Prematurity

Question 1

What are the causes of prematurity?

Answer 1

1. Unknown (most common)
2. Smoking
3. Low socio-economic status
4. Malnutrition
5. History of - prematurity, infection, PET, DM, polyhydramnios, closely spaced pregnancy, multiple pregnancy, uterine malformations, placental issues, PROM.

Question 2

What is this describing?

<37/40 completed weeks gestation.

Answer 2

Preterm

Question 3

What is this describing?

<2500g regardless of gestational age, may not be SGA if preterm.

Answer 3

Low birth weight

Question 4

What is this describing?

<1500g regardless of gestational age, may not be SGA if preterm.

Answer 4

Very low birth weight

Question 5

What is this describing?

<1000g regardless of gestational age, may not be SGA if preterm.

Answer 5

Extremely low birth weight

Question 6

What is this describing?

Birth weight below the 10th percentile for gestational age.

Answer 6

Small for gestational age (SGA)

Question 7

What is this describing?

Failure of growth in utero which may/may not result in a baby being SGA.

Answer 7

Intrauterine growth restriction (IUGR)

Question 8

What is this describing?
All growth parameters in an infant are small, suggesting foetus was affected from early pregnancy either due to chromosomal abnormalities or being constitutionally small.

Answer 8

Symmetrical SGA

Question 9

What is this describing?
Weight of an infant is affected but length and head circumference spared. Usually due to IUGR and an insult later in pregnancy (placental/PET).

Answer 9

Asymmetrical SGA

Question 10

What are the causes of symmetrical SGA?

Answer 10

Malnutrition, maternal hypoxia, alcohol, smoking, chromosomal, congenital infection.

Question 11

What are the causes of asymmetrical SGA?

Answer 11

PET, thrombosis/infarction (sickle cell)

Question 12

What causes hypothermia in a premature infant and how is it managed?

Answer 12

1. Thin skin, large body surface area, limited SC fat.

2. Humidified incubator, hat on head.

Question 13

What causes infection in a premature infant and how is it managed?

Answer 13

1. Less passive immunity as maternal Igs cross placenta at 30/40.
2. IV Abx, antibodies against specific infection, prophylactic anti-fungal.

Question 14

What causes feeding difficulties in preterm infants, what can it cause, and how is it managed?

Answer 14

1. No suck and swallow reflex until 34/40.
2. Necrotising enterocolitis
3. <34/40 TPN with milk via NG tube, breastmilk preferred as formula can increase risk of NEC.

Question 15

What will all babies born <28/40 have and how is it defined?

Answer 15

1. Apnoea

2. Pause of breathing of >20s

Question 16

What are the causes of apnoea of prematurity?

Answer 16

1. Immature respiratory drive

2. GORD, infection, seizures, hypoxia

Question 17

What is the management of apnoea of prematurity?

Answer 17

1. Mechanical ventilation, surfactant
2. Caffeine daily to stimulate respiratory centre of brain.
3. Most resolve by 34/40 and caffeine is stopped.

Question 18

What type of brain bleed can occur in prematurity?

Answer 18

Intraventricular haemorrhage

Question 19

What is the cause of intraventricular haemorrhage in neonates?

Answer 19

Prematurity

Question 20

What is the pathophysiology of intraventricular haemorrhage in prematurity?

Answer 20

Small vessels in subpendymal germinal matrix rupture. Matrix prominent between 24-34/40 then regresses by term, so it is rare in term neonates.

Question 21

What are the risk factors for intraventricular haemorrhage in prematurity?

Answer 21

1. Hypertension
2. Hypotension
3. High pCO2
4. Low O2

Question 22

What is this a presentation of?

Usually asymptomatic. Seizures, bulging fontanelle, prolonged apnoea, Hb drop. Premature infant.

Answer 22

Intraventricular haemorrhage

Question 23

How is intraventricular haemorrhage of prematurity diagnosed?

Answer 23

Cranial USS, babies born <32/40 have 3 scans in 1st week of life.

Question 24

What is the management for intraventricular haemorrhage of prematurity?

Answer 24

1. Reduce risk factors.

2. If hydrocephalus is increasing, drain using LP or shunt, otherwise it is self-resolving.

Question 25

What is this describing? | Abnormal proliferation of retinal blood vessels of premature babies.

Answer 25

Retinopathy of prematurity

Question 26

What are the risk factors for retinopathy of prematurity?

Answer 26

1. Low birth weight, prematurity | 2. Large fluctuations of oxygen, prolonged oxygen therapy.

Question 27

How is retinopathy of prematurity diagnosed?

Answer 27

1. Screening through initial ophthalmoscopy with pupil dilation. 2. Screen all at <32/40 or weight <1500g

Question 28

What are the complications of retinopathy of prematurity?

Answer 28

Vitreous haemorrhage, retinal detachment, blindness, visual problems.

Question 29

What is the management for retinopathy of prematurity?

Answer 29

1. Usually resolves spontaneously 2. Treat for severe stages with diode laser therapy under GA 3. Consider bevacizumab (anti-VEGF)

Question 30

What is this describing? | Serious acute inflammatory bowel condition that occurs in the 2nd/3rd week of life in premature babies.

Answer 30

Necrotising enterocolitis

Question 31

What is the cause of necrotising enterocolitis of prematurity?

Answer 31

1. Necrosis of the bowel due to lack of blood flow. | 2. Associated with prematurity, hypoxia, formula milk feeds.

Question 32

What is this a presentation of? Early - bile stained aspirates from stomach, abdominal distension, bloody stools, poor feeding, lethargy, vomiting. Late - abdominal discolouration, perforation, peritonitis, shock, DIC.

Answer 32

Necrotising enterocolitis

Question 33

How is necrotising enterocolitis of prematurity diagnosed?

Answer 33

1. Clinical diagnosis 2. Abdominal x-ray - dilated bowel, pneumatosis intestinalis (gas in bowel wall), bowel perforation (free air in abdomen)

Question 34

How is necrotising enterocolitis of prematurity prevented?

Answer 34

1. Introduce feeds gradually 2. Breast milk 3. Probiotics

Question 35

What is the active management for necrotising enterocolitis of prematurity?

Answer 35

1. Stop oral feeding (except probiotics), replace with TPN. 2. Analgesia 3. Culture faeces, crossmatch (risk of anaemia) 4. Abx - cefotaxime and vancomycin

Question 36

What is the surgical management for necrotising enterocolitis of prematurity?

Answer 36

If bowel perforation - conservative with peritoneal drainage or laparotomy to remove affected bowel and temporary stoma.