Preterm infant

Question 1

preterm defiintion

Answer 1

<37 weeks

Question 2

term birth definition

Answer 2

between 27-42 weeks

Question 3

post term definition

Answer 3

> 42 weeks

Question 4

below 31 weeks is what

Answer 4

very preterm

Question 5

below 27 weeks is what

Answer 5

extremely preterm

Question 6

why do half of deaths in childhood occur during the first year of a child’s life

Answer 6

strongly influenced by prefer delivery and low brith weight

Question 7

causes of preterm birth

Answer 7

cervical incompetence/uterine malformation
antepartum haemorrhage
IUGR
preg assoc htn
premature pre labour rupture of membranes
multiple pregnancy
spontaneous preterm labour

Question 8

what does >2 preterm deliveries increase the risk of

Answer 8

another preterm baby by 70%

Question 9

how much does an abnormally shaped uterus increase the risk of giving birth early by

Answer 9

19%

Question 10

how many more times likely are women to give birth early if they have multiple pregnancy

Answer 10

9x more likely

Question 11

risk factors of preterm birth

Answer 11

interval of <6 months between pregnancies
conceiving through in vitro fertilisation
smoking, alcohol, drugs
poor nutrition, chronic conditions (BP, DM), multiple miscarriages or abortions

Question 12

different between a term baby and a preterm baby when they are first born

Answer 12

get cold faster - smaller
have more fragile lungs so don’t breathe effectively
have fewer reserves
pulse oximetry often indicated

Question 13

do preterm babies need assistance or resuscitations

Answer 13

most very preterm babies need help with transition to air breathing - assistance

Question 14

when should cord clamping be done in preterm babies

Answer 14

if the baby is okay and can be kept warm pause for at least a minute to allow placental transfusion

Question 15

how are preterm babies kept warm

Answer 15

using a plastic bag or a heater
prewarm incubators
skin to skin
trans warmer mattress

Question 16

risks of lung inflation

Answer 16

lungs are fragile so over inflation can cause damage leading to inflammation and long term morbidity - can lead to bronchopulmonary dysplasia

Question 17

concerns in a preterm baby

Answer 17

temp control
feeding/nutrition
sepsis
systemic immaturity - RDS, PDA, ibraventricular haemorrhage, necrotising enterocolitis

Question 18

hypothermia is a risk factor for what

what does it increase

Answer 18

neonatal death

increases severity of all preterm morbidities

Question 19

why is thermal regulation ineffective in a preterm baby

Answer 19

low BMR
minimal muscle activity
subcut fat insulation is negligible
high ratio of surface area to body mass

Question 20

why is there an increased risk of potential nutritional compromise

Answer 20

limited nutritional reserves
immature metabolic pathways
increased nutritional demands

Question 21

what is gestational correction

Answer 21

adjusts the plot of measurement on the graph to account for the number of weeks a baby was born early

Question 22

when should gestational correction not be used for under 40 weeks baby

Answer 22

for 37+ weeks

Question 23

when should gestational correction be used till

Answer 23

1 year for infants born 32-36 weeks

2 years for infants born before 32 weeks

Question 24

what are the two types of neonatal sepsis

Answer 24

early onset mainly due to bacteria acquired before and after delivery

late onset acquired after delivery

Question 25

which organisms cause neonatal sepsis

Answer 25

group b strep gram neg - klebsiella, EColi, pseudomonas, salmonella gram pos - SA, coag neg staph, strep pneumonia, strep pyogenes

Question 26

management of neonatal sepsis

Answer 26

``` prevention hand washing super vigilant and infection screening judicial use of antibiotics optimum supportive measures ```

Question 27

what increases infection

Answer 27

incubators

Question 28

what are some of the respiratory complications of prematurity

Answer 28

RDS apnoea of prematurity bronchopulmonary dysplasia

Question 29

NRDS pathology

Answer 29

primary - surfactant deficiency, structural immaturity | secondary - alveolar damage, formation of exudate from leaky capillaries, inflammation, repair

Question 30

when is RDS common

Answer 30

75% in <29 weeks born | 10% in >32 weeks gestation

Question 31

clinical features of RDS

Answer 31

resp distress - tachypnoea, grunting, intercostal recession, nasal flaring, cyanosis worsening over minutes to hours usually improves over 2-4 days with active treatment

Question 32

management of RDS

Answer 32

maternal steroids surfactant ventilation - invasive or non invasice

Question 33

CVS complications in preterm

Answer 33

PDA | systemic hypotension

Question 34

``` PDA is what who is at risk what does it lead to oxygen requirements exacerbates what ```

Answer 34

``` when DA doesn't close premature infants symptoms of congestive HF are high RDS ```

Question 35

intraventricular haemorrhage is what

Answer 35

form of intracranial haemorhhage which begins with bleeding in the germinal matrix and 80% of the cases leads to bleeding intraventricular

Question 36

clinical presentation of a intraventricular haemorrhage

Answer 36

clinically silent 25-50% intermittent deterioration catastrophic deterioration most occur in first day of life - up to 90% of GMH-IVH insult is present by 72 hours

Question 37

risk factors for IVH

Answer 37

prematurity | RDS

Question 38

IVH preventive measures

Answer 38

antenatal steroids prompt and appropriate resuscitation avoid haemodynamic instability avoid hypoxia, hypercarbia, hyperopia and hypocardia

Question 39

IVH grade 1 and 2

Answer 39

neurodevelopment delay up too 20% and mortality is 10%

Question 40

IVH grade 3 and 4

Answer 40

neurodevelopment delay up to 80% and mortality is 50%

Question 41

NEC is the most common what what is it high incidence in who

Answer 41

neonatal surgical emergency widespread necrosis in the small and large intestine in premature infants

Question 42

clinical picture of NEC

Answer 42

usually after recovering form RDS early signs: lethargy and gastric residuals bloody stool, temp instability, apnoea and bradycardia

Question 43

other complications of prematurity

Answer 43

retinopathy - usually 6-8 weeks after delivery hypoglycaemia and hyponatraemia early cx osteopenia of prematurity later cx