDS respond to O2

Answer 8

Poorly responsive
-alveoli collapsed
-intrapulmonary shunting

Question 9

How to diagnose Neonatal RDS

Answer 9

Clinical + CXR
-diffuse ground glass appearance

Question 10

When are the lungs mature

Answer 10

When adequate surfactant is present
-around 35 weeks

Question 11

What ratio can be used to determine lung maturity

Answer 11

Lecithin-Spingomyeling (L/S)

Question 12

What L/S ratio suggests lung maturity

Answer 12

L/S >2.0

Question 13

What are the risk factors for Neonatal RDS

Answer 13

Prematurity

Maternal DM

C-Section Delivery

Question 14

How does Maternal DM lead to Neonatal RDS

Answer 14

High Insulin decreased surfactant production

Question 15

How does a C-Section Delivery lead to Neonatal RDS

Answer 15

Spared the stress response at delivery
-reduced fetal cortisol
-reduction in surfactant

Question 16

How to prevent Neonatal RDS in preterm delivery

Answer 16

Betamethasone
-corticosteroid given to mother

Question 17

How does Betamethasone help prevent Neonatal RDS

Answer 17

Betamethasone acts to stimulate surfactant production

Question 18

How to treat Neonatal RDS

Answer 18

Administer Surfactant
-via ET tube

Question 19

What are major complications of Neonatal RDS

Answer 19

Patent Ductus Arteriosus (PDA)

Bronchopulmonary Dypslasia

Question 20

What increases the risk of Retinopathy of Prematurity

Answer 20

Exposure to high oxygen content

Question 21

What is the feared outcome of Retinopathy of prematurity

Answer 21

Retinal detachment and blindness

Question 22

How to diagnose Retinopathy of Prematurity

Answer 22

Retinal Exam

Question 23

How to treat Retinopathy of Prematurity

Answer 23

Laser therapy

VEGF-Inhibitors

Question 24

What causes Apnea of Prematurity

Answer 24

Immature respiratory control resulting in cessation of breathing for at least 20 seconds

Question 25

How does Apnea of Prematurity present

Answer 25

Respiratory pauses with desaturation and/or bradycardia

Question 26

How to treat Apnea of Prematurity

Answer 26

nasal CPAP Methylxanthine Therapy

Question 27

How does Methylxanthine therapy work for Apnea of Prematurity

Answer 27

Blocks Adenosine-R -causes increased respiratory drive Adverse: Tachycardia

Question 28

What is Necrotizing Enterocolitis

Answer 28

Intestinal Necrosis and Obstruction

Question 29

Where does Necrotizing Enterocolitis usually occur

Answer 29

Terminal Ileum or Colon

Question 30

What can Necrotizing Enterocolitis lead to

Answer 30

Perforation and Infection

Question 31

What is Necrotizing Enterocolitis Associated with

Answer 31

Preterm infants Formula-fed babies -non human milk

Question 32

How does Necrotizing Enterocolitis Present

Answer 32

Feeding intolerance Abdominal Distention

Question 33

How is Necrotizing Enterocolitis Diagnosed

Answer 33

X-ray Alt is CT

Question 34

What does an X-ray show for Necrotizing Enterocolitis

Answer 34

Pneumatosis Intestinalis -gas in bowel wall

Question 35

How to treat Necrotizing Enterocolitis

Answer 35

Supportive Care Abx Surgery

Question 36

How do diagnose GERD

Answer 36

Clinical Suspicion

Question 37

How to Treat GERD

Answer 37

Diet Positioning Medications

Question 38

What is an Intraventricular Hemorrhage

Answer 38

Hemorrhage into the lateral Ventricle

Question 39

How does an Intraventricular Hemorrhage Present

Answer 39

Hypotonia Loss of spontaneous movements Seizure Coma

Question 40

How to diagnose an Intraventricular Hemorrhage

Answer 40

Cranial Ultrasound (US)

Question 41

How to treat an Intraventricular Hemorrhage

Answer 41

Supportive

Question 42

How does prematurity impact immune function

Answer 42

Impairs cellular immunity Decreased T and B Cells Neutropenia Risk of infection/sepsis

Question 43

What are the long-term complications of prematurity

Answer 43

Increased Mortatlity and morbidity (SIDS) increased Neurocognitive problems Growth impairment Impaired respiratory function

Question 44

What is a Postterm pregnancy

Answer 44

Delivery at 42 weeks or greater

Question 45

What does a postterm pregnancy usually result in

Answer 45

Macrosomia (large baby)

Question 46

What causes Dysmaturity Syndrome

Answer 46

Placenta Insufficiency and malnourishment

Question 47

What is Dysmaturity syndrome associated with

Answer 47

Intrauterine Growth Restriction (IUGR) -postterm -SGA babies

Question 48

What is the characteristic appearance of Dysmaturity syndrome

Answer 48

Long, thin arms/legs Dry Parchement-like skin Peeling/loose skin Long nails baby alert with wide-eyed look decreased/absent vernix

Question 49

What is Meconium Aspiration Syndrome associated with

Answer 49

pregnancy beyond 40 weeks

Question 50

How does Meconium Aspiration Syndrome Present

Answer 50

Tachypnea Cyanosis Meconium-stained amniotic fluid

Question 51

How to treat Meconium Aspiration Syndrome

Answer 51

Maintain O2 and Ventilation Empirical Abx

Question 52

What is defined as Small for Gestation Age (SGA)

Answer 52

<2500g (5.5lbs) <10th percentile

Question 53

What does SGA increase the risk of

Answer 53

Neonatal Mortality Newborn complications

Question 54

What is defined as Large for Gestational Age (LGA)

Answer 54

>4000g (8.8 lbs) >90th percentile

Question 55

What is LGA associated with

Answer 55

maternal DM Maternal pre-pregnancy weight Excessive maternal weight gain

Question 56

Maternal Complications of LGA

Answer 56

Vaginal Lacerations Severe postpartum hemorrhage Increased chance of C-Section

Question 57

Infant Complications of LGA

Answer 57

Shoulder Dystocia Brachial Plexus Injury Clavicular Fracture