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Premature / LBW / NICU Flashcards

(80 cards)

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1
Q

What type of small babies can you get

A

SGA
- Could be genetic or due to IUGR
LBW
IUGR

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2
Q

What is IUGR

A

If still in womb
<10th centile
Suggest something happening in womb to compromise blood flow / sick baby

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3
Q

What causes LBW

A 
Idiopathic
Placental insufficiency
Chromosomal
Infection - TORCH / CMV / syphillis
MCMA twins
Malformation
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4
Q

What causes placental sufficiency

A 
Maternal IHD
High BP 
PET 
Abruption 
DM
Systemic
Sickle cell  
Smoking / alcohol
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5
Q

What are common problems in LBW

A

Perinatal hypoxia - increased haematocrit, bilirubin and plasma viscosity
= Polycytheaemia as hypoxia = produce more
Hypoglycaemia
Hypothermia
Thrombocytopenia - BM concentrating on making RBC

NEC
GI - as blood flow to more important organs in stress
Nutrition
Meconium aspiration syndrome as stressed
IRDS as less surfactant
Infection

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6
Q

What are long term problems of LBW

A 
DM
Hypertension
Reduced Growth 
IHD
Obesity 
Renal failure
Stroke
Retinopathy 
Lung - asthma
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7
Q

What is mild LBW and extreme

A

LBW <2.5kg
VLBW <1.5kg
Extreme <1kg

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8
Q

What is symmetric LBW

A

OFC and weight in the same percentile

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9
Q

What causes symmetric

A 
1st trimester insult
Affects all DNA
Chromosomal 
Infection - TORCH 
Teratogenic drug 
Severe smoke / alcohol
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10
Q

Will symmetric LBW improve

A

Unlikely as will never have enough cells

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11
Q

What is asymmetric

A

OFC spares

Weight <10 centile

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12
Q

What causes asymmetric LBW

A

3rd trimester insult
Placental insufficiency - PIH
Will have catch up growth

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13
Q

Why is LBW associated with hypothermia

A

Lack of fat stores

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14
Q

Why is LBW associated with hypoglycaemia

A

No glycogen reserve as IUGR throughout pregnancy so constantly used up

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15
Q

What does the hypoxic state in utero of LBW babies cause

A

Increased haematocrit 20-22 (normal 18-20)
Increased plasma viscosity (VTE / slow circulation)
Polycythaemic to increase RBC as hypoxic
Increased bilirubin as have to break down
Thrombocytopenia as BM making RBC

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16
Q

How do you treat the hypoxic state of LBW babies

A

Partial exchange transfusion

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17
Q

Why does premature make you more prone to infection

A

IgG transfer in 3rd trimester
Immune system is underdeveloped
Interventions in premature
Can be caused by chorioamnitis

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18
Q

How do you treat infection

A

Prophylactic penicillin and gentamicin to cover strep and staph / gram -ve E.coli
Diff Ax if think meningitis

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19
Q

Do you worry more about pre-term but appropriate for gestational age or the pre-term SGA

A

Pre-term appropriate gestational age

SGA baby will have been under stress in the womb so produce natural steroids to mature lungs

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20
Q

Neonatal abstinence syndrome

A

OK

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21
Q

What has decreased infant mortality

A 
Obstetric care
Housing
Nutrition 
Immunisation
Ax
NHS
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22
Q

What is most important in LBW babies

A

Nutrition

More prone to food intolerance and gut unable to absorb

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23
Q

What causes pre-term babies

A 
Idiopathic 
Smoking / alcohol / drugs 
Over or underweight
FH 
Malnutrition
Infection - chorioamnitis
PET
DM
APH
Polyhydramnios
Twins
Malformation
PPROM
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24
Q

