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Flashcards in Preterm Infant Deck (35):
1

What is the average numbers of preterm births in Scotland?

6-7%

2

Who are most at risk of stillbirths and neonatal deaths?

Black or Black British Asian or Asian British
Teenage mothers & mothers over 40yo
Mothers living in poverty

3

What are the causes of preterm birth?

Spontaneous
Multiple pregnancy
Preterm prelabour rupture of membranes
Pregnancy associated HT
Cervical incompetence/uterine malformation
APH
IUGR

4

What are the RFs for preterm birth?

>2 preterm deliveries (70%)
Abnormally shaped uterus (19%)
Multiple pregnancy (9x)
Interval of <6/12 between pregnancies
Conceiving through IVF
Smoking, drinking and use of illicit drugs
Poor nutrition
Chronic conditions (high BP, DM)
Multiple miscarriages or abortions

5

What do most very preterm babies need help with?

Assistance with transition to air breathing, not resuscitation

6

Describe cord clamping in preterm birth

If baby is OK and can be kept warm, pause for at least 1min to allow placental transfusion

7

How can preterm babies best be kept warm?

Whilst still wet place them in a suitable plastic bag and later under a radiant heater

8

What can overinflation of the lungs of a preterm infant cause?

Damage leading to inflammation and long-term morbidity
Can cause cascade which will predispose to bronchopulmonary dysplasia

9

What are common concerns in the preterm infant?

Temp control
Feeding/nutrition
Sepsis
System immaturity/dysfunction- RDS, PDA, intraventricular haemorrhage (IVH), NEC
Others- metabolic, ROP

10

What is low admission temperature an independent risk factor for?

Neonatal death- increases severity of all preterm morbidities

11

What is gestational correction?

Adjusts the plot of a measurement to account for the number of weeks a baby was born early (40wks-gestational age)

12

How long should gestational correction be carried out?

1y for infants born 32-36wks
2y for infants born before 32 weeks

13

What is early onset sepsis (EOS) mainly due to?

Bacteria acquired before and during delivery

14

What is LOS due to?

Acquired after delivery (nosocomial or community sources)

15

What organisms can cause neonatal sepsis?

GBS
Gram -ve organisms: Klebsiella, E. coli, Pseudomonas and Salmonella
Gram +ve organisms: S. aureus, CONS, Strep, pneumonia, Strep. pyogenes

16

What do incubators increase the risk of?

Infection

17

What is the primary pathology of Hyaline Membrane Disease?

Surfactant deficiency
Structural immaturity

18

What is the secondary pathology of Hyaline Membrane Disease?

Alveolar damage
Formation of exudate from leaky capillaries
Inflammation
Repair

19

What are the clinical features of RDS?

Tachypnoea
Grunting
Intercostal recessions
Nasal flaring
Cyanosis
Worsen over minutes to hours
Natural history (nadir at 2-4 days then improvement)

20

How should RDS be managed?

Maternal steroid
Surfactant
Ventilation- invasive/non-invasive

21

What are some CV concerns in preterm infants?

PDA
Systemic hypotension

22

What can PDA cause?

Symptoms of CHF
High oxygen requirements
Exacerbates RDS

23

What is Intraventricular Haemorrhage?

A form of intracranial haemorrhage that occurs in preterm infants, which begins with bleeding into the germinal matrix

24

What do 80% of cases of Germinal Matrix Haemorrhage (GMH) lead to?

An intraventricular bleed

25

What is the clinical presentation of IVH?

Inverse relationship between incidence and gestational age at birth
Most occurs in first day, 90% by 72hrs

26

What are the 2 major RFs for IVH?

Prematurity
RDS

27

What are some preventive measures for IVH?

Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability, hypoxia, hypercarbia, hyperoxia, hypocarbia

28

How is IVH classified?

Grades 1-4

29

What is the outcome for Grade 1 and 2 IVH?

Neurodevelopmental delay in up to 20%
Mortality 10%

30

What is the outcome for Grade 3 and 4 IVH?

Neurodevelopmental delay in up to 80%
Mortality 50%

31

What is necrotising enterocolitis?

Widespread necrosis in the small and large intenstine

32

What is the clinical picture of NEC?

Usually after RDS recovery
Early signs: lethargy and gastric residuals
Bloody stool, temperature instability, apnoea and bradycardia

33

What are some other complications of NEC?

Retinopathy of prematurity- usually 6-8wks after delivery
Metabolic-
Early: hypoglycaemia, hyponatraemia
Late: osteopenia of prematurity

34

What are some overall complications of prematurity?

Higher mortality
Morbidity:
Neurodevelopmental outcome: impaired cognitive/motor/sensory skills, behavioural/psychological problem
Chronic health issues
Growth issues
Effect on adult health

35

What effects on adult health can prematurity have?

Insulin resistance
Hypertension and vascular changes
Associated with decrease reproduction in adulthood
Preterm women but not men were at increased risk of having preterm offspring