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Prematurity (10) Flashcards

1
Q

What defines prematurity?

A

Gestational age LESS than 37 weeks

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2
Q

Gestational age less than 37 weeks is defined as?

A

Prematurity

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3
Q

4 risks for prematurity?

A
  1. PPROM
  2. Intrauterine infections
  3. Uterine, cervical, placental abnormalities
  4. Multiple gestations
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4
Q

PPROM

A

Preterm Premature Rupture of Membranes before 37 weeks

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5
Q

Rupture of Membrane means?

A

Amniotic membrane spontaneously ruptures

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6
Q

What increases risk for PPROM?

A

History of PPROM, bleeding during pregnancy and maternal smoking

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7
Q

Chorioamnionitis

A

Inflammation of the placental membranes

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8
Q

Inflammation of the placental membranes

A

Chorioamnionitis

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9
Q

Funisitis

A

Inflammation of fetal umbilical cord

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10
Q

Inflammation of fetal umbilical cord

A

Funisitis

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11
Q

What histologic correlates are seen with intrauterine infections?

A

Chorioamnionitis

Funisitis

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12
Q

With prematurity, what are some things that could result?

A

Neonatal Respiratory Distress Syndrome
Necrotizing Enterocolitis
Sepsis
Intraventricular hemorrhage

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13
Q

Although preterm infants have low birth weight, is it usually proportional to their gestational age?

A

Yes

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14
Q

Infants who weigh less than 2500g at term are considered?

A

Undergrown (SGA)

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15
Q

Infants who weigh less than 2500g at term are given the designation?

A

SGA

Small for Gestational Age

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16
Q

What do SGA infants suffer from?

A

FGR

Fetal Growth Restriction

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17
Q

What 3 factors can cause FGR and thus SGA?

A

Maternal
Fetal
Placental

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18
Q

Most common maternal abnormality associated with FGR?

A

Decreased placental blood flow

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19
Q

What are examples of maternal conditions that can cause decreased placental blood flow and thus FGR?

A

Pre-eclampsia and Chronic Hypertension

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20
Q

Most common fetal abnormalities associated with FGR?

A

Congenital anomalies

Infections

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21
Q

If FGR is due to a fetal factor, how will the growth restriction present?

A

Symmetric

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22
Q

If FGR is due to a placental factor, how will the growth restriction present?

A

Asymmetrical that spares the brain

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23
Q

Another name for Neonatal Respiratory Distress Syndrome

A

Hyaline Membrane Disease

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24
Q

Cause of RDS?

A

Pulmonary immaturity and surfactant deficiency

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25
What stimuli promote surfactant DEFICIENCY?
Insulin and C section
26
What stimuli promote surfactant synthesis?
Cortisol and Labor
27
What cells produce surfactant and when is production amplified?
Type 2 alveolar cells after 35 weeks gestation
28
Decreased surfactant directly causes?
Increased surface tension in the alveoli
29
Increased surface tension in the alveoli causes?
Atelectasis - collapse of lung tissue due to loss of alveolar spaces
30
Decreased surfactant causes increased tension and atelectasis. What does that cause?
Hypoventilation and uneven perfusion
31
Main result of decreased surfactant, increased tension and atelectasis?
HYPOXEMIA AND CO2 RETENTION
32
Describe the order of events that ensue to get Hypoxemia and CO2 retention with RDS
- Decreased surfactant production - Increased surface tension in the alveoli - Atelectasis (collapse of alveoli) - Hypoventilation and uneven perfusion = HYPOXEMIA and CO2 RETENTION
33
Once Hypoxemia and CO2 retention have occurred with RDS, then what ensues?
Acidosis and pulmonary vasoconstriction that damages endothelial and epithelial cells
34
Acidosis and pulmonary vasoconstriction that damages the pulmonary cells then causes what?
Plasma leaks into the alveoli
35
If plasma leaks into the alveoli, what is formed?
Fibrin + necrotic cells
36
Fibrin + necrotic cells =
Hyaline membrane disease
37
Once Hypoxemia and CO2 Retention occur, describe how hyaline membrane disease is established
- Hypoxemia and CO2 retention - Acidosis and pulmonary vasoconstriction damages the endothelial and epithelial cells - Plasma is able to leak into the alveoli = Fibrin + necrotic cells in the lungs
38
Once RDS is already taking place, what in the cycle only causes further surfactant deficiency?
Hypoxemia and CO2 Retention
39
What do the lungs look like with RDS?
Solid, airless, reddish - purple color and they sink in water
40
Hyaline membrane disease has what characteristic features?
Necrotic tissue inside eosinophilic hyaline membranes made of fibrin
41
Symptoms of RDS?
Trouble breathing and cyanosis right after birth
42
How can you tell how much surfactant is present in a child's lungs?
Measure the phospholipids in the amniotic fluid
43
An L/S ratio of > ___ indicates mature lungs
2
44
What are the 2 options to prevent RDS and preterm birth?
1. Delay preterm labor | 2. Give antenatal steroids to increase maturation of lungs
45
2 complications that can arise after RDS?
1. Retrolental Fibroplasia | 2. Bronchopulmonary Dysplasia
46
Retrolental Fibroplasia
Occurs after RDS | - Increased VEGF --> induces angiogenesis and blood vessel formation that causes lesions on the retina
47
What is increased with Retrolental Fibroplasia?
VEGF
48
What cytokines cause Bronchopulmonary Dysplasia?
TNF IL-6 IL-8 IL-1beta
49
With Bronchopulmonary Dysplasia, what do the cytokine cause to happen?
Arrest alveolar development = large simplified alveoli
50
What 3 things are infants who survive RDS at risk for?
1. Patent ductus arteriosus 2. Intraventricular hemorrhage 3. NEC
51
NEC
Necrotizing Enterocolitis
52
What are most causes of Necrotizing Enterocolitis associated with?
Introduction of bacteria possible through enteral feeding
53
What molecule is always increased with NEC?
PAF | platelet activating factor
54
Describe the process of NEC
- Bacteria entry - Increased PAF increases permeability and enterocyte apoptosis - Inflammation with bacteria now inside colon - Necrosis - Further bacterial entry
55
What does increased PAF do?
Increases permeability and enterocyte apoptosis
56
What portions of the intestines are commonly impacted by NEC?
Terminal ileum, cecum, right colon
57
What does a segment of intestine look like with NEC?
Distended, gangrenous and with perforations
58
If perforations are present in the intestine with NEC what can that cause?
Peritonitis
59
What is always seen on x-ray with NEC?
GAS in the intestines!!! | pneumatosis Intestinalis
60
Symptoms of NEC?
Bloody stool Abdominal distention Circulatory collapse PNEUMATOSIS INTESTINALIS (GAS) on x-ray!!!!

MOD (68 decks)

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