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Complications In Neonates > Prematurity > Flashcards

Prematurity Flashcards

1
Q

What defines prematurity

A

Birth before 37 weeks gestation

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2
Q

What is extreme preterm

A

> 28 weeks

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3
Q

What is moderate/late preterm

A

32-38 weeks

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4
Q

Associations with prematurity

A

Social deprivation, smoking, alcohol, drugs, overweight, underweight, maternal co-morbidities, twins, person or family history of prematurity

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5
Q

Options for trying to delay birth

A

Prophylactic vaginal progesterone or prophylactic cervical cerclage

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6
Q

Options when preterm labour is suspected or confirmed

A

Tocolysis with nifidipine, maternal corticosteroids, IV Mg sulfate, delayed cord clamping or cord milking.

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7
Q

Issues faced in early premature life

A

RDS
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea
Bradycardia
Neonatal jaundice
Intraventricular haemorrhage
Retinopathy of maturity
Necrotising enterocolitis
Immature immune system
Infection

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8
Q

Long term complications of prematurity

A

Chronic lung disease
Learning and behavioural difficulties
Susceptibility to infections - particularly RTIs
Hearing and visual impairment
Cerebral palsy

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9
Q

What causes respiratory distress syndrome

A

Lack of surfactant, causing surface tension and alveoli to collapse

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10
Q

Symptoms of RDS

A

Blue coloured lips (cyanosis) fingers and toes, rapid shallow breathing, flaring nostrils, grunting sound when breathing

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11
Q

Management of RDS

A

Intratracheal instilation of artificial surfactant.
Glucocorticoids before delivery.
Long line put in.
MEchanical ventilation.
BPAP/high flow O2/nasal cannulae.
Ambient incubator oxygen.

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12
Q

What causes feeding difficulties

A

Immature gut resulting in feed intolerance

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13
Q

Management of feeding difficulties

A

Total parenteral nutrition.
Ng or OG tubes.
Maternal and donor expressed milk
Feeding protocols

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14
Q

What is IVH

A

Blood vessels in the brain of premature infants are not yet fully developed and are extremely fragile. Rarely presents at birth and happens in first several days of life

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15
Q

Symptoms of IVH

A

May be none, but can have breathing pauses, decreased muscle tone, decreased reflexes, excessive sleep, lethargy, weak suck

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16
Q

Diagnosis of IVH

A

Routine head US to all babies under 30 weeks. Head CT if there are symptoms

17
Q

What is NEC

A

Condition in which bowel of premature infants becomes ischaemic and infarcted. It’s precise cause is unclear

18
Q

Risk factors for NEC

A

Prematurity, low birth weight, non-breast milk feeds, sepsis, acute hypoxia, poor intestinal perfusion

19
Q

Presentation of NEC

A

Usually presents in premature neonates in first 3 weeks of life. Vomiting, bloody stools, abdominal distension, absent bowel sounds, signs of systemic compromise such as acidosis on BG

20
Q

Diagnosis of NEC

A

Abdominal XR. Bowel loops will be dilated, pneumatosis intestinalis (gas within bowel), portal venous gas, penumoperitoneum.

21
Q

How is NEC staged

A

Using Bell’s classification, which is a mix of clinical and radiological signs and findings

22
Q

Management of NEC

A

Patients made nil-by-mouth, NG tube passed and be admitted to neonatal unit. Broad spectrum antibiotics, total paental nutrition to rest bowel, supportive treatment with IV fluids and ventilation, surgery to resect necrotic sections of bowel may be necessary and essential in cases of bowel perforation.

23
Q

What is retinopathy of prematurity

A

Abnormal development of blood vessels in the retina which can lead to scarring, retinal detachment adn blindness.

24
Q

Main treatment of retinopathy of maturity

A

Systemically targetting areas of the retina to stop new blood vessels forming.
Transpupillary laser photocoagulation to halt and reverse neurovascularisation.

25
Q

Other options for treatment of retinopathy of prematurity

A

Cryotherapy, injections of intravitreal inhibitors, surgery if retinal detachment occurs

26
Q

What is apnoea of prematurity

A

Where breathing stops spontaneously for more than 20 seconds or shorter periods with oxygen desaturation or brachycardia

27
Q

Management of apnoea of prematurity

A

Apnoea monitors, tactile stimulation, IV caffeine to prevent, episodes will settle as baby grows

28
Q

Causes of apnoea of prematurity

A

Imaturity of ANS, infection, anaemia, airway obstruction, CNS pathology, GORD, neonatal abstinence syndrome

29
Q

Why is there jaundice in a premature baby

A

Exaggerated due to immature liver, and increased risk of complicationss

30
Q

What is Kernicterus

A

Brain damage due to high levels of bilirubin

31
Q

Management of jaundice

A

Phototherapy or exchange transfusion is levels are really high

Complications In Neonates (6 decks)

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