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MBBS 3: Pediatrics > Prematurity > Flashcards

Prematurity Flashcards

1
Q

What is prematurity?

A

when a baby is born before 37 completed weeks of gestation

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2
Q

What is a viable fetus?

A

when is born after 28 weeks gestation
Note: Birth before 28 weeks is a miscarriage or abortion

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3
Q

What is a low birth weight baby?

A

one with a birth weight of less than 2500g

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4
Q

What are the categories of low birth weight?

A
  1. low birth weight <2500g
  2. very low birth weight <1500g
  3. extremely low birth weight <1000g
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5
Q

Maternal predisposing factors of prematurity?

A
  1. Teen pregnancy
  2. Hard labour
  3. Poor nutrition
  4. Infections: Malaria, TORCHES
  5. Anaemia
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6
Q

What are the TORCHES infections?

A
  1. Toxoplasmosis
  2. Others (gonorrhea, hepatitis B, varicella-zoster virus, parvovirus B19, HIV)
  3. Rubella
  4. Cytomegalovirus
  5. Herpes Simplex
  6. Syphilis
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7
Q

Consequences of the TORCH infections?

A
  1. premature birth
  2. intrauterine growth restriction
  3. miscarriage
  4. stillbirth (loss of pregnancy after 20 weeks of gestation)
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8
Q

Fetal predisposing factors of prematurity?

A
  1. congenital anomalies
  2. genetic conditions
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9
Q

Complications of prematurity?

A
  1. apneic attacks
  2. respiratory distress syndrome
  3. anaemia
  4. jaundice
  5. infection
  6. food intolerance
  7. necrotising enterocolitis
  8. cerebral and intraventricular haemorrhage
  9. heart failure and pulmonary edema
  10. poor mental and intellectual development years
  11. retinopathy of prematurity
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10
Q

What causes apneic attacks?

A

The baby is prone to these attacks because of immaturity of the lungs and the respiratory centre

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11
Q

What causes RDS?

A
  • Atelectasis can develop with the possibility of developing hyaline membrane disease
  • Notice that all these lead to respiratory distress syndrome
  • Frequent apnoec attacks leads to cyanosis and signify very poor chance of survival
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12
Q

What causes anemia?

A
  1. The immature bone marrow
  2. iron stores in the foetus are laid in the last four weeks of intra-uterine life make premature baby is prone to anaemia
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13
Q

What causes jaundice?
Complications of jaundice?

A

Due to immaturity of the liver, bilirubin cannot be conjugated
- Sometimes the level of unconjugated bilirubin rises to as high as 20mg/100ml and causes kernicterus
- Kernicterus is neurological sequelae that comes as a result of the bilirubin crossing the blood brain barrier.

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14
Q

What causes infection?

A

common complication since the immune system is immature

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15
Q

What causes NEC?

A

immaturity of the childs digestive system
- NEC involves infection and inflammation in the childs gut which may stem from the growth of dangerous bacteria in parts of the intestine they don usually live

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16
Q

What causes food intolerance?

A

digestive system may not be fully developed

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17
Q

What causes cerebral and intraventricular haemorrhage?

A

The fragile capillaries and small veins easily rupture and the baby may display abnormal neurological function

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18
Q

What causes heart failure and pulmonary edema?

A
  1. the poor muscular tone of the baby may prevent adequate venous return causing accumulation of the blood in the extremities
  2. Asphyxia adds to the circulatory problems and later the baby goes into heart failure and pulmonary oedema
19
Q

What causes poor mental and intellectual development in later years?

A
  1. prolonged asphyxia to which the premature baby is prone can lead to mental retardation and low intelligence later in life.
  2. Neurological conditions like Kernicterus and Intracranial haemorrage
20
Q

What causes retinopathy?

A

The immature retina is at risk of further destruction that may or may not lead to permanent visual impairment, especially with exposure to high concentrations of oxygen

21
Q

Management of a preterm/LBW?

A
  1. Routine care of the newborn is applicable to a preterm baby
  2. Checking respirations of the baby, heart rate, colour, tone/grimance, cry
  3. Provide warmth
  4. If the baby is stable, she/he is kept on skin to skin contact with the mother and a comprehensive assessment is done after ninety minutes of birth
  5. Observe for the complications of LBW and Prematurity e.g. respiratory problems - give O2 if need arises and monitor
  6. Comprehensive care
  7. elimation problems
  8. feeding
  9. growth monitoring
22
Q

What is comprehensive care?

A
  1. Cord care with 7.1% chlohexidine
  2. Eye care with TEO (tetracycline eye ointment)
  3. Administration of Vitamin K according to birth weight intramuscular injection to prevent haemorrhagic disease of the new-born (to form blood clots)
23
Q

What are elimination problems?

A

to observe if the baby is passing stools and urine
- Frequency of stools should be noted and loose stools could be associated with infection

24
Q

Feeding management?

A
  1. The maximum amount is normally 200-220 ml/kg per day divided in eight feeds.
  2. Very small babies (< 1500 grams) should be fed every two hours.
  3. Larger babies (> 1500 grams) should be fed every three hours.
  4. As the baby grows and reaches 40 weeks gestation or reaches a weight or 2500 grams), gradually replace scheduled feeding with feeding on demand.
  5. Observe for signs of food intolerance which include; vomiting of feeds tinged with bile, abdominal distension and bloody stool
    - These should be reported, investigated and managed promptly
25
Q

Growth monitoring?

