Premie problems

Question 1

Premature survival

Answer 1

10% survival without major problems at 23 weeks

60% survival at 24 weeks, half have moderate neuro-disability

Survival at 26 weeks 80-90%,

Question 2

RDS 3 main problems

Answer 2

– Surfactant deficiency
– Immature lung structure
– Weakness of chest wall

Question 3

Synagis/ Palivizumab is ?

Answer 3

anti-RSV monoclonal antibody, expensive, need injection once a month during RSV season

Question 4

Premature risk factors for infection

Answer 4

–	Poor cell mediated responses
–	Poor humoral responses
–	Poor innate immunity
–	Little passive immunity
–	Limited oral intake in some
–	Invasive lines and tubes
–	Staff and parents

Question 5

IVH grade 1

Answer 5

In germinal matrix only

Question 6

IVH Grade 2

Answer 6

Within ventricles, no distension

Question 7

IVH Grade 3

Answer 7

Distended ventricle

Question 8

IVH Grade 4

Answer 8

Parenchymal involvement

Question 9

premie age

4 wk old 24 week =28 weeks

so an 8 month old 24 week =

Answer 9

4 months

Question 10

Vaccinate from when baby is born at

Answer 10

2,4,6 months

Question 11

Discharge if

Answer 11

feed,
maintain temp, 
breathe by yourself
>35 weeks
>1.8kg

Question 12

Preterm
Late preterm
Very Preterm
Extreme Preterm

Answer 12

<37 weeks
34-36 weeks
<32 weeks
<28 weeks

Question 13

Low birth weight
Very low birth weight
Extremely low birth weight

Answer 13

<2.5Kg
<1.5kg
<1kg

Question 14

Preterm delivery causes
top three
Other

Answer 14

spontaneous PTL
Infection
PPROM

elective
APH
Cervical incompetence
multiple pregnancy

Question 15

Prematurity complications

Answer 15

Respiratory
	Respiratory Distress Syndrome
	Apnoea of prematurity
	Bronchopulmonary dysplasia 
Cardiovascular
	Patent ductus arteriosus
Fluids/Electrolytes
	Immature kidneys
	Hypoglycaemia
	Hypocalcaemia
	Infectious Disease
	Sepsis
GI
	Necrotising enterocolitis 
	Jaundice
	Ileus & feeding difficulties
Hematological
	Anaemia
Neurological
	Intraventricular haemorrhage
	Periventricular leucomalacia 
Other
	Hypothermia
	Retinopathy of prematurity

Question 16

Before birth, give ?

Answer 16

steroids
magnesium sulphate
antibiotics if PPROM

Question 17

at birth give

Answer 17

surfactant if under <28 weeks

Question 18

VLBW 4 main problems

Answer 18

PDA
NEC
ROP
Cholestatic jaundice

Question 19

Resp distress signs

Answer 19

• Respiratory rate >60 bpm
• Retractions (inter/subcostal,sternal)
• Grunting
• Cyanosis
• Low SpO2 on Pulse Oximeter

Question 20

Apnoea of prematurity tx

Answer 20

• Stimulation
• O2/ CPAP
• Caffeine

Question 21

PDA Tx

Answer 21

Paracetamol or Ibuprofen (indomethacin)

Surgical or catheter ligation if vent dependent

Question 22

NEC: clinical & x-ray features

Answer 22

Abdominal distension
Failure to tolerate feeds
Bile-stained gastric aspirate
Blood stained stools
Abdominal x-rays shows dilated bowel loops with gas in the bowel walls

Question 23

term babies develop NEC within first few days of life. Babies born earlier develop NEC at a later age. Average age onset:

Answer 23

20. 2 days for babies born less than 30 weeks
21. 8 days for babies born at 31-33 weeks’ EGA
22. 4 days for babies born after 34 weeks gestation.

Question 24

NEC: treatment & prevention

Answer 24

Stop oral feeds, give IV fluids/TPN
Commence IV antibiotics including metronidazole
Nasogastric aspiration
Blood pressure support if the baby becomes hypotensive
Surgery if severe NEC or bowel perforation.
Prevention: Probiotics

Question 25

Risk of neuro handicap by weight

Answer 25

> 1500 grams: outcome very good
1000 – 1500 grams: 7% handicap
< 1000 grams (and particularly < 750 grams): risk handicap is greater

Question 26

PVL affects the white matter around the lateral ventricles
long tract fibres particularly affected, risk cerebral palsy (especially spastic diplegia)

Secondary to

Answer 26

hypotension leading to cerebral ischaemia
Hypocarbia ( paCO2 < 4 kPa)
Hypoglycaemia
Sepsis / inflammation

Question 27

Early complications of IVH

Answer 27

acute deterioration
Apnoea, 
bradycardia, 
seizures, 
shock

Question 28

Late complications of IVH

Answer 28

hydrocephalus = post haemorrhagic ventricular dilation

Question 29

Hydrocephalus Sx

Answer 29

Inappropriate increase in head circumference
Lethargy & drowsiness
Vomiting
Tense fontanelle, widely spaced sutures

Question 30

Hydrocephalus Tx

Answer 30

Tap CSF
May require ventriculo-peritoneal shunt
+/- reservoir until VP shunt

Question 31

IVH Dx

Answer 31

clinical

U/S

Question 32

clinical presentation IVH

50% may be “silent”
unexplained deterioration

Answer 32

hypotonia
poor colour
reduced movements

Cerebral irritability
Shock
Bulging fontanelle +/- expanding head
An exaggerated or absent Moro reflex
Fits / seizures
Deteriorating feeding skills

Question 33

risk factors for IVH

Answer 33

Prematurity
Birth asphyxia
RDS
Bleeding disorders
Pneumothorax
PDA
Birth trauma
Breech delivery

Question 34

Tell me about the germinal matrix

Answer 34

site of embryonal neurons/fetal cells which migrate to cortex

highly cellular and very vascular, esp preterm

IVH mostly in < 3 days, 90% in first week

Question 35

BPD aetiology

Answer 35

Prematurity (immature lungs)
Ventilation (stretch, collapse, O2 )
Infection 
Fluid overload / PDA
Poor response to inflammation
Gastro-oespophageal reflux

Question 36

BPD histology

Answer 36

Peribronchial fibrosis thickening of the bronchial walls with muscular hypertrophy

Question 37

BPD CXR

Answer 37

streaky interstitial markings atelectasis
hyperinflation
cysts