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Flashcards in Pre-term infant Deck (30)
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  1. Pre-term 
  2. Term 
  3. Post-term 

  1. Pre-term = a birth that occurs before 37 completed weeks of gestation & after 22 weeks 
  2. Term = a birth between 37 weeks and 42weeks of gestation
  3. Post-term = a birth that occurs after 42 completed weeks of gestation


List the causes of pre-term births 

  • Spontaneous pre-term labour 
  • Multiple pregnancy 
  • Preterm PROM 
  • Pregnancy associated HTN (PET included in this) 
  • IUGR 
  • Antepartum haemorrhage 
  • Cervical incompetence/ uterine malformation 


What are the main differences in care that needs to be provided for a pre-term baby compared to a term baby ?

  • Need more help to stay warm
  • Have more fragile lungs and don’t breathe effectively
  • Have fewer nutrient reserves (less fat) 
  • Delay cord clamping if possible


How are pre-term babies given extra help to keep warm when born ?

They are put in a plastic bag under a radiant heater 


What are the other extra measures taken to care for a preterm baby when born ?

  • Ensure airway/ breating, if not require ventilation 
  • Take to NICU 
  • Plan supplemental breastmilk or LBW formula if < 2kg 
  • Measure BG before each 3hrly feed & tube if oral not tolerated 
  • If tube feed/oral contraindicated e.g. is in resp distress give IV feeding 


What are the 4 common problems a premature babies face?

  1. Temp control i.e. hypothermia 
  2. Feeding/ nutrition problems 
  3. Sepsis 
  4. System immaturity/ dysfunction - commonly resp distress sydrome (RDS), Patent ductus arteriosus (PDA), Intraventricular haemorrhage (IVH) & necrotising enterocolitis (NEC)


Why is there a risk of hypothermia in pre-term infants (note some of these apply to term infants too as you still have to keep them warm also) 

  • Low basal metabolic rate (BMR) 
  • Minimal muscular activity 
  • S/C fat insulation and brown fat is negligable 
  • High ratio of surface area to body mass 


Why is there an increased risk of nutritional compromise in pre-term infants ?

  • They have limited nutritional reserves (low fat reserves) 
  • Gut immaturity - malabsorption 
  • Immature metabolic pathways 
  • Increased nutrient demands 


How are pre-term infants (between 32 to 36+6 weeks) plotted on a growth chart ?

  • There is a pre-term section on the standard growth charts which is to the left of the main plotting graph
  • It is used for preterm infants aged 32+0 and above until 42 weeks


How are pre-term infants (< 32 weeks) plotted on a growth chart ?

  • A special low birth weight growth chart should be used 
  • Note EDD = estimated delivery date which is simply alculated by adding 40 weeks onto last menstrual period 


What are the risk factors for the development of neonatal sepsis ?

  • Mother colonised with Group B strep (GBS) - streptococcus agalctinae main one 
  • Prolonged rupture of membranes (PROM) > 18hrs 
  • Significant GBS bacteruria during current pregnancy > 104 cfu/ml
  • Maternal temp > 38 during labour 
  • Chorioamnioitis = inflam of fetal membranes due to bacterial infection 
  • Sustained intrapartum fetal tachycardia 
  • Prior delivery of an infant with GBS disease 


Why are premature babies more at risk of developing sepsis?

  • Immature immune system
  • Intensive care environment
  • Indwelling tubes and lines


Describe the presentation of neonatal sepsis 

  • Resp distress symptoms (same as RDS) 
  • Pallor
  • Delayed cap refill 
  • Lethargy, poor feeding and indifferent to pain when taking bloods from them 
  • Vital signs - tachypnoea, tachycardia, hypotension, variable temp (high, low or norm) 


What investigations should be done for suspected neonatal sepsis ?

  • Blood culture, lumbar puncture & urine culture 
  • BG levels 
  • FBC; WBC & neutrophils 
  • CRP 


What is the treatment of pyrexia of unkown source (same as sepsis)

IV Amoxicillin + metronidazole + gentamicin (GAM)

Note - if possible meningococcal septicaemia then treat as per menigitis guidelines


What is the paediatric treatment of meningitis ?

  • < 3 months tx = cefotaxime + amoxicillin 
  • > 3 months tx = 1st dose cefotaxaxime + amoxicillin, subsequent doses are ceftriaxone + amoxicillin 
  • + dexamethasone 


What is the paeidatric treatment of a suspected line infection (common in NICU as they often have lines in) ?

IV vancomycin (+ gentamicin if gram -ve sepsis suspected) 


Define what aponea of prematurity is 

This is fairly common in premature babies where they stop breathing for 15-20 seconds during sleep 


Define what bronchopulmonary dysplasia is and how it is treated 

  • This is immature/ underdeveloped lungs & airways, resulting in breathing problems 
  • Tx = ventilation + pulmonary surfactant + O2 


Describe the pathogenesis of respiratory distress syndrome 

  1. This condition is due to a deficiency of alveolar surfactant, which is mainly confined to premature babies 
  2. The insufficient surfactant leads to alveolar collapse, re-inflamtion with each breath exhausts the baby & respiratory failure follows which leads to decreased CO, hypotension, acidosis & renal failure 
  3. It is treatable and usually gradually worsens until 2-4 days & then gradually gets better 


What are the presenting features of RDS?

  • Tachypnoea 
  • Grunting 
  • Nasal flaring 
  • Intercostal recessions 
  • Cyanosis 


What is the management of RDS ?

Give pulmonary surfactant 

  • Ventilation 1st line = non-invasive ventilation with CPAP
  • Ventilation 2nd line = invasive ventilation 


What are the signs/symptoms of a patent ductus arteriosus ?

Typically asmptomatic but can present with: 

  • Tachypnoea 
  • Excessive sweating 
  • Inability or difficult feeding & weight loss/ no gain 

Murmur heard is systolic in first few weeks of life developing into a continuous machine like murmur 


Why are premature babies at greater risk of intraventricular haemorrhage (IVH)?

Due to having unsupported blood vessels 


What are the signs/symptoms suggestive of IVH ?

  • Seizures 
  • Bulging fontanelles 
  • Decreased conciousness 
  • Decreased moro reflex 
  • May be asymptomatic 


How is IVH diagnosed ?

U/S (transfontanelle) 


What is the treatment of IVH ?

  • Head elevation 
  • Circulatory support 
  • Seizure control 


What is retinopathy of prematurity ?

  • This is where abnormal vessels grow in the back of the eye which then tend to leak/bleed leading to scarring of the retina. 
  • This scarring can lead to retinal dettachement & blindness 


What is osteoporosis of prematurity ?

Premature infants may not recieve the proper amount of calcium & phosphorus, putting them at risk of fractures & possibly rickets 


Nectrotising enterocolitis, hypoglycaemia & hyponatraemia all mentioned in sick-term infant lecture