A

babies have to be weighed on a daily basis
- The baby might lose 10 % of their birthweight by 7- 10 day, and therefore a slight drop in weight is normal
- The baby regains the weight within the first 2 weeks

26
Q

Management of hematological problems?

A

Hemoglobin is estimated weekly to exclude anaemia

27
Q

Management of temperature instability?

A

premature and low birthweight babies require prolonged and continuous skin to skin contact for more than twenty hours per day to maintain a normal body temperature, failure of which requires a heater

28
Q

Management of neurological problems?

A
  1. monitor general behaviour of the baby with particular attention to its activity- they may be inactive or hyper alert.
  2. Also look for seizures
    - Remember that neonatal seizures may not be so obvious as they tend to be subtle and may be missed ( usually focal seizures due to the poorly myelinated nerves)
29
Q

What is physiological jaundice?
Treatment?

A
  • appears after 48 hours: maximum by 4th and 5th day in term and 7th day in preterm
  • generally disappears without any treatment but some will require photoherapy
30
Q

What is pathological jaundice?

A
  • starting on the first day of life
  • associated with fever
  • deep jaundice: palms and soles
31
Q

Causes of pathological jaundice?

A
  1. hemolysis
  2. congenital infection
  3. neonatal sepsis
32
Q

What is prolonged/pathological jaundice?
Clinical features?

A
  • jaundice lasting for longer than 14 days in term infants and 21 days in preterm infants
  • stool clay coloured
  • urine dark colour
33
Q

Causes of prolonged jaundice?

A
  1. hypothyroidism
  2. neonatal hepatitis
  3. biliary atresia
34
Q

Management of jaundice?

A

after 24 hours and is visible in the palms of the hands and soles of the feet, that’s regarded severe jaundice
1. Jaundice should be managed in hospital under phototherapy
2. Where available, the bilirubin levels should be assessed and these will guide management.
3. Those who develop jaundice after 24 hours need to be closely monitored and advised on exclusive breast feeding as this is physiological and clears on its own

35
Q

What is a jaundice Kramer chart?

A

for all babies who are jaundiced in the first 24 hours of life
1. area 1 + 2 (head + trunk) - if preterm, low birth weight, or sick
2. area 1-5 (head, trunk, pelvis, legs + arms, feet + hands) - all babies including healthy term babies

36
Q

Management of infections?

A
  1. Babies must be monitored for signs of infection which are;- rash, discharge from the eyes, moist umbilical cord, grey color and temperature instability.
  2. Frequent hand washing is encouraged to both the mother and the care giver
  3. The immune system of premature babies is underdeveloped which makes them susceptible to infections.
  4. In addition babies could be born preterm or with low birthweight as a result of intrauterine infections
    > These neonates are often initiated on antibiotics to treat infections
37
Q

Management of metabolic disorders?

A
  1. Preterm and Low birthweight babies are also prone to hypoglycaemia and it is very important to maintain proper nutrition for the baby
  2. Proper nutrition also assists in preventing hypothermia
38
Q

What is Kangaroo mother care?

A
  • is early, prolonged continuous skin-to-skin contact between mother (or her surrogate) and her low birth weight infant
  • the baby is placed skin-to-skin against the mother’s chest wearing only a nappy, hat and socks, and secured in an upright position between the mother’s breasts by wrapping a cloth around both mother and baby
39
Q

Benefits of KMC?

A
  1. It has proven benefit in decreasing neonatal mortality
  2. It decreases morbidity by decreasing risk of neonatal infections, improves cardio-pulmonary circulation, and improves brain development
  3. KMC has psychosocial benefits in that it improves bonding between the child and the mother.
  4. KMC encourages exclusive breastfeeding
40
Q

Types of KMC?

A
  1. continuous
  2. intermittent
41
Q

What is continuous KMC?

A
  • It takes place when the baby is in skin-to-skin position for 24 hours every day (except for very short periods when the mother has to bath or use the toilet)
  • It is initiated in the hospital and as soon as baby is stable and other criteria are met, this is continued at home
  • It requires the support from family members.
  • Although there are will known benefits, continuous KMC is labour intensive and not very well done because of this.
42
Q

What is intermittent KMC?

A
  • It is when the baby is put in skin-to-skin contact for a few hours each day
  • When not in KMC position, the baby is kept warm in an incubator or warmly wrapped
  • It is mostly used for very small and sick babies, and/or for mothers who do not want to or are not yet ready or able to practice continuous KMC
43
Q

Danger signs taught in KMC?

A
  1. Hypothermia
  2. Fever
  3. Red, swollen eyelids and pus discharge from eyes
  4. Red swollen and/or pus around the cord or umbilicus
  5. Convulsions/fits
  6. Jaundice/ yellow skin
  7. Convulsions
  8. Breathing problems – apnea, chest in-drawing, grunting, flaring, cyanosis
  9. Lethargy (excessive sleepiness, reduced activity).

MBBS 3: Pediatrics (40 decks)

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