What is term

A

37-42

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25
Mild prematurity
32-37
26
Moderate
28-32
27
Extreme
<28 weeks
28
What Is important if premature
``` Nutrition Fluid - dextrose TPN if long term Syringe feed NG Vitamins ABIDEK Iron at 28 days Establish feet ```
29
Complications of pre-term
``` IRDS Bronchopulmonary dysplasia Minor resp issues IVH Periventricular leucomalacia Post haemorrhagic hydrocephalus Hypoxic ischaemic encephalopathy Neonatal jaundice NEC PDA Infection Low BP Hypothermia Hypoglycaemia Nutrition as poor feeding ```
30
What are long term complications of pre-term
``` Chronic lung - asthma / bronchiolitis Anaemia of prematurity Metabolic bone disease Retinopathy Cerebral palsy Low IQ / learning difficulties Hearing and visual ```
31
How do you screen for long term issues
Cranial USS | Retinopathy
32
What causes IRDS
``` Deficiency of alveolar surfactant Lungs can't expand Collapse Large pressure needed to inflate Leads to inadequate gas exchange, hypoxia and hypercapnia ```
33
What does this cause
``` Respiratory distress - Tachypnoea - Grunting - Nasal flaring - Cyanosis - Recession Exhaustion Resp failure - hypoxia/. hypercapnia ```
34
What are RF for IRDS and what is protective
``` Pre-term - Surfact produced >24 weeks Maternal DM - Hyperinsulin in baby inhibits cortisol C-section Male Perinatal asphyxia 2nd born twin ``` Protective - stresses baby = cortisol production - PPROM - IUGR - Maternal HTN - Antenatal steroid
35
How do you Dx
``` Blood gas CXR - Widespread bilateral change - Indistinct heart border - Air bronchogram - Ground glass opacity - May see tube if intubated ```
36
How do you prevent
Antenatal steroid 12 hours apart if any threat Stresses lung to prevent Delayed cord clamping
37
How do you Rx
``` O2 - nasal or mask or just flow to maintain pressure CPAP - open and inflate lung Support ventilation if blood gas worsens May need intubation Endotracheal surfactant once intubated ```
38
Complications of RDS / increased risk
``` Pneumothorax Infection Apnoea IVH Pulmonary haemorrhage NEC Renal failure ``` Long term Chronic lung Retinopathy due to hypoxia Neuro, hearing and visual
39
When do you use CPAP
If only problem is keeping airway open
40
What is Ddx of IRDS
``` Sepsis = important TTN Meconium aspiration Congenital lung Persistent pulmonary hypertension Cardiac ```
41
What causes bronchopulmonary dysplasia
Lung overstretch e.g. ventilation | Causes oxygen toxicity
42
What does bronchopulmonary dysplasia cause
``` Persistent hypoxia Difficulty weaning of ventilation Infection due to tube Severe bronchiolitis Atelactisis - collapse Poor feeding ```
43
How do you treat
Steroids Surfactant High calories feed
44
What are complications
``` GORD Feeding issue Decreased IQ Cerebral palsy Asthma ```
45
What causes minor respiratory issues and what can underlying issue be
Baby forget to breath Babies are mouth breather's Can be a pre-drome of illness
46
What minor issues is there
Apnoea >15s Desaturation Bradycardia Irregular breathing
47
How do you treat
Attach apnoea monitors to premature baby IV Caffeine - neuroprotective and stimulates resp CPAP
48
What is most common limiting factor for poor prognosis in pre-term
Intra-ventricular haemorrhage
49
When does IVH occur
First 72 hours
50
How does it present
Seizure Bulging fontanelle Cerebral irritability
51
How do you Dx
Cranial USS as fontanelle hasn't closed MRI Bloods
52
How do you Rx
Ante-natal steroid | Treat haemorrhagic shock
53
What do you do if hydrocephalus / raised ICP
Drainage | Shunt
54
What are complications
Post haemorrhagic hydrocephalus if clot occlude Decreased IQ Cerebral palsy
55
What is periventricular leucomalacia
White matter surrounding ventricles deprived O2 and blood
56
What types of intracranial haemorrhage I there
IVH = most common in pre-term SAH Subdural after forceps
57
What causes hypoxic ischaemic encephalopathy
``` SUSPECT IF ANY OF THESE EVENTS Brain injury 2 prolonged hypoxia / asphyxia / resp distress IVH PML Placental insufficeincy Cord prolapse Long delivery Abruption Maternal hypoxia / shock Infection Anaemia ```
58
What does mild HIE present with and how does it resolve
``` Hyperalert Hypertonia Poor feeding Irritable Acidosis on blood gas / poor Low APGAR Resolve within 24 hours and normal prognosis ```
59
How does more severe present and how does it resolve
Hypotonia Seizure Apnoea Hyporeflexia / absent sucking rreflex etc Resp depression Coma Takes weeks to resolve and usually lasting damage
60
How do you Dx
EEG | Flat single line
61
How do you Rx
``` Neonatal resus and ventilation Support circulation Support seizure Support nutrition Support acid base balance Therapeutic hypothermia for brain protection ```
62
What are the complications
``` Cerebral palsy Epilepsy Blind Deaf Learning difficulty ```
63
How does hypoglycaemia present
``` Hypothermia Hypotonia Lethargy Infection Apnoea Resp difficulty Poor feeding Vomiting High pitched cry Seizure Neuro complications ```
64
What are RF
``` Physiological in first few hours just encourage feed Pre-term IUGR SGA LGA / macrosomia Maternal DM Maternal BB use Sepsis Hypothermia Inborn error Beckwith Weidman ```
65
What should all irritable babies get
U+E BG Sepsis screen
66
How do you treat
``` Dextrogel Enteral feed - NG tube IV 10% glucose Regular electrolyte if on fluid Glucagon Hydrocrotisone Recheck glucose ```
67
When is hypo normal
Transient in 1st few days | Observe and encourage feed
68
What are RF for hypothermia
Premature LBW Prolonged resus
69
How do you investigate
Sepsis screen TFT Monitor blood glucose
70
How do you Rx
``` Dry Warm towel Radiant heater Heated oxygen Incubator ```
71
What are the complications
Increased energy demand + O2 Metabolic acidosis as poor perfusion Pulmonary hypotension
72
What causes hypotonia
``` Sepsis Hypothyroid Jaundice Prader-Willi Down Benzo's HIE Cerebral palsy Neuromuscular Maternal myasthenia gravis Meconium aspiration Hypoglycaemia ```
73
What are neuromuscular causes
``` Spina bifida Myasthenia gravis Muscular dystrophy Guillian Barre Spinal muscular atrophy Cerebral palsy DMD - but doesn't present till later ```
74
What do you do if hypotonic
Sepsis screen | Underlying cause - BG / TFT / LFT
75
What do you follow up on
Development
76
What causes haemorrhage disease of newborn
Vit K defiicency
77
How does it present
Bruising Jaundice IVH / kidney
78
What causes retinopathy of premature / LBW
Abnormal development of retinal blood vessels | Can lead to scarring, retinal detachment and blindness
79
How is it screened of
30-31 weeks gestation if born <27 weeks Or 4-5 weeks if >27 weeks Screen every 2 weeks until can be seen that developing normal
80
How do you Rx
Laser photocoagulation to prevent neovascularisation Intravitreal VEGF Surgery if retinal detachment occurs

Paediatrics (35 decks)

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