Pre Term Birth Flashcards
Necrotising enterocolitis
Part of the bowel becomes necrotic leading to perforation
Onset - after first several weeks of life after first few feeds
Vomiting and diarrhoea Abdominal distension Abdominal wall erythema Haematochezia- bloody stools Not tolerating feeds / early sign Tender abdomen and absent bowel sounds Generally unwell
Babies who fail to thrive
Apnea and respiratory failure - important findings
Lethargy
Shock and hypotension - late finding
Coagulopathy
Lab tests: Thrombocytopenia Metabolic acidosis on blood gas Hyponatraemia Low chloride Decreases in Hb and haematocrit - if bleeding from rectum etc
Abdominal X-ray - pneumatosis intestinalis- has in bowel wall
Management: largely medical and supportive
Medical - discontinue feeds and Nothing by mouth if due to feeding
NG tube and bowel rest
Broad spectrum antibiotics
Consider total parenteral nutrition (TPN)
Surgery - If clinically deteriorating or haemodynamically unstable (septic shock or hypertension) or pneumoperitoneum suggesting ischemic or perforated intestines - explorative laprotomy
If progressive hypotension or lethargy - surgery
Remove dead bowel tissue
Retinopathy of prematurity
Retinal blood vessel development starts around 16 wks and completed by 37-40 wks, blood vessel grow from middle of retina to outer area stimulated by hypoxia , exposure to high levels of o2 stops normal blood vessels being formed and when the hypoxic environment recurs - retina responds by producing excessive blood vessels as well as scar tissues, these vessels may regress and leave the retina without a blood supply and scar tissue may cause retinal detachment
Premies born before 32 weeks or under 1.5kg should be screened for ROP
Causes blood vessels to grow in abnormal ways and grow inside retina causing scarring or retina when they shrink , they pull on the retina causing the retina to pull away from the back of the eye causing retinal detachment
Hence this can lead to blindness
Screening done by ophthalmologist if premature or low birth weight
6 stages of ROP
Stage 0- no ROP but risk until blood vessel completely grown
Stage 1 - mildly abnormal blood vessel growth
Stage 2 - moderate abnormal blood vessel growth - no treatment needed upto this stage
Stage 3- severely abnormal blood vessel growth - treat this before stage 4 develops
Stage 4- when retina is partially detached or moved from the back of the eye
Stage 5- occurs when retina is completely detached or moved from back of the eye
Stage 4/5 are serious and baby can have severe visual disturbances and blindness
Management-
Laser surgery - transpupillary diode laser therapy
Argon laser or cryotherapy
Medication shot into eyes to stop abnormal blood vessel growth
Hypoxic-ischemic encephalopathy (HIE)
Damage to neonatal brain during birth due to prolonged or severe hypoxia leading to ischaemic brain damage
Can lead to cerebral palsy in long term or death if severe HIE
Causes: things leading to asphyxia - deprivation of oxygen to the brain Maternal shock Intrapartum haemorrhage Prolapsed chord Nuchal cord around baby’s neck
Mild / poor feeding , irritable and hyper alert - normal prognosis - resolves within 24 hours
moderate - poor feeding , lethargic and seizures , can take wks to resolve and upto 40% develop Cerebral palsy
Severe - reduced consciousness, apnoeic and flaccid and reduced/absent reflexes ; 50% mortality and 90% develop cerebral palsy
Therapeutic hypothermia may benefit active cooling according to strict protocol - to reduce inflammation and neurone loss after acute hypoxic injury - within 6 hours of initial insult and temp range - 33.5-35.0C
Apnea of prematurity
Apneic spells defined as cessation of breathing for 20secs or longer or shorter pause accompanied by bradycardia (<80) ; cyanosis (<80-85%spo2) or pallor
Classified as central (cessation or breathing effort) or obstructive (airflow obstruction) or mixed
Infants born less than 28 weeks will have this most likely
Monitoring - continuous pulse oximetry and cardiac monitoring - apnea alarms set to 20 secs
Prevention - avoid extreme flexion or extension of neck to maintain patency of upper airway , stable thermal environment, limit nasal suctioning , maintain spo2 between 88-94% as hypoxia can stimulate episodes
Treatment
Caffeine citrate - blocks adenosine receptors - recommenced for all infants born <28 weeks as well as 29-32 wks.
Nasal CPAP with caffeine - reduces severity of apnea
Blood transfusions
GORD treatment
Chronic lung disease of prematurity
Bronchopulmonary dysplasia (BPD)
Chronic lung disease in infants who receive mechanical respiratory support with high oxygenation in the neonatal period
Diagnosis made when infant requires oxygen therapy past 36 weeks
Signs of increased work of breathing ( tachypnea, recession and nasal flaring )
Poor feeding and weight gain
Crackles and wheezes on chest
Prevention
Use CPAP rather than intubation and ventilation when possible
Don’t overoxygenate
Steroids /caffeine can reduce risk
